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PubMed2002

Nithsdale Schizophrenia Surveys 23: movement disorders. 20-year review.

BACKGROUND: In the past 10 years the new atypical antipsychotic drugs have stimulated further interest in the pharmacological management of schizophrenia. The risk of movement disorders has been reported to be less with these new agents. AIMS: To examine the current prevalence of movement disorders among all people with schizophrenia in a discrete geographical area, to compare the prevalence in patients receiving and not receiving atypical antipsychotic drugs; and to compare current prevalence with prevalence over the past 20 years. METHOD: In Nithsdale, south-west Scotland, in 1999/2000, we replicated previous studies by using the Abnormal Involuntary Movements Scale, Simpson-Angus scale and Barnes Akathisia Rating Scale to measure tardive dyskinesia, parkinsonism and akathisia, respectively. Mental state was assessed by the Positive and Negative Syndrome Scale. RESULTS: In 136 patients the prevalence of probable tardive dyskinesia was 43%, of parkinsonism 35% and of akathisia 15%. Parkinsonism was present as often in those receiving atypicals as in those receiving standard oral antipsychotics. The prevalence of tardive dyskinesia has doubled over 20 years. CONCLUSIONS: Movement disorders remain significant problems for patients despite the introduction of atypical antipsychotic drugs.

Adult↗

PubMed2000

Neuropsychologic assessment of patients for movement disorder surgery.

The neuropsychologic evaluation of patients under consideration for movement disorder surgery is recognized as being an essential component of the preoperative process. Patients with early-stage concomitant dementia must be identified and the relative risk of postoperative cognitive decline evaluated. Knowledge of the patterns of an individual's strengths and weaknesses might also be a factor in deciding on a neurosurgical procedure. Although the advent of pallidal deep brain stimulation (DBS) has possibly resulted in reduced risk of induced cognitive impairment, even this procedure has been associated with negative sequelae. DBS within the subthalamic nucleus is becoming the method of choice and this may lead to cognitive and behavioral compromise, especially in the elderly patient. The team considering the establishment of neurosurgical treatment is often at a loss to decide how much neuropsychologic testing is required to determine relative risks of cognitive or behavioral morbidity as a consequence of the procedure. A brief summary of expected outcome and of pertinent family process and psychodynamic issues are addressed. This article is intended to serve as a guide to permit clinicians to choose the appropriate length and depth of neuropsychologic assessment, but also to highlight the confounding factors often present in these patients.

Affect↗

PubMed1998

Experimental developments in movement disorders: update on proposed free radical mechanisms.

Free radicals have been implicated in the pathogenesis of movement disorders such as Parkinson's disease and Huntington's disease. Some basic aspects about free radicals as they relate to oxidative stress in neurodegeneration are summarized. Old and new experimental findings pertinent to oxidative damage in movement disorders are reviewed. Finally, the degree to which toxin-induced and genetically engineered experimental models have been useful in delineating parts of the mechanisms involved in the cascade of events that lead to neuronal death is emphasized.

Animals↗

PubMed1996

Comparison of cognitive-behavioral therapy and clonazepam for treating periodic limb movement disorder.

Many patients with periodic limb movement disorder (PLMD) display inadequate sleep hygiene, and others decline conventional pharmacologic intervention for their form of sleep disturbance. Nonetheless, the use of nonpharmacologic therapies with PLMD remains unexplored. The current study was designed to compare the short-term treatment effects of a cognitive-behavioral therapy (CBT) and conventional pharmacotherapy (clonazepam) among a group of insomniacs with PLMD. The 16 subjects participating in this study first underwent baseline assessment procedures, including completion of a sleep log for 2 weeks, an ambulatory polysomnogram (APSG) and an Insomnia Symptom Questionnaire (ISQ). They then were randomized either to CBT (n = 8) or standard clonazepam therapy (n = 8). Subjects maintained sleep logs throughout a 4-week treatment and then completed a second APSG and ISQ. Comparison of pre- and post-treatment data suggested that the two treatments led to equal improvements in sleep log measures of sleep-wake times and ISQ measures of subjective sleep concerns. Patients treated with CBT showed a decrease in daytime napping, whereas the clonazepam group reported increased napping. Conversely, those treated with clonazepam showed larger declines in periodic limb movement-arousals per hour of sleep than did the CBT group. Post-treatment interviews suggested that both CBT and clonazepam therapies were generally well tolerated by study participants. It is concluded that both treatments may be useful for PLMD but that the two treatments may have contrasting effects across selected measures of improvement. Additional research is needed to examine the long-term efficacy of CBT as a primary or adjunctive treatment for varying levels of PLMD severity.

Aged↗

PubMed1998

Functional imaging of neurotransmitter systems in movement disorders.

PET and SPECT enable the direct measurement of components of the dopaminergic and other systems in the living human brain and offer unique opportunity for the in vivo quantification of the dopaminergic function in PD and other movement disorders. The need to establish the early and differential diagnosis of PD is increasingly important given the recent evidence that early pharmacologic intervention may slow progression of this progressive degenerative disease. Accordingly, imaging with PET and SPECT using specific neuromarkers has been increasingly important to biochemically identify the loss of specific neurotransmitters, their synthesizing enzymes and their receptors in movement disorders. Through the parallel development of new radiotracers, kinetic models and better instruments, PET and SPECT technology is enabling investigation of increasingly more complex aspects of the human brain neurotransmitter systems. This paper summarizes the results of different PET-SPECT studies used to evaluate the various elements of the dopamine system in the human brain with PET and intends to introduce the newly emerging specific tracers and their applications to clinical research in movement disorders.

Brain↗

PubMedDate not supplied

[Frequency of movement disorders in children].

We analyze the main clinical characteristics of a series of 800 patients seen by us, who had movement disorders which had started during childhood. The results are compared with those movement disorders of adult onset reported in the literature.

Adolescent↗

PubMed1982

Treatment of hyperkinetic movement disorders with tetrabenazine: a double-blind crossover study.

Tetrabenazine, a presynaptic monoamine depleting agent, has been reported to have an ameliorating effect in a variety of hyperkinetic movement disorders. In a double-blind crossover trial of tetrabenazine versus placebo, 19 patients with a variety of hyperkinetic movement disorders were evaluated. During the evaluation period, all but 4 patients were treated for three or more weeks at a maximum dosage of 200 mg per day. The patients were examined and rated using clinical assessment of hyperkinesia, and movies of their activities were randomized and rated by an independent group of neurologists. A good correlation was found between the clinical examination scale and the film analysis score. Improvement was seen in all 4 patients with tardive dyskinesia, 4 of 6 patients with Meige disease, and 5 of 6 patients with other dystonias. One patient with Huntington disease showed marked improvement and 2 patients with congenital choreoathetosis showed only mild improvement. The most frequent side effects included daytime drowsiness, drooling or sialorrhea, insomnia, restlessness and anxiety, parkinsonian features, and mild postural hypotension. The adverse effects resolved with continued administration or with reduction in dosage. Tetrabenazine is a useful and safe therapeutic agent in some patients with hyperkinetic movement disorders.

Adolescent↗

PubMed1985

The elicitation of a movement disorder by trazodone: case report.

A 65-year-old woman with bipolar disorder and complicated cardiovascular disease who was on maintenance lithium therapy developed a movement disorder following high doses of trazodone for treatment of an acute depression. When the trazodone was reduced, the involuntary movements promptly ceased. Although the movement disorder could not with certainty be attributed to trazodone alone, the drug at least acted as an eliciting agent.

Aged↗

PubMed2004

A novel movement disorder of the lower lip.

Four patients, aged 25 to 42 years presented with acute onset of a movement disorder characterized by a tonic, sustained, lateral and outward protrusion of one half of the lower lip. The movement disorder was present at rest, while in some patients, it was also present during speech. In all cases, the abnormal lip posture could be suppressed voluntarily. Neurological examination was otherwise normal. Extensive laboratory investigation failed to reveal any causative factors for secondary focal dystonia. Treatment with oral medications and botulinum toxin was mostly ineffective. Spontaneous remissions were frequent.

Acute Disease↗

PubMed2002

Prevalence of restless legs syndrome and periodic limb movement disorder in the general population.

BACKGROUND: Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are two sleep disorders characterized by abnormal leg movements and are responsible for deterioration in sleep quality. However, the prevalence of these disorders is not well known in the general population. This study aims to document the prevalence of RLS and PLMD in the general population and to identify factors associated with these conditions. METHODS: Cross-sectional studies were performed in the UK, Germany, Italy, Portugal and Spain. Overall, 18,980 subjects aged 15 to 100 years old representative of the general population of these five European countries underwent telephone interviews with the Sleep-EVAL system. A section of the questionnaire assessed leg symptoms during sleep. The diagnoses of PLMD and RLS were based on the minimal criteria provided by the International Classification of Sleep Disorders. RESULTS: The prevalence of PLMD was 3.9% and RLS was 5.5%. RLS and PLMD were higher in women than in men. The prevalence of RLS significantly increased with age. In multivariate models, being a woman, the presence of musculoskeletal disease, heart disease, obstructive sleep apnea syndrome, cataplexy, doing physical activities close to bedtime and the presence of a mental disorder were significantly associated with both disorders. Factors specific to PLMD were: being a shift or night worker, snoring, daily coffee intake, use of hypnotics and stress. Factors solely associated with RLS were: advanced age, obesity, hypertension, loud snoring, drinking at least three alcoholic beverages per day, smoking more than 20 cigarettes per day and use of SSRI. CONCLUSIONS: PLMD and RLS are prevalent in the general population. Both conditions are associated with several physical and mental disorders and may negatively impact sleep. Greater recognition of these sleep disorders is needed.

Adolescent↗

PubMed1994

Regional cerebral perfusion abnormalities after cardiac operations. Single photon emission computed tomography (SPECT) findings in children with postoperative movement disorders.

Despite the clinical and pathologic indicators implicating injury to the basal ganglia in children with hyperkinetic movement disorders, we were previously unable to identify lesions in these structures by means of cranial computed tomography or magnetic resonance imaging. We evaluated regional cerebral perfusion measured by single photon emission computed tomography (SPECT) with technetium 99m hexamethyl propylene amine oxime as a technique to localize functional cerebral abnormalities in eleven children who had a movement disorder after hypothermic cardiac surgery. Perfusion defects of the deep gray matter were noted in six of these eleven patients and cortical perfusion defects in nine. For both cortical and subcortical defects a strong right-sided predilection was present. Our findings suggest functional brain injury not detectable by conventional cranial computed tomography and magnetic resonance imaging in these patients. We speculate that these perfusion defects might relate to the behavioral and developmental sequelae in survivors of this syndrome. SPECT may identify subclinical injury in patients at risk for future neurodevelopmental problems and contribute to our understanding of the mechanisms of cerebral injury in the patient operated on for cardiac disease.

Brain↗

PubMed1989

Prevalence of dyskinesia and related movement disorders in a developmentally disabled population.

The prevalences and inter-relationships of five types of movement disorders were evaluated in a large, developmentally disabled (DD) population (n = 1227); prevalence was evaluated with regard to severity, age, gender and antipsychotic-drug (APD) exposure. Dyskinesia was found in 48% of the sample, dystonia in 29%, akathisia in 13%, Parkinsonism in 3% and paroxysms in 4%. Many persons had more than one symptom so that 72% had one or more of the five target symptoms. Although the five movement-disorder categories were not mutually exclusive, analysis supported the individuality of the categories as defined in this study. The prevalences of dyskinesia and Parkinsonism were considerably greater than those in the general population. On the other hand, the prevalence of dyskinesia was similar to that reported for psychiatric and institutionalized geriatric populations. Parkinsonism increased with age and male gender, while dyskinesia increased with age and female gender. APD-exposure was significantly correlated only with akathisia.

Adolescent↗

PubMed1993

Cocaine-related movement disorders.

We describe four patients, two with Tourette's syndrome, one with the combination of idiopathic dystonia and essential-like tremor, and one with tardive dystonia, who noted marked exacerbation of their movement disorders after exposure to cocaine. These patients provide support for the hypothesis that dopaminergic preponderance plays an important role in the pathogenesis of certain hyperkinetic movement disorders. Cocaine should be regarded as an important cause or precipitant of hyperkinetic movement disorders.

Adult↗

PubMedDate not supplied

[Advances in the surgical treatment of Parkinson disease and other movement disorders].

OBJECTIVE: To present the latest advances in surgery for patients with Parkinson's disease and other movement disorders, emphasizing pallidotomy and deep cerebral stimulation (DCS), thalamic, pallidal and subthalamic, their indications and complications. DEVELOPMENT: Advances in neurophysiology and radiology have led to greater understanding of the physiology of the basal ganglia. This has led to the revival of old surgical techniques (pallidotomy) and the clinical application of new variants on these techniques. Pallidotomy is indicated in patients with advanced Parkinson's disease who are under the age of 65 years and have no psychiatric complications or drug-induced debilitating dyscinesias. In most of these patients the daily dose of levodopa is reduced by approximately 30%. Any complications which occur are transient. The versatility of adjustment of the parameters of deep cerebral stimulation allow them to be adjusted to the patient's needs. Complications include transitory paraesthesia of the side contralateral to the stimulation, transitory tonic contraction of the face and limbs and in some cases dyskinesias which are similar to those induced by drugs. In the United States of America, the Food and Drugs Administration has authorized the use of thalamic DCS for treatment of essential/familial or Parkinsonian tremor of the hands. It is expected that by the end of this year pallidal-DCS will have been approved for the treatment of rigidity, tremor and bradykinesia in Parkinson's disease. CONCLUSION: Pallidotomy and DCS seem to be safe, useful techniques for the treatment of late complications of Parkinson's disease and possibly other movement disorders also.

Electric Stimulation↗

PubMed2003

Case studies in movement disorders.

Six cases representing the most commonly encountered movement disorders-restless legs syndrome with periodic limb movements, tics, myoclonus, chorea, essential tremor, and cervical dystonia-are presented. Discussion of each case focuses on a practical approach to recognizing the important clinical features of each movement disorder as well as the current therapeutic options. A detailed discussion of botulinum toxin follows the case on cervical dystonia, focusing on its mechanism of action, clinical indications, side effects, and dosing.

Adolescent↗

PubMed1988

[Central dysregulations as a cause of movement disorders in performance sports? An analysis of movement in sports with reference to functional anatomic and neurophysiologic viewpoints].

Typical orthopaedic findings and typical disturbances of movement in sports point to central dysregulation in motor disturbances in competitive sports compared with the ideal models set up under biomechanical aspects and from the viewpoint of sports practice. Neurophysiological data collected so far confirm this view. The central influence on movement is manifested by a change in peripheral proprioceptive properties, i.e. by a change in the pre-innervation of the musculature. If the musculature is subjected to high strain as in sports aiming at high performance levels, such changes produce an extremely high stretch tone in the phase of dynamic-eccentric muscular contraction resulting in functional reversal of two-joint muscles such as the M.rectus femoris and the M.gastrocnemius. This procedure is manifested in the region of system-immanent weak spots of the positional and locomotor system and, in the pelvic girdle region by tipping of the pelvis in ventral direction, with consecutive evasive shifts of the vertebral column and extremities.

Central Nervous System↗

PubMed1992

Movement disorders: why don't those synapses fire?

From mobility to disability; this is the plight of the patient with a movement disorder. Alterations in motor functioning may include gait, balance, coordination and tone as well as voluntary and involuntary movements. These changes need to be observed, assessed and monitored, then correlated with the neuropathology and neurochemistry. The nurse, by doing this, provides the physician with the crucial information for successful medical management. This presentation will identify the pathology and required nursing assessment for the more prevalent movement disorders and provide an overview of pharmaceutical management.

Documentation↗

PubMed1996

Mesencephalic clefts with associated eye movement disorders.

OBJECTIVE: To describe two patients with mesencephalic midline clefts and associated eye movement disorders. DESIGN: Case reports. RESULTS: The first patient developed bilateral internuclear ophthalmoplegia with exotropia, reduced convergence, right ptosis, right fourth-nerve palsy, and right elevator palsy several years after meningitis with hydrocephalus. The second patient had bilateral internuclear ophthalmoplegia with exotropia, reduced convergence, bilateral ptosis, limited upward gaze, and right hypertropia since childhood. In both patients, magnetic resonance imaging showed a midline cleft extending from the cerebral aqueduct into the midbrain. CONCLUSION: It is likely that the clefts affected the oculomotor nuclei and medial longitudinal fasciculi, accounting for the eye movement disorders.

Adult↗