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Kulcsarova K, Baloghova J, Necpal J, Skorvanek M. Skin Conditions and Movement Disorders: Hiding in Plain Sight. Mov Disord Clin Pract 2022; 9:566-583. [PMID: 35844274 PMCID: PMC9274368 DOI: 10.1002/mdc3.13436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Skin manifestations are well-recognized non-motor symptoms of Parkinson's disease (PD) and other hypokinetic and hyperkinetic movement disorders. Skin conditions are usually well visible during routine clinical examination and their recognition may play a major role in diagnostic work-up. In this educational review we: (1) briefly outline skin conditions related to Parkinson's disease, including therapy-related skin complications and their management; (2) discuss the role of skin biopsies in early diagnosis of PD and differential diagnosis of parkinsonian syndromes; and focus more on areas which have not been reviewed in the literature before, including (3) skin conditions related to atypical parkinsonism, and (4) skin conditions related to hyperkinetic movement disorders. In case of rare hyperkinetic movement disorders, specific dermatological manifestations, like presence of angiokeratomas, telangiectasias, Mongolian spots, lipomas, ichthyosis, progeroid skin changes and others may point to a very specific group of disorders and help guide further investigations.
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Affiliation(s)
- Kristina Kulcsarova
- Department of Neurology, Medical FacultyUniversity of Pavol Jozef SafarikPavolSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Janette Baloghova
- Department of DermatovenerologyMedical Faculty, University of Pavol Jozef SafarikKosiceSlovak Republic
- Department of DermatovenerologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Jan Necpal
- Department of NeurologyZvolen HospitalZvolenSlovak Republic
| | - Matej Skorvanek
- Department of Neurology, Medical FacultyUniversity of Pavol Jozef SafarikPavolSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
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Parfyonov M, Friedlander R, Banno B, Elbe D, Horvath G. Psychiatric Manifestations in Patients with Biopterin Defects. Neuropediatrics 2022; 53:176-181. [PMID: 35098520 DOI: 10.1055/s-0042-1742323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Psychiatric manifestations in patients with tetrahydrobiopterin (BH4) defects are common, and may occur even with treatment of the underlying disorder. The neurobiological background of these conditions has been linked to abnormalities of neurotransmitters, such as dopamine, serotonin, norepinephrine, and gamma-aminobutyric acid. Here, we review the psychiatric profile of all patients with BH4 defects followed in the pediatric and adult metabolic clinics at our center. Three patients with autosomal recessive (AR) guanosine triphosphate cyclohydrolase (GTPCH) deficiency and three patients with 6-pyruvoyl tetrahydropterin synthase (PTPS) deficiency were reviewed.All patients had behavioral disturbances and two had significant psychiatric comorbidities. These included attention deficit/hyperactivity disorder, anxiety, depression, aggression, or oppositional defiant disorder. One patient with PTPS deficiency had a severe psychiatric presentation, requiring inpatient admission and temporary placement into foster care for intensive behavioral therapy. Another with AR GTPCH deficiency was diagnosed with aggressive behavioral dysregulation requiring intensive psychiatric treatment. Management of the psychiatric manifestations of BH4 defects can be challenging, due to lack of information and studies of interactions between psychiatric medications on the deficient neurotransmitters and their receptors in these conditions. Further studies are needed to establish safety and efficacy of these treatments.
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Affiliation(s)
- Maksim Parfyonov
- Division of Pediatric Neurology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robin Friedlander
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Banno
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dean Elbe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Child & Adolescent Mental Health, Healthy Minds Centre, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Gabriella Horvath
- Division of Biochemical Genetics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Adult Metabolic Diseases Clinic, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Salari M, Etemadifar M, Ghanbari K. Atypical parkinsonism and self-mutilation: A new lens on the old concept. Clin Case Rep 2021; 9:e04958. [PMID: 34765199 PMCID: PMC8572327 DOI: 10.1002/ccr3.4958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/13/2021] [Accepted: 09/25/2021] [Indexed: 11/07/2022] Open
Abstract
We report a case of atypical parkinsonism and self-mutilation.
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Affiliation(s)
- Mehri Salari
- Functional Neurosurgery Research Center Shohada Tajrish Comprehensive Neurosurgical Center of Excellence Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Masoud Etemadifar
- Department of Neurosurgery School of Medicine Isfahan University of Medical Science Isfahan Iran
| | - Kimia Ghanbari
- Functional Neurosurgery Research Center Shohada Tajrish Comprehensive Neurosurgical Center of Excellence Shahid Beheshti University of Medical Sciences Tehran Iran
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Salari M, Etemadifar M, Ghanbari K. Atypical parkinsonism and self-mutilation: A new lens on the old concept. Clin Case Rep 2021; 9:e04432. [PMID: 34267912 PMCID: PMC8271262 DOI: 10.1002/ccr3.4432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Indexed: 11/12/2022] Open
Abstract
We report a case of atypical parkinsonism and self-mutilation.
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Affiliation(s)
- Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
| | - Masoud Etemadifar
- Department of Functional Neurosurgery Medical SchoolIsfahan University of Medical SciencesIsfahanIran
| | - Kimia Ghanbari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of ExcellenceShahid Beheshti University of Medical SciencesTehranIran
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Bonomo R, Latorre A, Bhatia KP. Self-Injurious Behaviour in SCA17: A New Clinical Observation. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-672. [PMID: 31565537 PMCID: PMC6744813 DOI: 10.7916/tohm.v0.672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/06/2019] [Indexed: 12/01/2022]
Abstract
Background Self-injurious behaviour has historically been associated with borderline personality disorder. Nevertheless, over recent years, it has been reported in numerous neurological syndromes, especially hyperkinesias. Case report Two cases of SCA17 manifested self-injurious behaviour, namely repetitive scratching of the skin resulting in severe excoriations. In one of them, the abnormal behaviour was associated with the inability to resist the impulse to commit the act along with relief following the damage. Discussion This is the first report describing self-injurious behaviour in SCA17, but the mechanisms underlying it are still not clear. Further studies are needed to clarify the pathophysiology of such manifestation in hyperkinetic syndromes.
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Affiliation(s)
- Roberta Bonomo
- Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, London, UK.,Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, IT
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, London, UK.,Department of Human Neurosciences, Sapienza University of Rome, Rome, IT
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, University College London (UCL) Institute of Neurology, London, UK
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