SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A 14-year-old girl developed a movement disorder after a streptococcal infection. In the acute phase of the illness she exhibited simple and complex motor tics and chorea, but all abnormal movements ceased over the following eight months, without recurrence. This case raises questions about the relationship between tics, chorea and auto-immune reactivity.
We describe a patient with intermittent, at times rhythmic trunk flexion movements. Neurophysiological assessment excluded a psychogenic movement disorder. The segmental spinal myoclonus occurred 6 years after radiation therapy of the brain and entire spinal cord, and we suggest this patient to be the first case of a late-delayed sequela of spinal cord irradiation presenting as segmental spinal myoclonus.
The movement disorders progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) both deposit tau in degenerating neurons and are considered to be tauopathies. The recently developed scheme for staging tissue degeneration in another tauopathy, frontotemporal dementia [Broe et al., Neurology 2003;60:1005-1011] was applied to pathologically confirmed PSP (n = 24) and CBD (n = 9) cases and correlated with clinical indices. In contrast to frontotemporal dementia, the majority of PSP cases had limited or no visible atrophy, while the pattern of atrophy in CBD cases conformed to the existing staging scheme (all but one case exhibiting substantial visible tissue atrophy). Despite similar clinical severity and disease duration between groups, there was a marked difference between the PSP and CBD cases in pathological disease stage (chi(2) = 8.86; P = 0.03). The degree of global atrophy in PSP appears to be distinct from other tauopathies, while CBD fits the same pattern as other pathological forms of frontotemporal dementia.
A method for quantitative assessment of severity of movement disorders using video recordings and computer analysis is presented. It allows quantified comparison of pre- and post-treatment conditions.
Nearly every patient with a movement disorder has some type of behavioral dysfunction, whether it is personality change or intellectual impairment. Since these behaviors have confounding effects on the management of patients, it behooves clinicians to maintain awareness of the spectrum of mental changes in these diseases of the basal ganglia.
Polygraphic monitoring of abnormal movements during sleep started in the 1960s in the wake of the interest in sleep and sleep disorders triggered by the discovery of REM sleep. This paper reviews the contribution of the Bologna school to the identification and understanding of motor disorders in sleep.
Georges Albert Edouard Brutus Gilles de la Tourette (1857-1904), a French neurologist and pupil of Jean Martin Charcot at the Salpêtrière hospital in Paris, has gained common recognition through his description of the 'Maladie des Tics'. This complex neuropsychiatric disorder, later known as the 'Tourette's syndrome', nowadays is accepted as a specific entity of movement disorders. Gilles had started working under Charcot (1825-1893), the first physician to occupy a designated chair of neurology of neuropsychiatric history, in 1884. Then the Salpêtrière hospital was a centre of intensive research with an emphasis on hysteria and hypnosis. Tourette took an interest in hysteria, but also dedicated himself to various other neuropsychiatric disorders and to neuropathology. He published scientific works on epilepsia, neurasthenia and syphilitic myelitis. Although he devoted much time to his neuropsychiatric research and the publication of articles in medical journals, his career did not make significant progress, despite Charcot's unrestricted support. One reason was, that he disregarded questions, answers and problems, which were outside his interest fields. Hence, he was accused for having acquired an extremely filtered and one-sided knowledge. Also, his alienated and critical behaviour, which had not helped him to find many friends over the years, prevented him from professional promotion. In 1893 an assassination attempt on Gilles de la Tourette raised considerable public interest: Gilles was shot in his appartement in the Rue de l'Université 39 by a young woman, who had been his patient in the Salpêtrière and who claimed that she had been hypnotized without her agreement and thereby had lost her mental health. However, the patient was diagnosed with a disease nowadays called paranoid schizophrenia and therefore hypnosis was not attributed to any part of the disease. Due to episodes of melancholia and phases of delusions of grandeur and megalomania Gilles de la Tourette was forced to leave his hospital appointment in 1901. These symptoms and the corresponding neurological signs were attributed to the paretic neurosyphilis. He was institutionalized to the psychiatric hospital Cery near Lausanne, Switzerland. In the course of the following three years he became increasingly psychotic and demented, suffered from epileptic seizures and finally died in hospital on 22nd May 1904.
The ventral region of the motor thalamus that receives cerebellar afferents has been and still is the target of stereotactic interventions for movement disorders. According to Hassler, this area includes ventro-oralis posterior (Vop) and ventral intermedius (Vim) nuclei, although some investigators believe that Vop is associated with the pallidothalamic pathway. We sought to correlate our experimental data on distribution of nigral, pallidal, and cerebellar afferents to the monkey thalamus with Hassler's motor thalamic parcelations. We concluded that Hassler's parcelations retained their value, although some adjustments were needed to relate them to the current neuroanatomic data; particularly, the cerebellothalamic zone that represents the monkey ventral lateral nucleus (VL) corresponds topographically to Hassler's Vop, Vim, and most of Voi. Electron microscopic tracing studies have shown very complex circuitry in this region of the monkey thalamus, as the cerebellar and cortical afferents innervating it are engaged in complex synapses with thalamocortical projection neurons, and this interaction is strongly modulated by local circuit neurons and the input from the reticular thalamic nucleus, which are both inhibitory and gamma-aminobutyric acid (GABA)ergic. Spinothalamic afferents also reach the VL, but this input is less studied in the monkey. The circuitry subserving the activity of thalamocortical projection neurons in the VL should be considered while interpreting the functional data obtained in stereotactic surgery.
Models of basal ganglia function are described which encapsulate the principal pathophysiological mechanisms underlying parkinsonian akinesia on the one hand and abnormal involuntary movement disorders (dyskinesias) on the other. In Parkinson's disease, degeneration of the nigrostriatal dopamine system leads to overactivity of the 'indirect' striatopallidal projection to the lateral (external) segment of the globus pallidus. This causes inhibition of lateral pallidal neurons, which in turn project to the subthalamic nucleus. Disinhibition of the subthalamic nucleus leads to abnormal subthalamic overactivity and, as a consequence, overactivity of medial (internal) pallidal output neurons. Dyskinesias, such as are observed in Huntington's disease, levodopa-induced dyskinesia and ballism, share mechanistic features in common and are associated with decreased neuronal activity in both the subthalamic nucleus and the medial globus pallidus.
The authors present the current views on the use of electrical stimulation in selected movement disorders (Parkinson's disease, dystonia) and pain syndromes (central and neuropathic pain) refractory to pharmacological therapy. Stimulation should be applied in cases with an established diagnosis (especially Parkinson's disease and dystonia) and with a lack of efficacy despite the best available medical therapy. Therefore it should be the last treatment option, except of generalized dystonia, where it seems to be nowadays the treatment of choice. Suggested selection criteria are based on experience of different centers and on current medical literature. They are published to make the procedure more rational and more available in Poland.
Controversy exists between anatomical methods and single cell recording as the preferred approach in target localisation in functional neurosurgery for movement disorders. The controversy centres on accuracy as compared to practicality. We describe a mapping technique of semi-microstimulation utilising threshold measurements which has been used in 66 procedures in 50 subjects. We compared the accuracy of anatomical localisation with the final chosen target using the above technique. We also compared the benefit, the side effects and the surgical complication rate with published data on single cell recording and anatomical localisation. The mean difference in 3-dimensional space between the anatomical target and the physiological target was 6.85 mm (P < 0.0001). A good response was obtained in 80% of procedures. Mortality was 1.5%. The surgical complication rate was 1.5%. Mild side effects, serious side effects, transient side effects and permanent side effects were evident in 4.5%, 10.6%, 6.1% and 9.1% of procedures. These figures compared better than anatomical studies and similar to single cell recording studies. It is concluded that this approach provides both accuracy and simplicity and is recommended as a compromise to the currently available methods.
The clinical features of dystonia have not been evaluated in Southeast Asia. We therefore investigated the clinical spectrum and characteristics of dystonia in Singapore, a multi-ethnic Southeast Asian country comprising 77% Chinese, 14% Malays, and 8% Indians. We identified all dystonia patients from the Movement Disorders database and Botulinum Toxin clinic between 1995 and November 2004. Their medical records were reviewed to verify the diagnosis of dystonia and obtain demographic and clinical data using a standardized data collection form. A total of 119 (73%) patients had primary dystonia whilst 45 (27%) had secondary dystonia. There were 77% Chinese, 9% Malays, and 8% Indians. The most common focal dystonia were cervical dystonia (47%), writer's cramp (32%), and blepharospasm (11%). There was no significant difference in the distribution of dystonia between the different races. Males were noted to have earlier onset of dystonia overall. There was a significant male predominance in primary dystonia overall (M:F 1.6:1, P=0.008) and in the subgroup of focal dystonia (M:F 1.6:1, P=0.037). This contrasts with previous studies that found a female predominance. The role of genetic, hormonal, and environmental factors and their interactions need to be investigated to better understand the gender differences in the occurrence of dystonia.
Explore the source record for details and available documents.
A substantial body of evidence has accumulated regarding the efficacy and safety of neurosurgery for Parkinson's disease, essential tremor, and dystonia. Surgery for movement disorders (thalamotomy, pallidotomy, and subthalamic nucleotomy or subthalamotomy) was largely ablative (lesion-based). Given the safety and anatomy-preservation advantage, long-term electrical stimulation of these same targets (thalamus, globus pallidus, and subthalamic nucleus) is discussed as the treatment of choice. High-frequency deep brain stimulation procedures replicate the effects of ablative interventions, but do not require making a destructive brain lesion. This article outlines patient eligibility for surgery, targeting techniques, intraoperative findings, and potential complications and discusses the outcomes expected for each of the major interventions for which clinical trial data are available.
A new mutation displaying abnormal movement was obtained in the progeny of a female Wistar rat which had been given 10 mg/kg methylnitrosourea at an early stage of the gestational period. Genetic studies revealed that the character is inherited by an autosomal single recessive gene, and we designated this mutation groggy (gene symbol gr). The abnormal movement of the groggy rat was first apparent around postnatal day 15, while the histological studies revealed the appearance of numerous necrotic neurons in the striatum of the groggy rat on postnatal days 60 and 120.
There is an ongoing controversy about whether it is necessary to use microelectrode recording (MER) techniques in stereotactic surgery for Parkinson's disease and other movement disorders. This paper consists of a critical review of the published literature in order to analyze the value of MER in providing safe, efficient and accurate functional stereotactic surgery. Review of the literature revealed that MER techniques do not necessarily improve targeting accuracy or clinical results, compared to techniques using impedance monitoring and macrostimulation. In terms of safety for the patients, however, MER techniques are relatively safe, but non-Mer techniques, based on macrostimulation-guided surgery, are at least five times safer.
Functional brain imaging techniques such as positron emission tomography (PET) have contributed to our understanding of the pathophysiology of Parkinson's disease (PD) and other movement disorders. PET employs small amounts of positron emitting radioligands to produce quantitative measures of physiological and biochemical processes in the brain and other organs. In a PET experiment, a subject is given a compound of biological interest. The spatial and temporal distribution of the radiotracer is measured quantitatively in the course of the PET study, providing a tomographic representation of regional radioactivity concentration. In this review, we focus on the potential application of PET in the selection of suitable candidates and the assessment of surgical interventions such as pallidotomy, thalamotomy, and deep brain stimulation.
A register covering a 3-year period (1991-1993) was opened for all patients attending a Parkinson's disease and movement disorder clinic which has been running for 15 years in a reference hospital covering a population of 629,555 in Madrid. During the last 2 years, all 5 neurologists serving the reference health area joined to the hospital on a part-time basis. A total of 764 patients were seen during the study period, 56.2% of whom were follow-up patients. About half of the later (49%) were suffering from Parkinson's disease (PD), follow-up duration averaging 4.7 +/- 4.4 years. Follow-up in dystonias (11.8%) and choreas (8.1%) cases was similar and averaged 5.0 +/- 4.2 and 4.5 +/- 4.2 years, respectively. Out of 334 new referrals 192 were new parkinsonism patients, half of them (48.4%) with secondary parkinsonism, particularly drug-induced parkinsonism (32.2%). Incorporation of neurologists serving the reference health area to hospital activities correlated to a decrease in secondary parkinsonism referrals, a slight drop in de novo PD patients, but not in an earlier detection of new PD cases. We conclude that a monographic out-patient clinic may benefit from sharing activities with neurologists serving the referral health area, and from improving the neurological education of general practitioners.