Negative Myoclonus Secondary to Thalamic Infarction: Case Report.

Background: Movement disorders are an infrequent presentation to stroke, and in this context, negative myoclonus is not among the most common movement disorders, hence we present a case of negative myoclonus secondary to thalamic stroke. Case: A 75 year old male presented with left central facial palsy and negative myoclonus on his left upper limb. He was submitted to a diagnostic workup, with evidence of a right thalamic stroke. He was started on Phenobarbital 50 mg and the movement disorder resolved. Conclusion: Given the relevance of cerebrovascular disease as a cause of morbidity and mortality, it is important to the clinician to be aware of the less typical presentations such as the observed in our case, in order to provide adequate care to the patient.

Use of botulinum toxin for movement disorders.

The term movement disorders encompasses all disorders hypokinetic and hyperkinetic, which were previously known as extrapyramidal syndromes. With the definition of movement disorders and their diagnostic criteria and classifications, new studies for therapeutics could be performed. New drugs were launched, functional neurosurgery was developed, and the introduction of botulinum toxin (BoNT) for hyperkinesias was introduced. BoNT is an important therapy for dystonia, tics, myoclonus, and tremors. The aim of this review is to present the new and well-established uses of BoNT for movement disorders.

Development of Hyperkinesias after Long-term Pallidal Stimulation for Idiopathic Segmental Dystonia.

BACKGROUND: Chronic deep brain stimulation (DBS) of the globus pallidus internus (GPi) has become an established treatment for dystonia. While bradykinetic symptoms may occur on chronic stimulation, the appearance of hyperkinetic movements has not been well characterized. CASE REPORT: We report on the development of hyperkinesias after more than 10 years of GPi DBS. DISCUSSION: Hyperkinesias may evolve upon long-term GPi DBS in dystonia. This might be related to a combined effect consisting of a reduced threshold for effective GPi stimulation for dystonia and spread of current to the globus pallidus externus.

Massive lamotrigine poisoning. A case report.

Lamotrigine (LTG) represents the most commonly prescribed of the so-called new generation antiepileptic drugs. We describe a child who was admitted to the emergency room because of generalized tonic-clonic status epilepticus followed by a complex neurological picture with hyperkinesia and acute ataxia as a result of a LTG intoxication. The experience on acute LTG intoxication is very limited in pediatrics. The present case provides information on the clinical picture related to LTG overdose and confirms that drug intoxications should be considered in the differential diagnosis strategy when severe and polymorphic neurological symptoms occur acutely.

Clinical insights into use of apomorphine in Parkinson's disease: tools for clinicians.

Apomorphine was introduced before the era of levodopa as a treatment for idiopathic Parkinson's disease (iPD). A number of practical obstacles were to be solved before a wider use of the drug was possible. Today, however, the drug is probably still underutilized. Apomorphine is a strong nonergoline D1 and D2 receptor agonist with a dopaminergic effect comparable with levodopa. In this review motor and non-motor indications for intermittent injections and subcutaneous apomorphine infusions are listed. The reduction of 'off' periods is more than 50% on infusion therapy and if monotherapy is achieved a significant reduction of pre-existing levodopainduced dyskinesias is seen. The aim of this review is to give practical insight into apomorphine treatment, highlighting side effects, and complications and device-related problems are discussed with advice on how to prevent or handle these, should they occur. A number of practical points including the apomorphine test, requirements of the clinical setting, how to increase adherence and troubleshooting are added.