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PubMed1993

Neuroimaging of epilepsy, movement disorders, and degenerative diseases.

Neuroimaging has improved the understanding, diagnosis, and management of several neurologic diseases and syndromes. Recent advances in the neuroimaging of epilepsy, movement disorders, and degenerative diseases of the nervous system are reviewed. Current research confirms that structural and functional neuroimages each provide unique, clinically useful information in these disorders. Quantification of images improves their diagnostic sensitivity and specificity. Presymptomatic or early neurochemical changes have been identified and followed longitudinally in several neurodegenerative diseases, providing a method for monitoring response to therapeutic intervention and pathophysiologic hypothesis testing. Functional activation studies and receptor-specific radioligands continue to advance our understanding of these disorders. Future methods will take increasing advantage of both the ability to measure neuropharmacological and neurochemical changes in vivo, and the ability to combine images and information obtained with distinct structural and functional neuroimaging modalities.

Brain↗
PubMed1996

Spontaneous and drug-induced movement disorders in schizophrenia.

The extrapyramidal side-effects (EPS) of conventional neuroleptics are widely recognized. However, a substantial number of drug-naïve patients exhibit movement disorders which could be mistaken for EPS if drug therapy were started without a careful baseline assessment. Patients' experience of EPS during their first exposure to antipsychotic medication can have lasting effects on their attitudes to medication and compliance. Unmedicated, approximately 60% of patients will relapse in the first year after resolution of an acute psychotic episode, whereas prophylactic medication can reduce the relapse rate to less than 20%. The conventional neuroleptics produce antipsychotic effects at doses which differ little from those that induce EPS, and although anticholinergic medication helps to reduce the severity of EPS, it also causes side-effects, e.g. constipation, blurred vision, retention of urine, dry mouth and disturbances of sexual function. More importantly, anticholinergic drugs may worsen the psychosis and impair memory. Low or intermittent dose strategies with conventional neuroleptics may give patients relief from EPS, but they increase the relapse risk, and may also increase the risk of tardive dyskinesia. The serotonin-dopamine antagonist (SDA) antipsychotics, such as risperidone, produce both significant antipsychotic effects at doses which are lower than those that cause EPS, and also a lower level of EPS compared with conventional drugs. Clinical trials have shown that risperidone is effective in first-episode schizophrenia. In these trials the same doses were used as in chronic patients. However, clinical experience in Canada since the drug became generally available in 1993 suggests that first-episode patients require lower doses of risperidone than chronically ill patients who have had several acute psychotic episodes. More than 3 years of use has made it clear that risperidone should be seriously considered in first-episode patients, as it offers an opportunity to treat psychosis with minimal EPS. This in turn should lead to better compliance and a lower long-term relapse rate.

Antipsychotic Agents↗
PubMed2000

Japanese encephalitis with movement disorder and atypical magnetic resonance imaging.

With the advent of magnetic resonance imaging, brain lesions associated with Japanese encephalitis are increasingly being recognized and correlated with movement disorder. Bilateral haemorrhagic thalamic infarcts on MRI, suggested as a characteristic finding in Japanese encephalitis were conspicuous by their absence in this case report of Japanese encephalitis.

Adolescent↗
PubMed1984

Recent physiological and pathophysiological aspects of Parkinsonian movement disorders.

Deficits in the neural control of limb movements constitute a major part of Parkinsonian symptoms and are linked to a decay of dopaminergic neurotransmission. In animal models, Parkinsonian-like hypokinesia is consistently reproduced with large nigrostriatal dopamine depletions, while tremor and rigidity are less readily obtained. Lesions leading to a less than 70% striatal dopamine depletion are largely compensated by an increased activity of dopamine terminals. With more important lesions, supersensitivity of striatal non-adenylate cyclase-linked dopamine receptors occurs. Electrophysiological studies in Parkinsonian patients demonstrate increased reaction times and a reduced build-up of movement-related muscular activity underlying hypokinesia and provide circumstantial evidence for a central origin of tremor and rigidity. Single cell activity in unlesioned, behaving monkeys shows an increasingly direct relationship to movements when following the neural connections from mid-brain dopamine cells via striatum, globus pallidus, thalamus to pyramidal tract neurons of motor cortex. These data corroborate experimentally the concept that Parkinsonian hypokinesia is due to a failure of basic behavioral activating mechanisms.

Animals↗
PubMed1991

The association among negative symptoms, movement disorders, and frontal lobe psychological deficits in schizophrenic patients.

Neuropsychological tests of frontal lobe function were undertaken in 46 chronic schizophrenic patients who were also rated for movement disorders and negative symptoms. "High" and "low" SANS groups were formed by segregating around the median value. The "high" SANS group was found to differ significantly in terms of the severity of tardive dyskinesia (TD) and drug-induced parkinsonism, and frontal psychological tests. A possible mechanism is discussed within the context of known neostriatal psychological function.

Antipsychotic Agents↗
PubMed1991

Smoking and movement disorders in psychiatric patients.

Previous studies have suggested that tardive dyskinesia may occur more frequently in patients who smoke. Further evidence of an interaction between smoking and movement disorders includes the low lifetime exposure to cigarettes found in Parkinson's disease patients. In this study 126 patients with chronic psychiatric illnesses were blindly evaluated for tardive dyskinesia, neuroleptic-induced parkinsonism, and akathisia. Patients who smoked received significantly higher doses of neuroleptics but did not have significantly more frequent or more severe tardive dyskinesia or parkinsonism. Female smokers did have significantly more akathisia. These results are discussed with regard to interactions between smoking, central dopaminergic tone, and the psychopathology of extrapyramidal syndromes. The effect of smoking on neuroleptic blood levels as well as clinical symptomatology is also discussed.

Adult↗
PubMed2005

Drug-induced movement disorders in children and adolescents.

The use of psychotropic medication among children and adolescents is increasing with a concomitant increase in the incidence of drug-related movement disorders. This class of adverse reactions to medications can be divided into those that are acute in onset, others that are continuous as long as the offending drug is administered, and a final category consisting of symptoms that are persistent, even after the causative agent has been discontinued. Within these three categories, this review discusses the epidemiology, risk factors, clinical features and treatment of acute dystonic reactions, drug-induced parkinsonism, neuroleptic malignant syndrome, serotonin syndrome, acute akathisia, and the tardive syndromes. In addition, drugs that commonly cause tremor, chorea, or myoclonus are included.

Acute Disease↗
PubMed2004

Deep brain stimulation in movement disorders. The applications reconsidered.

In this study the role of DBS in advanced Parkinson disease (PD) is re-evaluated and new indications in the field of movement disorders are explored. The authors performed unilateral pallidal stimulation in 26 patients with advanced PD. At long-term follow-up review, the motor effect is unsatisfying. The authors conclude that unilateral pallidal stimulation is not a favourable treatment option for patients with advanced PD. Bilateral subthalamic nucleus stimulation was performed in twenty patients with advanced PD. After a minimum follow-up of 4 years, there was still a significant improvement in motor function and functional performance in all patients. One side-effect of the stimulation was however rather concerning: four patients presented with stimulation-induced hypomanic to manic characteristics. Bilateral subthalamic stimulation was performed in four patients with multiple system atrophy-parkinsonism. At long-term follow-up, the patients fared better with than without stimulation. The authors finally present a completely new indication for DBS: Tourette syndrome (TS). They review the literature on surgical procedures performed in TS, all of which consisted of making lesions. Three TS patients are presented on which bilateral thalamic stimulation was performed. At long-term follow-up, all major tics had disappeared, as well as associated behavioral disturbances.

Adult↗
PubMed1992

Drug-induced movement disorders in institutionalised adults with mental retardation: clinical characteristics and risk factors.

Fifty-three institutionalised adults with mental retardation, the majority (73.5%) moderate to severe, were examined for drug-induced movement disorders. Using a global AIMS score of 2 or more, 16 (34%) of the 47 subjects who had been exposed to neuroleptics had tardive dyskinesia (TD). Three of these had developed the dyskinesia upon withdrawal of neuroleptics. The dyskinetic movements were mainly seen in the lingual, perioral and other facial muscles. Two (33%) out of 6 subjects with no history of exposure to neuroleptics also had similar dyskinetic movements. The total neuroleptic dose significantly, and age marginally, but not sex, brain damage or level of mental retardation, emerged as risk factors for TD. Two (3.7%) subjects had definite akathisia and 16 (30.8%) significant extrapyramidal side effects. This study supports the findings of previous studies of considerable neurological adverse effects of neuroleptics in this patient group and cautions against their injudicious use. It provides further evidence for some putative risk factors for TD and is noteworthy for its lack of support for the contentious issue of brain damage as a risk factor.

Adult↗
PubMed1993

Gamma Knife thalamotomy and pallidotomy in patients with movement disorders: preliminary results.

The Leksell Gamma Knife is a useful and safe method to perform thalamotomy and pallidotomy in selected older patients with Parkinson's disease and related movement disorders. In this preliminary report, 2 of 3 patients with severe intention tremor were relieved of their symptoms by thalamotomy, as were 4 of 7 patients with Parkinson's tremor. Four of 8 patients had significant improvement of contralateral rigidity following pallidotomy.

Aged↗
PubMed1998

Case series: spectrum of neuroleptic-induced movement disorders and extrapyramidal side effects in childhood-onset schizophrenia.

OBJECTIVE: Neuroleptic-treated pediatric patients with childhood-onset schizophrenia (COS) are at risk for developing extrapyramidal side effects and involuntary movement disorders. A preliminary examination of the incidence of withdrawal dyskinesias (WD), tardive dyskinesia (TD), and extrapyramidal side effects in these patients is presented. METHOD: Thirty-four COS patients (mean age +/- SD, 14.2 +/- 2.1 years) were examined for TD using the Abnormal Involuntary Movements Scale and for extrapyramidal side effects using the Simpson-Angus Neurologic Rating Scale, after a 14- to 28-day drug-free period (n = 33), at week 6 of treatment and 2 to 4 years after completion of the study (n = 14). The mean (+/-SD) number of months of prior neuroleptic exposure for the group was 22.4 (15.0) months. RESULTS: Seventeen (50%) of 34 patients were noted to have either WD or TD at some point during their participation in the studies. The majority of patients experienced WD that were mainly in the orofacial region, transient in nature, and diminished with haloperidol and clozapine. Patients with TD/WD had greater levels of premorbid impairment (p = .02), increased severity of positive symptoms of schizophrenia (p < .01), and a trend toward more months of neuroleptic exposure (p = .10, one-tailed). CONCLUSIONS: A high proportion of COS patients were found to have TD/WD. The majority of these abnormal movements were not severe and generally improved over time. TD/WD in COS appears to be associated with greater premorbid impairment, severity of illness, and duration of neuroleptic exposure. J. Am. Acad.

Adolescent↗
PubMed2006

EFNS guidelines on management of restless legs syndrome and periodic limb movement disorder in sleep.

In 2003, the EFNS Task Force was set up for putting forth guidelines for the management of the Restless Legs Syndrome (RLS) and the Periodic Limb Movement Disorder (PLMD). After determining the objectives for management and the search strategy for primary and secondary RLS and for PLMD, a review of the scientific literature up to 2004 was performed for the drug classes and interventions employed in treatment (drugs acting on the adrenoreceptor, antiepileptic drugs, benzodiazepines/hypnotics, dopaminergic agents, opioids, other treatments). Previous guidelines were consulted. All trials were analysed according to class of evidence, and recommendations formed according to the 2004 EFNS criteria for rating. Dopaminergic agents came out as having the best evidence for efficacy in primary RLS. Reported adverse events were usually mild and reversible; augmentation was a feature with dopaminergic agents. No controlled trials were available for RLS in children and for RLS during pregnancy. The following level A recommendations can be offered: for primary RLS, cabergoline, gabapentin, pergolide, ropinirole, levodopa and rotigotine by transdermal delivery (the latter two for short-term use) are effective in relieving the symptoms. Transdermal oestradiol is ineffective for PLMD.

Advisory Committees↗
PubMed1984

Movement disorders in the psychiatric patient.

Abnormal movements or postures often present a diagnostic and therapeutic challenge to the psychiatrist or neurologist. The authors review pertinent anatomy and physiology of disorders of the extrapyramidal system, suggest aspects of the clinical history and examination particularly important for diagnosis, and describe a range of abnormal movements. They review several syndromes in which abnormalities of behavior and movement may occur together, including Huntington's chorea, Wilson's disease, Parkinson's disease, and tardive dyskinesia.

Adolescent↗
PubMed2005

Imaging the dopaminergic system in suspected parkinsonism, drug induced movement disorders, and Lewy body dementia.

This review discusses the role of pre- and post-synaptic dopaminergic imaging in suspected Parkinson's disease, vascular parkinsonism, the parkinsonian syndromes, drug induced movement disorder, and Lewy body dementia. It is envisaged that this information may be useful to neurologists, psychiatrists, physicians/geriatricians, radiologists and nuclear medicine physicians.

Brain↗
PubMed1997

Movement disorders associated with withdrawal from high-dose intravenous haloperidol therapy in delirious ICU patients.

Intravenous haloperidol is recommended as the drug of choice to treat delirium in ICU patients. Movement disorders and other adverse events commonly occur with oral haloperidol use but are rarely seen with IV haloperidol use, and withdrawal symptoms have not been reported with short-term ICU use. We describe self-limited dyskinesia during withdrawal of high-dose continuous IV haloperidol therapy in five ICU patients.

Adult↗
PubMed2002

EEG mapping, psychometric, and polysomnographic studies in restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) patients as compared with normal controls.

OBJECTIVES: Investigation of daytime brain function, psychopathology, and objective and subjective sleep and awakening quality in restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). METHODS: Thirty-three RLS and 26 PLMD patients free of psychotropic drugs were studied as compared with age- and sex-matched normal controls, utilizing electroencephalographic (EEG) mapping and clinical evaluations by the Zung Self-Rating Depression (SDS) and Anxiety Scale (SAS), the Quality of Life Index, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale. In a subsample of 12 RLS patients, 12 PLMD patients, and 12 controls, objective and subjective sleep and awakening quality were evaluated in two sleep laboratory nights (adaptation and baseline night). RESULTS: Scores of the PSQI, SDS, and SAS were found increased in both patient groups; RLS patients showed reduced quality of life, while in the PLMD group daytime sleepiness was increased. EEG mapping demonstrated findings characteristic of major depression in RLS patients and of generalized anxiety disorder in PLMD patients. Polysomnography showed a significant deterioration of sleep efficiency only for RLS patients, while nocturnal awakenings were increased in both patient groups. Concerning sleep architecture, both groups exhibited increased S1 and stage shifts and decreased S2, while only PLMD patients showed an increase in S4. The PLM/(h TST), the PLM/(h wake) and the PLMS-arousal index were significantly increased in both patient groups as compared with controls. Subjective sleep and awakening quality and thymopsychic measures were deteriorated in RLS. Morning mental performance and fine motor activity were deteriorated in both groups, reaction time only in RLS, numerical memory and attention variability only in PLMD. CONCLUSION: EEG mapping revealed neurophysiological correlates of depression and anxiety in RLS and PLMD, respectively, which were confirmed by self-ratings of symptoms.

Journal Article↗