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JMD : Journal of Movement Disorders

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Volume 12(1); January 2019
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Review Articles
Abnormal Eye Movements in Parkinsonism and Movement Disorders
Ileok Jung, Ji-Soo Kim
J Mov Disord. 2019;12(1):1-13.   Published online January 30, 2019
DOI: https://doi.org/10.14802/jmd.18034
  • 11,654 View
  • 726 Download
  • 18 Citations
AbstractAbstract PDFSupplementary Material
Abnormal eye movements are commonly observed in movement disorders. Ocular motility examination should include bedside evaluation and laboratory recording of ocular misalignment, involuntary eye movements, including nystagmus and saccadic intrusions/oscillations, triggered nystagmus, saccades, smooth pursuit (SP), and the vestibulo-ocular reflex. Patients with Parkinson’s disease (PD) mostly show hypometric saccades, especially for the selfpaced saccades, and impaired SP. Early vertical saccadic palsy is characteristic of progressive supranuclear palsy-Richardson’s syndrome. Patients with cortico-basal syndrome typically show a delayed onset of saccades. Downbeat and gaze-evoked nystagmus and hypermetric saccades are characteristic ocular motor findings in ataxic disorders due to cerebellar dysfunction. In this review, we discuss various ocular motor findings in movement disorders, including PD and related disorders, ataxic syndromes, and hyperkinetic movement disorders. Systemic evaluation of the ocular motor functions may provide valuable information for early detection and monitoring of movement disorders, despite an overlap in the abnormal eye movements among different movement disorders.
Pseudobulbar Affect in Parkinsonian Disorders: A Review
Mathew Hakimi, Carine W. Maurer
J Mov Disord. 2019;12(1):14-21.   Published online January 30, 2019
DOI: https://doi.org/10.14802/jmd.18051
  • 7,170 View
  • 252 Download
  • 8 Citations
AbstractAbstract PDF
Pseudobulbar affect (PBA) is a neurological symptom of inappropriate and uncontrollable laughter or crying that occurs secondary to a variety of neurological conditions, including parkinsonian disorders. PBA is a socially and emotionally debilitating symptom that has been estimated to affect 3.6% to 42.5% of the population with Parkinson’s disease. While indexing measures and treatment options for PBA have been extensively studied in neurological conditions such as amyotrophic lateral sclerosis and multiple sclerosis, there has been considerably less attention given in the literature to PBA in parkinsonian disorders. The purpose of this review is to discuss the pathophysiology of PBA, its prevalence and impact on quality of life in parkinsonian disorders, and the treatment options currently available. Areas requiring further study, including the development of standardized, cross-culturally validated methods of symptom assessment, and evidence-based studies exploring the efficacy of current treatment options in parkinsonian disorders, are also highlighted.
Original Articles
Sensory Trick Frames: A New Device for Blepharospasm Patients
Daniele Lorenzano, Steven Tansley, Daniel G. Ezra
J Mov Disord. 2019;12(1):22-26.   Published online January 16, 2019
DOI: https://doi.org/10.14802/jmd.18010
  • 6,620 View
  • 160 Download
  • 5 Citations
AbstractAbstract PDF
Objective
To determine whether the use of unique customized spectacles provided with modified side arms may be helpful in reducing benign essential blepharospasm (BEB) in patients describing periocular sensory tricks (ST).
Methods
A prospective descriptive study of patients with BEB with positive periocular or temporal region ST phenomenon response under the care of the Botox Clinic at Moorfields Eye Hospital, London, UK. Nine consecutive patients with BEB describing ST were recruited, and the disease frequency and severity were assessed with the Jankovic Rating Scale (JRS) and the Blepharospasm Disability Index (BSDI) before and after the use of the sensory trick frames (STF).
Results
A reduction in the score was noted in both severity (p = 0.0115) and frequency patterns (p = 0.0117) in the JRS in patients using the STF. A significant reduction of the BSDI score was also observed (p = 0.0314).
Conclusion
All the patients selected and fitted with the STF had a reduction in spasms and related symptoms. This new device may be helpful in some selected BEB patients who previously responded positively to periocular pressure alleviating maneuvers.
The ‘Hot Cross Bun’ Sign Is Not Always Multiple System Atrophy: Etiologies of 11 Cases
Christopher Way, David Pettersson, Amie Hiller
J Mov Disord. 2019;12(1):27-30.   Published online December 19, 2018
DOI: https://doi.org/10.14802/jmd.18031
  • 6,314 View
  • 269 Download
  • 9 Citations
AbstractAbstract PDF
Objective
To clarify the specificity of the ‘hot cross bun’ sign (HCBS) for multiple system atrophy (MSA) in adult cerebellar ataxia or parkinsonism.
Methods
The radiologic information systems at an academic center and affiliated veterans’ hospital were queried using the keywords ‘hot cross bun,’ ‘pontocerebellar,’ ‘cruciate,’ ‘cruciform,’ ‘MSA,’ ‘multiple system atrophy,’ and ‘multisystem atrophy.’ Scans were reviewed by a neurologist and neuroradiologist to identify the HCBS. Subjects with the HCBS were reviewed by 2 neurologists to identify the most likely etiology of the patient’s neurologic symptoms.
Results
Eleven cases were identified. Etiologies included MSA (4 probable, 2 possible), hereditary cerebellar ataxia (3/11), probable dementia with Lewy bodies (1/11), and uncertain despite autopsy (1/11).
Conclusion
MSA was the most common etiology. However, 5 of the 11 patients did not have MSA. The most common alternate etiology was an undefined hereditary cerebellar ataxia (3/11).
Clinical Characteristics of Involuntary Movement in Hospitalized Patients
Kyum-Yil Kwon, Hye Mi Lee, Seon-Min Lee, Seong-Beom Koh
J Mov Disord. 2019;12(1):31-36.   Published online December 20, 2018
DOI: https://doi.org/10.14802/jmd.18040
  • 4,842 View
  • 170 Download
  • 1 Citations
AbstractAbstract PDF
Objective
Neurological symptoms in hospitalized patients are not rare, and neurological consultation for movement disorders is especially important in evaluating or managing those with various movement disorders. Therefore, we investigated a clinical pattern of in-hospital consultations for various movement disorders in a tertiary care university hospital.
Methods
Over two years, a total of 202 patients (70.7 ± 11.8 years of age) presenting with movement disorders referred to movement disorder specialists were investigated.
Results
The main symptoms referred by nonneurologists were tremor (56.9%), parkinsonism (16.8%), and gait disturbance (8.9%). The most frequent diagnostic category was toxic/metabolic-caused movement disorder (T/MCMD) (35%) with regard to medications, followed by Parkinson’s disease (PD) (16%). Regarding the mode of onset, T/MCMD was the leading cause for acute (68%) and subacute onset (46%), while PD was the leading disorder (31%) for chronic onset.
Conclusion
The current study showed a characteristic pattern of inpatients presenting with movement disorders. Furthermore, our findings highlighted the clinical significance of drug use or metabolic problems for treating this patient population.
Less Pulsatile Levodopa Therapy (6 Doses Daily) Is Associated with a Reduced Incidence of Dyskinesia
Mark M. Lin, Robert Laureno
J Mov Disord. 2019;12(1):37-42.   Published online January 30, 2019
DOI: https://doi.org/10.14802/jmd.18046
  • 6,532 View
  • 234 Download
  • 5 Citations
AbstractAbstract PDF
Objective
To evaluate whether less pulsatile levodopa therapy (LPT) can reduce the development of levodopa-induced dyskinesia (LID).
Methods
This is a retrospective cohort study of patients with Parkinson’s disease at the movement disorders clinic of Medstar Washington Hospital Center. The study was not blinded or randomized. Patients were seen between August 2002 and August 2018. During these years, we treated patients with less pulsatile (6 doses daily) levodopa treatment to reduce LID. Occurrence of LID was recorded.
Results
Ninety-five patients with Parkinson’s disease taking levodopa were divided into two groups: 1) patients who were initially managed on LPT or who switched from traditional therapy (TT) (n = 61) (mean disease duration: 7.7 ± 4.8 years, mean levodopa duration: 5.6 ± 4.5 years and mean observation time: 4.3 ± 3.4 years), and 2) patients on TT throughout the observation period or until they developed dyskinesia (n = 34) (mean disease duration: 8.3 ± 3.8 years, mean levodopa duration: 6.2 ± 4.2 years and mean observation time: 4.1 ± 3.4 years). Three of the 61 LPT patients developed dyskinesia during the observation period. One of the patients developed dyskinesia after being switched to pulsatile doses by another doctor. In the other two, dyskinesia was minimal. In contrast to this 4.9% cumulative incidence, dyskinesia occurred in 50% (17/34) of TT patients, an incidence similar to that in published data (p < 0.001).
Conclusion
Less pulsatile levodopa with 6 daily doses was associated with a low incidence of LID. Further study of this method of treatment is warranted.
Brief communication
Assessment of Bone Mineral Density of Patients with Spinocerebellar Ataxia Type 3
Aline MS Farias, Simone Appenzeller, Marcondes C França, Alberto RM Martinez, Elba E Etchebehere, Thiago F Souza, Allan O Santos
J Mov Disord. 2019;12(1):43-46.   Published online January 30, 2019
DOI: https://doi.org/10.14802/jmd.18041
  • 4,181 View
  • 73 Download
  • 1 Citations
AbstractAbstract PDF
Objective
Machado-Joseph disease (MJD) is a spinocerebellar ataxia, and osteoporosis is a multifactor disease that may affect patients with neurologic conditions. The frequency of osteoporosis among MJD patients, however, has not been studied. The purpose of this study is to evaluate bone mineral density (BMD) and identify correlations between clinical factors and frequency of vertebral fractures in patients with MJD.
Methods
Clinical data, lumbar X-rays and BMD data were obtained in 30 patients with MJD.
Results
Ten patients (33.3%) showed low BMD in at least one of the sites studied based on Z-scores. The Z-score correlated directly with body mass index, and the femoral neck Z-score was inversely correlated with cytosine-adenine-guanine (CAG) expansion. There was no correlation between BMD and other clinical factors. Forty-three percent of the patients reported previous pathologic fractures. Five patients (16.7%) had at least one fracture detected by lumbar X-ray.
Conclusion
Low BMD and fractures are frequent among MJD patients, and careful management of BMD may be beneficial for these patients.
Case Report
Treatment of Hemichoreoathetosis with Arrhythmic Proximal Tremor after Stroke: The Role of Zona Incerta as a Target for Deep Brain Stimulation
Andrei Koerbel, Augusto Radünz do Amaral, Helena Bedatti Zeh, Eduardo Wollmann, Renata Fabiola Heil Koerbel, Carla Moro, Alexandre Luiz Longo
J Mov Disord. 2019;12(1):47-51.   Published online January 30, 2019
DOI: https://doi.org/10.14802/jmd.18032
  • 4,967 View
  • 103 Download
  • 2 Citations
AbstractAbstract PDFSupplementary Material
Deep brain stimulation (DBS) of the zona incerta has shown promising results in the reduction of medically refractory movement disorders. However, evidence supporting its efficacy in movement disorders secondary to hemorrhagic stroke or hemichoreoathetosis is limited. We describe a 48-year-old man who developed progressive hemichoreoathetosis with an arrhythmic, proximal tremor in his right arm following a thalamic hemorrhagic stroke. Pharmacological treatment was carried out with no change in the Abnormal Involuntary Movement Scale (AIMS) score after 4 weeks (14). After six sessions of botulinum toxin treatment, a subtle improvement in the AIMS score (13) was registered, but no clinical improvement was noted. The arrhythmic proximal movements were significantly improved after DBS of the zona incerta with a major decrease in the patient’s AIMS score (8). The response to DBS occurring after the failure of pharmacological and botulinum toxin treatments suggests that zona incerta DBS may be an alternative for postthalamic hemorrhage movement disorders.
Letters to the editor
Paroxysmal Kinesigenic Dyskinesia Presented Following Concussion
Norman Cottrill, Brian McCully, Mary Payne
J Mov Disord. 2019;12(1):52-53.   Published online December 19, 2018
DOI: https://doi.org/10.14802/jmd.18027
  • 5,069 View
  • 70 Download
  • 1 Citations
PDF
Gait Dyspraxia due to Right Occipital Infarct
Halil Onder, Ferda Buyuk
J Mov Disord. 2019;12(1):54-56.   Published online January 30, 2019
DOI: https://doi.org/10.14802/jmd.18033
  • 4,291 View
  • 62 Download
PDFSupplementary Material
Call Center Operator’s Dystonia
Dokyung Lee, Jung A Kim
J Mov Disord. 2019;12(1):57-59.   Published online December 19, 2018
DOI: https://doi.org/10.14802/jmd.18038
  • 4,230 View
  • 58 Download
PDFSupplementary Material
Transient Hypersomnolence Provoked by Metoclopramide in a Patient with Degenerative Parkinsonism
Sang-Won Yoo, Ko Eun Choi, Joong-Seok Kim
J Mov Disord. 2019;12(1):60-62.   Published online January 15, 2019
DOI: https://doi.org/10.14802/jmd.18042
  • 5,007 View
  • 80 Download
PDF
Novel Ferritin Light Chain Gene Mutation in a Korean Patient with Neuroferritinopathy
So Hoon Yoon, Nan Young Kim, Yun Joong Kim, Chul Hyoung Lyoo
J Mov Disord. 2019;12(1):63-65.   Published online January 30, 2019
DOI: https://doi.org/10.14802/jmd.18062
  • 4,383 View
  • 74 Download
  • 4 Citations
PDF

JMD : Journal of Movement Disorders