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PubMedDate not supplied

[Utility of dopamine transporter imaging (123-I Ioflupane SPECT) in the assessment of movement disorders].

OBJECTIVE: The aim of our work was to assess the diagnostic impact of 123-I Ioflupane SPECT in patients with tremor and some other sign of Parkinsonisms in regards to its categorization in Parkinsonisms with involvement/indemnity of presynaptic dopaminergic neurons as well as to establish a differential diagnosis between essential tremor (ET) and degenerative Parkinsonism. METHODS: 105 patients were included, 45 for differential diagnosis between Parkinsonism and ET, 52 to determine the origin of their Parkinsonism (degenerative vs secondary) and 8 with an established diagnosis, 5 Parkinson's disease and 3 ET. A dose of 185 MBq of Ioflupane 1-123 was administered and tomographic study acquired at 5 hours. After reconstruction, transaxial views were assessed by three observers. In all the patients, the diagnosis was established by a neurologist specialized in movement disorders, according to the symptoms, course, response to treatment and result of Ioflupane I-123. RESULTS: 42 patients were diagnosed of degenerative Parkinsonism (PD or Parkinsonism plus) and 63 of ET or secondary Parkinsonism. We obtained a values of sensitivity, specificity, PPV, NPV and accuracy of 93 %, 100 %, 100 %, 97 % and 97 % respectively. 123-I Ioflupane SPECT changed the treatment in 18 % of our patients. CONCLUSIONS: 123-I Ioflupane SPECT is a test of great value to establish the differential diagnosis between Parkinsonism vs ET and secondary vs degenerative Parkinsonism.

Adult↗
PubMed1977

CSF studies on the relationship between dopamine and 5-hydroxytryptamine in Parkinsonism and other movement disorders.

In Parkinson's disease, the concentration of homovanillic acid (HVA) was reduced in lumbar CSF from patients with idiopathic Parkinsonism (n = 54, P less than 0.05) and post-encephalitic Parkinsonism (n = 19, P less than 0.01). The reduction in the concentrations of 5-hydroxyindolylacetic acid (5-HIAA) was not significant, and there was no alteration in the levels of 4-hydroxy-3-methoxyphenylethylene glycol (MHPG). Treatment with L-dopa increased the concentration of HVA in the CSF (P less than 0.05) but had no effect on the levels of 5-HIAA and MHPG. Carbidopa given in combinations with L-dopa produced similar CSF concentrations of dopa as did L-dopa alone but caused less than half the rise in HVA. Fourteen patients who became functionally independent on treatment with L-dopa had higher 5-HIAA levels than 23 patients who showed no such improvement (P less than 0.001), suggesting that intact 5-hydroxyltryptamine neurones may be important in the therapeutic response to L-dopa. In a variety of movement disorders, the levels of HVA, 5-HIAA, and MHPG were not significantly different from age-matched controls. Treatment with tetrabenazine did not significantly alter the metabolite levels in patients in whom it produced either improvement, or side effects.

Aged↗
PubMed2000

Use of an intracranial near-infrared probe for localization during stereotactic surgery for movement disorders.

Localization of targets during stereotactic surgery is frequently accomplished by identification of the boundaries between the gray matter of various nuclei and the surrounding white matter. The authors describe an intracranial probe developed for this purpose, which uses near-infrared (NIR) light. The probe fits through standard stereotactic holders and emits light at its tip. The scattered light is detected and analyzed by a spectrometer, with the slope of the trailing portion of the reflectance curve used as the measurement value. Near-infrared readings were obtained during 27 neurosurgical procedures. The first three operations were temporal lobectomies, with values obtained from tracks in the resected specimen and resection bed. In the next five procedures, the probe was inserted stereotactically to a depth of 1 to 2 cm with measurements obtained every 1 mm. The probe was then used in 19 stereotactic procedures for movement disorders, obtaining measurements every 0.5 to 1 mm to target depths of 6 to 8 cm to interrogate subcortical structures. The NIR signals were correlated to distances beneath the cortical surface measured on postoperative computerized tomography or magnetic resonance imaging by using angle correction and three-dimensional reconstruction techniques. The NIR values for white and gray matter obtained during the lobectomies were significantly different (white matter 2.5+/-0.37, gray matter 0.82+/-0.23 mean +/- standard deviation). The NIR values from the superficial stereotactic tracks showed initial low values corresponding to cortical gray matter and high values corresponding to subcortical white matter. There was good correlation between the NIR signals and postoperative imaging in the 19 stereotactic cases. Dips due to adjacent sulci, a plateau of high signal due to subcortical white matter, a dip in the NIR signal during passage through the ventricle, dips due to the caudate nucleus, and peaks due to the white matter capsule between ventricle and thalamus were constant features. The putamen-capsule boundary and the lamina externa and interna of the globus pallidus could be distinguished in three cases. Elevated signals corresponding to the thalamic floor were seen in 10 cases. Nuances such as prior lesions and nonspecific white matter changes were also detected. There was no incidence of morbidity associated with use of the probe. Data acquisition was straightforward and the equipment required for the studies was inexpensive. The NIR probe described in this article seems to be able to detect gray-white matter boundaries around and within subcortical structures commonly encountered in stereotactic functional neurosurgery. This simple, inexpensive method deserves further study to establish its efficacy for stereotactic localization.

Brain↗
PubMed1999

Risperidone-induced rabbit syndrome: an unusual movement disorder caused by an atypical antipsychotic.

Rabbit syndrome is a rare side effect of chronic neuroleptic administration characterized by rapid, fine, rhythmic movements of the mouth along a vertical axis. It gains its name from an unusual resemblance to the chewing and puckering motions of the rabbit. It is generally thought to be an extra-pyramidal side effect, in part due to its rapid response to anti-cholinergic medication. This is the first case report of risperidone, an atypical antipsychotic, inducing the syndrome. The theoretical implications for the classification of the syndrome along the spectrum of neuroleptic-induced movement disorders are discussed.

Adult↗
PubMed2002

The mitochondrial common deletion in Parkinson's disease and related movement disorders.

The mitochondrial 4977-bp common deletion has been reported in some studies to occur exclusively or with increased frequency in the midbrain of patients with Parkinson's disease (PD). Other studies could not confirm these results; rather, it was suggested that the mitochondrial common deletion is associated with aging in the midbrain and not PD. One possible explanation for these conflicting results is the difficulty in quantifying mitochondrial DNA deletions or mutations in the whole midbrain or substantia nigra (SN) while only a subset of midbrain neurons degenerate in PD. In addition, none of the studies has addressed the cell types with the common deletion within the midbrain. In this study we used in situ hybridization to detect the common deletion in sections of midbrain from patients with PD, multiple system atrophy-parkinsonian type (MSA-P), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), age-matched controls, and individuals of different ages. The results demonstrated that the mitochondrial common deletion accumulated primarily in neurons but not glia in both the SN and other midbrain regions. There was no significant difference in the number or distribution of neurons with the common deletion or the average of the mean densities (AMD) of staining with the common deletion in nigral neurons among patients with PD, MSA-P, PSP, DLB, or age-matched controls. In addition, there was no difference in the number or distribution of neurons with the common deletion in nigral neurons between any age group, although there was a tendency for the common deletion to increase in the non-nigral neurons in older patients. These data indicate that accumulation of the 4977-bp common deletion in mitochondrial DNA in midbrain occurred primarily in neurons, and by this cytological approach, it was not associated with nigral neurodegeneration in the common movement disorders or aging.

Adolescent↗
PubMed1995

Heavy metals and the etiology of Parkinson's disease and other movement disorders.

Heavy metals, such as iron and manganese, are involved in neurologic disease. Most often these diseases are associated with abnormal environmental exposures or abnormal accumulations of heavy metals in the body. There is increasing recognition that heavy metals normally present in the body also may play a role in disease pathogenesis through free radical formation. When a part of the brain known as the basal ganglia is affected, movements become disordered. Parkinson's disease is one of the most common movement disorders and is related to destruction of neurons in the substantia nigra pars compacta (SNpc) of the basal ganglia. The combination of high concentration of iron and the neurotransmitter, dopamine, may contribute to the selective vulnerability of the SNpc. Dopamine can auto-oxidize to produce free radicals particularly in the presence of iron and other heavy metals.

Animals↗
PubMed1985

Prevalence of movement disorder in a methadone-maintained population.

Opioids and neuroleptics have similar effects in a variety of behavioral, biochemical, and clinical situations. Prolonged treatment with dopamine antagonists is associated with the development of a movement disorder, tardive dyskinesia. Animals treated with methadone for prolonged periods may also develop abnormal movements when challenged with amphetamines. In this study, 243 patients on methadone maintenance were examined for abnormal movements using the Abnormal Involuntary Movement Scale. Methadone treatment alone was not associated with increased abnormal movements. Three patients with abnormal movements were found, but each was also receiving neuroleptics.

Adult↗
PubMed1987

The effects of L-tryptophan on haloperidol-induced movement disorder in the rat.

An animal model of haloperidol-induced tardive dyskinesia was studied in relation to the dietary manipulation of tryptophan and its effect on the movement disorder. This study showed a significant negative behavioral response to the neuroleptic drug, haloperidol. Increased dietary tryptophan (1.0 vs. 0.3%) significantly reduced the frequency of drug-induced head movements. Brain serotonin levels were elevated by the drug treatment. Brain serotonin levels correlated significantly with the behavioral response. Contrary to expectation, brain dopamine levels did not correlate with the behavioral response. These findings suggest a possible serotonergic involvement in neuroleptic-induced tardive dyskinesia and an amelioration of the disorder through tryptophan supplementation.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1999

Treatment of periodic leg movement disorder and restless leg syndrome with talipexole.

In order to investigate the bedtime dose of talipexole, a D2 and alpha2 stimulant, on patients with periodic leg movement disorder (PLMD) and restless leg syndrome (RLS), we made a comparison of polysomnographic findings and subjective symptom ratings before and during 4 weeks of the treatment on five cases with RLS and PLMD. A significant decrease in both the frequencies of periodic leg movements and subjective symptom ratings and significant improvement of sleep composition were recognized during the treatment. We speculate that the combination of the agonistic action of D2 and alpha2 receptor with the drug might not only suppress PLMD and RLS but also improve sleep quality.

Azepines↗
PubMed1991

Ataxia telangiectasia presenting as an extrapyramidal movement disorder and ocular motor apraxia without overt telangiectasia.

Ataxia telangiectasia may present with few, if any, of its typical extraneurological manifestations, but the combination of an extrapyramidal movement disorder, ocular motor apraxia with head thrusting and cerebellar incoordination is characteristic. In this sporadic case there was no overt immune dysfunction, oculocutaneous telangiectasia were inconspicuous and the neurological presentation was atypical with dystonia predominating over cerebellar incoordination. The uncontrollable and disabling involuntary movements, which have not to our knowledge been described in ataxia telangiectasia before, showed a partial response to moderately large doses of benzhexol, but were refractory to all other medications. Treatment in the future is to be with increasing doses of benzhexol until the dystonia is controlled or larger doses cannot be tolerated.

Adult↗
PubMed2006

Review of the therapeutic management of Parkinson's disease. Report of a joint task force of the European Federation of Neurological Societies (EFNS) and the Movement Disorder Society-European Section (MDS-ES). Part II: late (complicated) Parkinson's disease.

To provide evidence-based recommendations for the management of late (complicated) Parkinson's disease (PD), based on a review of the literature. Complicated PD refers to patients suffering from the classical motor syndrome of PD along with other motor or non-motor complications, either disease-related (e.g. freezing) or treatment-related (e.g. dyskinesias or hallucinations). MEDLINE, Cochrane Library and INAHTA database literature searches were conducted. National guidelines were requested from all EFNS societies. Non-European guidelines were searched for using MEDLINE. Part II of the guidelines deals with treatment of motor and neuropsychiatric complications and autonomic disturbances. For each topic, a list of therapeutic interventions is provided, including classification of evidence. Following this, recommendations for management are given, alongside ratings of efficacy. Classifications of evidence and ratings of efficacy are made according to EFNS guidance. In cases where there is insufficient scientific evidence, a consensus statement ('good practice point') is made.

Antiparkinson Agents↗
PubMed2003

Can periodic limb movement disorder be diagnosed without polysomnography? A case-control study.

OBJECTIVES: (1) To determine whether clinical information can predict the presence of periodic limb movement disorder (PLMD). (2) To examine whether clinical data correlate with PLMD severity. METHODS: Sixty-one adult patients (48 males and 13 females, aged 55.1+/-14.1 years) with PLMD (without a clinical diagnosis of restless legs syndrome) were compared with 61 control patients without PLMD (43 males and 18 females, aged 49.6+/-16.1 years) in this case-control study. All patients completed a detailed questionnaire which included (1) demographics, (2) sleep complaints, (3) medical disorders, (4) use of medication, nicotine, and caffeine, and (5) history of nocturnal motor/sensory leg symptoms. All patients underwent standard polysomnography. RESULTS: The PLMD and control groups were similar in the prevalence of insomnia, hypersomnia, diabetes, peripheral neurologic disorders, anemia, spinal disease, antidepressant medication use, smoking, caffeine intake, and leg pain. Compared with the control group, the PLMD group reported more leg kicks (28% vs. 5%, P<0.001) and more crawling or aching sensations in legs (28% vs. 11%, P=0.023). The logistic regression analysis showed that only age (P=0.044), leg kicks (odds ratio (OR) 12.70, 95% confidence interval (CI) 2.80-57.63, P=0.001), and crawling or aching in legs (OR 5.23, 95% CI 1.16-23.44, P=0.029) were significantly related to the presence of PLMD. The positive predictive value of leg kicks in the diagnosis of PLMD was 85% and the negative predictive value was 57%. Within the PLMD group, only age correlated positively with the PLM-index (r=0.47, P<0.001). Both the PLM-index and the PLM arousal-index were negatively correlated with sleep efficiency on polysomnography (P=0.005 and P=0.006, respectively). CONCLUSIONS: Clinical data are not sufficiently predictive of the presence of PLMD to rule in or rule out the diagnosis. Polysomnography is required for establishing the diagnosis of PLMD in patients with insomnia or hypersomnia.

Case-Control Studies↗
PubMed2004

An update on the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder.

This paper reviews evidence from April, 1998 through April 2002 for the dopaminergic treatment of the restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). There has been increased study of dopaminergic agents for the treatment of these conditions since publication of a review paper and practice parameters that covered all types of medical treatment of RLS and PLMD in 1999. For this reason, the Restless Legs Syndrome Task Force and the Standards of Practice Committee decided to update the evidence on dopaminergic treatment of these conditions. This paper reviews the literature on levodopa, dopaminergic agonists (pergolide, pramipexole, ropinirole, talipexole, cabergoline, piribidel, DHEC), and other dopaminergic agents (amantadine, selegiline).

Dopamine Agonists↗
PubMed1999

Neuro-ophthalmology of eye-movement disorders.

Magnetic resonance and functional brain imaging continue to expand their roles in complementing the clinical examination to localize the causes of eye-movement disorders. A retrospective review from county-based clinical practices emphasized generally benign causes of third, fourth, and sixth cranial nerve palsies in children, but a study from a tertiary referral center found a high incidence of neoplasms causing sixth-nerve palsies in children. A prospective study found that 38% of diabetic patients with third-nerve palsies had anisocoria up to 2.5 mm. An initial attempt to develop an evidence-based practice pathway for the evaluation of ocular motor nerve palsies has been developed for isolated sixth-nerve palsies in adults. In an important study of Graves hyperthyroidism, treatment with radioactive iodine was more likely than methimazole therapy alone to be associated with the appearance or worsening of ophthalmopathy. The clinical worsening of eye findings could be prevented by concurrent administration of corticosteroids for 3 months. Smoking is still a major controllable risk factor for thyroid ophthalmopathy.

Abducens Nerve Diseases↗
PubMed2006

Periodic leg movements in sleep and periodic limb movement disorder: prevalence, clinical significance and treatment.

Periodic leg movements in sleep (PLMS) are a frequent finding in polysomnography. The prevalence of PLMS is estimated to be 4-11% in adults. In childhood, PLMS rarely occur although medical conditions like sleep apnea syndrome or neuropsychiatric disorders can lead to high rates of PLMS. In the elderly, PLMS are also common in subjects without sleep disturbances. In sleep studies, PLMS are found most frequently in restless legs syndrome (RLS) and often occur in narcolepsy, sleep apnea syndrome and REM sleep behavior disorder. Some patients with otherwise unexplained insomnia or hypersomnia reveal an elevated number of PLMS, a condition defined as periodic limb movement disorder (PLMD). PLMS were found also in various medical and neurological disorders that do not primarily affect sleep. A summary of these is presented. In sleep disorders related to dopaminergic dysfunction such as RLS, PLMS are considered to be a symptom of the disease. In other disorders like primary insomnia, the clinical relevance of PLMS is still being controversially discussed. Studies with findings both pro and contra are referred. To date, only a few studies have evaluated the efficacy of therapeutic substances in reducing PLMS in PLMD patients. Their results need to be confirmed in controlled randomized trials.

Aged↗
PubMed2005

Role of [18F]-dopa-PET imaging in assessing movement disorders.

FD-PET has proved to be an extremely useful technique for the noninvasive evaluation of nigrostriatal pathophysiology in patients with PD and other movement disorders. The development of ratio methods for image analysis has greatly reduced the complexity of these PET studies and has facilitated data analysis. With the recent advances in cyclotron targetry and automated synthesis modules FD-PET will soon become an important component of the clinical armamentarium.

Dihydroxyphenylalanine↗