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Horizontal eye movement disorders after posterior vermis infarctions.

The horizontal saccade, smooth pursuit, and vestibulo-ocular reflex gains were recorded in 19 patients with cerebellar infarction documented with MRI, and in a group of control subjects. Bilateral saccade hypometria and a decrease in ipsilateral smooth pursuit gain were found only in patients with a lesion affecting the posterior vermis. These results in humans support experimental findings suggesting that the posterior vermis controls both saccade accuracy and smooth pursuit velocity.

Adult↗

[Neuroleptic-induced movement disorders: historical perspectives].

Soon after the discovery of neuroleptics, neurological side effects of the extrapyramidal type were reported. The first description of neuroleptic-induced parkinsonism dates back to the "Swiss Symposium on Chloropromazine" held in 1953. Steck in 1954 vividly described the symptoms in a convincing manner. In 1955, Delay and Denicker, observing the therapeutic efficacy and extrapyramidal activity of two seemingly different compounds as chloropromazine and reserpine, used the term "neuroleptic" to characterize this common property. Two years later they proposed a definition of neuroleptics taking into account therapeutic efficacy as well as side effects. Such a definition was not accepted by American authors who preferred term like "major tranquilizers" and finally "antipsychotics". The meaning of neuroleptic parkinsonism (whether it was a side effect or part of the therapeutic action) had been discussed for a long time. The analogy with the clinical manifestations of Von Economo's encephalitis lethargica was also mentioned. Tardive dyskinesia appeared in the literature in the late 1950's. The first report was made by Schoenecker in 1957 who described bucco-oral movements persisting after the neuroleptics were diminished or discontinued. He concluded that these manifestations were different from the acute extrapyramidal side effects. Two years later Sigwald et al. reported involuntary movements of the tongue, lips and facial muscles which appeared after several years of phenothiazine treatment. In 1960 Uhrbrand and Faurbye described bucco-linguo-masticatory movements sometimes associated with trunk and foot movements. Half of these cases persisted (and a few aggravated) after neuroleptic withdrawal. In others the condition was unmasked by the neuroleptic discontinuation. In 1964 Faurbye et al. proposed the term "tardive dyskinesia" for this extrapyramidal side effect. After an initial description by Druckman et al. in 1962, the term of "tardive dystonia" was first used in 1973 by Keegan and Rajput. The patients described in the early literature were mainly of an advanced age with organic involvement. The first serious epidemiological studies were undertaken in the late 1960's, showing prevalences varying between 0.5 to 65%! Most of the predisposing factors suspected in early studies (cerebral lesions, lobotomy, ECT) were not confirmed in more recent studies that emphasized the role of an older age and a female gender. The interest in tardive dyskinesia varies from one country to another. Perhaps, dyskinesia was more severe and problematic in the USA because of more liberal indications for neuroleptic use, higher doses and smaller choice of neuroleptic medications. Medicolegal aspects have also increased the apprehension of american physicians. Tardive dyskinesia remains an enigmatic phenomenon and a therapeutic challenge. In the future, the possible discovery of antipsychotic molecules devoid of extrapyramidal side effects may discourage the research on these unresolved issues.

Antipsychotic Agents↗

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗

Deanol acetamidobenzoate treatment in choreiform movement disorders.

Deanol acetamidobenzoate was administered in double-blind, crossover fashion with placebo to five patients with tardive dyskinesia, three patients with Huntington's chorea, and one patient with posthemiplegic chorea. No significant effect on dyskinesia was observed. Preliminary administration of physostigmine salicylate to patients with tardive dyskinesia had a variable effect, while benztropine mesylate produced no change. Since the status of deanol as an effective precursor of acetylcholine is uncertain, further trials with putative cholinergic agents remain warranted in choreiform syndromes.

Benztropine↗

Effect of an opiate antagonist on movement disorders.

Animal experiments suggest that opiate peptides might play a role in extrapyramidal function. This hypothesis was tested by administering the opiate antagonist, naltrexone, in doses sufficient to antagonize exogenous opiates, to patients with parkinsonism and Huntington's disease. No improvement in the clinical features of either disorder was noted.

Adult↗

CSF monamine metabolites in movement disorders and normal aging.

We measured four monoamine metabolite levels in CSF before and after probenecid administration to normal controls and to patients with Huntington's disease (HD), dystonia, and tardive dyskinesia. We identified differences only for the dopamine metabolite homovanillic acid (HVA), which showed increased baseline values and decreased turnover in normal aging, but decreased baseline values and normal turnover in HD. These results suggest that dopamine neurons are linked both to normal aging and to HD and that CSF HVA studies can distinguish differences in the functioning of dopamine neurons in normal aging and HD.

3,4-Dihydroxyphenylacetic Acid↗

Metric characteristics of the drug-induced extrapyramidal symptoms scale (DIEPSS): a practical combined rating scale for drug-induced movement disorders.

The metric properties of the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) were examined in 182 subjects treated with antipsychotics. Inter-rater reliability, test-retest reliability, and concurrent validity with other rating scales for EPS were high. Four factors were identified and the optimal diagnostic cut-off scores were obtained. These results suggest that the DIEPSS is a reliable and valid multidimensional rating scale.

Adult↗

CADASIL presenting with a movement disorder: a clinical study of a Chilean kindred.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary vascular disease that usually begins with migraine, followed by repeated strokes and progressive dementia. We describe an unusual clinical presentation of this condition in members of a Chilean family with an established NOTCH3 mutation. We report early clinical, neuropsychological, transcranial ultrasound, magnetic resonance imaging (MRI), cerebral blood flow, and skin biopsy findings on these patients. Of the patients, 2 presented with facial dystonia, 1 of whom had abnormal single photon emission computed tomography and transcranial ultrasound studies after normal brain MRI scans. Our report emphasizes that CADASIL must be considered in the study of patients with secondary dystonia.

Adult↗

Joubert syndrome surviving to adulthood associated with a progressive movement disorder.

A 48-year-old man presented with a progressive gait disorder. He had longstanding ataxia, oculomotor apraxia, motor delay, and cognitive impairment, diagnosed as cerebral palsy. Physical examination revealed ataxia, oculomotor apraxia, extrapyramidal signs, and a wide-based, shuffling gait. Magnetic resonance imaging showed vermian aplasia, consistent with Joubert syndrome. Positron emission tomography scan revealed normal fluorodopa uptake, but elevated raclopride binding, compatible with dopamine deficiency. This case demonstrates that a patient with Joubert syndrome may survive into adulthood and present as a chronic neurologic disorder with subacute extrapyramidal signs.

Age Factors↗