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Abstract
We examined a consecutive series of 40 patients with Parkinson's disease (PD) for the presence of anxiety. We found that 40 % met DSM-III criteria for generalized anxiety disorders, and half of them also met criteria for either major depression or minor depression. While depression was associated with long duration of illness and more severe cognitive and physical impairments, anxiety was not associated with greater impairment. We conclude that anxiety, with or without depression, constitutes a frequent psychiatric problem among patients with PD.
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Affiliation(s)
- S E Starkstein
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
| | - R G Robinson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA
| | - R Leiguarda
- Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
| | - T J Preziosi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Sabe L, Jason L, Juejati M, Leiguarda R, Starkstein S. Sensitivity and specificity of the Mini-Mental State Exam in the diagnosis of dementia. Behav Neurol 2014; 6:207-10. [PMID: 24487136 DOI: 10.3233/ben-1993-6405] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Mini-Mental State Exam (MMSE) is a brief cognitive test that assesses several cognitive domains, such as orientation, attention, concentration, memory, language, and constructional abilities. While the MMSE was found to be valid and reliable in the diagnosis of moderate dementia, its sensitivity and specificity for the diagnosis of mild dementia has been rarely examined. We assessed the specificity and sensitivity of the MMSE in a consecutive series of 44 patients with mild dementia, and a group of age-comparable normal controls. While the specificity of the MMSE for the diagnosis of mild dementia was very high (100%), the sensitivity was only 55% [20 of the 44 patients with mild dementia had an MMSE score in the normal range (≥26 points)]. On the other hand, the assessment with both the Buschke Selective Reminding and the Boston Naming tests discriminated mild Alzheimer's disease patients with normal MMSE scores from controls with a sensitivity and specificity of 64%. In conclusion, the assessment with verbal memory and naming tasks provided a significantly more sensitive measure of early dementia than the MMSE.
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Affiliation(s)
- L Sabe
- Department of Behavioral Neurology, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
| | - L Jason
- Department of Behavioral Neurology, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
| | - M Juejati
- Department of Behavioral Neurology, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
| | - R Leiguarda
- Department of Clinical Neurology, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
| | - S Starkstein
- Department of Behavioral Neurology, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina Department of Clinical Neurology, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
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Rodríguez MLC, Campos J, Forcato C, Leiguarda R, Maldonado H, Molina VA, Pedreira ME. Enhancing a declarative memory in humans: the effect of clonazepam on reconsolidation. Neuropharmacology 2012; 64:432-42. [PMID: 22819624 DOI: 10.1016/j.neuropharm.2012.06.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/23/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
Abstract
A consolidated memory recalled by a specific reminder can become unstable (labile) and susceptible to facilitation or impairment for a discrete period of time. This labilization phase is followed by a process of stabilization called reconsolidation. The phenomenon has been shown in diverse types of memory, and different pharmacological agents have been used to disclose its presence. Several studies have revealed the relevance of the GABAergic system to this process. Consequently, our hypothesis is that the system is involved in the reconsolidation of declarative memory in humans. Thus, using our verbal learning task, we analyzed the effect of benzodiazepines on the re-stabilization of the declarative memory. On Day 1, volunteers learned an association between five cue- response-syllables. On Day 2, the verbal memory was labilized by a reminder presentation, and then a placebo capsule or 0.25 mg or 0.03 mg of clonazepam was administered to the subjects. The verbal memory was evaluated on Day 3. The volunteers who had received the 0.25 mg clonazepam along with the specific reminder on Day 2, exhibited memory improvement. In contrast, there was no effect when the drug was given without retrieval, when the memory was simply retrieved instead of being reactivated or when short-term memory testing was performed 4 h after reactivation. We discuss the GABAergic role in reconsolidation, which shows a collateral effect on other memories when the treatment is aimed at treating anxiety disorders. Further studies might elucidate the role of GABA in the reconsolidation process associated with dissimilar scenarios. This article is part of a Special Issue entitled 'Cognitive Enhancers'.
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Affiliation(s)
- M L C Rodríguez
- Laboratorio de Neurobiología de la Memoria, Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, IFIBYNE - CONICET, Ciudad Universitaria, Pab II (1428), Buenos Aires, Argentina
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Martín ME, Sasson Y, Crivelli L, Roldán Gerschovich E, Campos JA, Calcagno ML, Leiguarda R, Sabe L, Allegri RF. Relevance of the serial position effect in the differential diagnosis of mild cognitive impairment, Alzheimer-type dementia, and normal ageing. Neurologia 2012; 28:219-25. [PMID: 22695314 DOI: 10.1016/j.nrl.2012.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 04/09/2012] [Accepted: 04/22/2012] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Serial position effects are observed when a person memorises a series of words exceeding his or her attention span. Cognitively normal individuals recall words at the beginning and end of the list more frequently than those in the middle, which reflects the way that short- and long-term episodic memory works. OBJECTIVE To study the serial position effect in patients with mild cognitive impairment (MCI) compared to subjects with Alzheimer-type dementia (AD) or normal ageing (NA). METHODS 30 AD, 25 MCI and 20 NA subjects underwent neurological and neuropsychological assessment. The Rey Auditory Verbal Learning Test (RAVLT) was used to study primacy, middle, and recency effects and delayed recall for each group. RESULTS The general memory pattern of MCI subjects was very similar to that of AD subjects, and was characterised by reduced learning capacity, rapid forgetfulness and clear recency effect in learning. With regard to delayed recall, however, there were differences in performance; MCI subjects' ability to recall words at the beginning and middle of the list was similar to that of normal subjects, while their memory of words at the end of the list was poor, as in AD subjects. CONCLUSIONS RAVLT is a tool permitting us to distinguish between MCI and NA subjects. The recency index for the delayed recall task is a valid indicator for distinguishing between MCI patients and patients with normal ageing.
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Affiliation(s)
- M E Martín
- Servicio de Neurología Cognitiva, Neuropsicología y Neuropsiquiatría, Instituto de Investigaciones Neurológicas Raúl Carrera, FLENI, Buenos Aires, Argentina
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Starkstein SE, Migliorelli R, Manes F, Tesón A, Petracca G, Chemerinski E, Sabe L, Leiguarda R. The prevalence and clinical correlates of apathy and irritability in Alzheimer's disease. Eur J Neurol 2011; 2:540-6. [DOI: 10.1111/j.1468-1331.1995.tb00171.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roldan Gerschcovich E, Guinjoan S, Cerquetti D, Achaval D, Costanzo E, Leiguarda R. PO23-TH-19 Subgenual cingulated DBS stimulation and decision making. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)71076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Rossi M, Gerschcovich ER, Gerschcovich ER, de Achaval D, Perez-Lloret S, Cerquetti D, Cammarota A, Inés Nouzeilles M, Fahrer R, Merello M, Leiguarda R. Decision-making in Parkinson's disease patients with and without pathological gambling. Eur J Neurol 2009; 17:97-102. [PMID: 19780806 DOI: 10.1111/j.1468-1331.2009.02792.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Pathological gambling (PG) in Parkinson's disease (PD) is a frequent impulse control disorder associated mainly with dopamine replacement therapy. As impairments in decision-making were described independently in PG and PD, the objective of this study was to assess decision-making processes in PD patients with and without PG. METHODS Seven PD patients with PG and 13 age, sex, education and disease severity matched PD patients without gambling behavior were enrolled in the study. All patients were assessed with a comprehensive neuropsychiatric and cognitive evaluation, including tasks used to assess decision-making abilities under ambiguous or risky situations, like the Iowa Gambling Task (IGT), the Game of Dice Task and the Investment Task. RESULTS Compared to PD patients without gambling behavior, those with PG obtained poorer scores in the IGT and in a rating scale of social behavior, but not in other decision-making and cognitive tasks. CONCLUSIONS Low performance in decision-making under ambiguity and abnormal social behavior distinguished PD patients with PG from those without this disorder. Dopamine replacement therapy may induce dysfunction of the ventromedial prefrontal cortex and amygdala-ventral striatum system, thus increasing the risk for developing PG.
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Affiliation(s)
- M Rossi
- Movement Disorders Section, Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina
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Merello M, Tenca E, Lloret SP, Martín ME, Bruno V, Cavanagh S, Antico J, Cerquetti D, Leiguarda R. Prospective randomized 1-year follow-up comparison of bilateral subthalamotomy versus bilateral subthalamic stimulation and the combination of both in Parkinson's disease patients: a pilot study. Br J Neurosurg 2009; 22:415-22. [DOI: 10.1080/02688690801971667] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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Reyes MA, Perez-Lloret S, Lloret SP, Roldan Gerschcovich E, Gerscovich ER, Martin ME, Leiguarda R, Merello M. Addenbrooke's Cognitive Examination validation in Parkinson's disease. Eur J Neurol 2008; 16:142-7. [PMID: 19049504 DOI: 10.1111/j.1468-1331.2008.02384.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a clear need for brief, sensitive and specific cognitive screening instruments in Parkinson's disease (PD). OBJECTIVES To study Addenbrooke's Cognitive Examination (ACE) validity for cognitive assessment of PD patient's using the Mattis Dementia Rating Scale (MDRS) as reference method. A specific scale for cognitive evaluation in PD, in this instance the Scales for Outcomes of Parkinson's disease-Cognition (SCOPA-COG), as well as a general use scale the Mini-mental state examination (MMSE) were also studied for further correlation. METHODS Forty-four PD patients were studied, of these 27 were males (61%), with a mean (SD) age of 69.5 (11.8) years, mean (SD) disease duration of 7.6 (6.4) years (range 1-25), mean (SD) total Unified Parkinson's Disease Rating Scale (UPDRS) score 37 (24) points, UPDRS III 16.5 (11.3) points. MDRS, ACE and SCOPA-COG scales were administered in random order. All patients remained in on-state during the study. RESULTS Addenbrooke's Cognitive Examination correlated with SCOPA-COG (r = 0.93, P < 0.0001), and MDRS (r = 0.91 P < 0.0001) and also with MMSE (r = 0.84, P < 0.001). Area under the receiver-operating curve, taking MDRS as the reference test, was 0.97 [95% confidence interval (CI): 0.92-1.00] for ACE, 0.92 (95% CI: 0.83-1.00) for SCOPA-COG and 0.91 (95% CI: 0.83-1.00) for MMSE. Best cut-off value for ACE was 83 points [Sensitivity (Se) = 92%; Specificity (Sp) = 91%; Kappa concordance (K) = 0.79], 20 points for the SCOPA-COG (Se = 92%; Sp = 87%; K = 0.74) and 26 points for MMSE (Se = 61%; Sp = 100%; K = 0.69). CONCLUSION Addenbrooke's Cognitive Examination appears to be a valid tool for dementia evaluation in PD, with a cut-off point which should probably be set at 83 points, displaying good correlation with both the scale specifically designed for cognitive deficits in PD namely SCOPA-COG, as well as with less specific tests such as MMSE.
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Affiliation(s)
- M A Reyes
- Movement Disorders Section, Neuroscience Department and Cognitive Department, Institute for Neurological Research Raul Carrea FLENI, Buenos Aires, Argentina
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Merello M, Balej J, Tenca E, Leiguarda R. Kinematic evaluation of gestural and repetitive single joint movements of the arm after posteroventral pallidotomy, subthalamotomy or both procedures combined in two Parkinson's disease patients: two case studies. Eur J Neurol 2008; 15:406-12. [PMID: 18353126 DOI: 10.1111/j.1468-1331.2008.02085.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Two patients with severe Parkinson's disease undergoing partial or complete ablative interruption of basal ganglia (BG) output are presented. One patient who underwent bilateral subthalamotomy, and a second who underwent unilateral posteroventral pallidotomy, followed 7 years later by a bilateral subthalamotomy because of contralateral disease progression, were studied. In addition to the usual clinical evaluation, changes in joint kinematics observed during unconstrained, skilled multi-joint movement and repetitive single joint (RSJ) movement of the wrist were studied. Clinical UPDRS items referred to hand movements contralateral to the procedure, and instrumental measurement of RSJ improved in both patients after either pallidotomy or subthalamotomy. When both BG outflow paths were interrupted as was the case in the second patient (bilateral subthalamotomy after the initial pallidotomy), no added clinical improvement was observed, RSJ even deteriorated slightly. Instrument-based studies for movement alteration detection after simultaneous ablation of the globus pallidus and the subthalamic nucleus of these two patients showed greater sensitivity than clinical evaluation alone. Complex gestural movement performance remained unaffected after partial (subthalamotomy or pallidotomy) or complete interruption of BG outflow (case 2), indicating BG compensatory capacity after total outflow interruption remained intact.
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Affiliation(s)
- M Merello
- Movement Disorders Section, Neuroscience Department, Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina.
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Nogués M, Barroso F, Rivero A, Cammarota A, Leiguarda R. P35.19 Pain: Unusual presentation of hereditary neuropathy with liability to pressure palsies (HNPP). Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Capparelli FJ, Diaz MF, Hlavnika A, Wainsztein NA, Leiguarda R, Del Castillo ME. Cefepime- and cefixime-induced encephalopathy in a patient with normal renal function. Neurology 2006; 65:1840. [PMID: 16344542 DOI: 10.1212/01.wnl.0000187079.12413.6a] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F J Capparelli
- Raul Carrea Institute for Neurological Research (FLENI), Medical Education and Clinical Research Center Norberto Quirno, Buenos Aires, Argentina.
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Bekinschtein T, Leiguarda R, Armony J, Owen A, Carpintiero S, Niklison J, Olmos L, Sigman L, Manes F. Emotion processing in the minimally conscious state. J Neurol Neurosurg Psychiatry 2004; 75:788. [PMID: 15090585 PMCID: PMC1763566 DOI: 10.1136/jnnp.2003.034876] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Merello M, Starkstein S, Nouzeilles MI, Kuzis G, Leiguarda R. Bilateral pallidotomy for treatment of Parkinson's disease induced corticobulbar syndrome and psychic akinesia avoidable by globus pallidus lesion combined with contralateral stimulation. J Neurol Neurosurg Psychiatry 2001; 71:611-4. [PMID: 11606671 PMCID: PMC1737599 DOI: 10.1136/jnnp.71.5.611] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Posteroventral pallidotomy (PVP) has proved to be an effective method for the treatment of Parkinson's disease. However, data on bilateral procedures are still limited. To assess the effects of bilateral globus pallidus (GPi) lesion and to compare it with a combination of unilateral GPi lesion plus contralateral GPi stimulation (PVP+PVS), an open blind randomised trial was designed. METHODS A prospective series of patients with severe Parkinson's disease refractory to medical treatment, and severe drug induced dyskinesias, were randomised either to simultaneous bilateral PVP or simultaneous PVP+PVS. All patients were assessed with the core assessment programme for intracerebral transplantation (CAPIT), and a comprehensive neuropsychological and neuropsychiatric battery both before surgery and 3 months later. RESULTS The severe adverse effects found in the first three patients subjected to bilateral PVP led to discontinuation of the protocol. All three patients developed depression and apathy. Speech, salivation, and swallowing, as well as freezing, walking, and falling, dramatically worsened. By contrast, all three patients undergoing PVP+PVS had a significant motor improvement. CONCLUSION Bilateral simultaneous lesions within the GPi may produce severe motor and psychiatric complications. On the other hand, a combination of PVP+ PVS significantly improves parkinsonian symptoms not associated with the side effects elicited by bilateral lesions.
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Affiliation(s)
- M Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Montañeses 2325, 1428 Buenos Aires, Argentina.
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Garcia M, D'Giano C, Estellés S, Leiguarda R, Rabinowicz A. Ictal tachycardia: its discriminating potential between temporal and extratemporal seizure foci. Seizure 2001; 10:415-9. [PMID: 11700994 DOI: 10.1053/seiz.2000.0529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A wide variety of CNS lesions have been associated with changes in heart rate (HR). However, in epileptic patients their value to lateralize seizure onset remains controversial. This study aims to assess if HR changes associated with partial onset seizures could be useful in lateralizing seizure onset. We analysed HR changes on 100 seizures from 38 consecutive patients (mean age: 27.5 years) admitted for video-EEG telemetry monitoring. We evaluated the R-R interval 30 seconds before the seizure onset and 10, 20 and 120 seconds after the onset. We assessed whether there was a correlation between HR changes and seizure type, left/right differences and different semiological components for each seizure. We recorded 100 seizures. Three non-lateralized seizures were excluded from the analysis; 63/97 (65%) had left hemisphere onset, mainly from the temporal lobe (57.7%). The mean baseline HR was 77 beats per minute Ictal tachycardia (HR: > or = 107.06 beats per minute) was detected in 32 seizures, with ictal onset from the mesial temporal lobe structures in 23/32; 16/32 occurred during the first 10 seconds and 16/32 during the next 20 seconds from the seizure onset independently of the site of origin. Among the different semiological components for each seizure, only dystonic posturing and automatism correlated with HR increments. We did not find bradycardia in our series. Ictal tachycardia occurs most frequently with seizures arising from the mesial temporal lobe and it may not reliably predict the lateralization of seizure onset.
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Affiliation(s)
- M Garcia
- Epilepsy Program, Instituto de Investigaciones Neurológicas Raúl Carrea, Buenos Aires, Argentina
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Abstract
Ideomotor apraxia is defined as a disturbance in timing, sequencing, and spatial organization of gestural movements. Left hemisphere motor dominance reflected by ideomotor apraxia mainly refers to spatially and temporally complex movements performed outside the natural context. While clinicoanatomical studies have failed to unveil a specific lesion correlating with apraxia, white matter damage-interrupting corticocortical and corticosubcortical connections-seems crucial for the deficit to be persistent and severe. Patients with basal ganglia lesions and disorders, such as Parkinson's disease and progressive supranuclear palsy, may exhibit ideomotor apraxia. The putative roles of the basal ganglia in object-oriented action, and therefore in praxis, would include among others (a) the selection of the kinematic parameters and the direction of arm movements, (b) working as an integral part of brain systems involved in timing and representation of action sequences, (c) encoding behavioral context, and (d) working as a subcortical component of the parietofrontal circuits devoted to sensorimotor transformation (e.g., reaching). Several studies suggest that basal ganglia pathology per se may not cause overt apraxia. However, when it is combined with dysfunction of the cortical components of the neural systems involved in sequencing, sensorimotor transformation, and response selection, different types of ideomotor praxis deficits would become clinically manifested.
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Affiliation(s)
- R Leiguarda
- Raúl Carrea Institute of Neurological Research, FLENI, Buenos Aires, Argentina.
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Nogués M, Leiguarda R, Sevlever G, García H. [Chronic hereditary ataxic polyneuropathy]. Medicina (B Aires) 2001; 60:316-20. [PMID: 11050807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Sensory ataxic polyneuropathies are characterised by the presence of sensory ataxia due to damage to large myelinated sensory fibres, with total or relative preservation of muscle strength, pain and temperature sensation. Hereditary ataxic polyneuropathies are exceptional and very few families with this disorder have been reported so far. We here describe the neurological, electrophysiological and sural nerve biopsy data of four siblings with an ataxic chronic polyneuropathy, starting after age 50. They had an ataxic gait which worsened in darkness, horizontal nystagmus, hypo or areflexia, and severe impairment of limbs' propriocaption. Nerve conduction studies showed absent sensory nerve action potentials in all nerves tested. Somatosensory evoked potentials showed reduced amplitude and prolonged latencies. Sural nerve biopsy showed a severe loss of myelinated and unmyelinated fibres. Symptoms slowly progressed over the years. The recognition of this syndrome is important in the search for the etiology of chronic ataxic neuropathies.
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Affiliation(s)
- M Nogués
- Departamento de Neurología, Instituto de Investigaciones Neurológicas Dr. Raúl Carrea (FLENI), Buenos Aires.
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Affiliation(s)
- M Merello
- Department of Neurology, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.
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Jost L, Jost L, Nogués M, Dávalos M, Turín M, Manes F, Leiguarda R. [Neurological complications of renal transplant]. Medicina (B Aires) 2000; 60:161-4. [PMID: 10962803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Advances in surgical procedures and new immunosuppressor therapies have improved the outcome of renal grafts. However, these changes have been accompanied by infectious, neoplastic and neurologic complications. The purpose of this study was to determine the incidence of neurologic complications among 542 patients receiving a renal transplant (from living or cadaveric donors) at CEMIC between 1970 and 1996. Neurologic complications occurred in 43 patients (8%) as follows: 8 meningitis (1.5%), 8 acute confusional syndrome (1.5%), 7 encephalitis (1.3%), 7 cerebrovascular accidents (1.3%), 6 convulsions (1.1%), 3 tumors (0.5%), 3 femoral nerve lesion (0.5%), and 1 epidural lipomatosis (0.1%). Etiologic agents most commonly observed in meningitis were: Cryptococcus neoformans, Listeria monocytogenes and Mycobacterium tuberculosis. Major difficulties arose in the diagnosis of encephalitis. Diagnosis of the above complications required clinical astuteness and repeated bacteriologic, serologic and imaging studies.
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Affiliation(s)
- L Jost
- Sección Nefrología, Centro de Educación Médica e Investigaciones Clínicas Dr. Norberto Quirno (CEMIC), Buenos Aires, Argentina.
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Abstract
We assessed a consecutive series of 398 patients with probable Alzheimer's disease (AD) for the presence of Generalized Anxiety Disorder (GAD) using a standardized neuropsychiatric evaluation. Five percent of patients showed GAD during the 4 weeks preceding the psychiatric evaluation. AD patients with GAD showed significantly higher scores of depression, irritability, overt aggression, mania, and pathological crying than AD patients without GAD. The most severe symptoms of anxiety were those of tension, fears, insomnia, and physical complaints.
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Affiliation(s)
- E Chemerinski
- Department of Neuropsychiatry, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
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Leiguarda R, Merello M, Balej J, Starkstein S, Nogues M, Marsden CD. Disruption of spatial organization and interjoint coordination in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy. Mov Disord 2000; 15:627-40. [PMID: 10928572 DOI: 10.1002/1531-8257(200007)15:4<627::aid-mds1006>3.0.co;2-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Patients with basal ganglia diseases may exhibit ideomotor apraxia. To define the nature of the impairment of the action production system, we studied a repetitive gesture of slicing bread by three-dimensional computergraphic analysis in eight nondemented patients with Parkinson's disease in the "on" state, five with progressive supranuclear palsy and four with multiple system atrophy. Two patients with Parkinson's disease and two with progressive supranuclear palsy showed ideomotor apraxia for transitive movements on standard testing. A Selspott II system was used for kinematic analysis of wrist trajectories and angular motions of the shoulder and elbow joints. Patients with Parkinson's disease, progressive supranuclear palsy, and even some with multiple system atrophy exhibited kinematic deficits in the spatial precision of movement and velocity-curvature relationships; in addition, they failed to maintain proper angle/angle relationships and to apportion their relative joint amplitudes normally. Spatial disruption of wrist trajectories was more severe in patients with ideomotor apraxia. We posit that the basal ganglia are part of the parallel parieto-frontal circuits devoted to sensorimotor integration for object-oriented behavior. The severity and characteristics of spatial abnormalities of a transitive movement would therefore depend on the location and distribution of the pathologic process within these circuits.
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Affiliation(s)
- R Leiguarda
- Raúl Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina
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Leiguarda R, Merello M, Balej J. Apraxia in corticobasal degeneration. Adv Neurol 2000; 82:103-21. [PMID: 10624475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- R Leiguarda
- Department of Neurology, Raúl Carrea Institute of Neurological Research, FLENI, Buenos Aires, Argentina
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Abstract
Twenty-six patients with syringomyelia were studied with polysomnography to determine the frequency of periodic limb movements (PLM) and its relationship to the presence of a Chiari anomaly, the severity of corticospinal tract involvement, and localization of the syrinx. Sixteen patients showed PLM in stages I and II of non-REM sleep and three PLM also while awake. There were no statistically significant differences in overall disability, corticospinal signs, presence of an associated Chiari anomaly, and disease duration between patients with and without PLM, although there was a trend for patients with PLM to have more severe disease. There was preservation of the lumbosacral enlargement of the spinal cord by the syrinx in all patients with PLM. The latency delay between lower and upper limb muscles was suggestive of conduction along propriospinal pathways. Syringomyelia may lead to an abnormal state of spinal hyperexcitability favoring the appearance of PLM. Detailed magnetic resonance image studies of patients with different localizations of the syrinx cavities may help to determine which tracts are involved in the production of PLM.
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Affiliation(s)
- M Nogués
- Department of Clinical Neurophysiology, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Kuzis G, Sabe L, Tiberti C, Merello M, Leiguarda R, Starkstein SE. Explicit and implicit learning in patients with Alzheimer disease and Parkinson disease with dementia. Neuropsychiatry Neuropsychol Behav Neurol 1999; 12:265-9. [PMID: 10527111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To examine the differential impairment of implicit and explicit memory systems in cortical and subcortical dementias. BACKGROUND Whereas verbal priming was reported to be impaired in patients with Alzheimer Disease (AD), patients with Parkinson Disease (PD) may be relatively more impaired on tasks of motor skill learning. METHODS We examined 15 patients with Alzheimer disease, 10 patients with Parkinson disease and dementia (PD-D), 15 patients with PD but no dementia, and 24 age-comparable normal control subjects with a neuropsychologic battery that included tests of explicit memory (Buschke Selective Reminding Test, Benton Visual Retention Test, Digits Span), and tests of implicit memory (Word-Stem Completion task and the Maze Test). RESULTS AD and PD-D groups showed similar deficits on all measures of explicit memory, and performed significantly worse than PD patients without dementia and normal control subjects. On the other hand, there were no significant between-group differences in any of the measures of implicit memory. CONCLUSIONS Our study demonstrated preserved implicit learning in the context of severe explicit learning deficits in patients with dementia, but could not demonstrate a different profile of memory deficits between so-called cortical and subcortical dementias.
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Affiliation(s)
- G Kuzis
- Department of Neuropsychiatry, Raul Carrea Institute of Neurological Research, Buenos Aires, Argentina.
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Merello M, Nouzeilles MI, Cammarota A, Leiguarda R. Effect of memantine (NMDA antagonist) on Parkinson's disease: a double-blind crossover randomized study. Clin Neuropharmacol 1999; 22:273-6. [PMID: 10516877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Our aim was to evaluate the effect of Memantine (1-amino 3,5-dimethyl-adamantane hydrochloride) on cardinal symptoms of Parkinson's disease and on the latency, duration, and magnitude of the response to a single dose of L-Dopa and on drug-induced dyskinesias. Twelve Hoehn-Yahr III-IV patients with idiopathic Parkinson's disease with motor fluctuations and drug-induced dyskinesias were randomized to the NMDA antagonist memantine or placebo in a cross-over design. A single-dose L-Dopa challenge was performed after each medication arm. A significant drug effect on the Unified Parkinson's Disease Rating Scale motor score was observed in "off" and "on" states (F(1,11) = 13.5; p < 0.003). No significant effect on drug-induced dyskinesias was seen. The results suggest that memantine may improve parkinsonian symptoms independently of dopaminergic drugs and, in contrast to recent findings with amantadine, it has no effect on drug-induced dyskinesias.
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Affiliation(s)
- M Merello
- Neurology Department, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Abstract
OBJECTIVE To determine the frequency and types of abnormalities of respiratory control during sleep in syringomyelia and syringobulbia and to provide a basis to predict patients at risk of sudden death. METHODS Thirty patients (15 male and 15 female; mean age 39.0 +/- 12.6 years) with communicating syringomyelia were divided into two groups: those with evidence of syringobulbia (17 patients) and those without compromise of the medulla or syringomyelia (13 patients). Patients were studied with pulmonary function studies and polysomnography. Respiratory center sensitivity to CO2 (rebreathing technique) was measured in 9 patients. RESULTS Severely affected patients had mild-to-moderate restriction and individual patients had bilateral diaphragmatic or vocal cord palsy, abnormal respiratory rhythm, prolonged inspiratory time, or an abnormal respiratory response to CO2. Very prolonged central, obstructive, and mixed sleep apneas with low O2 saturation values and a fixed heart rate were recorded in most patients with syringobulbia. Five patients developed severe respiratory complications and died during a follow-up period of 10 years. Respiratory abnormalities failed to correlate with syrinx size. CONCLUSIONS Severe abnormalities in respiratory rhythm generation during sleep occur in patients with syringobulbia. The respiratory disturbances are not due to muscle weakness and they are not correlated with the size of the cavity. The combination of dysphagia and dysphonia in patients with longstanding syringomyelia and syringobulbia predicted likelihood of respiratory disturbances during sleep.
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Affiliation(s)
- M Nogués
- Department of Clinical Neurophysiology, Instituto de Investigaciones Neurológicas Dr. Raúl Carrea, Buenos Aires, Argentina.
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Abstract
We present a patient with clinically evident beginning-of-dose motor deterioration who had undergone posteroventral pallidotomy. This patient underwent an intrasurgical apomorphine test followed by single cell recording of the internal globus pallidus (GPi) to determine changes in GPi firing rate during the occurrence of such phenomenon. A significant increase in GPi firing rate coincident with worsening of patient disabilities prior to improvement was found. This finding suggests that beginning-of-dose motor deterioration may be mediated by enhanced thalamic inhibition.
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Affiliation(s)
- M Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Merello M, Nouzeilles MI, Cammarota A, Betti O, Leiguarda R. Comparison of 1-year follow-up evaluations of patients with indication for pallidotomy who did not undergo surgery versus patients with Parkinson's disease who did undergo pallidotomy: a case control study. Neurosurgery 1999; 44:461-7; discussion 467-8. [PMID: 10069582 DOI: 10.1097/00006123-199903000-00011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Many reports published during the past 5 years have shown evidence of the beneficial effect of posteroventral pallidotomy (PVP) in large groups of patients for up to 3 years, but none of them have compared patients who underwent surgery with a control group. OBJECTIVE To compare the evolution of Parkinson's disease symptoms at 1-year follow-up between patients who underwent surgery and those who did not. MATERIAL AND METHODS Ten patients with idiopathic Parkinson's disease refractory to treatment who were included in the Core Assessment for Intracerebral Transplantation program for PVP did not undergo surgery because financial support was lacking. These patients were followed up for 1 year as if they had been operated on and were finally compared with 10 patients having similar characteristics in whom PVP had been performed during the same period of time. RESULTS There were no significant differences at basal evaluation in the motor section scores of the Unified Parkinson's Disease Rating Scale between those patients who underwent surgery and those who did not, but a significant reduction in Unified Parkinson's Disease Rating Scale motor score in the group who underwent surgery at 1-year evaluation was found (P < 0.006). Dyskinesias, which was nonsignificantly different at basal evaluation, showed, at the 1-year follow-up, a significant reduction in the group who underwent surgery (P < 0.04). Scores from the subsets of the Unified Parkinson's Disease Rating Scale addressing rigidity, tremor, and bradykinesia also proved significantly different at the 1-year follow-up. The slope of the line generated by the two evaluations for each group showed a negative value in the group who underwent surgery (value of -0.21) and a positive value in the group who did not (value of 0.148). CONCLUSION At the 1-year follow-up, microelectrode-guided PVP produced significant changes in patient motor status and disease progression versus a comparable group of patients who did not undergo surgery during the same period of time.
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Affiliation(s)
- M Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research, Fundacion Para la Lucha Contra las Enfermeda des Neurologicas de la Infancia, Buenos Aires, Argentina
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Abstract
OBJECTIVE To determine the effect of a single dose of apomorphine on internal globus pallidus (GPi) neuronal discharge in patients with Parkinson's disease (PD). PATIENTS AND METHODS Nine PD patients who underwent microelectrode-guided posteroventral pallidotomy (PVP) were studied. After identification of a single GPi unit discharge with sufficient spike S/N ratio to allow reliable thresholding, basal recording was followed by a single 3-mg subcutaneous injection. One-minute samples were recorded 10', 30', and 60' after apomorphine. RESULTS In four patients, recording was lost after 5-10 minutes. In two, changes were observed at peak-of-dose but recording was then lost, whereas three completed recording and returned to baseline, all five showing significant reduction in GPi firing rate (mean +/- standard deviation for basal and post-apomorphine were 143+/-55.6 and 52+/-19.2, respectively; p <0.002). CONCLUSION In patients with PD, apomorphine induces changes in GPi spontaneous discharge and modifies firing rates resembling recordings in normal primates. These findings show that clinical improvement as well as induction of dyskinesias following DA administration could be mediated by reduction of GPi outflow.
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Affiliation(s)
- M Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Merello M, Nouzeilles MI, Kuzis G, Cammarota A, Sabe L, Betti O, Starkstein S, Leiguarda R. Unilateral radiofrequency lesion versus electrostimulation of posteroventral pallidum: a prospective randomized comparison. Mov Disord 1999; 14:50-6. [PMID: 9918344 DOI: 10.1002/1531-8257(199901)14:1<50::aid-mds1010>3.0.co;2-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Microelectrode-guided posteroventral pallidotomy (PVP) has shown to be an effective method in the treatment of a group of patients with advanced Parkinson's disease. A nonlesioning approach by means of deep brain electrodes connected to a programmable neuropacemaker has also been used to inhibit the internal segment of globus pallidus (posteroventral stimulation [PVS]) reporting comparable clinical efficacy to the one obtained with the ablative method. Nevertheless, no controlled studies have been performed to compare the efficacy of both procedures. A prospective series of 13 patients with a clinical indication for globus pallidus surgery was randomized either to a pallidotomy or stimulator implantation, and comparisons on motor and neuropsychologic measurements were made on a 3-month follow-up basis. Primary measurements of efficacy showed a comparable effect on Unified Parkinson's Disease Rating Scale and activities of daily living score after both procedures. Secondary measurements of efficacy showed that although both techniques improve hand tapping score and dyskinesia score, the bilateral improvement in the former was greater after PVS whereas the latter improved more significantly after PVP. No significant changes in neuropsychologic parameters were observed after either PVP or PVS. Side effects and surgery complications occurred in six of 13 patients (three after PVP and three after PVS): they were mild, transient, and unrelated to optic tract injury. In conclusion, the short-time effect and safety of both procedures is comparable.
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Affiliation(s)
- M Merello
- Neurology Department, Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina
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Chemerinski E, Petracca G, Tesón A, Sabe L, Leiguarda R, Starkstein SE. Prevalence and correlates of aggressive behavior in Alzheimer's disease. J Neuropsychiatry Clin Neurosci 1998; 10:421-5. [PMID: 9813787 DOI: 10.1176/jnp.10.4.421] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors assessed a consecutive series of 196 patients with probable Alzheimer's disease (AD) for the presence of aggressive behavior, using a standardized neurological, neuropsychiatric, and neuropsychological battery that included both the Overt Aggression Scale and the Irritability Scale. Twelve percent of patients showed aggressive episodes (5% with verbal aggression, 7% with physical aggression) during the 4 weeks preceding the psychiatric evaluation. Physical aggression was significantly associated with more frequent delusions and more severe irritability.
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Affiliation(s)
- E Chemerinski
- Department of Neuropsychiatry, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina.
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Merello M, Cammarota A, Nouzeilles MI, Betti O, Leiguarda R. Confirmation of the antidyskinetic effect of posteroventral pallidotomy by means of an intraoperative apomorphine test. Mov Disord 1998; 13:533-5. [PMID: 9613748 DOI: 10.1002/mds.870130325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We present a series of six consecutive Parkinson's disease patients undergoing posteroventral pallidotomy (PVP), who received an apomorphine injection after thermolesioning the posteroventral region of the internal globus pallidus (GPi) to evaluate the effect of the lesion on drug-induced dykinesias and therefore to proceed with further lesions or to conclude the surgery. Five of six patients failed to present dykinesias or did so to a significantly lesser degree (F [2,10] 42.6; p < 0.0001) so that surgery was concluded. One patient continued having contralateral dyskinesia despite an improvement in rigidity and bradykinesia, therefore, a new track was performed followed by a new lesion. No differences were found between intrasurgical and 1-month postoperative apomorphine test values. This report indicates that the use of an apomorphine test after thermolesioning may provide a reliable tool to check lesion efficacy on dyskinesia. The development of techniques that provide additional clinical information to the electrophysiological recording could help improve the outcome of patients undergoing pallidotomy.
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Affiliation(s)
- M Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Tiberti C, Sabe L, Jason L, Leiguarda R, Starkstein S. A randomized, double-blind, placebo-controlled study of methylphenidate in patients with organic amnesia. Eur J Neurol 1998; 5:297-299. [PMID: 10210846 DOI: 10.1046/j.1468-1331.1998.530297.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We examined the usefulness of methylphenidate (MPH) in the treatment of organic amnesia in a randomized, double-blind, placebo-controlled design. Twenty patients with amnesia due to closed head injuries (n = 10), viral encephalitis (n = 2), stroke lesions (n = 4), or surgical brain resections (n = 4) were assessed with a neuropsychological battery after the intake of MPH (10, 20, 30 or 40 mg), or placebo. We found no significant benefit of MPH for any of the cognitive tests.Copyright Lippincott-Raven Publishers
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Affiliation(s)
- C Tiberti
- Department of Neuropsychiatry, RaGl Carrea Institute of Neurological Research, Buenos Aires, Argentina
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Merello M, Nouzeilles MI, Cammarotta A, Pikielny R, Leiguarda R. Changes in the motor response to acute L-dopa challenge after unilateral microelectrode-guided posteroventral pallidotomy. Clin Neuropharmacol 1998; 21:135-8. [PMID: 9579303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To determine the effect of unilateral posteroventral pallidotomy (PVP) on latency and duration of response to L-dopa ipsilateral and contralateral to the side of the lesion, six severe fluctuating Hoehn-Yahr IV patients with Parkinson's disease were evaluated 2 days before and after unilateral PVP. After an overnight drug holiday in a fasting state, patients were challenged with a single dose of 200/50 mg of L-dopa/ carbidopa. Sequential tapping tests every 5 minutes in both hands were used to measure changes in motor status. Duration of L-dopa effect was significantly longer after PVP (p < 0.03). Mean latency of the effect improved by 50% without reaching statistical significance. Despite a clear, asymmetric improvement of cardinal Parkinson's disease symptoms after unilateral PVP, changes in the dose-response L-dopa profile occurred symmetrically, suggesting that mechanisms underlying the two effects are distinct.
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Affiliation(s)
- M Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Tiberti C, Sabe L, Kuzis G, García Cuerva A, Leiguarda R, Starkstein SE. Prevalence and correlates of the catastrophic reaction in Alzheimer's disease. Neurology 1998; 50:546-8. [PMID: 9484396 DOI: 10.1212/wnl.50.2.546] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We examined the prevalence of the catastrophic reaction (CR) in 146 patients with Alzheimer's disease. Sixteen percent showed a CR during the neuropsychological evaluation. A factor analysis of the CR scale demonstrated an anxious/angry factor that was significantly associated with higher irritability scores and a longer duration of illness, as well as a depressive factor that was significantly associated with more severe cognitive impairments and older age.
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Affiliation(s)
- C Tiberti
- Department of Neuropsychiatry, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
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Starkstein SE, Petracca G, Chemerinski E, Tesón A, Sabe L, Merello M, Leiguarda R. Depression in classic versus akinetic-rigid Parkinson's disease. Mov Disord 1998; 13:29-33. [PMID: 9452322 DOI: 10.1002/mds.870130109] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We examined the prevalence of major depression and dysthymia in 78 patients with the classic variant of Parkinson's disease (PD) (that is, tremor plus rigidity and/or bradykinesia), and in 34 patients with the akinetic-rigid variant. Although the prevalence of dysthymia was similar in both groups (classic PD, 31%; and akinetic-rigid PD, 32%), patients with akinetic-rigid PD had a significantly higher prevalence of major depression (38% versus 15%, respectively; p < 0.01). A stepwise regression analysis demonstrated that bradykinesia was the extrapyramidal sign with the highest correlation with Hamilton depression scale scores. Our findings demonstrate a significant association between major depression and the akinetic-rigid type of PD.
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Affiliation(s)
- S E Starkstein
- Department of Neuropsychiatry, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
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Nogués M, Rivero A, Salvat F, Manes F, Salvat J, Leiguarda R. 4-52-04 Respiratory synkinesis due to spinal cord and root lesions. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kuzis G, Sabe L, Tiberti C, Merello M, Leiguarda R, Starkstein S. 2-12-16 Explicit and implicit memory in Alzheimer's disease (AD) and Parkinson's disease (PD) with dementia. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Petracca G, Manes F, Chemerinski E, Leiguarda R, Starkstein S. 2-07-35 Prevalence and psychiatric correlates of pathological affect in stroke patients. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jost L, Jost L, Dávalos M, Manes F, Leiguarda R, Merello M, Esteguy M, Nogués M. 5-27-01 Neurological complications after renal transplantation, a local experience. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leiguarda R, Merello M, Balej J, Starkstein S, Marsden C. 1-30-14 Disruption of spatial organization of gestural movements in patients with Parkinson's disease: A kinematic analysis. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Balej J, Delfino M, Garcia H, Cammarota A, Cerquetti D, Merello M, Leiguarda R. 2-15-01 Mathematical method for GPi firing discharge analysis. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kuzis G, Sabe L, Tiberti C, Merello M, Leiguarda R, Starkstein S. 1-30-11 Neuropsychological deficits after palidotomy in patients with Parkinson's disease (PD). J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Piedimonte F, Bonamico L, Salvat J, Leiguarda R. 5-46-08 Stereotactic trigeminal nucleotomy for postherpetic neuralgia. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Merello M, Schteinshnaider A, Nouzeilles M, Cammarota A, Leiguarda R, Del Val A, Starkstein S. 4-30-14 Prevalence and phenomenology of abnormal involuntary movements (AIMs) in autism versus mental retardation. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Merello M, Cammarota A, Betti O, Nouzeilles MI, Cerquetti D, Garcia H, Pikielny R, Leiguarda R. Involuntary movements during thermolesion predict a better outcome after microelectrode guided posteroventral pallidotomy. J Neurol Neurosurg Psychiatry 1997; 63:210-3. [PMID: 9285460 PMCID: PMC2169667 DOI: 10.1136/jnnp.63.2.210] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Eight of the first 15 patients with advanced Parkinson's disease who underwent microelectrode guided posteroventral pallidotomy developed transient abnormal involuntary movements during thermolesion, four of whom also did so during high frequency macrostimulation. Abnormal involuntary movements found before thermolesion were choreic, ballistic, or choreoathetoid in nature, usually persisted less than 60 minutes, and were contralateral to the site of thermolesion in six and bilateral in two of them. The appearance of abnormal involuntary movements during macrostimulation or thermolesion of the internal globus pallidus correlated with better surgical outcome as measured by UPDRS motor items and CAPIT timed test, so that they seem to be of prognostic value.
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Affiliation(s)
- M Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research, FLENI, Buenos Aires, Argentina
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Abstract
OBJECTIVE To investigate the importance of major depression in the production of cognitive deficits in patients with Parkinson disease (PD). DESIGN A comprehensive neuropsychological and psychiatric assessment was conducted in 19 patients with PD and major depression, 31 patients with PD without depression, 27 patients with major depression but without PD, and 12 age-comparable healthy controls. SETTING Outpatient clinic. RESULTS Patients with major depression (with or without PD) had significantly more severe cognitive deficits than both healthy controls and patients with PD without depression on tests of verbal fluency and auditory attention, while patients with PD and major depression had significantly more severe deficits on tasks of abstract reasoning and set alternation compared with the other 3 groups. CONCLUSIONS Major depression in patients with PD is associated with significant deficits on specific cognitive tasks. While some of these deficits may be explained by the presence of major depression, frontal lobe-related cognitive impairments may result from an interaction between neuropathologic factors in PD and the mechanism of major depression.
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Affiliation(s)
- G Kuzis
- Department of Neuropsychiatry, Raul Carrea Institute of Neurological Research, Buenos Aires, Argentina
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Starkstein SE, Chemerinski E, Sabe L, Kuzis G, Petracca G, Tesón A, Leiguarda R. Prospective longitudinal study of depression and anosognosia in Alzheimer's disease. Br J Psychiatry 1997; 171:47-52. [PMID: 9328494 DOI: 10.1192/bjp.171.1.47] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim was to examine the longitudinal evolution of depression and anosognosia in patients with probable Alzheimer's disease (AD). METHOD Sixty-two of a consecutive series of 116 AD patients that were examined with a structured psychiatric interview had a follow-up evaluation between one and two years after the initial evaluation. RESULTS At the initial evaluation 19% of the 62 patients had major depression, 34% had dysthymia, and 47% were not depressed. After a mean follow-up of 16 months, 58% of patients with major depression at the initial evaluation were still depressed, whereas only 28% of patients with initial dysthymia and 21% of the non-depressed patients were depressed at follow-up. During the follow-up period, all three groups showed similar declines in cognitive status and activities of daily living. At the initial evaluation, 39% of the patients had anosognosia, and there was a significant increment of anosognosia during the follow-up period. CONCLUSIONS While dysthymia in AD is a brief emotional disorder, major depression is a longer-lasting mood change. Anosognosia is another prevalent disorder among AD patients, and increases with the progression of the illness.
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Affiliation(s)
- S E Starkstein
- Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
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Starkstein SE, Sabe L, Vázquez S, Di Lorenzo G, Martínez A, Petracca G, Tesón A, Chemerinski E, Leiguarda R. Neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1997; 63:66-73. [PMID: 9221970 PMCID: PMC2169637 DOI: 10.1136/jnnp.63.1.66] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine neurological, neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease. METHODS A consecutive series of patients with probable Alzheimer's disease was assessed with a comprehensive neuropsychological battery, a structured psychiatric evaluation, the unified Parkinson's disease rating scale, MRI, and single photon emission computed tomography with technetium 99m hexamethylpropyleneamine oxime (HMPAO) and regional cerebral perfusion measurements. RESULTS Patients with Alzheimer's disease and leukoaraiosis were significantly more apathetic and had significantly more extrapyramidal signs than patients with Alzheimer's disease without leukoaraiosis. Patients with Alzheimer's disease with leukoaraiosis also had significantly lower bilateral perfusion in the basal ganglia, thalamus, and frontal lobes than patients with Alzheimer's disease without leukoaraiosis. On the other hand, there were no significant differences between groups in age, duration of illness, depression scores, severity of delusions, or deficits on specific neuropsychological tasks. CONCLUSIONS Leukoaraiosis in Alzheimer's disease may produce significant basal ganglia, and thalamic and frontal lobe dysfunction, which may be associated with more severe apathy and extrapyramidal signs.
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Affiliation(s)
- S E Starkstein
- Department of Behavioral Neurology, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina
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