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Nakaya Y, Hayashi K, Suzuki A, Asano R, Hayashi K, Fujita K, Kawabata K, Kobayashi Y, Sato M. Treatment of Intracranial Hemorrhage Induced Hemichorea- Hemiballism by Low-Frequency Repetitive Transcranial Magnetic Stimulation. Acta Neurol Taiwan 2024; 33(2):88-89. [PMID: 37968091] [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: 11/17/2023]
Abstract
An 80-year-old woman with a history of rheumatoid arthritis, hypertension, and hyperlipidemia, and no family history of hyperkinesis developed suddenly involuntary movement and visited our hospital two-day after onset. Neuro-examination revealed hemichorea-hemiballismus in the right side of the body, including the face (Suppl. video). Blood tests revealed neither hyperglycemia nor acanthocyte. Brain MRI showed acute microbleeding in the left subthalamic nucleus (Figure 1A-C). Although she was treated with haloperidol (max. 4.5 mg/day), hemichorea-hemiballismus did not subside. Repetitive transcranial magnetic stimulation (rTMS) with a low-frequency protocol (LFP) (1 Hz, 1200 pulses, with a stimulus intensity of 90% of the resting motor threshold, 3 days/week for 2-week) was applied to the left precentral knob (Figure 1D). Its effect was drastic, as the symptoms disappeared for half-hour after rTMS. Hemichorea-hemiballism then reappeared but was attenuated by repeated rTMS. The symptoms disappeared after one-month. Subthalamic nucleus lesions can develop hemichorea-hemiballism (1). According to a study on Huntington's disease and diabetic hemichorea-hemiballism, increased thalamocortical drive may increase the excitability of excitatory and inhibitory circuits of the frontal cortex as the etiologies of hyperkinesia (2-3). However, the target points of rTMS in treating hemichorea-hemiballism have not been consistent in literature. Moreover, rTMS with a LFP on the bilateral supplementary motor areas is effective in treating chorea in Huntington's disease (2). Additionally, rTMS on the ipsilateral precentral knob (primary motor cortex) with continuous θ burst stimulation (cTBS), which decreases the excitability and inhibitory cortical circuits, was effective in treating contralateral hemichorea caused by midbrain hemorrhage (3). Similar to cTBS, LFP can suppress cortical excitation (4); therefore, we applied rTMS with LFP on the primary motor cortex to treat hemichorea-hemiballism. Our results were drastic for both short- and long-term efficiency. This is the first report of the efficacy of rTMS with LFP in treating hemichorea-hemiballism caused by encephalorrhagia.
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Affiliation(s)
- Yuka Nakaya
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
| | - Koji Hayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
| | - Asuka Suzuki
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
| | - Rei Asano
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
| | - Kouji Hayashi
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-City, Fukui 910-3190, Japan
| | - Kazuki Fujita
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-City, Fukui 910-3190, Japan
| | - Kaori Kawabata
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-City, Fukui 910-3190, Japan
| | - Yasutaka Kobayashi
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-City, Fukui 910-3190, Japan
| | - Mamiko Sato
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
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Nakaya Y, Hayashi K, Suzuki A, Asano R, Hayashi K, Fujita K, Kawabata K, Kobayashi Y, Sato M. Treatment of Intracranial Hemorrhage Induced Hemichorea- Hemiballism by Low-Frequency Repetitive Transcranial Magnetic Stimulation. Acta Neurol Taiwan 2024; 33(2):93-94. [PMID: 38030220] [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: 12/01/2023]
Abstract
An 80-year-old woman with a history of rheumatoid arthritis, hypertension, and hyperlipidemia, and no family history of hyperkinesis developed suddenly involuntary movement and visited our hospital two-day after onset. Neuro-examination revealed hemichorea-hemiballismus in the right side of the body, including the face (Suppl. video). Blood tests revealed neither hyperglycemia nor acanthocyte. Brain MRI showed acute microbleeding in the left subthalamic nucleus (Figure 1A-C). Although she was treated with haloperidol (max. 4.5 mg/day), hemichorea-hemiballismus did not subside. Repetitive transcranial magnetic stimulation (rTMS) with a low-frequency protocol (LFP) (1 Hz, 1200 pulses, with a stimulus intensity of 90% of the resting motor threshold, 3 days/week for 2-week) was applied to the left precentral knob (Figure 1D). Its effect was drastic, as the symptoms disappeared for half-hour after rTMS. Hemichorea-hemiballism then reappeared but was attenuated by repeated rTMS. The symptoms disappeared after one-month. Subthalamic nucleus lesions can develop hemichorea-hemiballism (1). According to a study on Huntington's disease and diabetic hemichorea-hemiballism, increased thalamocortical drive may increase the excitability of excitatory and inhibitory circuits of the frontal cortex as the etiologies of hyperkinesia (2-3). However, the target points of rTMS in treating hemichorea-hemiballism have not been consistent in literature. Moreover, rTMS with a LFP on the bilateral supplementary motor areas is effective in treating chorea in Huntington's disease (2). Additionally, rTMS on the ipsilateral precentral knob (primary motor cortex) with continuous θ burst stimulation (cTBS), which decreases the excitability and inhibitory cortical circuits, was effective in treating contralateral hemichorea caused by midbrain hemorrhage (3). Similar to cTBS, LFP can suppress cortical excitation (4); therefore, we applied rTMS with LFP on the primary motor cortex to treat hemichorea-hemiballism. Our results were drastic for both short- and long-term efficiency. This is the first report of the efficacy of rTMS with LFP in treating hemichorea-hemiballism caused by encephalorrhagia.
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Affiliation(s)
- Yuka Nakaya
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
| | - Koji Hayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
| | - Asuka Suzuki
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
| | - Rei Asano
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
| | - Kouji Hayashi
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-City, Fukui 910-3190, Japan
| | - Kazuki Fujita
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-City, Fukui 910-3190, Japan
| | - Kaori Kawabata
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-City, Fukui 910-3190, Japan
| | - Yasutaka Kobayashi
- Graduate School of Health Science, Fukui Health Science University, 55-13-1 Egami, Fukui-City, Fukui 910-3190, Japan
| | - Mamiko Sato
- Department of Rehabilitation Medicine, Fukui General Hospital, 55-16-1 Egami, Fukui-City, Fukui 910- 8561, Japan
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Avenali M, Zangaglia R, Cuconato G, Palmieri I, Albanese A, Artusi CA, Bozzali M, Calandra-Buonaura G, Cavallieri F, Cilia R, Cocco A, Cogiamanian F, Colucci F, Cortelli P, Di Fonzo A, Eleopra R, Giannini G, Imarisio A, Imbalzano G, Ledda C, Lopiano L, Malaguti MC, Mameli F, Minardi R, Mitrotti P, Monfrini E, Spagnolo F, Tassorelli C, Valentino F, Valzania F, Pacchetti C, Valente EM. Are patients with GBA-Parkinson disease good candidates for deep brain stimulation? A longitudinal multicentric study on a large Italian cohort. J Neurol Neurosurg Psychiatry 2024; 95:309-315. [PMID: 37879897 PMCID: PMC10958298 DOI: 10.1136/jnnp-2023-332387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND GBA variants increase the risk of developing Parkinson disease (PD) and influence its outcome. Deep brain stimulation (DBS) is a recognised therapeutic option for advanced PD. Data on DBS long-term outcome in GBA carriers are scarce. OBJECTIVE To elucidate the impact of GBA variants on long-term DBS outcome in a large Italian cohort. METHODS We retrospectively recruited a multicentric Italian DBS-PD cohort and assessed: (1) GBA prevalence; (2) pre-DBS clinical features; and (3) outcomes of motor, cognitive and other non-motor features up to 5 years post-DBS. RESULTS We included 365 patients with PD, of whom 73 (20%) carried GBA variants. 5-year follow-up data were available for 173 PD, including 32 mutated subjects. GBA-PD had an earlier onset and were younger at DBS than non-GBA-PD. They also had shorter disease duration, higher occurrence of dyskinesias and orthostatic hypotension symptoms.At post-DBS, both groups showed marked motor improvement, a significant reduction of fluctuations, dyskinesias and impulsive-compulsive disorders (ICD) and low occurrence of most complications. Only cognitive scores worsened significantly faster in GBA-PD after 3 years. Overt dementia was diagnosed in 11% non-GBA-PD and 25% GBA-PD at 5-year follow-up. CONCLUSIONS Evaluation of long-term impact of GBA variants in a large Italian DBS-PD cohort supported the role of DBS surgery as a valid therapeutic strategy in GBA-PD, with long-term benefit on motor performance and ICD. Despite the selective worsening of cognitive scores since 3 years post-DBS, the majority of GBA-PD had not developed dementia at 5-year follow-up.
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Affiliation(s)
- Micol Avenali
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Giada Cuconato
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Bozzali
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Giovanna Calandra-Buonaura
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Cilia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Antoniangela Cocco
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Filippo Cogiamanian
- Neurophysiopathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Colucci
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alessio Di Fonzo
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Eleopra
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giulia Giannini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alberto Imarisio
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Claudia Ledda
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Francesca Mameli
- Neurophysiopathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Minardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Edoardo Monfrini
- Neurology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Cristina Tassorelli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Enza Maria Valente
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Koy A, Kühn AA, Schiller P, Huebl J, Schneider GH, Eckenweiler M, Rensing-Zimmermann C, Coenen VA, Krauss JK, Saryyeva A, Hartmann H, Lorenz D, Volkmann J, Matthies C, Schnitzler A, Vesper J, Gharabaghi A, Weiss D, Bevot A, Marks W, Howser A, Monbaliu E, Mueller J, Prinz-Langenohl R, Visser-Vandewalle V, Timmermann L. Long-Term Follow-Up of Pediatric Patients with Dyskinetic Cerebral Palsy and Deep Brain Stimulation. Mov Disord 2023; 38:1736-1742. [PMID: 37358761 DOI: 10.1002/mds.29516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) has been increasingly used in the management of dyskinetic cerebral palsy (DCP). Data on long-term effects and the safety profile are rare. OBJECTIVES We assessed the efficacy and safety of pallidal DBS in pediatric patients with DCP. METHODS The STIM-CP trial was a prospective, single-arm, multicenter study in which patients from the parental trial agreed to be followed-up for up to 36 months. Assessments included motor and non-motor domains. RESULTS Of the 16 patients included initially, 14 (mean inclusion age 14 years) were assessed. There was a significant change in the (blinded) ratings of the total Dyskinesia Impairment Scale at 36 months. Twelve serious adverse events (possibly) related to treatment were documented. CONCLUSION DBS significantly improved dyskinesia, but other outcome parameters did not change significantly. Investigations of larger homogeneous cohorts are needed to further ascertain the impact of DBS and guide treatment decisions in DCP. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anne Koy
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Petra Schiller
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julius Huebl
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
- Department of Neurology, Munich Municipal Hospital Bogenhausen, Munich, Germany
| | | | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelia Rensing-Zimmermann
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Deep Brain Stimulation, University Medical Center, Freiburg, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Hans Hartmann
- Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Delia Lorenz
- Department of Pediatrics, University Children's Hospital, Wuerzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Cordula Matthies
- Department of Stereotactic and Functional Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Vesper
- Department of Functional Neurosurgery and Stereotaxy, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Tübingen, Germany
| | - Daniel Weiss
- Department of Neurology, Medical Faculty, University of Tübingen, Tübingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Warren Marks
- Department of Neurology, Cook Children's Medical Center, Fort Worth, Texas, USA
- Department of Pediatrics, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
| | - Angela Howser
- Department of Pediatrics, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
| | - Elegast Monbaliu
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Brugge, Belgium
| | - Joerg Mueller
- Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | | | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
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CHEN Y, SUN J, LYU T, HONG J, LIU Y, ZHU L, LI B, LIU L. Effect of acupuncture treatment on nonketotic hyperglycemic hemichorea-hemiballismus: a case report. J TRADIT CHIN MED 2023; 43:829-833. [PMID: 37454270 PMCID: PMC10320454 DOI: 10.19852/j.cnki.jtcm.20230308.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/10/2022] [Indexed: 07/18/2023]
Abstract
Nonketotic hyperglycemic hemichorea-hemiballismus is a rare syndrome in the clinic, and treatment is often delayed. Hypoglycemic therapy is the most widely used and effective treatment, but some patients experience a slower improvement. Other symptomatic treatment medicines have some degree of side effects. Acupuncture treatment is beneficial for hemichorea-hemiballismus. A male patient, aged 59 years, first visited our hospital outpatient department due to motor agitation with involuntary movements of the right limb. He had a history of type 2 diabetes mellitus and poor blood glucose control. His serum glucose was 26.5 mmol/L (normal: 4.4-6.1 mmol/L), and magnetic resonance imaging demonstrated an irregular area of high signal intensity in T1-weighted imaging, low signal intensity on T2-weighted imaging, and high signal intensity in the left corpus striatum in T2-FLAIR imaging. Hospitalization was recommended for the patient. After ruling out other possibilities, he was eventually diagnosed with nonketotic hyperglycemic hemichorea-hemiballismus. Intensive glycemic control was immediately started with subcutaneous injection and acupuncture treatment at "governor vessel 13 acupoints", and the involuntary movements completely disappeared on the ninth day of hospitalization. The pathophysiology of nonketotic hyperglycemic hemichorea-hemiballismus is unclear. Different patient histories lead to different brain tissue conditions, and relapses and uncontrolled blood glucose add difficulties to treatment. According to Traditional Chinese Medicine theory, insufficient kidney essence leads to brain dystrophy and causes the symptoms of hemichorea-hemiballismus. Research evidence has shown that acupuncture at "governor vessel 13 acupoints" has a beneficial treatment effect on nonketotic hyperglycemic hemichorea-hemiballismus.
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Affiliation(s)
- Ying CHEN
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Jingqing SUN
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Tianli LYU
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Jiahui HONG
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Yuhan LIU
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Liying ZHU
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Bin LI
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Lu LIU
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
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Yilmaz Gokmen G, Akcay B, Kecelioglu S, Ozen MS, Yuce H. Physical and well-being effect of scapular kinesio taping combined with conventional physiotherapy in shoulder impingement syndrome: A randomized controlled study. J Back Musculoskelet Rehabil 2023; 36:1375-1383. [PMID: 37694348 DOI: 10.3233/bmr-220396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Kinesio taping (KT) is one of the treatment methods used on patients with shoulder impingement syndrome (SIS). There are different results regarding its effectiveness in the literature. OBJECTIVE To investigate the effects of scapular KT combined with a conventional physiotherapy program on scapular dyskinesia, shoulder pain, upper extremity function, and well-being in patients with SIS. METHODS The study was conducted with 60 outpatients diagnosed with SIS, aged 40-65 years. The patients were divided into two groups: KT [conventional physiotherapy program + scapular KT (targets scapular retraction and is applied along the inferior-medial edge of the scapula, starting from the processus coracoids), n= 30] and control [conventional physiotherapy program, n= 30]. In before- and after-treatment evaluations, the Lateral Scapular Slide Test (LSST) for scapular dyskinesia, a Visual Analogue Scale (VAS) for shoulder pain, and the Disabilities of the Arm, Shoulder, and Hand (DASH) for upper extremity function were used. In addition, at the end of treatment, a Kinesio taping Satisfaction Survey, created by the researchers, was filled out by the KT group for the assessment of well-being. RESULTS The interaction effect of Group*Time was not statistically significant in all outcome measures (p> 0.05). However, the main effect of both group and time was statistically significant in the DASH-Function/Symptom, VAS-Rest, VAS-Activity, and VAS-Night (p< 0.05). Moreover, only the main effect of time was statistically significant in LSST-1 and LSST-3 (p< 0.05). In the KT group, the satisfaction level was 8.50 ± 1.69 and the recommendation level was 8.72 ± 1.81. CONCLUSION Both conventional physiotherapy programs and additional scapular KT improved scapular dyskinesia, reduced pain, and increased the upper extremity function. Adding scapular KT to treatment did not change the results, but it had positive psychological effects and yielded a high satisfaction rate.
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Hwang M, Lee S, Lim C. Effects of the Proprioceptive Neuromuscular Facilitation Technique on Scapula Function in Office Workers with Scapula Dyskinesis. ACTA ACUST UNITED AC 2021; 57:medicina57040332. [PMID: 33915824 PMCID: PMC8067054 DOI: 10.3390/medicina57040332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
Background and Objectives; Proprioceptive neuromuscular facilitation (PNF) are effective in improving and maintaining Range of motion(ROM), increasing muscular strength and power, and increasing athletic performance, especially after exercise. The scapula patterns defined in PNF are activated within the upper extremity patterns and scapula motions together. Proper function of the upper extremities requires both motion and stability of the scapula. The purpose of this study was to compare the effects of scapula stabilization exercise training involving muscle strengthening, muscle balance, and movement control exercises on office workers with scapula dysfunction. Materials and Methods: A total of 42 office workers with scapula dyskinesis were recruited and randomly divided into three groups: muscle strengthening exercise group (n = 14), muscle balance exercise group (n = 14), and movement control exercise group (n = 14). The participants underwent 18 sessions (25 min/session, 3 days a week for 6 weeks) of training involving the three types of exercises. Results: The measurement outcomes included the scapula index, measured using a digital Vernier caliper; scapula function, evaluated using the Disability of the Arm, Shoulder, and Hand (DASH) outcome questionnaire (pain and performing, work ability, and sports and art activities); and scapulohumeral movements (scapula upward rotation at humeral abduction angles of 0°, 45°, 90°, 135°, and 180°), evaluated using inclinometers. After the exercise intervention, the scapula index (p = 0.002), DASH pain and performing score (p = 0.000), DASH work ability score (p = 0.000), DASH sports and art activity score (p = 0.027), and scapulohumeral movements (scapula upward rotation at 0° (p = 0.013) and 45° (p = 0.043) humeral abduction) showed significantly greater improvements in the movement control group than in the muscle strengthening and muscle balance groups. Conclusions: Thus, proprioceptive neuromuscular facilitation can be used as a rehabilitation intervention for scapula position and movement, pain reduction, and functional improvement in office workers with scapula dyskinesis.
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Affiliation(s)
- Myeungsik Hwang
- Department of Physical Therapy, Bumin Hospital, Seoul 07590, Korea;
| | - Sangbin Lee
- Department of Physical Therapy, Namseoul University, Cheonan 31020, Korea
- Correspondence: (S.L.); (C.L.); Tel.: +82-41-580-2532 (S.L.); +82-32-820-4424 (C.L.); Fax: +82-32-820-4069 (C.L.)
| | - Chaegil Lim
- Department of Physical Therapy, Gachon University, Incheon 21936, Korea
- Correspondence: (S.L.); (C.L.); Tel.: +82-41-580-2532 (S.L.); +82-32-820-4424 (C.L.); Fax: +82-32-820-4069 (C.L.)
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Wang Q, Ma N, Wang P, Wang M, Shao Y, Zhao X. Effects of eye-acupuncture combined with rehabilitation training for poststroke dyskinesia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25036. [PMID: 33725887 PMCID: PMC7969281 DOI: 10.1097/md.0000000000025036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Poststroke dyskinesia is the most common clinical symptom after stroke, which greatly affects the patients' daily life. Eye-acupuncture is an effective method for stroke. And the rehabilitation training has been widely used for patients suffer from stroke. However, whether eye-acupuncture combined with rehabilitation training has greater clinical efficacy for poststroke dyskinesia is still unknown. Our aim in this systematic review was to evaluate the clinical efficacy of eye-acupuncture combined with rehabilitation training (EACRT) as a treatment for dyskinesia after stroke. METHODS AND ANALYSIS We will search the following 4 databases of registered trials and 7 electronic databases from inception to March 2021:Cochrane Stroke Group, Cochrane Central Register of Controlled, the World Health Organization International Clinical Trials Registry Platform, the Chinese Clinical Trial Registry; PubMed, MEDLINE, Embase, CNKI, VIP, WanFang, and CBM. All relevant randomized controlled trials focus on EACRT will be included. The primary outcome will be the Fugl-Meyer Assessment. The Secondary outcomes will include Activity of Daily Living, clinical effective rate and the Visual Analogue Score. Two reviewers will independently conduct the Study selection and data extraction. The data synthesis and assessment of risk of bias will be performed by RevMan5.2. ETHICS AND DISSEMINATION The ethical approval is unnecessary that systematic review is based on published articles other than patients. The results of this meta-analysis will be published in an open access (OA) journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA). PROSPERO REGISTRATION NUMBER CRD42020168278.
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Affiliation(s)
- Qi Wang
- Liaoning University of Traditional Chinese Medicine
| | - Nanting Ma
- Liaoning University of Traditional Chinese Medicine
| | - Pengqin Wang
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Mei Wang
- Liaoning University of Traditional Chinese Medicine
| | - Yan Shao
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xitong Zhao
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, China
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Abstract
Pediatric movement disorders (PMDs) consist of a heterogeneous group of signs and symptoms caused by numerous neurological diseases. Different neurological disorders in children also share overlapping movement disorders making a diagnosis of the underlying cause of the movement disorder challenging. The similarity of the symptoms across multiple disease types suggests that there may be a final common motor pathway causing the overlapping movement disorders. There are numerous disorders in children associated with disturbances in tone and involuntary movements. This chapter will focus primarily on those disorders that involve abnormalities of tone and other important considerations of pediatric movement disorders. This chapter will address rating scales and goals for treatment and will include a review of symptomatic treatment and, where possible, the treatment of the underlying disease processes. The chapter will review representative disorders, including an inborn error of metabolism, an autoimmune disorder, and a group of neurodegenerative disorders. These examples demonstrate how the disorder's underlying pathophysiology results in a specific approach to the underlying disease and the associated conditions of tone and involuntary movements. Finally, the multiple treatment options for cerebral palsy and considerations of cerebral palsy mimics will be discussed.
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Affiliation(s)
- Stephen R Deputy
- Department of Neurology, Division of Child Neurology, Louisiana State University Health Sciences Center at New Orleans, Children's Hospital, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Ann H Tilton
- Department of Neurology, Division of Child Neurology, Louisiana State University Health Sciences Center at New Orleans, Children's Hospital, 200 Henry Clay Ave., New Orleans, LA, 70118, USA.
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10
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Yu P, Wang Y, Yuan J, Chen J, Lei Y, Han Z, Liu D, Zhao Y, Wang P, Luo F. Observation for the effect of rTMS combined with magnetic stimulation at Neiguan (PC6) and Sanyinjiao (SP6) points on limb function after stroke: A study protocol. Medicine (Baltimore) 2020; 99:e22207. [PMID: 32957353 PMCID: PMC7505310 DOI: 10.1097/md.0000000000022207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is the primary cause of adult disability in China, which causes serious personal, family, and social burden. "Central peripheral central" closed-loop rehabilitation theory is proved to be an effective neural rehabilitation model. Based on this theory, repetitive transcranial magnetic stimulation (rTMS) combined with magnetic stimulation of Neiguan (PC6) and Sanyinjiao (SP6) may be an effective treatment for limb dysfunction after stroke. However, the efficacy and mechanism of repetitive magnetic stimulation of M1 region combined with magnetic stimulation of Neiguan and Sanyinjiao points on limb dysfunction after stroke has not been confirmed. METHODS/DESIGN This study is a prospective, randomized, controlled, open trial. We randomly divided 42 subjects, aged 35 to 80 years, diagnosed with ischemic stroke within 1 month, into 2 groups with a ratio of 1:1. On the basis of this medical treatment, patients in the experimental group received 1 Hz rTMS in M1 area on the contralateral side, and 3 Hz rTMS treatment at Neiguan point and Sanyinjiao point on the affected side. The control group was treated with acupuncture (body acupuncture). All patients were treated once a day and followed up for 10 days. The National Institute of Health Stroke Scale score, simplified fulg Meyer, modified Barthel index, and cortical excitability were evaluated on the day of enrollment and the 10th day of treatment respectively. The modified Barthe index was followed up on the 30th day of treatment, and the adverse reactions were recorded at any time. The mechanism of rTMS will be revealed by Barthe index before treatment, on the 10th day of treatment and on the 30th day of follow-up. The results were analyzed by spss19.0 software, and the quantitative indexes were analyzed by t test and rank sum test. χ test was used for non-grade counting, and rank sum test was used for grade counting. All statistical tests were performed with bilateral test. If P value is less than or equal to .05, the difference will be considered statistically significant. CONCLUSION The purpose of this study was to determine the effect of repetitive magnetic stimulation of M1 region combined with magnetic stimulation of Neiguan and Sanyinjiao points on limb function after stroke. Through this study, we expect to explore a new scheme for the treatment of poststroke dyskinesia, and prove that compared with rTMS and acupuncture alone, the closed-loop rehabilitation theory based on "center peripheral center" can be more efficient and safe in the treatment of poststroke limb dysfunction. TRIAL REGISTRATION The trial was registered in China clinical trial registry (http://www.chictr.org.cn/index.aspx), ID: ChiCTR1900026890 (October 25, 2019).
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Affiliation(s)
- Penglong Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Yuan Wang
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
- School of Clinical Medical, Shannxi University of Chinese Medicine, Xianyang
| | - Jie Yuan
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Chen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Yaling Lei
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Zucheng Han
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Dongling Liu
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Yuan Zhao
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Pei Wang
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Fan Luo
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
- School of Clinical Medical, Shannxi University of Chinese Medicine, Xianyang
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11
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Aquino CC, Duffley G, Hedges DM, Vorwerk J, House PA, Ferraz HB, Rolston JD, Butson CR, Schrock LE. Interleaved deep brain stimulation for dyskinesia management in Parkinson's disease. Mov Disord 2019; 34:1722-1727. [PMID: 31483534 PMCID: PMC10957149 DOI: 10.1002/mds.27839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/09/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with Parkinson's disease, stimulation above the subthalamic nucleus (STN) may engage the pallidofugal fibers and directly suppress dyskinesia. OBJECTIVES The objective of this study was to evaluate the effect of interleaving stimulation through a dorsal deep brain stimulation contact above the STN in a cohort of PD patients and to define the volume of tissue activated with antidyskinesia effects. METHODS We analyzed the Core Assessment Program for Surgical Interventional Therapies dyskinesia scale, Unified Parkinson's Disease Rating Scale parts III and IV, and other endpoints in 20 patients with interleaving stimulation for management of dyskinesia. Individual models of volume of tissue activated and heat maps were used to identify stimulation sites with antidyskinesia effects. RESULTS The Core Assessment Program for Surgical Interventional Therapies dyskinesia score in the on medication phase improved 70.9 ± 20.6% from baseline with noninterleaved settings (P < 0.003). With interleaved settings, dyskinesia improved 82.0 ± 27.3% from baseline (P < 0.001) and 61.6 ± 39.3% from the noninterleaved phase (P = 0.006). The heat map showed a concentration of volume of tissue activated dorsally to the STN during the interleaved setting with an antidyskinesia effect. CONCLUSION Interleaved deep brain stimulation using the dorsal contacts can directly suppress dyskinesia, probably because of the involvement of the pallidofugal tract, allowing more conservative medication reduction. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Camila C Aquino
- Sleep and Movement Disorder Division, University of Utah, Salt Lake City, Utah, USA
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Department of Health, Evidence and Impact, McMaster University, Hamilton, Minnesota, Canada
| | - Gordon Duffley
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - David M Hedges
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Johannes Vorwerk
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Henrique B Ferraz
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Christopher R Butson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | - Lauren E Schrock
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
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Abstract
Motor dysfunction is a common and severe complication of stroke that affects the quality of life of these patients. Currently, motor function rehabilitation predominantly focuses on active movement training; nevertheless, the role of sensory input is usually overlooked. Sensory input is very important to motor function. Voluntary functional movement necessitates preparation, execution, and monitoring functions of the central nervous system, while the monitoring needs the participation of the sensory system. Sensory signals affect motor functions by inputting external environment information and intrinsic physiological status as well as by guiding initiation of the motor system. Recent studies focusing on sensory input-based rehabilitation training for post-stroke dyskinesia have demonstrated that sensory function has significant effects on voluntary functional movements. In conclusion, sensory input plays a crucial role in motor function rehabilitation, and the combined sensorimotor training modality is more effective than conventional motor-oriented approaches.
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13
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Hishikawa N, Fukui Y, Sato K, Takemoto M, Yamashita T, Ohta Y, Abe K. A Unique Case with Oral Dyskinesia, Chorea, Ataxia, and Mild Cognitive Impairment with Caudate Atrophy and Characteristic Brain Calcifications. Intern Med 2018; 57:2399-2402. [PMID: 29607952 PMCID: PMC6148178 DOI: 10.2169/internalmedicine.9454-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The authors report a man who developed oral dyskinesia at 46 years of age, followed by slowly progressive choreic movement and mild cognitive impairment over 20 years. He showed caudate atrophy and four types of intracranial calcification in the hippocampus (dot-like), cerebellar white matter (vague-mass), occipital cortices (laminar), and cerebral white matter (linear). Linear-calcification in the corona radiata seems to be deposition along small veins, which may be related to the white matter changes and to the decreased regional cerebral blood flow in the frontal and parietal lobes. The present case shows a slowly progressive disease with caudate atrophy and characteristic brain calcifications.
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Affiliation(s)
- Nozomi Hishikawa
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yusuke Fukui
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kota Sato
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Mami Takemoto
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Toru Yamashita
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yasuyuki Ohta
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Koji Abe
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Shin AR, Lee JH, Kim DE, Cynn HS. Thera-Band application changes muscle activity and kyphosis and scapular winging during knee push-up plus in subjects with scapular winging: The cross-sectional study. Medicine (Baltimore) 2018; 97:e0348. [PMID: 29620665 PMCID: PMC5902258 DOI: 10.1097/md.0000000000010348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Scapular winging (SW) is defined as increased prominence of the whole medial border of the scapula. Many researchers recently recommended knee push-up plus (KPP) for enhancing serratus anterior (SA) activation. However, during push-up plus, thoracic kyphosis (TK) may usually occur as a compensatory movement. Thus, the purpose of this study was to investigate the effect of Thera-Band application during KPP on rectus abdominis (RA) activity, TK angle (TKA), SA activity, and amount of SW in subjects with SW.Fifteen subjects performed KPP with Thera-Band applied to different posterior body parts (no Thera-Band, in the occiput, and in the thoracic region). Electromyography was used to record the RA and SA activities. Image J software was used to calculate the compensatory TKA during KPP, and a scapulometer was used to measure SW in the quadruped position. One-way repeated-measures analysis of variance was used to test for significance.KPP with Thera-Band in the occiput showed significantly lower RA activity (P = .001) and TKA (P < .001) than KPP with no Thera-Band. SA activity (P = .020, P = .047) and SW (P < .001, P < .001) were significantly lower with Thera-Band applied to the occiput and thoracic regions than in KPP with no Thera-Band.Thera-Band applied to the occiput and thorax can be beneficial as it decreases RA and SA muscle activity and reduces TKA and SW during KPP in subjects with SW.
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15
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Monbaliu E, Himmelmann K, Lin JP, Ortibus E, Bonouvrié L, Feys H, Vermeulen RJ, Dan B. Clinical presentation and management of dyskinetic cerebral palsy. Lancet Neurol 2017; 16:741-749. [PMID: 28816119 DOI: 10.1016/s1474-4422(17)30252-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 06/02/2017] [Accepted: 06/29/2017] [Indexed: 12/21/2022]
Abstract
Cerebral palsy is the most frequent cause of severe physical disability in childhood. Dyskinetic cerebral palsy (DCP) is the second most common type of cerebral palsy after spastic forms. DCP is typically caused by non-progressive lesions to the basal ganglia or thalamus, or both, and is characterised by abnormal postures or movements associated with impaired tone regulation or movement coordination. In DCP, two major movement disorders, dystonia and choreoathetosis, are present together most of the time. Dystonia is often more pronounced and severe than choreoathetosis, with a major effect on daily activity, quality of life, and societal participation. The pathophysiology of both movement disorders is largely unknown. Some emerging hypotheses are an imbalance between indirect and direct basal ganglia pathways, disturbed sensory processing, and impaired plasticity in the basal ganglia. Rehabilitation strategies are typically multidisciplinary. Use of oral drugs to provide symptomatic relief of the movement disorders is limited by adverse effects and the scarcity of evidence that the drugs are effective. Neuromodulation interventions, such as intrathecal baclofen and deep brain stimulation, are promising options.
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Affiliation(s)
- Elegast Monbaliu
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Dominiek Savio Instituut, Gits, Belgium
| | - Kate Himmelmann
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jean-Pierre Lin
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Laura Bonouvrié
- Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - R Jeroen Vermeulen
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bernard Dan
- Department of Neurology, Université Libre de Bruxelles, Brussels, Belgium; Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.
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Lin JG, Chen CJ, Yang HB, Chen YH, Hung SY. Electroacupuncture Promotes Recovery of Motor Function and Reduces Dopaminergic Neuron Degeneration in Rodent Models of Parkinson's Disease. Int J Mol Sci 2017; 18:ijms18091846. [PMID: 28837077 PMCID: PMC5618495 DOI: 10.3390/ijms18091846] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 12/12/2022] Open
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disease. The pathological hallmark of PD is a progressive loss of dopaminergic neurons in the substantia nigra (SN) pars compacta in the brain, ultimately resulting in severe striatal dopamine deficiency and the development of primary motor symptoms (e.g., resting tremor, bradykinesia) in PD. Acupuncture has long been used in traditional Chinese medicine to treat PD for the control of tremor and pain. Accumulating evidence has shown that using electroacupuncture (EA) as a complementary therapy ameliorates motor symptoms of PD. However, the most appropriate timing for EA intervention and its effect on dopamine neuronal protection remain unclear. Thus, this study used the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-lesioned mouse model (systemic-lesioned by intraperitoneal injection) and the 1-methyl-4-phenylpyridinium (MPP+)-lesioned rat model (unilateral-lesioned by intra-SN infusion) of PD, to explore the therapeutic effects and mechanisms of EA at the GB34 (Yanglingquan) and LR3 (Taichong) acupoints. We found that EA increased the latency to fall from the accelerating rotarod and improved striatal dopamine levels in the MPTP studies. In the MPP+ studies, EA inhibited apomorphine induced rotational behavior and locomotor activity, and demonstrated neuroprotective effects via the activation of survival pathways of Akt and brain-derived neurotrophic factor (BDNF) in the SN region. In conclusion, we observed that EA treatment reduces motor symptoms of PD and dopaminergic neurodegeneration in rodent models, whether EA is given as a pretreatment or after the initiation of disease symptoms. The results indicate that EA treatment may be an effective therapy for patients with PD.
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Affiliation(s)
- Jaung-Geng Lin
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
| | - Chao-Jung Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan.
| | - Han-Bin Yang
- Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan.
| | - Yi-Hung Chen
- Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan.
- Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan.
- Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung 40402, Taiwan.
| | - Shih-Ya Hung
- Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan.
- Division of Colorectal Surgery, China Medical University Hospital, Taichung 40447, Taiwan.
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17
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Ghika J. [Not Available]. Rev Med Suisse 2017; 13:209-211. [PMID: 28703978] [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: 06/07/2023]
Affiliation(s)
- Joseph Ghika
- Service de neurologie, Hôpital du Valais Sion, Avenue Grand Champsec 80, 1950 Sion
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18
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Abstract
BACKGROUND Idiopathic Parkinson's disease (IPD) is a neurodegenerative disorder, with the severity of the disability usually increasing with disease duration. IPD affects patients' health-related quality of life, disability, and impairment. Current rehabilitation approaches have limited effectiveness in improving outcomes in patients with IPD, but a possible adjunct to rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve these outcomes in IPD. OBJECTIVES To assess the effectiveness of tDCS in improving motor and non-motor symptoms in people with IPD. SEARCH METHODS We searched the following databases (until February 2016): the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library ; 2016 , Issue 2), MEDLINE, EMBASE, CINAHL, AMED, Science Citation Index, the Physiotherapy Evidence Database (PEDro), Rehabdata, and Inspec. In an effort to identify further published, unpublished, and ongoing trials, we searched trial registers and reference lists, handsearched conference proceedings, and contacted authors and equipment manufacturers. SELECTION CRITERIA We included only randomised controlled trials (RCTs) and randomised controlled cross-over trials that compared tDCS versus control in patients with IPD for improving health-related quality of life , disability, and impairment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality (JM and MP) and extracted data (BE and JM). If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports. MAIN RESULTS We included six trials with a total of 137 participants. We found two studies with 45 participants examining the effects of tDCS compared to control (sham tDCS) on our primary outcome measure, impairment, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS). There was very low quality evidence for no effect of tDCS on change in global UPDRS score ( mean difference (MD) -7.10 %, 95% confidence interval (CI -19.18 to 4.97; P = 0.25, I² = 21%, random-effects model). However, there was evidence of an effect on UPDRS part III motor subsection score at the end of the intervention phase (MD -14.43%, 95% CI -24.68 to -4.18; P = 0.006, I² = 2%, random-effects model; very low quality evidence). One study with 25 participants measured the reduction in off and on time with dyskinesia, but there was no evidence of an effect (MD 0.10 hours, 95% CI -0.14 to 0.34; P = 0.41, I² = 0%, random-effects model; and MD 0.00 hours, 95% CI -0.12 to 0.12; P = 1, I² = 0%, random- effects model, respectively; very low quality evidence).Two trials with a total of 41 participants measured gait speed using measures of timed gait at the end of the intervention phase, revealing no evidence of an effect ( standardised mean difference (SMD) 0.50, 95% CI -0.17 to 1.18; P = 0.14, I² = 11%, random-effects model; very low quality evidence). Another secondary outcome was health-related quality of life and we found one study with 25 participants reporting on the physical health and mental health aspects of health-related quality of life (MD 1.00 SF-12 score, 95% CI -5.20 to 7.20; I² = 0%, inverse variance method with random-effects model; very low quality evidence; and MD 1.60 SF-12 score, 95% CI -5.08 to 8.28; I² = 0%, inverse variance method with random-effects model; very low quality evidence, respectively). We found no study examining the effects of tDCS for improving activities of daily living. In two of six studies, dropouts , adverse events, or deaths occurring during the intervention phase were reported. There was insufficient evidence that dropouts , adverse effects, or deaths were higher with intervention (risk difference (RD) 0.04, 95% CI -0.05 to 0.12; P = 0.40, I² = 0%, random-effects model; very low quality evidence).We found one trial with a total of 16 participants examining the effects of tDCS plus movement therapy compared to control (sham tDCS) plus movement therapy on our secondary outcome, gait speed at the end of the intervention phase, revealing no evidence of an effect (MD 0.05 m/s, 95% CI -0.15 to 0.25; inverse variance method with random-effects model; very low quality evidence). We found no evidence of an effect regarding differences in dropouts and adverse effects between intervention and control groups (RD 0.00, 95% CI -0.21 to 0.21; Mantel-Haenszel method with random-effects model; very low quality evidence). AUTHORS' CONCLUSIONS There is insufficient evidence to determine the effects of tDCS for reducing off time ( when the symptoms are not controlled by the medication) and on time with dyskinesia ( time that symptoms are controlled but the person still experiences involuntary muscle movements ) , and for improving health- related quality of life, disability, and impairment in patients with IPD. Evidence of very low quality indicates no difference in dropouts and adverse events between tDCS and control groups.
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Affiliation(s)
- Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
- SRH Fachhochschule für Gesundheit Gera gGmbHDepartment of PhysiotherapyNeue Str. 28‐3007548 GeraThüringenGermany07548
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolLöscherstr. 18DresdenGermanyD‐01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
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Scheer S, John RM. Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Children and Adolescents. J Pediatr Health Care 2016; 30:347-58. [PMID: 26507948 DOI: 10.1016/j.pedhc.2015.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 12/18/2022]
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease that is becoming increasingly recognized in the pediatric population. It may be the most common cause of treatable autoimmune encephalitis. The majority of cases of anti-NMDAR encephalitis are idiopathic in etiology, but a significant minority can be attributed to a paraneoplastic origin. Children with anti-NMDAR encephalitis initially present with a prodrome of neuropsychiatric symptoms, often with orofacial dyskinesias followed by progressively worsening seizures, agitation, and spasticity, which may result in severe neurologic deficits and even death. Definitive diagnosis requires detection of NMDAR antibodies in the cerebrospinal fluid. Optimal outcomes are associated with prompt removal of the tumor in paraneoplastic cases, as well as aggressive immunosuppressive therapy. Early detection is essential for increasing the chances for a good outcome. Close follow-up is required to screen for relapse and later onset tumor presentation. The nurse practitioner plays a major role in the research, screening, diagnosis, treatment, follow-up, and rehabilitation of a child or adolescent with anti-NMDAR encephalitis.
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TODA H, SAIKI H, NISHIDA N, IWASAKI K. Update on Deep Brain Stimulation for Dyskinesia and Dystonia: A Literature Review. Neurol Med Chir (Tokyo) 2016; 56:236-48. [PMID: 27053331 PMCID: PMC4870178 DOI: 10.2176/nmc.ra.2016-0002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/01/2016] [Indexed: 12/11/2022] Open
Abstract
Deep brain stimulation (DBS) has been an established surgical treatment option for dyskinesia from Parkinson disease and for dystonia. The present article deals with the timing of surgical intervention, selecting an appropriate target, and minimizing adverse effects. We provide an overview of current evidences and issues for dyskinesia and dystonia as well as emerging DBS technology.
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Affiliation(s)
- Hiroki TODA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Kita, Osaka
| | - Hidemoto SAIKI
- Department of Neurology, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Kita, Osaka
| | - Namiko NISHIDA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Kita, Osaka
| | - Koichi IWASAKI
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Kita, Osaka
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Diaz MCB, Rosales RL. A Case Report on Dyskinesia Following Rivastigmine Patch 13.3 mg/24 hours for Alzheimer's Disease: Perspective in the Movement Disorders Spectrum Following Use of Cholinesterase Inhibitors. Medicine (Baltimore) 2015; 94:e1364. [PMID: 26313774 PMCID: PMC4602930 DOI: 10.1097/md.0000000000001364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Current reports on movement disorder adverse effects of acetylcholinesterase inhibitors only include extrapyramidal symptoms and myoclonus.Here is a case of an 81-year-old female Filipino with dementia who presented with first-onset generalized choreiform movements.The etiology of the clinical finding of dyskinesia was investigated through laboratories, neuroimaging, and electroencephalogram, all of which yielded negative results. Review of her medications included the rivastigmine (Exelon) patch, which had just been increased to 13.3 mg/24-hour-dose 3 months prior. With all other possible causes excluded, a trial discontinuation of rivastigmine, showed decreased frequency of the dyskinesia 48 hours after, with complete resolution after 6 days, and no recurrence since then.This case thus presents a probable association or causality between the choreiform movement and rivastigmine at 13.3 mg/24-hour-dose patch because of clear temporal proximity, lack of alternative explanations, and a reversal of the dyskinesia upon medicament discontinuation.
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Affiliation(s)
- Maria Cristina B Diaz
- From the Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Espana, Manila, Philippines
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Boyraz I, Uysal H, Koc B, Sarman H. Clonus: definition, mechanism, treatment. Med Glas (Zenica) 2015; 12:19-26. [PMID: 25669332] [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] [Received: 09/04/2014] [Revised: 12/22/2014] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
Clonus is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons. Clonus may be found at the ankle, patella, triceps surae, wrist, jaw, biceps brachii. In general, clonus may occur in any muscle with a frequency of 5-8 Hz and the average period of oscillations of the ankle clonus is approximately 160-200 ms. Plantar flexion (PF) comprises 45% of the period, dorsifleksion (DF) comprises 55% of the period. The first beat is always longer, with the time shortening in continuing beats and becoming stable in the 4th or 5th period. The exact mechanism of clonus remains unclear. Two different hypotheses have been asserted regarding the development of clonus. The most widely accepted explanation is that hyperactive stretch reflexes in clonus are caused by self-excitation. Another alternative explanation for clonus is central generator activity that arises as a consequence of appropriate peripheral events and produces rhythmic stimulation of the lower motor neurons. The durations of clonus burst were found longer than the durations of Soleus medium-latency reflex (MLR). There is a similarity in their nature, although the speed and cause of the stretch of triceps surae differ in the MLR and the clonus, and there is a sufficient period of time for group II afferents and for other spinal mechanisms to be involved in the clonus, together with Ia afferents. Clonus can be treated by using baclofen, applying cold, botox or phenol injections.
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Affiliation(s)
- Ismail Boyraz
- Physical Medicine and Rehabilitation, Abant Izzet Baysal University, Bolu, Turkey
| | - Hilmi Uysal
- Neurology, Akdeniz University Hospital, Antalya, Turkey
| | - Bunyamin Koc
- Physical Medicine and Rehabilitation, Abant Izzet Baysal University, Bolu, Turkey
| | - Hakan Sarman
- Orthopeadics Department, Abant Izzet Baysal University, Bolu, Turkey
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Dexel J, Kopkow C, Kasten P. [Scapulothoracic dysbalance in overhead athletes. Causes and therapy strategies]. Orthopade 2014; 43:215-222. [PMID: 24595989 DOI: 10.1007/s00132-013-2143-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND A key element for movement of the arm is the position and motion of the scapula. A stable basis for efficient arm function is only possible if the scapula makes three dimensional movements coordinated with the upper arm. AIM This article presents a discussion of causes, diagnosis and therapy options for scapular dyskinesis. MATERIAL AND METHODS The article is based on a literature search in the PubMed database and taking own experience into account. RESULTS Soft tissue and bony injuries, muscle insufficiency and dysbalance can alter the position and function of the scapula. This pathological position and motion is called scapular dyskinesis. This clinically presents as a prominent medial border and malrotation (lacking external rotation and posterior tilt) of the scapula when raising the arm. The clinical examination includes a visual inspection followed by clinical tests of the scapula at rest and during movement. Specific exercises of the musculature surrounding the scapula and specific techniques for schooling the senses for positioning and movement can harmonize the sequence of movements and restore the dynamic scapular stability. CONCLUSION A conservative stepwise and stage-adapted exercise program can be used to treat scapular dyskinesis with good results.
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Affiliation(s)
- J Dexel
- Sektion Schulter, Ellenbogen, Hand, Universitätscentrum Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74 , 01307, Dresden, Deutschland
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Meliucheva LA. [Electrophysiological control of stereotactic method for treatment of neuromotor dyskinesia and epilepsy]. ACTA ACUST UNITED AC 2013; 39:125-33. [PMID: 23789392 DOI: 10.7868/s0131164613020094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The results of electrophysiological control of stereotactic method for patient treatment are introduced. There are patients with Parkinsonian disease or some forms of neuromotor dyskinesia and epilepsy. Our practice declared that different diseases can be corrected by electrostimulations or mycrodestruction the same brain deep structures. We can say that the pathophysiological mechanisms of formation these diseases are similar and have some common characters.
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Alvarez V, Rossetti AO, Michel P, Kuntzer T, Nater B, Démonet JF, Schluep M, Du Pasquier R, Vingerhoets F. [2012: news in neurology]. Rev Med Suisse 2013; 9:62-65. [PMID: 23367707] [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: 06/01/2023]
Abstract
In 2012, intramuscular midazolam appears as effective as intravenous lorezepam for the first line treatment of convulsive status epilepticus. Perampanel, a new anti-epileptic drug, will be soon available. Two oral treatments are now available for stroke prevention in atrial fibrillation setting. The methylphenidate and the Tai Chi could increase the walk capacity of patients suffering from Parkinson disease. A comprehensive cardiac work-up is essential for some congenital myopathy. A new drug against migraine seems free from vasoconstrictive effect. Antioxidants are harmful in Alzheimer disease. Some oral medication will be available for multiple sclerosis.
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Affiliation(s)
- V Alvarez
- Service de neurologie, Département des neurosciences cliniques, CHUV, Lausanne.
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Borloz S, Graf V, Gard S, Ziltener JL. [Scapular dyskinesis]. Rev Med Suisse 2012; 8:2422-2428. [PMID: 23346745] [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: 06/01/2023]
Abstract
The scapula plays a crucial role for proper shoulder function, serving as a stable base for rotator cuff activation and as a link in the kinetic chain. Joint, ligament or muscular problems near the scapula can lead to malpositions or to an altered movement pattern. This abnormal situation is called "scapular dyskinesis", which appears to be a non-specific response to a painful condition of the shoulder. The clinical examination of the scapula is crucial for every patient presenting a painful shoulder. Systematic observation and testing enable the practitioner to detect subtle static and dynamic abnormalities. Visual evaluation, objective measurements and corrective manoeuvres can evaluate the role of the "scapular dyskinesis" in the shoulder painful condition. The scapular rehabilitation will address muscular retractions and imbalances and restore a good dynamic stability, starting with analytical work, and evolving into more functional and specific exercises.
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Affiliation(s)
- Stéphane Borloz
- Unité de médecine physique et rééducation orthopédique, Département de chirurgie, HUG, 1211 Genève 14
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Abstract
Deep brain stimulation (DBS) has developed during the past 20 years as a remarkable treatment option for several different disorders. Advances in technology and surgical techniques have essentially replaced ablative procedures for most of these conditions. Stimulation of the ventralis intermedius nucleus of the thalamus has clearly been shown to markedly improve tremor control in patients with essential tremor and tremor related to Parkinson disease. Symptoms of bradykinesia, tremor, gait disturbance, and rigidity can be significantly improved in patients with Parkinson disease. Because of these improvements, a decrease in medication can be instrumental in reducing the disabling features of dyskinesias in such patients. Primary dystonia has been shown to respond well to DBS of the globus pallidus internus. The success of these procedures has led to application of these techniques to multiple other debilitating conditions such as neuropsychiatric disorders, intractable pain, epilepsy, camptocormia, headache, restless legs syndrome, and Alzheimer disease. The literature analysis was performed using a MEDLINE search from 1980 through 2010 with the term deep brain stimulation, and several double-blind and larger case series were chosen for inclusion in this review. The exact mechanism of DBS is not fully understood. This review summarizes many of the current and potential future clinical applications of this technology.
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Affiliation(s)
- Mark K Lyons
- Department of Neurological Surgery, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
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28
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Zhang HM, Tang Q. [Rehabilitation evaluation on post-stroke abnormal movement pattern prevented and treated with acupuncture and rehabilitation]. Zhongguo Zhen Jiu 2011; 31:487-492. [PMID: 21739685] [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: 05/31/2023]
Abstract
OBJECTIVE To explore the impacts of acupuncture and rehabilitation on post-stroke abnormal patterns of limb movement and evaluate them via rehabilitation method. METHODS Ninety cases of post-stroke movement disorder were randomly divided into an acupuncture-rehabilitation group, a body acupuncture group and a medication group, 30 cases in each group. In medication group, the conventional medication in neurological department was administered. In acupuncture-rehabilitation group and body acupuncture group, on the basis of the therapy as medication group, scalp acupuncture (such as parietal area and anterior parietal area, etc.), rehabilitation training and traditional body acupuncture [such as Jianyu (LI 15) and Fengshi (GB 31),etc.] were supplemented. The continuous electric stimulation was applied in body acupuncture group. The treatment lasted for 8 weeks. The assessment of clinical efficacy, Fugl-Meyer score, Modified Ashworth scale (MAS), range of motion (ROM) and shoulder pain score were taken as observation indices for rehabilitation evaluation before and after treatment in each group. RESULTS The effective rate was 93.1% (27/29) in acupuncture-rehabilitation group, which was superior to 66.7% (20/30) in body acupuncture group and 57.1% (16/28) in control group (both P<0.01) separately. After treatment, Fugl-Meyer score, MAS, ROM of the lower limbs and shoulder joint and shoulder pain score (except medication group) were all remarkably improved as compared with those before treatment in each group (all P<0.01). The improvements in Fugl-Meyer score, MAS, ROM of the upper limbs and shoulder pain score in acupuncture-rehabilitation group were significantly superior to those in body acupuncture group and medication group (P<0.05, P<0.01). CONCLUSION Acupuncture and rehabilitation therapy and traditional body acupuncture remarkably improve in post-stroke movement disorder. But acupuncture and rehabilitation therapy is apparently superior to traditional body acupuncture. This therapy can effectively prevent and treat post-stroke abnormal patterns and it is greatly significant in the improvement of survival quality for the patients.
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Affiliation(s)
- Hui-min Zhang
- Acupuncture Department, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
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Nicolelis MA, Fuentes R, Petersson P, Thevathasan W, Brown P. Spinal cord stimulation failed to relieve akinesia or restore locomotion in Parkinson disease. Neurology 2010; 75:1484; author reply 1484-5. [PMID: 20956795 DOI: 10.1212/wnl.0b013e3181f46f10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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31
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El Otmani H, Moutaouakil F, Fadel H, Slassi I. [Painful legs and moving toes syndrome associated with lumbar radiculopathy]. Rev Neurol (Paris) 2009; 165:980-3. [PMID: 19446858 DOI: 10.1016/j.neurol.2009.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/22/2008] [Revised: 12/30/2008] [Accepted: 01/21/2009] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Painful legs and moving toes (PLMT) is a rare syndrome characterized by spontaneous neuropathic pain in the lower limbs associated with peculiar involuntary movements of the toes. It has been associated with a variety of peripheral and central nervous system diseases. Pathophysiology is unclear and treatment approaches remain largely empirical. CLINICAL CASE We report a case of a 42-year-old women with typical presentation of PLMT syndrome, associated with lumbar (L5) disc prolapse. Oxcarbazepine gave a partial improvement. CONCLUSION Clinical presentations and etiological aspects of the PLMT syndrome are described and pathophysiological mechanisms and therapeutic possibilities discussed.
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Affiliation(s)
- H El Otmani
- Service de neurologie, hôpital Al Kortobi, 90000 Tanger, Maroc.
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34
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Rodrigues JP, Walters SE, Watson P, Stell R, Mastaglia FL. Globus pallidus stimulation improves both motor and nonmotor aspects of quality of life in advanced Parkinson's disease. Mov Disord 2008; 22:1866-70. [PMID: 17659634 DOI: 10.1002/mds.21427] [Citation(s) in RCA: 45] [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: 11/06/2022] Open
Abstract
Our purpose was to measure the change in quality of life (QoL) following deep brain stimulation of the globus pallidus interna (GPi-DBS) in advanced Parkinson 's disease (PD), and identifies any associations with changes in motor features of the disease. Eleven patients (age range 54-69 years, 2 women) underwent GPi-DBS (4 unilateral, 7 bilateral). Outcome measures included assessment of PD-specific QoL (mean 8 months postsurgery) using the PDQ-39 questionnaire, and standard motor assessments. Off-period UPDRS III motor scores fell by (43 +/- 8)% (mean +/- SEM). Dyskinesia severity was reduced on the abnormal involuntary movement scale by (80 +/- 3)% and UPDRS IVa by (58 +/- 8)%. QoL as assessed by the PDQ39SI improved by (30 +/- 5)%, with significant improvements in mobility, activities of daily living, bodily discomfort, emotional wellbeing, communication, and cognitions subscales. Bilateral and unilateral groups demonstrated equivalent PDQ39SI improvement. QoL improvement was highly correlated with dyskinesia reduction but not reduction in UPDRS score or age at surgery. GPi-DBS markedly improves QoL in advanced PD. The impacts are broad and improve QoL domains not directly affected by the motor symptoms of the disease. Reduced dyskinesia plays a major role in the improvement of QoL in GPi-DBS treated patients.
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Affiliation(s)
- Julian P Rodrigues
- Centre for Neuromuscular and Neurological Disorders, Australian Neuromuscular Research Institute, University of Western Australia, Nedlands, Western Australia, Australia.
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35
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Gold SJ, Hoang CV, Potts BW, Porras G, Pioli E, Kim KW, Nadjar A, Qin C, LaHoste GJ, Li Q, Bioulac BH, Waugh JL, Gurevich E, Neve RL, Bezard E. RGS9-2 negatively modulates L-3,4-dihydroxyphenylalanine-induced dyskinesia in experimental Parkinson's disease. J Neurosci 2007; 27:14338-48. [PMID: 18160641 PMCID: PMC6673430 DOI: 10.1523/jneurosci.4223-07.2007] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 11/11/2007] [Indexed: 11/21/2022] Open
Abstract
Chronic L-dopa treatment of Parkinson's disease (PD) often leads to debilitating involuntary movements, termed L-dopa-induced dyskinesia (LID), mediated by dopamine (DA) receptors. RGS9-2 is a GTPase accelerating protein that inhibits DA D2 receptor-activated G proteins. Herein, we assess the functional role of RGS9-2 on LID. In monkeys, Western blot analysis of striatal extracts shows that RGS9-2 levels are not altered by MPTP-induced DA denervation and/or chronic L-dopa administration. In MPTP monkeys with LID, striatal RGS9-2 overexpression--achieved by viral vector injection into the striatum--diminishes the involuntary movement intensity without lessening the anti-parkinsonian effects of the D1/D2 receptor agonist L-dopa. In contrasts, in these animals, striatal RGS9-2 overexpression diminishes both the involuntary movement intensity and the anti-parkinsonian effects of the D2/D3 receptor agonist ropinirole. In unilaterally 6-OHDA-lesioned rats with LID, we show that the time course of viral vector-mediated striatal RGS9-2 overexpression parallels the time course of improvement of L-dopa-induced involuntary movements. We also find that unilateral 6-OHDA-lesioned RGS9-/- mice are more susceptible to L-dopa-induced involuntary movements than unilateral 6-OHDA-lesioned RGS9+/+ mice, albeit the rotational behavior--taken as an index of the anti-parkinsonian response--is similar between the two groups of mice. Together, these findings suggest that RGS9-2 plays a pivotal role in LID pathophysiology. However, the findings also suggest that increasing RGS9-2 expression and/or function in PD patients may only be a suitable therapeutic strategy to control involuntary movements induced by nonselective DA agonist such as L-dopa.
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Affiliation(s)
- Stephen J. Gold
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Chau V. Hoang
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Bryan W. Potts
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Gregory Porras
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5227, Universite Victor Segalen-Bordeaux 2, 33076 Bordeaux, France
| | - Elsa Pioli
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5227, Universite Victor Segalen-Bordeaux 2, 33076 Bordeaux, France
| | - Ki Woo Kim
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Agnes Nadjar
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5227, Universite Victor Segalen-Bordeaux 2, 33076 Bordeaux, France
| | - Chuan Qin
- Institute of Lab Animal Sciences, Chinese Academy of Medical Sciences, 100021 Beijing, China
| | - Gerald J. LaHoste
- Department of Psychology, University of New Orleans, New Orleans, Louisiana 70148
| | - Qin Li
- Institute of Lab Animal Sciences, Chinese Academy of Medical Sciences, 100021 Beijing, China
| | - Bernard H. Bioulac
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5227, Universite Victor Segalen-Bordeaux 2, 33076 Bordeaux, France
| | - Jeffrey L. Waugh
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390
| | - Eugenia Gurevich
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, and
| | - Rachael L. Neve
- Department of Genetics, Harvard Medical School, Belmont, Massachusetts 02478
| | - Erwan Bezard
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5227, Universite Victor Segalen-Bordeaux 2, 33076 Bordeaux, France
- Institute of Lab Animal Sciences, Chinese Academy of Medical Sciences, 100021 Beijing, China
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Abstract
Parkinson's disease (PD), a slowly, progressive degenerative disorder of the central nervous system, which affects about ten million people world-wide, is currently treated symptomatically. Current treatment aim i. e. to balance the decreased dopamine turnover in striatal neurons. Chronic exposure to dopaminergic agents, however, supports onset of motor complications and dyskinesia in the long term. Dyskinesia appear mainly as chorea, athetosis, dystonia, stereotypia, ballism or a combination. Sometimes excessive abnormal facial, body and limb movements depend on the overall dosage of dopaminergic substitution. This is why the main therapy is based on reducing the total dosage of dopaminergic substances. Either alternative or additional well-tried substances like apomorphine, amantadine or clozapine are used. New possibilities in treatment emerge from substances like sarizotan, istradefylline, fipampezol or talampanel. Even so disability and reduced quality of life in PD patients and their caregivers may exist. This survey describes the major clinical features, aetiology and demographics of treatment-associated dyskinesia in PD.
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Affiliation(s)
- G Ellrichmann
- Neurologische Klinik im St. Josef-Hospital, Ruhr Universität Bochum.
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Abstract
OBJECTIVE To perform a review of the epidemiology, pathogenesis, clinical presentation, diagnosis and management of laryngeal dyskinesia. METHODS A search of the Medline database from 1966 to 2003 was performed. A manual search was performed of the references of each article. RESULTS Laryngeal dyskinesia is a respiratory condition characterized by abnormal vocal cord adduction and airflow limitation at the level of the larynx in the absence of evidence of local organic disease. It typically presents to the ED as wheeze, stridor or apparent upper airway obstruction. It occurs across a wide age range, is more common in females, and is typically associated with a range of underlying psychopathologies. Diagnosis is often delayed and unnecessary emergency treatment such as intubation and tracheostomy is not uncommon. Patients are commonly on high-dose steroids and are frequent users of the health-care system, often over prolonged periods. There are multiple diagnostic features on history and examination, and flexible nasendoscopy of the vocal cords in the ED can be used to confirm the diagnosis. Treatment options in the ED include sedation and use of continuous positive airway pressure. Long-term treatment involves a multidisciplinary approach involving respiratory physicians/ear, nose and throat surgeons, speech therapy and psychiatry. CONCLUSION Laryngeal dyskinesia remains an under-appreciated cause of respiratory presentations to the ED. Emergency physicians are ideally placed to make the diagnosis and initiate appropriate referral for specific therapies that have a high level of success.
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Affiliation(s)
- Sean G Lawrence
- Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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Herzog J, Pinsker M, Wasner M, Steigerwald F, Wailke S, Deuschl G, Volkmann J. Stimulation of subthalamic fibre tracts reduces dyskinesias in STN-DBS. Mov Disord 2007; 22:679-84. [PMID: 17266046 DOI: 10.1002/mds.21387] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [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: 11/11/2022] Open
Abstract
Rarely, the postoperative management of patients with subthalamic deep brain stimulation (STN-DBS) is complicated by pharmacologically intractable dyskinesias. Here we report that in three of these patients additional stimulation of a proximal contact located within the subthalamic white matter may lead to a significant reduction of dyskinesias associated with STN-DBS. We propose that pallidofugal fiber tracts play a major role in the etiopathology of dyskinesias and their blockade through DBS may explain our observations.
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Affiliation(s)
- J Herzog
- Department of Neurology, Neurozentrum, Christian-Albrechts-Universität Kiel, Kiel, Germany
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39
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Abstract
This article reviews four of the involuntary hyperkinetic motor disorders that affect the orofacial region: bruxism, orofacial dystonia, oromandibular dyskinesia, and medication-induced extrapyramidal syndrome-dystonic reactions. It discusses and contrasts the clinical features and management strategies for spontaneous, primary, and drug-induced motor disorders in the orofacial region. The article provides a list of medications that have been reported to cause drug-related extrapyramidal motor activity, and discusses briefly the genetic and traumatic events that are associated with spontaneous dystonia. Finally, it presents an approach for management of the orofacial motor disorders. The contraindications, side effects, and usual approach for medications and injections are covered. An overview of the indications, contraindications, and complications of using botulinum toxin as a therapeutic modality is discussed briefly.
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Affiliation(s)
- Glenn T Clark
- Department of Diagnostic Sciences, Orofacial Pain and Oral Medicine Center, University of Southern California School of Dentistry, 925 West 34th Street, Room B-14, Los Angeles, CA 90089-0641, USA.
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Gil-Robles S, Cif L, Biolsi B, Tancu C, El Fertit H, Coubes P. [Neurosurgical treatment in childhood dystonias and dyskinesias]. Rev Neurol 2006; 43 Suppl 1:S169-72. [PMID: 17061185] [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: 05/12/2023]
Abstract
AIM To present the post-surgery clinical results of deep brain stimulation of the internal globus pallidus (GPi) in a group of paediatric patients with primary and secondary dystonic-dyskinetic syndrome. PATIENTS AND METHODS Between November 1996 and May 2006, 121 patients were submitted to interventions with bilateral deep brain stimulation of the GPi, 58 of whom were children (age range: 5-16 years); 35 were cases of primary dystonia, of which 17 were carriers of the DYT1 mutation and 10 were not. A further 8 cases were myoclonic dystonias, 3 of whom presented the DYT11 mutation. With regard to the secondary dystonias, 4 were carriers of PKAN (pantothenate kinase-associated neurodegeneration) syndrome and 9 were cases of post-anoxic encephalopathies. RESULTS Percentage improvements were as follows: in the case of DYT1+ primary dystonias, 80% at one year maintained at 3 years; in cases of DYT1-, 70% at one year maintained at 3 years, and in the myoclonic dystonias, 50% at one year and 85% at 3 years. In the group of patients with secondary dystonias due to post-anoxic encephalopathies, we found an improvement of 30% at one year and 40% at 3 years; in the group with PKAN syndrome, the figures were 60% at one year and 50% at two years. CONCLUSIONS Treatment involving bilateral deep brain stimulation of the GPi nuclei in childhood cases of generalised dystonias is highly effective, the best prognoses being those offered by the group with primary dystonias and especially those related to the DYT1 mutation. Treatment also proved to be effective in the case of secondary dystonias, although with lower degrees of improvement.
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Affiliation(s)
- S Gil-Robles
- Centre Hospitalo Universitaire de Montpellier, Montpellier, Francia.
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Chung SJ, Jeon SR, Kim SR, Sung YH, Lee MC. Bilateral effects of unilateral subthalamic nucleus deep brain stimulation in advanced Parkinson's disease. Eur Neurol 2006; 56:127-32. [PMID: 16960454 DOI: 10.1159/000095704] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 07/12/2006] [Indexed: 11/19/2022]
Abstract
To investigate the bilateral effects of unilateral subthalamic nucleus deep brain stimulation (STN-DBS), we prospectively studied 9 consecutive advanced Parkinson's disease (PD) patients (2 men and 7 women) who underwent unilateral STN-DBS. Patients were evaluated preoperatively and at 3 and 6 months postoperatively with and without dopaminergic medications ('on' and 'off' medication, respectively). Postoperatively, patients were assessed with and without stimulation. We found that, when compared with baseline, the 'off' medication scores of the Unified Parkinson's Disease Rating Scale motor part (UPDRS III) and activities of daily living (UPDRS II) were improved by 37% (p = 0.028) and 50% (p = 0.046) at 6 months after surgery, respectively. Stimulation while 'off' medication improved the total UPDRS score by 42% (p = 0.028) at 6 months. At 6 months after surgery, the subscore of UPDRS III of body parts contralateral to the DBS implantation had improved by 48% (p = 0.028), and the ipsilateral subscore of UPDRS III and the axial subscore of UPDRS III had improved by 20% (p = 0.027) and 39% (p = 0.028), respectively. Daily dosage of levodopa was reduced by 15% at 6 months. No patient exhibited permanent side effects. These findings indicate that unilateral STN-DBS may be a reasonable surgical procedure for selected PD patients who have markedly asymmetric parkinsonism.
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Affiliation(s)
- Sun J Chung
- Center for Parkinsonism and Other Movement Disorders, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels C, Deutschländer A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J. A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med 2006; 355:896-908. [PMID: 16943402 DOI: 10.1056/nejmoa060281] [Citation(s) in RCA: 1830] [Impact Index Per Article: 101.7] [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: 11/19/2022]
Abstract
BACKGROUND Neurostimulation of the subthalamic nucleus reduces levodopa-related motor complications in advanced Parkinson's disease. We compared this treatment plus medication with medical management. METHODS In this randomized-pairs trial, we enrolled 156 patients with advanced Parkinson's disease and severe motor symptoms. The primary end points were the changes from baseline to six months in the quality of life, as assessed by the Parkinson's Disease Questionnaire (PDQ-39), and the severity of symptoms without medication, according to the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III). RESULTS Pairwise comparisons showed that neurostimulation, as compared with medication alone, caused greater improvements from baseline to six months in the PDQ-39 (50 of 78 pairs, P=0.02) and the UPDRS-III (55 of 78, P<0.001), with mean improvements of 9.5 and 19.6 points, respectively. Neurostimulation resulted in improvements of 24 to 38 percent in the PDQ-39 subscales for mobility, activities of daily living, emotional well-being, stigma, and bodily discomfort. Serious adverse events were more common with neurostimulation than with medication alone (13 percent vs. 4 percent, P<0.04) and included a fatal intracerebral hemorrhage. The overall frequency of adverse events was higher in the medication group (64 percent vs. 50 percent, P=0.08). CONCLUSIONS In this six-month study of patients under 75 years of age with severe motor complications of Parkinson's disease, neurostimulation of the subthalamic nucleus was more effective than medical management alone. (ClinicalTrials.gov number, NCT00196911 [ClinicalTrials.gov].).
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Apetauerova D, Ryan RK, Ro SI, Arle J, Shils J, Papavassiliou E, Tarsy D. End of day dyskinesia in advanced Parkinson's disease can be eliminated by bilateral subthalamic nucleus or globus pallidus deep brain stimulation. Mov Disord 2006; 21:1277-9. [PMID: 16637040 DOI: 10.1002/mds.20896] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report the therapeutic effects of deep brain stimulation (DBS) in 2 patients with Parkinson's disease (PD) with severe end of dose dyskinesia that was resistant to medical therapy. In both patients, severe, end of day ballistic dyskinesias occurred when the last levodopa dose of the day was wearing off. Globus pallidus (GPi) DBS in 1 case and subthalamic (STN) DBS in the second case produced full resolution of end of day dyskinesia.
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Affiliation(s)
- Diana Apetauerova
- Department of Neurology, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
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Graff-Radford J, Foote KD, Rodriguez RL, Fernandez HH, Hauser RA, Sudhyadhom A, Rosado CA, Sanchez JC, Okun MS. Deep Brain Stimulation of the Internal Segment of the Globus Pallidus in Delayed Runaway Dyskinesia. ACTA ACUST UNITED AC 2006; 63:1181-4. [PMID: 16908749 DOI: 10.1001/archneur.63.8.1181] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 11/14/2022]
Abstract
BACKGROUND Dyskinesias that occur during a period without medication after embryonic cell transplantation have been commonly reported in double-blind trials; however, to date, they have not been reported in the few patients who participated in open-label pilot studies. DESIGN Single case observation with preoperative and postoperative data, and intraoperative single-cell physiology. PATIENT A patient who underwent embryonic cell transplantation in 1993 as part of the University of South Florida open-label study was referred for evaluation of intractable dyskinesia of the right arm. The dyskinesia was present during evaluation of the patient after a 12-hour period without medication and was clinically disabling. It was manifested as a severe groping movement of the hand. Intraoperative physiologic evaluation revealed decreased firing rates in the internal segment of the globus pallidus. RESULTS Deep brain stimulation of the internal segment of the globus pallidus resulted in resolution of the dyskinesia. CONCLUSION This case highlights the delayed development of runaway dyskinesia after a period without medication as an important potential long-term adverse effect of embryonic cell transplantation in patients with Parkinson disease.
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Affiliation(s)
- John Graff-Radford
- Department of Neurology, University of Florida Movement Disorders Center, University of Florida, Gainesville, FL, USA
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Pahwa R, Factor SA, Lyons KE, Ondo WG, Gronseth G, Bronte-Stewart H, Hallett M, Miyasaki J, Stevens J, Weiner WJ. Practice Parameter: Treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): [RETIRED]. Neurology 2006; 66:983-95. [PMID: 16606909 DOI: 10.1212/01.wnl.0000215250.82576.87] [Citation(s) in RCA: 381] [Impact Index Per Article: 21.2] [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: 11/15/2022] Open
Abstract
Objective: To make evidence-based treatment recommendations for the medical and surgical treatment of patients with Parkinson disease (PD) with levodopa-induced motor fluctuations and dyskinesia. To that end, five questions were addressed. 1. Which medications reduce off time? 2. What is the relative efficacy of medications in reducing off time? 3. Which medications reduce dyskinesia? 4. Does deep brain stimulation (DBS) of the subthalamic nucleus (STN), globus pallidus interna (GPi), or ventral intermediate (VIM) nucleus of the thalamus reduce off time, dyskinesia, and antiparkinsonian medication usage and improve motor function? 5. Which factors predict improvement after DBS?Methods: A 10-member committee including movement disorder specialists and general neurologists evaluated the available evidence based on a structured literature review including MEDLINE, EMBASE, and Ovid databases from 1965 through June 2004.Results, Conclusions, and Recommendations: 1. Entacapone and rasagiline should be offered to reduce off time (Level A). Pergolide, pramipexole, ropinirole, and tolcapone should be considered to reduce off time (Level B). Apomorphine, cabergoline, and selegiline may be considered to reduce off time (Level C). 2. The available evidence does not establish superiority of one medicine over another in reducing off time (Level B). Sustained release carbidopa/levodopa and bromocriptine may be disregarded to reduce off time (Level C). 3. Amantadine may be considered to reduce dyskinesia (Level C). 4. Deep brain stimulation of the STN may be considered to improve motor function and reduce off time, dyskinesia, and medication usage (Level C). There is insufficient evidence to support or refute the efficacy of DBS of the GPi or VIM nucleus of the thalamus in reducing off time, dyskinesia, or medication usage, or to improve motor function. 5. Preoperative response to levodopa predicts better outcome after DBS of the STN (Level B).
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Affiliation(s)
- R Pahwa
- University of Kansas Medical Center, Kansas City, USA
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Portman AT, van Laar T, Staal MJ, Rutgers AWF, Journee HL, Leenders KL. Chronic stimulation of the subthalamic nucleus increases daily on-time without dyskinesia in advanced Parkinson's disease. Parkinsonism Relat Disord 2006; 12:143-8. [PMID: 16460986 DOI: 10.1016/j.parkreldis.2005.10.007] [Citation(s) in RCA: 11] [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] [Received: 05/13/2005] [Revised: 10/18/2005] [Accepted: 10/25/2005] [Indexed: 11/21/2022]
Abstract
We assessed the efficacy of chronic stimulation of the subthalamic nucleus (STN-DBS) in 20 patients with Parkinson's disease (PD) by means of clinical assessments and patient diaries 12 months after surgery. STN-DBS reduced the UPDRS part III off-medication score by 33%, and successively improved complete daily on-time without dyskinesia at 12 months significantly. In conclusion, our study demonstrates the efficacy of chronic STN-DBS on motor features in a selected population of advanced PD patients. In addition to clinical assessments, patients' diaries serve as an essential tool to evaluate the functional motor status after STN-DBS.
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Affiliation(s)
- A T Portman
- Department of Neurology, University Medical Center, Groningen, The Netherlands
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Nowak DA, Tisch S, Hariz M, Limousin P, Topka H, Rothwell JC. Sensory timing cues improve akinesia of grasping movements in Parkinson's disease: A comparison to the effects of subthalamic nucleus stimulation. Mov Disord 2006; 21:166-72. [PMID: 16161152 DOI: 10.1002/mds.20657] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 11/10/2022] Open
Abstract
Five parkinsonian subjects with chronic bilateral stimulation of the subthalamic nucleus and five sex- and age-matched healthy controls grasped, lifted, and held an instrumented object. The grip-lift task was either performed at self-determined speed or in response to an auditory cuing signal. Parkinsonian subjects performed the task with subthalamic nucleus stimulation switched ON and OFF. In Parkinson's disease, stimulation of the subthalamic nucleus and the presentation of auditory timing cues improved akinesia of both the grasp and lift components of the task. The finding that auditory timing cues improve akinesia in the absence of subthalamic nucleus stimulation suggests that the basal ganglia are less involved in the control of movements made in response to environmental cues. However, subthalamic nucleus stimulation caused parkinsonian subjects to apply excessive grip forces, regardless of whether the movement was made under self-determined or externally guided speed conditions. This implies that subthalamic nucleus stimulation produces a generalized upregulation in the gain of all components of a movement without the subtlety of focused control that is required to normalize performance.
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Affiliation(s)
- Dennis A Nowak
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom.
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Abstract
OBJECTIVE To report the effects of noninvasive standard physical therapy (PT) interventions on an involuntary movement disorder after stroke. DESIGN Single case with clinical follow-up over 2 years. SETTING Inpatient stroke and rehabilitation services and outpatient clinic. PARTICIPANT A man with acute bilateral ballism after unilateral subthalamic infarction. INTERVENTIONS Rhythmic coordinated bilateral limb movements and firm tactile stimulation to the hand. MAIN OUTCOME MEASURES We had not anticipated that dyskinesia itself would specifically improve during treatment. Consequently, we used qualitative clinical observations, including review of videotaped performance, and self-reported limb control. Hypotheses concerning treatment effects were developed after data collection. RESULTS Involuntary movements recurrently improved within treatment sessions. CONCLUSIONS PT may improve dyskinesia after stroke. The benefit may be adjunctive or alternative to current invasive treatments of movement disorders after brain injury and merits confirmation. The improvements are consistent with current research indicating that (1) intact cortical, subcortical, cerebellar, and spinal areas interact to generate bilateral rhythmic limb movements that can overcome dyskinesia and (2) tactile stimulation can improve motor deficits associated with basal ganglia disorders. Finally, because functional activities assessments improved our evaluation of ballism, these should be routinely used along with conventional neurologic examination to assess involuntary movement disorders.
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Affiliation(s)
- Victor W Mark
- Department of Physical Medicine and Rehabilitation, University of Alabama, 619 19th Street, Birmingham, AL 25249, USA.
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Kamei T, Yoshioka T, Shirakawa Y, Sakamoto T, Murata A, Asari Y, Okumura T, Endo Y, Shimazu T, Tomioka J. [Guidelines for the treatment of acute chemical poisoning--10--symptomatic therapy. The measures against convulsions]. Chudoku Kenkyu 2005; 18:263-6. [PMID: 16119823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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