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2.
World Neurosurg ; 133: 80-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574329

RESUMO

BACKGROUND: Bobble-head doll syndrome is a rare neurological syndrome presenting with repetitive anteroposterior head movements. It is usually associated with expansile cystic lesions in the third ventricular region. CASE DESCRIPTION: An 8-year-old boy presented with involuntary bobbling head movements. Magnetic resonance imaging of the brain revealed an extensive suprasellar cyst resulting in obstructive hydrocephalus. Endoscopic ventriculo-cysto-cisternostomy resulted in improved clinical outcome. CONCLUSIONS: Endoscopic ventriculo-cysto-cisternostomy is an effective, less-invasive technique in the treatment of suprasellar cysts that results in resolution of the bobbling head movements.


Assuntos
Cistos Aracnóideos/etiologia , Cistos do Sistema Nervoso Central/complicações , Discinesias/etiologia , Hidrocefalia/etiologia , Terceiro Ventrículo/anormalidades , Ventriculostomia/métodos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/cirurgia , Criança , Discinesias/diagnóstico por imagem , Discinesias/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Masculino , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Resultado do Tratamento
5.
Expert Opin Drug Saf ; 18(12): 1203-1218, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31619083

RESUMO

Introduction: Dyskinesia is a motor complication of Parkinson's disease (PD) characterized by clinical heterogeneity and complex pathogenesis and associated with long-term levodopa therapy. Recent and controversial views on the management of PD patients have suggested that overall dyskinesia rates, and particularly troublesome dyskinesia, may be declining due to more conservative levodopa dosing regimens, widespread availability and early introduction of deep brain stimulation, and use of continuous drug delivery strategies. Nevertheless, anti-dyskinetic agents continue to be evaluated in clinical trials and recent efforts have focused on non-dopaminergic drugs.Areas covered: In this review, the authors discuss the clinical phenomenology and current understanding of dyskinesia in PD with a focus on up-to-date therapeutic strategies to prevent and manage these drug-related involuntary movements.Expert opinion: The way dyskinesia in PD is currently managed should be changed and attention should be focused toward a more personalized medicine rather than a one-fits-all-approach. The correct identification of dyskinesia types and tailored treatments are crucial for a better management of these involuntary movements together with a holistic approach which considers additional influencing factors. The future for dyskinesia treatment is likely to be found in non-dopaminergic approaches, first set into motion by the introduction of amantadine.


Assuntos
Antiparkinsonianos/administração & dosagem , Discinesias/tratamento farmacológico , Doença de Parkinson/tratamento farmacológico , Animais , Antiparkinsonianos/efeitos adversos , Estimulação Encefálica Profunda , Sistemas de Liberação de Medicamentos , Discinesia Induzida por Medicamentos/prevenção & controle , Discinesias/etiologia , Discinesias/fisiopatologia , Humanos , Levodopa/administração & dosagem , Levodopa/efeitos adversos , Doença de Parkinson/fisiopatologia
6.
J Stroke Cerebrovasc Dis ; 28(10): 104287, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31351828

RESUMO

BACKGROUND: Movement disorders including hemichorea-hemiballism as the initial presentation of an acute ischemic stroke are uncommon. Structures outside of the deep subcortical areas such as the subthalamic nucleus or basal ganglia are rarely involved. CASE REPORT: We report a case of a 72-year-old man with vascular risk factors who presented with acute onset right-sided hemichorea-hemiballism. Metabolic-, infectious-, and toxic-related conditions were ruled out, his EEG was without epileptiform changes. An MRI confirmed an acute ischemic stroke in the parieto-occipital region without any subcortical structures involved. Atrial Fibrillation was later discovered during his hospitalization and was treated appropriately. CONCLUSIONS: Although rare, strokes outside of the subthalamic nucleus can result in hemichorea-hemiballism.


Assuntos
Fibrilação Atrial/complicações , Infarto Cerebral/etiologia , Coreia/etiologia , Discinesias/etiologia , Idoso , Fibrilação Atrial/diagnóstico , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/fisiopatologia , Coreia/diagnóstico , Coreia/fisiopatologia , Discinesias/diagnóstico , Discinesias/fisiopatologia , Humanos , Masculino
7.
Lakartidningen ; 1162019 Mar 26.
Artigo em Sueco | MEDLINE | ID: mdl-31192395

RESUMO

We present a case of hemichorea/hemiballism, a rare complication of hyperglycemia. Diagnosis is made clinically by signs of unilateral involuntary movements of the extremities combined with typical neuroradiological findings in the basal ganglia. Guidelines for treatment of the condition are lacking but in many cases correction for hyperglycemia is sufficient for full symptom relief. In other cases, symptomatic treatment with haloperidol and tetrabenazine can be used.


Assuntos
Coreia/etiologia , Discinesias/etiologia , Hiperglicemia/complicações , Idoso de 80 Anos ou mais , Antidiscinéticos/uso terapêutico , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/patologia , Coreia/tratamento farmacológico , Discinesias/tratamento farmacológico , Feminino , Haloperidol/uso terapêutico , Humanos , Hiperglicemia/diagnóstico por imagem , Hiperglicemia/terapia , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
8.
Expert Opin Pharmacother ; 20(11): 1405-1411, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31039621

RESUMO

Background: Gait disorders are common in Parkinson's disease patients who respond poorly to dopaminergic treatment. Blockade of adenosine A2A receptors is expected to improve gait disorders. Istradefylline is a first-in-class selective adenosine A2A receptor antagonist with benefits for motor complications associated with Parkinson's disease. Research design and methods: This multicenter, open-label, single-group, prospective interventional study evaluated changes in total gait-related scores of the Part II/III Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Freezing of Gait Questionnaire (FOG-Q) in 31 Parkinson's disease patients treated with istradefylline. Gait analysis by portable gait rhythmogram was performed. Results: MDS-UPDRS Part III gait-related total scores significantly decreased at Weeks 4-12 from baseline with significant improvements in gait, freezing of gait, and postural stability. Significant decreases in MDS-UPDRS Part II total scores and individual item scores at Week 12 indicated improved daily living activities. At Week 12, there were significant improvements in FOG-Q, new FOG-Q, and overall movement per 48 h measured by portable gait rhythmogram. Adverse events occurred in 7/31 patients. Conclusions: Istradefylline improved gait disorders in Parkinson's disease patients complicated with freezing of gait, improving their quality of life. No unexpected adverse drug reactions were identified. Trial registration: UMIN-CTR (UMIN000020288).


Assuntos
Antagonistas do Receptor A2 de Adenosina/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Purinas/uso terapêutico , Antagonistas do Receptor A2 de Adenosina/efeitos adversos , Administração Oral , Idoso , Esquema de Medicação , Discinesias/etiologia , Feminino , Marcha/fisiologia , Transtornos Neurológicos da Marcha/complicações , Transtornos Neurológicos da Marcha/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Estudos Prospectivos , Purinas/efeitos adversos , Qualidade de Vida , Resultado do Tratamento
9.
Epileptic Disord ; 21(2): 154-165, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31010798

RESUMO

Hyperkinetic seizures are usually associated with frontal lobe epilepsy. However, some patients have hyperkinetic seizures of temporal lobe origin. The semiological differences in hyperkinetic seizures between frontal and temporal lobe epilepsy have not been well studied. Here, we retrospectively assessed ictal semiology in order to distinguish between hyperkinetic seizures of frontal lobe origin and those of temporal lobe origin. We retrospectively reviewed data on patients who had undergone surgery for hyperkinetic seizures of temporal or frontal lobe origin and achieved favourable seizure outcomes (Engel Class I) with a minimum postoperative follow-up of 24 months. We reviewed seizure histories, imaging reports, video-EEG monitoring data, operative records, and pathological findings. We analysed and compared the hyperkinetic semiology of video-recorded seizures of temporal lobe origin and those of frontal lobe origin. Forty hyperkinetic seizures in eight patients (seven adult patients and one 12-year-old patient) with temporal lobe epilepsy and 45 hyperkinetic seizures in nine patients (eight adult patients and one 16-year-old patient) with frontal lobe epilepsy were analysed. Emotional facial expressions (such as fear, laughing, or anger), bilateral forceful elbow flexion, bilateral forceful grasping, facial flushing, and bilateral facial contraction were observed significantly more frequently in seizures of frontal lobe origin. Oroalimentary automatisms, seizures during wakefulness, salivation, and bilateral drop of the corners of the mouth were observed significantly more frequently in seizures of temporal lobe origin. Observation of a number of signs during hyperkinetic manifestations may help to predict whether a seizure originates from the frontal lobe or the temporal lobe.


Assuntos
Discinesias/fisiopatologia , Epilepsia do Lobo Frontal/fisiopatologia , Epilepsia do Lobo Temporal/fisiopatologia , Adolescente , Adulto , Criança , Discinesias/etiologia , Eletroencefalografia , Epilepsia do Lobo Frontal/complicações , Epilepsia do Lobo Frontal/diagnóstico , Epilepsia do Lobo Frontal/cirurgia , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/cirurgia , Seguimentos , Humanos , Estudos Retrospectivos , Gravação em Vídeo , Adulto Jovem
12.
Rinsho Shinkeigaku ; 59(3): 119-124, 2019 Mar 28.
Artigo em Japonês | MEDLINE | ID: mdl-30814448

RESUMO

Cell therapy for Parkinson's disease has a history of being applied clinically with aborted embryos as donor source. Efficacy of the therapy under the appropriate condition has been reported. Based on this experience and the advancement of stem cell technology, clinical trials of cell therapy with embryonic stem cells (ESCs) or induced pluripotent stem cells (iPSCs) are going to start soon in several countries. In Japan a physician-initiated clinical trial of iPSC-based therapy for Parkinson's disease has launched since 2018. This trial adopts allogeneic transplantation with a cell line from iPSC stock. This article discusses patient selection, procedure, and risk of the therapy. It also introduces the world's current situation of the cell therapy for Parkinson's disease.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos/métodos , Terapia Baseada em Transplante de Células e Tecidos/tendências , Células-Tronco Pluripotentes Induzidas/transplante , Doença de Parkinson/terapia , Transplante de Células-Tronco/métodos , Transplante de Células-Tronco/tendências , Animais , Autoenxertos , Carcinogênese , Terapia Baseada em Transplante de Células e Tecidos/efeitos adversos , Neurônios Dopaminérgicos , Discinesias/etiologia , Células-Tronco Embrionárias , Antígenos HLA , Histocompatibilidade , Humanos , Tolerância Imunológica , Células-Tronco Pluripotentes Induzidas/patologia , Risco , Transplante de Células-Tronco/efeitos adversos
13.
Medicine (Baltimore) ; 98(9): e14597, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817577

RESUMO

OBJECTIVE: This study aims to develop an assistive technology-180° rotating feeding spoon that could improve the ability of eating of self-care patients with upper extremity dyskinesia. METHODS: The Brunnstrom 6-stage rating of hemiplegia was adopted. During the different recovery stages of the upper limbs, the patients orally ate using a feeding spoon with a non-rotatory head and a 180° rotating feeding spoon. The ability of these patients to eat by themselves was observed, and the basic activity of daily living (BADL) was assessed using the Barthel index (BI). RESULTS: The Brunnstrom assessment scale was used to analyze the results of the patient's upper limb function examination, and the results revealed that the 180° rotating feeding spoon could assist patients with different degrees of upper limb dysfunction when eating independently. CONCLUSIONS: The 180° rotating feeding spoon can assist patients with upper limb dysfunction when eating independently. For patients with different degrees of upper limb dysfunction, the spoon can provide different degrees of aid.


Assuntos
Utensílios de Alimentação e Culinária , Discinesias/reabilitação , Hemiplegia/complicações , Autocuidado/instrumentação , Equipamentos de Autoajuda , Extremidade Superior , Idoso , Discinesias/etiologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Exp Neurol ; 317: 155-167, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30890329

RESUMO

Parkinson's disease (PD) is a neurodegenerative disease with affected individuals exhibiting motor symptoms of bradykinesia, muscle rigidity, tremor, postural instability and gait dysfunction. The current gold standard treatment is pharmacotherapy with levodopa, but long-term use is associated with motor response fluctuations and can cause abnormal movements called dyskinesias. An alternative treatment option is deep brain stimulation (DBS) with the two FDA-approved brain targets for PD situated in the basal ganglia; specifically, in the subthalamic nucleus (STN) and globus pallidus pars interna (GPi). Both improve quality of life and motor scores by ~50-70% in well-selected patients but can also elicit adverse effects on cognition and other non-motor symptoms. Therefore, identifying a novel DBS target that is efficacious for patients not optimally responsive to current DBS targets with fewer side-effects has clear clinical merit. Here, we investigate whether the ventroanterior (VA) and ventrolateral (VL) motor nuclei of the thalamus can serve as novel and effective DBS targets for PD. In the limb-use asymmetry test (LAT), hemiparkinsonian rats showcased left forelimb akinesia and touched only 6.5 ±â€¯1.3% with that paw. However, these animals touched equally with both forepaws with DBS at 10 Hz, 100 µsec pulse width and 100 uA cathodic stimulation in the VA (n = 7), VL (n = 8) or at the interface between the two thalamic nuclei which we refer to as the VA|VL (n = 12). With whole-cell patch-clamp recordings, we noted that VA|VL stimulation in vitro increased the number of induced action potentials in proximal neurons in both areas albeit VL neurons transitioned from bursting to non-bursting action potentials (APs) with large excitatory postsynaptic potentials time-locked to stimulation. In contrast, VA neurons were excited with VA|VL electrical stimulation but with little change in spiking phenotype. Overall, our findings show that DBS in the VA, VL or VA|VL improved motor function in a rat model of PD; plausibly via increased excitation of residing neurons.


Assuntos
Núcleos Anteriores do Tálamo , Estimulação Encefálica Profunda , Doença de Parkinson Secundária/terapia , Núcleos Ventrais do Tálamo , Potenciais de Ação , Animais , Discinesias/etiologia , Discinesias/terapia , Potenciais Pós-Sinápticos Excitadores , Membro Anterior , Lateralidade Funcional , Hidroxidopaminas , Masculino , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson Secundária/fisiopatologia , Técnicas de Patch-Clamp , Ratos , Ratos Sprague-Dawley
17.
Dtsch Med Wochenschr ; 144(3): 203-206, 2019 02.
Artigo em Alemão | MEDLINE | ID: mdl-30703842

RESUMO

INTRODUCTION: A non-ketotic hyperglycaemia may cause an affection of basalganglia and, in the following, lead to a hemiballism-hemichorea movement-disorder. HISTORY: A 68-year-old male patient was admitted at our ward with a subacute and painless hemichorea-hemiballism movement-disorder. FINDINGS AND DIAGNOSIS: Due to elevated levels of glycated haemoglobin, negative ketone bodies in the urine and characteristic changes of the striatum in MR-imaging the diagnosis of a non-ketotic hyperglycemia induced hemichorea-hemiballism was made. THERAPY AND COURSE: An antidiabetic treatment was applied using Metformin, Insulin glargin and Sitagliptin as well as a symptomatic treatment with Risperidon 3 mg. In the following, blood sugar levels normalized and a beginning regression of symptoms was observed. CONCLUSIONS: The exact pathophysiology of this phenomenon is still not fully understood and will need to be investigated. Nevertheless, this disease should always be taken into consideration if the typical clinical presentation as well as matching laboratory tests and imaging features are found.


Assuntos
Coreia , Discinesias , Hiperglicemia , Idoso , Coreia/diagnóstico , Coreia/etiologia , Discinesias/diagnóstico , Discinesias/etiologia , Humanos , Hiperglicemia/complicações , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Masculino , Metformina/uso terapêutico
19.
J Neurol ; 266(3): 631-635, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30631917

RESUMO

We describe the case of a 58-year-old patient with complete callosal agenesis, who developed after a stroke a long lasting and distressing diagonistic dyspraxia. We found two original treatments to relieve the patient from his left limb conflicting movements. Reinforcing left arm sensory input minimized dyspraxic movements but was difficult to apply daily and was found unsatisfactory by the patient. As left anarchic, unwished movements of diagonistic dyspraxia have been attributed to the lack of inhibition exerted by supplementary motor area on right motor cortex, we applied sham-controlled rTMS to the right motor cortex. This procedure provided a dramatic suppression of left-hand involuntary movements. To our knowledge, this is the first description of the successful treatment of diagonistic dyspraxia.


Assuntos
Agenesia do Corpo Caloso/patologia , Apraxias/terapia , Discinesias/terapia , Mãos/fisiopatologia , Córtex Motor/fisiopatologia , Acidente Vascular Cerebral/complicações , Estimulação Magnética Transcraniana/métodos , Agenesia do Corpo Caloso/diagnóstico por imagem , Apraxias/diagnóstico por imagem , Apraxias/etiologia , Apraxias/fisiopatologia , Discinesias/etiologia , Discinesias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia
20.
Ann Neurol ; 85(3): 352-358, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30675918

RESUMO

OBJECTIVE: There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. METHODS: The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38). RESULTS: A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92). INTERPRETATION: CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352-358.


Assuntos
Doenças Autoimunes do Sistema Nervoso/fisiopatologia , Doenças Autoimunes do Sistema Nervoso/psicologia , Encefalite/fisiopatologia , Encefalite/psicologia , Adolescente , Adulto , Idoso , Agressão/psicologia , Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Encefalite Antirreceptor de N-Metil-D-Aspartato/fisiopatologia , Encefalite Antirreceptor de N-Metil-D-Aspartato/psicologia , Ataxia/etiologia , Ataxia/fisiopatologia , Doenças Autoimunes/complicações , Doenças Autoimunes/fisiopatologia , Doenças Autoimunes/psicologia , Doenças Autoimunes do Sistema Nervoso/complicações , Delusões/psicologia , Discinesias/etiologia , Discinesias/fisiopatologia , Distonia/etiologia , Distonia/fisiopatologia , Encefalite/complicações , Encefalomielite Aguda Disseminada/complicações , Encefalomielite Aguda Disseminada/fisiopatologia , Encefalomielite Aguda Disseminada/psicologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Alucinações/psicologia , Humanos , Transtornos da Linguagem/etiologia , Transtornos da Linguagem/fisiopatologia , Encefalite Límbica/complicações , Encefalite Límbica/fisiopatologia , Encefalite Límbica/psicologia , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/fisiopatologia , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Reprodutibilidade dos Testes , Convulsões/etiologia , Convulsões/fisiopatologia , Índice de Gravidade de Doença , Adulto Jovem
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