Thalamic stimulation in movement disorders.
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To determine the subjective perception patients have of abnormal movements, 170 patients with various hyperkinesias were interviewed with questions directed at the "voluntary" or intentional versus "involuntary" aspects of their symptoms. One hundred and two of 110 patients with non-tic disorders thought that the abnormal movements were entirely involuntary. Forty-one of 60 tic disorder patients stated that all their motor and phonic tics were intentionally produced. Fifteen others had both voluntary and involuntary components, usually with the former predominating. A "voluntary" response could be used to predict the correct diagnostic category (tic versus non-tic) in 8 of 9 patients for whom the referral category was incorrect. These results suggest that a large proportion of the motor and phonic symptoms experienced by tic patients are irresistibly but purposefully executed, more akin to compulsions than to the other "involuntary" hyperkinesias with which they are commonly discussed.
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Tremor is one of the most common adult neurologic disorders. It is characterized by Involuntary, rhythmic and oscillatory movements of a body part. Tremor affects quality of life by impeding simple motor tasks and activities of daily living and heightening self consciousness. Severe tremor can undermine independence, relationships, and recreational and social activities. Initial clinical objectives include determining the tremor type and ruling out Parkinson's disease. Severe cases typically require pharmacologic therapy, and in some instances, surgical intervention; both strategies for severe cases, however, have drawbacks.
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Video image analysis is able to provide quantitative data on postural and movement abnormalities and thus has an important application in neurological diagnosis and management. The conventional techniques require patients to be videotaped while wearing markers in a highly structured laboratory environment. This restricts the utility of video in routine clinical practise. We have begun development of intelligent software which aims to provide a more flexible system able to quantify human posture and movement directly from whole-body images without markers and in an unstructured environment. The steps involved are to extract complete human profiles from video frames, to fit skeletal frameworks to the profiles and derive joint angles and swing distances. By this means a given posture is reduced to a set of basic parameters that can provide input to a neural network classifier. To test the system's performance we videotaped patients with dopa-responsive Parkinsonism and age-matched normals during several gait cycles, to yield 61 patient and 49 normal postures. These postures were reduced to their basic parameters and fed to the neural network classifier in various combinations. The optimal parameter sets (consisting of both swing distances and joint angles) yielded successful classification of normals and patients with an accuracy above 90%. This result demonstrated the feasibility of the approach. The technique has the potential to guide clinicians on the relative sensitivity of specific postural/gait features in diagnosis. Future studies will aim to improve the robustness of the system in providing accurate parameter estimates from subjects wearing a range of clothing, and to further improve discrimination by incorporating more stages of the gait cycle into the analysis.
The treatment of sleep apnea with nasal continuous positive airway pressure (CPAP) occasionally has been associated with the appearance of periodic limb movement (PLM) disorder, but it has not been clear whether CPAP induces PLM, or whether the PLM is simply disguised until apnea is treated. We report the emergence of PLM after the inadvertent application of CPAP in a patient without sleep apnea.
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