Efficacy of a 5-day, intensive, multidisciplinary, outpatient physical and occupational therapy protocol in the treatment of functional movement disorders: A retrospective study.

BACKGROUND: The use of rehabilitation services has been shown to be beneficial for patients with functional movement disorders (FMD). However, there is great variability in the type of rehabilitation services utilized. In the present study we aimed at determining the efficacy of an intense outpatient physical rehabilitation program as a treatment modality for patients with FMD. METHODS: Eighteen participants underwent treatment in a specialized outpatient rehabilitation program utilizing a multidisciplinary approach for the treatment of FMD. Participants completed a series of tests on day one and day five of the program. RESULTS: Results indicated statistically significant improvements in all but one motor and gait outcomes in patients with functional movement disorders treated with physical rehabilitation. CONCLUSION: These results provide support for the continued use of physical and occupational therapy for functional movement disorder patients. Further research is needed to fully validate these findings and there remains a need for further study into multidisciplinary approaches that may be even more efficacious.

Therapeutic Applications of Botulinum Neurotoxin for Autonomic Symptoms in Parkinson's Disease: An Updated Review.

Parkinson's disease is the most common age-related motoric neurodegenerative disease. In addition to the cardinal motor symptoms of tremor, rigidity, bradykinesia, and postural instability, there are numerous non-motor symptoms as well. Among the non-motor symptoms, autonomic nervous system dysfunction is common. Autonomic symptoms associated with Parkinson's disease include sialorrhea, hyperhidrosis, gastrointestinal dysfunction, and urinary dysfunction. Botulinum neurotoxin has been shown to potentially improve these autonomic symptoms. In this review, the varied uses of botulinum neurotoxin for autonomic dysfunction in Parkinson's disease are discussed. This review also includes discussion of some additional indications for the use of botulinum neurotoxin in Parkinson's disease, including pain.

Heterozygous VPS13A and PARK2 Mutations in a Patient with Parkinsonism and Seizures.

Neuroacanthocytosis (NA) is a diverse group of disorders in which nervous system abnormalities co-occur with irregularly shaped red blood cells called acanthocytes. Chorea-acanthocytosis is the most common of these syndromes and is an autosomal recessive disease caused by mutations in the vacuolar protein sorting 13A (VPS13A) gene. We report a case of early onset parkinsonism and seizures in a 43-year-old male with a family history of NA. Neurologic examinations showed cognitive impairment and marked parkinsonian signs. MRI showed bilateral basal ganglia gliosis. He was found to have a novel heterozygous mutation in the VPS13A gene, in addition a heterozygous mutation in the PARK2 gene. His clinical picture was atypical for typical chorea-acanthocytosis (ChAc). The compound heterozygous mutations of VPS13A and PARK2 provide the most plausible explanation for this patient's clinical symptoms. This case adds to the phenotypic diversity of ChAc. More research is needed to fully understand the roles of epistatic interactions on phenotypic expression of neurodegenerative diseases.

Attitudes toward use and timing of deep brain stimulation: a patient's with DBS perspective.

OBJECTIVE: To guide responsive policy and better understand factors that might shape patients' decisions to have DBS earlier, we explore perspectives and attitudes toward earlier deep brain stimulation (DBS) of Parkinson disease (PD) patients with DBS. INTRODUCTION: Before the US Food and Drug Administration released its change of indication for the use of DBS for PD, several groups had performed DBS earlier in disease course. METHODS: We designed an online survey comprising Likert-type, multiple choice, and rank-order questions and distributed it to PD patients. We analyzed patient considerations for having chosen DBS and for choosing or rejecting to have DBS earlier, as well as factors potentially shaping perspectives around DBS and its timing. Data was analyzed using descriptive and inferential statistics. RESULTS: Among the 160 participants in the sample, the most important consideration for choosing DBS was the possibility of better symptomatic control compared to medication alone. The most important consideration for delaying DBS was possible ineffectiveness. 41.3 % (n = 66) of respondents supported earlier DBS use, 38.8 % (n = 62) did not, and the remainder (n = 30) were uncertain. Patients who supported earlier DBS use cited the possibility of better symptomatic control than with medication alone, while those who did not support earlier use felt that medication options should be exhausted first. CONCLUSION: Our results suggest that there are multiple factors shaping patient perceptions around earlier DBS implantation. Future work should compare perceptions before and after DBS implantation, as well as pair perceptions with clinical outcomes.