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JMD : Journal of Movement Disorders

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Volume 11(3); September 2018
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Review Articles
The Relationship between Saccades and Locomotion
Anshul Srivastava, Omar F. Ahmad, Christopher Pham Pacia, Mark Hallett, Codrin Lungu
J Mov Disord. 2018;11(3):93-106.   Published online August 9, 2018
DOI: https://doi.org/10.14802/jmd.18018
  • 11,231 View
  • 422 Download
  • 9 Citations
AbstractAbstract PDFSupplementary Material
Human locomotion involves a complex interplay among multiple brain regions and depends on constant feedback from the visual system. We summarize here the current understanding of the relationship among fixations, saccades, and gait as observed in studies sampling eye movements during locomotion, through a review of the literature and a synthesis of the relevant knowledge on the topic. A significant overlap in locomotor and saccadic neural circuitry exists that may support this relationship. Several animal studies have identified potential integration nodes between these overlapping circuitries. Behavioral studies that explored the relationship of saccadic and gait-related impairments in normal conditions and in various disease states are also discussed. Eye movements and locomotion share many underlying neural circuits, and further studies can leverage this interplay for diagnostic and therapeutic purposes.
Clinical and Imaging Features of Multiple System Atrophy: Challenges for an Early and Clinically Definitive Diagnosis
Hirohisa Watanabe, Yuichi Riku, Kazuhiro Hara, Kazuya Kawabata, Tomohiko Nakamura, Mizuki Ito, Masaaki Hirayama, Mari Yoshida, Masahisa Katsuno, Gen Sobue
J Mov Disord. 2018;11(3):107-120.   Published online August 9, 2018
DOI: https://doi.org/10.14802/jmd.18020
  • 13,324 View
  • 1,032 Download
  • 15 Citations
AbstractAbstract PDF
Multiple system atrophy (MSA) is an adult-onset, progressive neurodegenerative disorder. Patients with MSA show various phenotypes during the course of their illness, including parkinsonism, cerebellar ataxia, autonomic failure, and pyramidal signs. Patients with MSA sometimes present with isolated autonomic failure or motor symptoms/ signs. The median duration from onset to the concomitant appearance of motor and autonomic symptoms is approximately 2 years but can range up to 14 years. As the presence of both motor and autonomic symptoms is essential for the current diagnostic criteria, early diagnosis is difficult when patients present with isolated autonomic failure or motor symptoms/signs. In contrast, patients with MSA may show severe autonomic failure and die before the presentation of motor symptoms/signs, which are currently required for the diagnosis of MSA. Recent studies have also revealed that patients with MSA may show nonsupporting features of MSA such as dementia, hallucinations, and vertical gaze palsy. To establish early diagnostic criteria and clinically definitive categorization for the successful development of disease-modifying therapy or symptomatic interventions for MSA, research should focus on the isolated phase and atypical symptoms to develop specific clinical, imaging, and fluid biomarkers that satisfy the requirements for objectivity, for semi- or quantitative measurements, and for uncomplicated, worldwide availability. Several novel techniques, such as automated compartmentalization of the brain into multiple parcels for the quantification of gray and white matter volumes on an individual basis and the visualization of α-synuclein and other candidate serum and cerebrospinal fluid biomarkers, may be promising for the early and clinically definitive diagnosis of MSA.
Original Articles
Individual Therapeutic Singing Program for Vocal Quality and Depression in Parkinson’s Disease
Eun Young Han, Ji Young Yun, Hyun Ju Chong, Kyoung-Gyu Choi
J Mov Disord. 2018;11(3):121-128.   Published online August 9, 2018
DOI: https://doi.org/10.14802/jmd.17078
  • 9,424 View
  • 242 Download
  • 8 Citations
AbstractAbstract PDFSupplementary Material
Objective
Patients with Parkinson’s disease (PD) frequently experience depression associated with voice problems. Singing involves the use of similar muscles and the neural networks associated with vocal function and emotional response. The purpose of this study is to enhance vocal quality and depressive symptoms of patients with PD using individual singing program.
Methods
The Individual Therapeutic Singing Program for PD (ITSP-PD) was conducted by a certified music therapist. In total, nine PD patients with a subjective voice problem or depression participated in 6 sessions over 2 weeks. We measured the Maximum Phonation Time (MPT) via the Praat test, the Voice Handicap Index (VHI), the Voice-Related Quality of Life (V-RQOL) and the Geriatric Depression Scale (GDS).
Results
In total, 8 out of 9 patients completed all the sessions; 6 out of 8 patients participated in the follow-up test after 6 months. A statistically significant change in MPT (p = 0.011) was observed between the pre- and post-tests. The VHI (p = 0.035) and the GDS (p = 0.018) were significantly lower in the post-test. In the pre-, post-, and follow-up tests, the MPT (p = 0.030), V-RQOL (p = 0.008), and GDS (p = 0.009) were significantly changed.
Conclusion
The ITSP-PD based on neurological singing therapy for PD showed therapeutic possibility for vocal function and depression in patients with PD. Our findings suggest the need for a randomized study to examine the continuing positive effects of the ITSP-PD over a longer period of time.
Transfer Dysphagia Due to Focal Dystonia
Priyanka Samal, Vinay Goyal, Govind K Makharia, Chandan J Das, Sankar Prasad Gorthi, Vishnu V Y, Mamta Bhushan Singh, M V Padma Srivastava
J Mov Disord. 2018;11(3):129-132.   Published online September 30, 2018
DOI: https://doi.org/10.14802/jmd.17081
  • 5,148 View
  • 116 Download
  • 1 Citations
AbstractAbstract PDFSupplementary Material
Objective
The inability to propel a bolus of food successfully from the posterior part of the oral cavity to the oropharynx is defined as transfer dysphagia. The present case series describes the varied presentation of transfer dysphagia due to focal dystonia and highlights the importance of early detection by following up on strong suspicions.
Methods
We describe seven cases of transfer dysphagia due to focal dystonia. Transfer dysphagia as a form of focal dystonia may appear as the sole presenting complaint or may present with other forms of focal dystonia.
Results
Four out of seven patients had pure transfer dysphagia and had previously been treated for functional dysphagia. A high index of suspicion, barium swallow including videofluoroscopy, associated dystonia in other parts of the body and response to drug therapy with trihexyphenidyl/tetrabenazine helped to confirm the diagnosis.
Conclusion
Awareness of these clinical presentations among neurologists and non-neurologists can facilitate an early diagnosis and prevent unnecessary investigations.
Musculoskeletal Problems Affect the Quality of Life of Patients with Parkinson’s Disease
Young Eun Kim, Han-Joon Kim, Ji Young Yun, Woong-Woo Lee, Hui-Jun Yang, Jong-Min Kim, Beomseok Jeon
J Mov Disord. 2018;11(3):133-138.   Published online September 30, 2018
DOI: https://doi.org/10.14802/jmd.18022
  • 5,870 View
  • 130 Download
  • 8 Citations
AbstractAbstract PDF
Objective
Musculoskeletal problems are more common in patients with Parkinson’s disease (PD) than in normal elderly, but the impact of musculoskeletal problems on health-related quality of life (HRQoL) in patients with PD is unknown.
Methods
Four hundred consecutive patients with PD were enrolled for the evaluation of musculoskeletal problems and HRQoL. HRQoL was assessed by the 36-Item Short Form Health Survey, which comprised physical health and mental health.
Results
Of the total patients, 265 patients had musculoskeletal problems, and 135 patients did not have musculoskeletal problems. Patients with musculoskeletal problems reported lower levels of HRQoL in terms of physical health than did patients without musculoskeletal problems (p < 0.05). In women, all components of physical health were lower in patients with musculoskeletal problems than in patients without musculoskeletal problems (p < 0.05). Meanwhile, in men, only the bodily pain score of physical health was lower in patients with musculoskeletal problems than in patients without musculoskeletal problems. Mental health and physical health were negatively correlated with depression, Unified Parkinson’s Disease Rating Scale I & II scores, and pain severity from musculoskeletal problems, in that order (p < 0.01 for all).
Conclusion
These results suggest that musculoskeletal problems in patients with PD affect HRQoL significantly, mainly in terms of physical health rather than mental health and especially in women rather than men. Musculoskeletal problems should not be overlooked in the care of patients with PD.
Cognition, Olfaction and Uric Acid in Early de novo Parkinson’s Disease
Hwa Reung Lee, Joong Hyun Park, Sang Won Han, Jong Sam Baik
J Mov Disord. 2018;11(3):139-144.   Published online September 30, 2018
DOI: https://doi.org/10.14802/jmd.18037
  • 5,178 View
  • 136 Download
  • 4 Citations
AbstractAbstract PDF
Objective
Cognitive impairment is one of the nonmotor symptoms in Parkinson’s disease (PD), and olfactory dysfunction is used as a marker to detect premotor stages of PD. Serum uric acid (sUA) levels have been found to be a risk factor for PD. Our objective in this study was to examine whether sUA levels are associated with cognitive changes and olfactory dysfunction in early de novo PD patients.
Methods
The study participants included 196 de novo PD patients. We assessed cognitive function by the Korean versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment and assessed olfactory function by the Korean version of the Sniffin’ Sticks test.
Results
The mean sUA level was 4.7 mg/dL and was significantly lower in women than in men. Cognitive scores were lower in women, suggesting that sUA levels were related to cognitive function. The olfactory functions were not related to sUA level but were clearly associated with cognitive scores. Olfactory threshold, odor discrimination, and odor identification were all significantly related to cognitive scores.
Conclusion
We conclude that lower sUA levels were associated with cognitive impairment, not olfactory dysfunction, in de novo PD patients. This finding suggests that UA is neuroprotective as an antioxidant in the cognitive function of PD patients.
Case Report
A Patient with Myotonic Dystrophy Type 1 Presenting as Parkinsonism
Ji-Hyun Choi, Jee-Young Lee, Han-Joon Kim, Beomseok Jeon
J Mov Disord. 2018;11(3):145-148.   Published online September 30, 2018
DOI: https://doi.org/10.14802/jmd.18028
  • 4,478 View
  • 93 Download
AbstractAbstract PDF
The current body of literature contains 5 reports of myotonic dystrophy (DM) with parkinsonism: 4 reports of DM type 2 and 1 report of clinically suspected DM type 1. To date, there have been no genetically proven cases of DM type 1 with parkinsonism. Here, we report the first case of genetically proven DM type 1 and parkinsonism that developed ahead of muscle symptoms with bilateral putaminal, presynaptic dopaminergic deficits on imaging. A 54-year-old female patient presented with bradykinesia, axial and bilateral limb rigidity, stooped posture, and hypomimia, which did not respond to levodopa. At age 56, she developed neck flexion weakness. Examination showed bilateral facial weakness, percussion and grip myotonia, and electromyography confirmed myotonic discharges. A genetic study of DM type 1 showed a DMPK mutation. At age 58, gait freezing, postural instability, and frequent falling developed and did not respond to increasing doses of levodopa. At age 59, the patient died from asphyxia.
Letter to the editor
Chorea in Sporadic Creutzfeldt-Jakob Disease
Ai Huey Tan, Tsun Haw Toh, Soon Chai Low, Si Lei Fong, Kah Kian Chong, Kee Wei Lee, Khean Jin Goh, Shen-Yang Lim
J Mov Disord. 2018;11(3):149-151.   Published online August 9, 2018
DOI: https://doi.org/10.14802/jmd.18017
  • 4,555 View
  • 144 Download
  • 3 Citations
PDFSupplementary Material

JMD : Journal of Movement Disorders