Static and dynamic postural control: Comparison between community old adults and people with Parkinson's disease.

AIMS: To compare the static and dynamic postural control of people with Parkinson's disease and community old adults. METHODS: Thirty-five people were in the Parkinson's disease group (PDG; 12 women, 62.4 ± 11.0 years, 77.9 ± 15.6 kg, 166.5 ± 11.0 cm, 27.9 ± 3.8 kg/m2 , 1.9 ± 0.5 Hoehn & Yahr) and 32 were in the old adults group (OAG; 13 women, 69.5 ± 6.0 years, 74.2 ± 12.3 kg, 165.0 ± 8.3 cm, 27.2 ± 4.0 kg/m2 ). The static balance was measured on a force platform, three 30-s trials in four conditions: feet side-by-side (FSBS) and semi-tandem stance (ST) positioning, eyes open (EO) and eyes closed (EC). The total sway path length (SPL), sway area (SA), anterior-posterior (APSR) and medial-lateral (MLSR) sway range of the centre of pressure were obtained. Dynamic balance was assessed using the timed-up-and-go test (TUG). For comparison between groups and repeated-measures, a mixed-design ANOVA was carried out and the Mann-Whitney U test to compare TUG between groups. The significance level was set at p ≤ .05. RESULTS: Between groups, PDG presented higher mean values for SPL, APSR and SA in feet side-by-side eyes open compared to the OAG, for SPL in feet side-by-side eyes closed, for SPL and SA in STEO. For repeated-measures, both groups had higher mean values in the EC condition compared to EO and MLSR compared to APSR. No significant difference was found between groups for TUG. CONCLUSION: Balance disorders are found early in people with Parkinson's disease compared to healthy older adults. Thus, Parkinson's disease seems to advance the process of alterations in the postural control system.

Optimizing Prelemniscal Radiations as a Target for Motor Symptoms in Parkinson's Disease Treatment.

OBJECTIVE: To better define prelemniscal radiations (Raprl) as a target for the control of tremor and rigidity in Parkinson's disease (PD). METHODS: A total of 36 deep brain stimulation (DBS) electrodes were stereotactically implanted in Raprl contralateral to the extremities to be treated. Effects on symptoms were evaluated using UPDRS-III before and after DBS, and significance was determined using the Wilcoxon test. The location of DBS contacts in cases with optimum versus suboptimum results was evaluated using Student's t test and percentage improvement correlated through a bivariable Pearson test. The power and percentage of spike components for microelectrode recordings were statistically compared between the target point and structures located above and below. RESULTS: Raprl-DBS improved tremor and rigidity (p < 0.01). The potency of microelectrode recordings indicated that the target was formed by fibers. There was no correlation between demographic characteristics and clinical outcome, and there were no significant differences in stereotactic placement between cases with optimum and suboptimum results. Tremor and rigidity were selectively improved in cases with suboptimum results. CONCLUSION: Raprl-DBS is an effective treatment for the motor symptoms of PD. Selective improvement of symptoms suggests that the target has different fiber components related to either tremor or rigidity, and variations in improvement between cases may derive from individual variations of the location of these fibers.

Achados de ultrassonografia transcraniana na doença de Parkinson e no tremor essencial: relato de casos / Transcranial sonography findings in Parkinson's disease and essential tremor: cases report

A ultrassonografia transcraniana tem sido objeto de investigação como ferramenta diagnóstica em neurologia nos últimos anos. Ela permite boa visualização de estruturas cerebrais situadas na linha média, sítio frequente de anormalidades nas doenças do movimento. Relatamos os casos de pacientes com a doença de Parkinson e o tremor essencial em que a ultrassonografia transcraniana foi capaz de sugerir o diagnóstico.

Over the last years, transcranial sonography has been investigated as a diagnostic tool in neurology. It allows a good visualization of midline brain structures, a frequent site of involvement in movement disorders. The authors discuss cases of Parkinson's disease and essential tremor where transcranial sonography could suggest the diagnosis of the condition.

[The use of fibrolaryngoscopy in muscle tension dysphonia in telemarketers]. / Utilidad de la fibrolaringoscopía en la disfonía por tensión muscular en teleoperadores.

INTRODUCTION: Muscle tension dysphonia (MTD) is a voice disorder in the absence of current organic laryngeal pathology, without obvious psychogenic or neurological aetiology. The laryngeal features of MTD include a posterior glottal gap and supraglottic hyperfunctional activities; however, it remains unclear if these features are specific to MTD. This report aims to compare the laryngeal features in telemarketer patients with MTD versus non-dysphonic control subjects. METHODS: We reported on an observational, analytic and transversal study. Fiberoptic nasal endoscopy was performed on 57 patients (28 telemarketers with MTD and 29 control subjects). These random-sequence videotapes were independently rated by an expert laryngologist according to the modified Morrison and Rammage classification. In addition, a questionnaire about vocal symptoms and other details was completed. RESULTS: The posterior glottal gap was the most common feature in telemarketers with MTD, while incomplete glottal gap was observed more frequently in non-dysphonic patients. More than 70% of the videotapes were rated as pathologic. There was no statistical difference in the prevalence of normal features or bowing glottal gap between patients and control subjects. Anterior-posterior supraglottic contraction was more frequent in the control group. The major symptoms found were: voice gets tired quickly, increased vocal effort and neck tension. CONCLUSIONS: The heterogeneity in the laryngeal features in telemarketers with MTD seen under fibroscopy and their presence among the non-dysphonic population suggest that they cannot determine by themselves the diagnosis of MTD.

Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: long-term outcomes of 45 cases.

BACKGROUND: Posttraumatic knee stiffness is a very debilitating condition. Judet's quadricepsplasty technique has been used for more than 50 years. However, few reports of quadricepsplasty results exist in the literature. METHODS: We report the results of 45 cases of posttraumatic arthrofibrosis of the knee treated with Judet's quadricepsplasty. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). RESULTS: The degree of flexion increased from 33.6 degrees (range, 5­80 degrees) preoperatively to 105 degrees (range, 45­160 degrees)immediately after surgery, followed by a slight fall in the range of motion (ROM) in the late postoperative period, which reached an average of 84.8 degrees. There was no significant correlation between knee strength and the patient's gender, but there was a slight trend of lower strength with age. Although Judet's quadricepsplasty technique dates from more than 50 years ago, it still provides good outcomes in the treatment of rigid knees of various etiologies. In general, all cases showed the same pattern of a small decrease in the ROM in the late postoperative period. CONCLUSION: Judet's quadricepsplasty can increase the ROM of rigid knees. The ROM obtained with the surgery persists long term.

Behavioral effects of exposure to endosulfan and methyl parathion in adult rats.

Endosulfan (ES) and methyl parathion (MP) are widely used in Latin America, and simultaneous exposure to both products is documented. This exposure may have effects on the nervous system because their targets include the GABAergic and cholinergic systems, which are main modulators of neuronal excitability in the cortex and hippocampus. We tested whether low-level, repeated exposure of adult rats to commercial formulations containing ES and MP disrupts spatial learning in the water maze. Five groups of eight animals received subcutaneously appropriate dilutions of the commercial formulations to yield the following treatments during 10 days: saline, 25 mg/kg ES, 2 mg/kg MP (MP(2)), 25 mg/kg ES plus 1 mg/kg MP (ES+MP(1)) and 25 mg/kg ES plus 2 mg/kg MP (ES+MP(2)). In addition, markers of neurological function, renal and hepatic damage were explored as potential consequences of exposure. In the absence of overt toxicity, the groups exposed to the ES plus MP showed significantly longer escape latencies, higher number of failures to reach the platform and more time in the periphery of the tank than the control and single-exposed groups. This finding shows that commercial formulations of ES and MP have marginal effects when administered individually but can produce behavioral alterations when given in combination.

Subthalamic prelemniscal radiation stimulation for the treatment of Parkinson's disease: electrophysiological characterization of the area.

Previous reports have provided evidence of a reticulo-thalamic system, extending from the mesencephalic reticular formation (MRF) to the ventrolateral thalamus (VL), involved in the production of tremor. In humans, a funnel of fibers in the posterior subthalamus named the prelemniscal radiations (Raprl) has been described as an exquisite target to treat tremor in cases of Parkinson's disease. In the present study, a group of 14 patients suffering from Parkinson's disease, with prominent unilateral tremor and rigidity, were implanted with tetrapolar depth brain stimulation (DBS) electrodes in Raprl to perform chronic electrical stimulation (ES) for the treatment of patient symptoms. Electrodes were left externalized to corroborate their placement throughout MRI studies and also to perform the following electrophysiological battery: (a) recording of somatosensory-evoked responses (SEP) through different electrode contacts and scalp by means of a paradigm to study the attention process; (b) evoking scalp EEG responses by stimulation with low (3 cps, 6 cps) and high (60-120 cps) frequencies with stimuli delivered through different electrode contacts, and (c) studying recovery cycle (RC) potentials in the Raprl while the upper MRF was being stimulated and, conversely, the RC in MRF while Raprl was being stimulated, before and after subacute Raprl stimulation. Thereafter, the electrodes were internalized and connected to a pulse generator (IPG) to carry on chronic ES, while the effects of stimulation were determined through a quantitative evaluation that measured phasic and tonic muscular activity with EMG recordings during different motor tasks. Results indicate the following: (a) that late, but not early, SEP components were recorded in Raprl and modulated in different attentive conditions; (b) that bilateral recruiting responses and spike and wave complexes were elicited by Raprl through low-frequency stimulation, while bilateral positive DC shifts induced by high-frequency stimulation were recorded, similar to those obtained in animals from MRF, and (c) that Raprl-ES induced RC inhibition at Raprl, but Raprl ES did not change MRF-RC. Long-term Raprl-ES induced a significant decrease in tremor and rigidity. It was concluded that Raprl represents a subthalamic circuit electrophysiologically related to MRF in the genesis of tremor and rigidity and in the process of selective attention. Raprl-ES induced a significant improvement in tremor and rigidity by causing inhibition of the stimulated area.

Syndrome of continuous muscle fiber activity. Case report with 11-year follow-up.

A 16-year-old male patient who presented with muscle stiffness and dysphonia is described. Electromyography revealed continuous motor activity that was unaffected by peripheral nerve block or general anaesthesia, but was abolished by curare. The patient had a marked improvement after using phenytoin. The follow-up 11-years later corroborates with the proposed benignity of this syndrome, in spite of being dependent on medication.

Syndrome of continuous muscle fiber activity: case report with 11-year follow-up

É relatado o caso de um paciente de 16 anos de idade do sexo masculino com quadro de rigidez muscular e disfonia. Eletromiografia revelou atividade motora contínua que näo era alterada por bloqueio do nervo periférico ou anestesia geral, mas era abolida por curare. O paciente apresentou acentuada melhora após o uso de fenitoína. O seguimento do caso 11 anos mais tarde vem corroborar o proposto caráter benigno desta síndrome, apesar de o paciente ainda depender da medicaçäo

Neuroleptic malignant syndrome.

Neuroleptic malignant syndrome is a relatively uncommon life-threatening disorder. The widespread use of the neuroleptic and psychotropic medications, however, makes it important for the primary care physician to understand the clinical presentation, differential diagnosis, and management of neuroleptic malignant syndrome. Early recognition should be possible. Rapid diagnosis followed by aggressive supportive care and specific pharmacologic therapy can be life saving.

[Relationship of decerebrate rigidity maintenance with muscular contraction permanence after spinal cord section in dogs]. / Relações do tempo de manutenção da rigidez de descerebração com permanência de contratura muscular após transsecção da medula espinhal, em cães

The mammalian spinal cord seems to be capable of information retation in simmilar fashion to the cerebral cortex memory storation. The intercollicular transection otherwise, relieving bulbar and mesencephalic areas from cerebral and cerebelar influences produces tetanic contraction on antigravidity muscles due to somatory with stimuli originated from muscle spindle. This phenomena is very suitable to memory retention studies since myotatic reflex is monossinaptic, occurs in this case, on a simple nervous structure (the spinal cord) and can be easily identified and quantitified, through muscular responses. In the present work, decerebrate rigidity effects upon spinal cord before and after spinal section, was studied. Physiological parameters were recorded in order to maintain the experimental condition of the dogs, as close as possible to normal, Our results showed that thirty and forty-five minutes in time difference of decerebrate rigidity influence on spinal motoneurons has little effects in tetany persistance after spinal section. However, ninety minutes period of time between the two transections produces considerable increase in rigidity permanence after spinal cord section. The relationship of our results with differents types of memory and the basic mechanism involved in the response is unknown and will be the subject of future investigations.