Does Parkinson's disease interfere with electromyographic fatigue of masticatory muscles?

Parkinson's disease is a neurodegenerative disease with manifestations related to oxidative stress and damage to the skeletal striated musculature. This study evaluated the electromyographic fatigue of the masseter and temporal muscles in individuals with Parkinson's disease. The median frequency of the normotensive electromyographic signal was analyzed in 16 individuals, aged between 50 and 70 years, with Parkinson's disease in stages I and III of the Hoehn and Yahr disability scale (n=8) or without the disease (n=8). The data were tabulated and analyzed statistically (t-test, p .05). Compared with the group without Parkinson's disease, the group with the disease showed an increase in the median frequency, with significant differences for the right masseter (p=.05) and the right temporal (p=.03) muscles. The results suggest that there is a link between Parkinson's disease and functional alterations of the masticatory system, especially when electromyographic fatigue is assessed.

Phytocannabinoids and epilepsy

WHAT IS KNOWN AND OBJECTIVE

Antiepileptic drugs often produce serious adverse effects, and many patients do not respond to them properly. Phytocannabinoids produce anticonvulsant effects in preclinical and preliminary human studies, and appear to produce fewer adverse effects than available antiepileptic drugs. The present review summarizes studies on the anticonvulsant properties of phytocannabinoids.

METHODS

Literature search using the PubMed database to identify studies on phytocannabinoids and epilepsy.

RESULTS AND DISCUSSION

Preclinical studies suggest that phytocannabinoids, especially cannabidiol and cannabidivarin, have potent anticonvulsant effects which are mediated by the endocannabinoid system. Human studies are limited in number and quality, but suggest that cannabidiol has anticonvulsant effects in adult and infantile epilepsy and is well tolerated after prolonged administration.

WHAT IS NEW AND CONCLUSION

Phytocannabinoids produce anticonvulsant effects through the endocannabinoid system, with few adverse effects. Cannabidiol and cannabidivarin should be tested in randomized, controlled clinical trials, especially in infantile epileptic syndromes.

Cortical thinning of the right anterior cingulate cortex in spider phobia: a magnetic resonance imaging and spectroscopy study

There a lack of consistent neuroimaging data on specific phobia (SP) and a need to assess volumetric and metabolic differences in structures implicated in this condition. The aim of this study is investigate possible metabolic (via (1)H MRS) and cortical thickness abnormalities in spider-phobic patients compared to healthy volunteers. Participants were recruited via public advertisement and underwent clinical evaluations and MRI scans. The study started in 2010 and the investigators involved were not blind in respect to patient groupings. The study was conducted at the Ribeirão Preto Medical School University Hospital of the University of São Paulo, Brazil. Patients with spider phobia (n=19) were matched to 17 healthy volunteers with respect to age, education and socio-economic status. The spider SP group fulfilled the diagnostic criteria for spider phobia according to the Structured Clinical Interview for DSM-IV. None of the participants had a history of neurological, psychiatric or other relevant organic diseases, use of prescribed psychotropic medication or substance abuse. All imaging and spectroscopy data were collected with a 3 T MRI scanner equipped with 25 mT gradient coils in 30-minute scans. The Freesurfer image analysis package and LC Model software were used to analyze data. The hypothesis being tested was formulated before the data collection (neural correlates of SP would include the amygdala, insula, anterior cingulate gyrus and others). The results indicated the absence of metabolic alterations, but thinning of the right anterior cingulate cortex (ACC) in the SP group when compared to the healthy control group (mean cortical thickness±SD: SP=2.11±0.45 mm; HC=2.16±0.42 mm; t (34)=3.19, p=0.001 [-35.45, 71.00, -23.82]). In spectroscopy, the ratios between N-acetylaspartate and creatine and choline levels were measured. No significant effect or correlation was found between MRS metabolites and scores in the Spider Phobia Questionnaire and Beck Anxiety Inventory (p>0.05). The ACC is known to be related to the cognitive processing of fear and anxiety and to be linked with the conditioning circuit. The MRS findings are preliminary and need more studies. The finding of reduced ACC thickness in SP is in agreement with evidence from previous functional neuroimaging studies and highlights the importance of this brain area in the pathophysiology of SP.

Cannabidiol can improve complex sleep-related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson's disease patients: a case series

WHAT IS KNOWN AND OBJECTIVE

Cannabidiol (CBD) is the main non-psychotropic component of the Cannabis sativa plant. REM sleep behaviour disorder (RBD) is a parasomnia characterized by the loss of muscle atonia during REM sleep associated with nightmares and active behaviour during dreaming. We have described the effects of CBD in RBD symptoms in patients with Parkinson's disease.

CASES SUMMARY

Four patients treated with CBD had prompt and substantial reduction in the frequency of RBD-related events without side effects.

WHAT IS NEW AND CONCLUSION

This case series indicates that CBD is able to control the symptoms of RBD.

Electromyographic analysis of masseter and temporal muscles, bite force, masticatory efficiency in medicated individuals with schizophrenia and mood disorders compared with healthy controls

This study aimed to comparatively analyse the electromyographic activity of the masseter and temporal muscles at rest and during mandible postural clinical conditions (right and left laterality, protrusion and maximum voluntary contraction), right and left maximum molar bite forces and the masticatory efficiency of individuals with schizophrenia or mood disorders - all medicated (medicated groups) compared with control group (healthy volunteers) via electromyography. Individuals were distributed into three groups: Group I (Schizophrenia - 20 individuals), Group II (mood disorders - 20 individuals) and Group III (Control - 40 individuals). Basically, the results were only statistically significant for the clinical mandible conditions and bite force. The most unsatisfactory results were observed in the medicated groups in relation to the control group. The group with mood disorders obtained the most unsatisfactory results compared with the group with schizophrenia. It was suggested by these observations that the association of mood disorders and schizophrenia with medication has negatively affected the stomatognathic system in relation to controls when the electromyography and bite force were used for the analysis.

Longitudinal follow-up of cavum septum pellucidum and adhesio interthalamica alterations in first-episode psychosis: a population-based MRI study

BACKGROUND

Neurodevelopmental alterations have been described inconsistently in psychosis probably because of lack of standardization among studies. The aim of this study was to conduct the first longitudinal and population-based magnetic resonance imaging (MRI) evaluation of the presence and size of the cavum septum pellucidum (CSP) and adhesio interthalamica (AI) in a large sample of patients with first-episode psychosis (FEP).

METHOD

FEP patients (n=122) were subdivided into schizophrenia (n=62), mood disorders (n=46) and other psychosis (n=14) groups and compared to 94 healthy next-door neighbour controls. After 13 months, 80 FEP patients and 52 controls underwent a second MRI examination.

RESULTS

We found significant reductions in the AI length in schizophrenia FEP in comparison with the mood disorders and control subgroups (longer length) at the baseline assessment, and no differences in any measure of the CSP. By contrast, there was a diagnosis×time interaction for the CSP length, with a more prominent increase for this measure in the psychosis group. There was an involution of the AI length over time for all groups but no diagnosis×time interaction.

CONCLUSIONS

Our findings suggest that the CSP per se may not be linked to the neurobiology of emerging psychotic disorders, although it might be related to the progression of the disease. However, the fact that the AI length was shown to be shorter at the onset of the disorder supports the neurodevelopmental model of schizophrenia and indicates that an alteration in this grey matter junction may be a risk factor for developing psychosis.

Ageing and surface EMG activity patterns of masticatory muscles

The purpose of this study was to evaluate the influence of age on the electromyographic activity of masticatory muscles. All volunteers were Brazilian, fully dentate (except for Group I - mixed dentition), Caucasian, aged 7-80, and divided into five groups: I (7-12 years), II (13-20 years), III (21-40 years), IV (41-60 years) and V (61-80 years). Except for Group V, which comprised nine women and eight men, all groups were equally divided with respect to gender (20 M/20 F). Surface electromyographic records of masticatory muscles were obtained at rest and during maximal voluntary contraction, right and left laterality, maximal jaw protrusion and maximal clenching in the intercuspal position. Statistically significant differences (P < 0.05) were found in all clinical conditions among the different age groups. Considerably different patterns of muscle activation were found across ages, with greater electromyographic activity in children and youth, and decreasing from adults to aged people.

Cannabidiol for the treatment of psychosis in Parkinson's disease

The management of psychosis in Parkinson's disease (PD) has been considered a great challenge for clinicians and there is a need for new pharmacological intervention. Previously an antipsychotic and neuroprotective effect of Cannabidiol (CBD) has been suggested. Therefore, the aim of the present study was to directly evaluate for the first time, the efficacy, tolerability and safety of CBD on PD patients with psychotic symptoms. This was an open-label pilot study. Six consecutive outpatients (four men and two women) with the diagnosis of PD and who had psychosis for at least 3 months were selected for the study. All patients received CBD in flexible dose (started with an oral dose of 150 mg/day) for 4 weeks, in addition to their usual therapy. The psychotic symptoms evaluated by the Brief Psychiatric Rating Scale and the Parkinson Psychosis Questionnaire showed a significant decrease under CBD treatment. CBD did not worsen the motor function and decreased the total scores of the Unified Parkinson's Disease Rating Scale. No adverse effect was observed during the treatment. These preliminary data suggest that CBD may be effective, safe and well tolerated for the treatment of the psychosis in PD.

Correlation between bite force and electromyographic activity in dentate and partially edentulous individuals

Dental absence interferes in the physiological functioning of the masticatory system, promoting occlusal and functional alterations. The purpose of this study was to verify maximal bite force and maximal bite force correlated with electromyographic activity in 14 partially edentulous and 14 dentate individuals. Bite force in right and left molar and incisor regions were registered using a dynamometer with capacity of up to 1000N, adapted for oral conditions and at the same time electromyography was performed using Myosystem-Br1 with electrodes positioned on right and left masseter and temporalis muscles, and one reference electrode on the frontal bone. The highest value out of three recordings was considered the individual's maximal bite force. Statistical analysis of the bite force data was performed by means of t-test and Pearson's bivariate correlation test was used for the analysis between bite and electromyographic activity using SPSS 12.0 software. Dentate individuals showed greater maximal bite force in the three regions. Correlations between electromyographic activity and bite force in the dentate group obtained positive coefficients for every muscle in the right molar region, for the left temporalis in the left molar region, and for every muscle in the incisive region. For the partially edentulous group, only the left temporalis muscle presented a positive correlation in the right molar region, there was positive correlation for the right masseter and right and left temporalis in the left molar region, and, in the incisive region, every muscle presented negative correlation. These data evidence the strong influence of dental loss over the maximal bite force and small correlation between bite force and electromyographic activity.

Whole-brain voxel-based morphometry in Kallmann syndrome associated with mirror movements

BACKGROUND AND PURPOSE

There are 2 main hypotheses concerning the cause of mirror movements (MM) in Kallmann syndrome (KS): abnormal development of the primary motor system, involving the ipsilateral corticospinal tract; and lack of contralateral motor cortex inhibitory mechanisms, mainly through the corpus callosum. The purpose of our study was to determine white and gray matter volume changes in a KS population by using optimized voxel-based morphometry (VBM) and to investigate the relationship between the abnormalities and the presence of MM, addressing the 2 mentioned hypotheses.

MATERIALS AND METHODS

T1-weighted volumetric images from 21 patients with KS and 16 matched control subjects were analyzed with optimized VBM. Images were segmented and spatially normalized, and these deformation parameters were then applied to the original images before the second segmentation. Patients were divided into groups with and without MM, and a t test statistic was then applied on a voxel-by-voxel basis between the groups and controls to evaluate significant differences.

RESULTS

When considering our hypothesis a priori, we found that 2 areas of increased gray matter volume, in the left primary motor and sensorimotor cortex, were demonstrated only in patients with MM, when compared with healthy controls. Regarding white matter alterations, no areas of altered volume involving the corpus callosum or the projection of the corticospinal tract were demonstrated.

CONCLUSION

The VBM study did not show significant white matter changes in patients with KS but showed gray matter alterations in keeping with a hypertrophic response to a deficient pyramidal decussation in patients with MM. In addition, gray matter alterations were observed in patients without MM, which can represent more complex mechanisms determining the presence or absence of this symptom.

Effect of congenital blindness on EMG activity of the facial muscles

The aim of this work was to analyze electromyographically the facial muscles: orbicularis oris (upper and lower fascicles), orbicularis oculi (right and left lateral portions) and frontal, in blind and clinically normal (control) individuals, in various clinical conditions. Electromyographic averages of all data collected were normalized by maximal voluntary contraction of the studied muscles and statistical analysis was performed by Student's t test, using "Statistical Package for the Social Sciences" software--SPSS 12.0 (Chicago, IL). It was found that electromyographic alterations occur in the facial musculature that influences facial expressions of individuals. Results for the orbicularis oris muscle demonstrated that myoelectric activity among blind and control subjects was greater for the control group at muscular rest, blowing, and in labial projection. Electromyographic analysis of the orbicularis oculi among blind and control subjects in three clinical conditions studied demonstrated that activity was greater for the control group at muscular rest, blinking, and forced blinking. For the frontal muscles were demonstrated that electromyographic activity was greater for blind individuals. These data suggest the influence of congenital blindness on muscular development, including alterations in electromyographic activity of skin musculature in individuals with visual impairment.

Electromyographic analysis of upper and lower fascicles of the orbicularis oris muscle in deaf individuals, in mandibular rest position, compared to hearers

This study had the aim to analyze electromyographically, the upper and lower fascicles of the orbicularis oris muscle in bilingual, oralist deaf individuals, comparing them with clinically healthy volunteers in mandibular rest position. This was performed in 50 patients of both sexes with an average age of 18.5 years, divided into 4 groups. 1. Ten deaf bilingual, nasal-breathing patients; 2. Ten deaf bilingual, buccal-breathing patients; 3. Ten deaf oralist, nasal-breathing patients; 4. Twenty healthy volunteers, nasal-breathing patients. An electromyograph K6-I EMG Light Channel Surface Electromyography (Myo-tronics Co. Seattle, WA, EUA) of eight channels was used. The electrodes applied were duotrodes, silver-chloride surface, disposable. Statistical analysis was performed using the SPSS software version 10.0 (Chicago, IL). Continuos data with normal distribution were analyzed by univariate analysis of variance (ANOVA). The level of significance was set at alpha= 0.01. Comparing the EMG activity of the orbicularis oris muscle made it possible to verify that, during clinical mandibular rest position, all four groups presented various levels of electromyographic (EMG) activity with statistically significant differences (F = 8.81, p < 0.01). Based this study's data, it was possible to conclude that the electromyography analysis of the orbicularis oris muscle in deaf individuals showed that deaf individuals presented higher levels of EMG activity of the orbicularis oris muscle than normal controls during mandibular rest position.

Assessment of the maximum voluntary arm muscle contraction in sign language for the deaf

OBJECTIVE

The purpose of this study was to investigate the levels of upper member muscles' activation of deaf individuals, who use the Brazilian sign language - LIBRAS, comparing these findings to volunteers with no postural deviations and normal hearing

METHODS

Forty eight volunteers divided into two groups comprising healthy and deaf subjects (24 volunteers for each group). The signs of rest were obtained with the volunteer maintaining the upper member in an anatomical position, but with the forearm flexed and sustained by the lower member. Maximum voluntary isometric contractions (MVIC) of the biceps, triceps, deltoid, and trapezius muscles were performed in the position of muscular function testing. Statistical analysis was performed using the SPSS-10.0. Continuous data with normal distribution were analyzed by ANOVA with the significance level of p < 0.01.

RESULTS

The normalized electromyographic muscle data obtained in muscular rest do not show statistically significant differences among the studies muscles, in both groups. In the comparison of normalized RMS values obtained in MVIC, the mean values for the trapezius muscle of deaf group were statistically lower than control group.

CONCLUSIONS

This study's results indicate there are no differences between the levels of muscular activation for arm biceps, arm triceps, and the anterior portion of the deltoid muscle between the mean normalized RMS values of deaf and healthy individuals.

Changes in masticatory muscles activity associated with Eagle's syndrome

AIM

This study had the goal of analyzing masseter and temporalis muscles of individuals with Eagle's Syndrome, establishing comparisons with healthy control individuals by means of electromyography, due to the importance of the masticatory musculature upon the various functions of the stomatognathic system and the effects of Eagle's syndrome on this system's functioning.

METHOD

Ten women with Eagle's syndrome and ten healthy controls volunteered to participate in the study. A Myosystem I system, Prosecon Ltda (Uberlândia/MG, Brazil) with 12 channels was used Active differential electrodes were placed on the belly of both masseters and on the anterior temporalis. Firstly, rest position was registered and then the patients were instructed to clench their teeth with maximum strength for four seconds to register the Clenching at Usual Maximum Intercuspation. Next, the clinical conditions of chewing, mandible laterality, and water swallowing were performed.

RESULTS

The normalized data of muscle activity during the different clinical conditions and at rest position were compared by Student's t test, considering two groups: controls and syndrome bearers. The masticatory muscles of every syndrome bearers showed hyperactivity during the analyzed clinical conditions; except for chewing, in which the right masseter did not show greater electromyographic activity.

CONCLUSION

It is concluded that individuals with the syndrome showed muscular hyperactivity when compared to healthy individuals, due to the interference of the elongated styloid process, which leads to dysfunctions of the stomatognathic system in the syndrome bearers, with signs and symptoms related to craniofacial pain, dysphagia, otalgy, temporomandibular dysfunctions, and headache.

Electromyographic analysis of the masseter and temporal muscles in oralized deaf individuals

Deaf individuals show a number of difficulties related to the functionality of the stomatognathic system, mainly by reason of the little or no use of facial musculature during speech either due to the use of sign language or to the difficulty that these individuals have in articulating words. The stomatognathic system muscles play important roles in functions such as mastication, deglutition, and phonation. This study aimed to assess, by means of computerized bilateral electromyography (EMG), masseter and temporal muscles of 12 oralized deaf individuals in clinical activities that involve part of this masticatory musculature and compare this system's functionality with that of 12 normal listening individuals, performing the same activities. An 8-channel K6-I EMG Light Channel Surface Electromyography device was used (Myo-Tronics Co.Seattle, WA, USA), in addition to disposable double electrodes covered with silver chloride (Duotrodes; Myo-tronics Co., Seattle, WA) containing a conductor gel (Myogel- Myo-tronics Co., Seatlle, WA). The averaged rectified EMG values were normalized with reference to the EMG amplitude induced by a maximum bite force. The statistical analysis confirmed that there were any significant differences between the groups, clinical activities, and muscles, and also effects of interaction among them. The analysis made use of Variance Analysis (ANOVA). Significant differences (p < 0.01) for both muscles were found among the clinical conditions, with deaf individuals showing greater electromyographic activity for both muscles for the clinical activity protrusion. Deaf individuals showed a lower muscular activity for clinical activities that demanded a greater masseter and temporal muscular activity such as mastication, mouth opening and closing, and dental compression. Greater electromyographic values were found for both deaf individuals and healthy controls during clinical activities of mastication and dental compression. Based on the obtained data, we concluded that deaf individuals showed a lower activity of the masticatory musculature than healthy individuals; the differences were significant at the level of p < 0.01 between the performed clinical activities; and all deaf individuals and healthy controls showed greater electromyographic values for mastication and dental compression.

Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug

A high dose of delta9-tetrahydrocannabinol, the main Cannabis sativa (cannabis) component, induces anxiety and psychotic-like symptoms in healthy volunteers. These effects of delta9-tetrahydrocannabinol are significantly reduced by cannabidiol (CBD), a cannabis constituent which is devoid of the typical effects of the plant. This observation led us to suspect that CBD could have anxiolytic and/or antipsychotic actions. Studies in animal models and in healthy volunteers clearly suggest an anxiolytic-like effect of CBD. The antipsychotic-like properties of CBD have been investigated in animal models using behavioral and neurochemical techniques which suggested that CBD has a pharmacological profile similar to that of atypical antipsychotic drugs. The results of two studies on healthy volunteers using perception of binocular depth inversion and ketamine-induced psychotic symptoms supported the proposal of the antipsychotic-like properties of CBD. In addition, open case reports of schizophrenic patients treated with CBD and a preliminary report of a controlled clinical trial comparing CBD with an atypical antipsychotic drug have confirmed that this cannabinoid can be a safe and well-tolerated alternative treatment for schizophrenia. Future studies of CBD in other psychotic conditions such as bipolar disorder and comparative studies of its antipsychotic effects with those produced by clozapine in schizophrenic patients are clearly indicated.

Suppression of obsessive-compulsive symptoms after epilepsy surgery

We report two male patients with medically intractable epilepsy and obsessive-compulsive disorder (OCD) symptoms. Both patients experienced remission of obsessive-compulsive symptoms after surgical treatment of epilepsy. Although the surgeries targeted different brain regions, the two patients had in common unilateral anterior cingulate cortex ablation. On the basis of these observations, we discuss the pathophysiology of OCD symptoms, emphasizing the role of corticosubcortical pathways in their genesis. Our data suggest that surgeries that affect neural loops associated with obsessive-compulsive symptoms can lead to an improvement of OCD; however, the structures responsible for this effect cannot be conclusively determined.

The effect of the Schwartz-Jampel syndrome on masticatory and facial musculatures--an electromyographic analysis

This study had the goal to perform an electromyography evaluation of the orbicularis oris, orbicularis oculi, masseter, and temporal muscles of two siblings with Schwartz-Jampel syndrome (SJS), in different clinical activities, comparing them to healthy controls (C). The Schwartz-Jampel syndrome is a rare genetic disorder (71 cases reported in worldwide literature), in which myotonia may be observed in the facial muscles, determining a standard facie that shows an appearance of someone who is sad and weeping For the electromyography (EMG), a Myotronics--K61 electromyographer, was used, with superficial and disposable silver chloride electrodes. By means of the analysis of the obtained results, we observed significant statistical differences for the masseter muscle and for orbicularis oculi muscles (p < 0.01) among the studied groups, in which the individuals with SJS presented greater muscular activity than the normal ones, used as healthy controls. The statistical difference between the two groups was not significant for the temporal muscle, as well as for the orbicularis oris muscle, although the EMG averages were much greater in patients who were bringers of the syndrome. This high muscular activity may be related to the facial osseous alterations, evidenced in both patients with SJS, such as the mandibular migrognathia, with an atrophy of the mandibular cortex and a consequent approximation between the inferior dental root apices and the mandible base, as well as the presence of hypoplastic condyles in terms of size and height.

Diagnostic profile of inpatients as a determinant of length of stay in a general hospital psychiatric unit

The aim of this study was to determine if the diagnostic profile of inpatients of a psychiatric unit in a general hospital influences the length of stay. The results of a retrospective survey comprising the first 16 years of operation of the Psychiatric Unit of the Ribeirão Preto General Hospital (PURP) showed that the progressive increase observed in the length of stay correlated with the increase in percentage of schizophrenia diagnosis, after the 8th year of hospital operation, and of affective disorders, after the 12th year. The length of hospitalization kept increasing until the 16th year, even though there was no change in the diagnostic profile of the patients admitted to the unit. In a prospective study encompassing the next six months, 61 inpatients were evaluated with the Structured Clinical Interview for DSM-III-R and the Brief Psychiatric Rating Scale (BPRS). The results showed that 82% of the inpatients fulfilled the diagnostic criteria for the schizophrenic or affective disorder spectrum at admission, with a discharge rate slower than for other diagnoses, although the length of hospitalization did not significantly differ among diagnostic categories. The results further demonstrated that in every diagnostic category more than 50% of the patients stayed in hospital for more than one week after reaching a BPRS score equal to 6, indicative of discharge. Overall, these data suggest that the increase in length of hospitalization may be due to a higher percentage of patients with a diagnosis of schizophrenia and affective disorder admitted to the PURP. In addition, patients with low symptomatic levels remained in hospital longer than they should have.

Factor structure of Bech's version of the Brief Psychiatric Rating Scale in Brazilian patients

The objective of the present study was to evaluate the factor structure of Bech's version of the Brief Psychiatric Rating Scale (BPRS), translated into Portuguese. The BPRS was administered to a heterogeneous group of psychiatric inpatients (N = 98) and outpatients (N = 62) in a University Hospital. Each patient was evaluated from one to eight times. The interval between consecutive interviews was one week for the inpatients and one month for the outpatients. The results were submitted to factorial analysis. The internal consistency of the total scale and of each factor was also estimated. Factorial analysis followed by normalized orthogonal rotation (Varimax) yielded four factors: Withdrawal-Retardation, Thinking Disorder, Anxious-Depression and Activation. Internal consistency measured by Cronbach's alpha coefficient ranged from 0.766 to 0.879. The data show that the factor structure of the present instrument is similar to that of the American version of the BPRS which contains 18 items, except for the absence of the fifth factor of the latter scale, Hostile-Suspiciousness.