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Volume 14(2); May 2021
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Review Articles
Manganese and Movement Disorders: A Review
Dinkar Kulshreshtha, Jacky Ganguly, Mandar Jog
J Mov Disord. 2021;14(2):93-102.   Published online April 6, 2021
DOI: https://doi.org/10.14802/jmd.20123
  • 4,756 View
  • 319 Download
  • 8 Citations
AbstractAbstract PDF
Scientific and technological advances achieved with industrial expansion have led to an ever-increasing demand for heavy metals. This demand has, in turn, led to increased contamination of soil, water and air with these metals. Chronic exposure to metals may be detrimental not only to occupational workers but also to the nonoccupational population exposed to these metals. Manganese (Mn), a commonly used heavy metal, is an essential cofactor for many enzymatic processes that drive biological functions. However, it is also a potential source of neurotoxicity, particularly in the field of movement disorders. The typical manifestation of Mn overexposure is parkinsonism, which may be difficult to differentiate from the more common idiopathic Parkinson’s disease. In addition to environmental exposure to Mn, other potential etiologies causing hypermanganesemia include systemic health conditions, total parenteral nutrition and genetic mutations causing Mn dyshomeostasis. In this review, we critically analyze Mn and discuss its sources of exposure, pathophysiology and clinical manifestations. We have highlighted the global public health impact of Mn and emphasize that movement disorder specialists should record a detailed social and occupational history to ensure that a toxic etiology is not misdiagnosed as a neurodegenerative disease. In the absence of a definite therapeutic option, early diagnosis and timely institution of preventive measures are the keys to managing its toxic effects.
Environmental Risk Factors for Progressive Supranuclear Palsy
Hee Kyung Park, Sindana D. Ilango, Irene Litvan
J Mov Disord. 2021;14(2):103-113.   Published online May 26, 2021
DOI: https://doi.org/10.14802/jmd.20173
  • 4,112 View
  • 172 Download
AbstractAbstract PDF
Typically, progressive supranuclear palsy (PSP) is clinically characterized by slow vertical saccades or supranuclear gaze palsy, levodopa-resistant parkinsonism with predominant axial symptoms, and cognitive executive impairment. Over the past decades, various PSP phenotypes, including PSP with predominant parkinsonism, PSP with corticobasal syndrome, PSP with progressive gait freezing, and PSP with predominant frontal dysfunction, have been identified from pathologically confirmed cases. Expanding knowledge led to new diagnostic criteria for PSP that with increased disease awareness led to increased PSP prevalence estimates. The identification of environmental and modifiable risk factors creates an opportunity to intervene and delay the onset of PSP or slow disease progression. To date, despite the increasing number of publications assessing risk factors for PSP, few articles have focused on environmental and lifestyle risk factors for this disorder. In this article, we reviewed the literature investigating the relationship between PSP and several environmental and other modifiable lifestyle risk factors. In our review, we found that exposures to toxins related to diet, metals, well water, and hypertension were associated with increased PSP risk. In contrast, higher education and statins may be protective. Further case-control studies are encouraged to determine the exact role of these factors in the etiopathogenesis of PSP, which in turn would inform strategies to prevent and reduce the burden of PSP.
Viewpoint
Minipolymyoclonus: A Critical Appraisal
Jacky Ganguly, Jia Ren Chai, Mandar Jog
J Mov Disord. 2021;14(2):114-118.   Published online May 26, 2021
DOI: https://doi.org/10.14802/jmd.20166
  • 2,731 View
  • 130 Download
  • 3 Citations
PDF
Original Articles
Telemedicine in an Academic Movement Disorders Center during COVID-19
Christine Doss Esper, Laura Scorr, Sosi Papazian, Daniel Bartholomew, Gregory Jacob Esper, Stewart Alan Factor
J Mov Disord. 2021;14(2):119-125.   Published online March 18, 2021
DOI: https://doi.org/10.14802/jmd.20099
  • 3,291 View
  • 119 Download
  • 6 Citations
AbstractAbstract PDF
Objective
Telemedicine has rapidly gained momentum in movement disorder neurology during the coronavirus disease (COVID-19) pandemic to preserve clinical care while mitigating the risks of in-person visits. We present data from the rapid implementation of virtual visits in a large, academic, movement disorder practice during the COVID-19 pandemic.
Methods
We describe the strategic shift to virtual visits and retrospectively examine elements that impacted the ability to switch to telemedicine visits using historical prepandemic in-person data as a comparator, including demographics, distance driven, and diagnosis distribution, with an additional focus on patients with deep brain stimulators.
Results
A total of 686 telemedicine visits were performed over a five-week period (60% of those previously scheduled for in-office visits). The average age of participants was 65 years, 45% were female, and 73% were Caucasian. Men were more likely to make the transition (p = 0.02). Telemedicine patients lived farther from the clinic than those seen in person (66.47 km vs. 42.16 km, p < 0.001), age was not associated with making the switch, and patient satisfaction did not change. There was a significant shift in the distribution of movement disorder diagnoses seen by telemedicine compared to prepandemic in-person visits (p < 0.001). Patients with deep brain stimulators were more likely to use telemedicine (11.5% vs. 7%, p < 0.001).
Conclusion
Telemedicine is feasible, viable and relevant in the care of movement disorder patients, although health care disparities appear evident for women and minorities. Patients with deep brain stimulators preferred telemedicine in our study. Further study is warranted to explore these findings.
Patient Knowledge, Attitude and Perceptions towards Botulinum Toxin Treatment for Movement Disorders in India
Thavasimuthu Nisha Mol, Nitish Kamble, Vikram V. Holla, Rohan Mahale, Pramod Kumar Pal, Ravi Yadav
J Mov Disord. 2021;14(2):126-132.   Published online April 26, 2021
DOI: https://doi.org/10.14802/jmd.20094
  • 2,805 View
  • 71 Download
AbstractAbstract PDFSupplementary Material
Objective
There is limited literature on the knowledge, attitude, and perceptions (KAP) of botulinum toxin (BoNT) treatment among patients and caregivers. The objective of this study was to assess the KAP in patients undergoing BoNT treatment for movement disorders.
Methods
One hundred patients with movement disorders from National Institute of Mental Health and Neurosciences Hospital in Bengaluru, South India, were recruited. The patients underwent demographic, clinical, and Patient Knowledge Questionnaire on Botulinum Toxin Use in Movement Disorders (PKQ-BMD)-based evaluations.
Results
The mean age of patients at the time of presentation was 47.97 ± 14.19 years (range, 12–79). Of all the patients, 26 (28%) patients were anxious, and 86% of these patients were reassured after appropriate counseling. There were 83 (89%) patients who found BoNT to be a costlier option. Education and previous Internet searches influenced positive performance in the “knowledge” domain and overall PKQ-BMD scores. The “number of injections” was also positively correlated with KAP performance.
Conclusion
This study showed that knowledge and perceptions about BoNT treatment need to be further improved. Wider availability of the Internet has provided a positive impact on patients’ and carers’ KAP. Internet-based information, higher educational qualifications of the patients, and a higher number of BoNT injection sessions are the most important predictors of satisfactory KAP related to BoNT injection treatment in patients with movement disorders.
Factors Associated with Medication Beliefs in Patients with Parkinson’s Disease: A Cross-Sectional Study
Sung Reul Kim, Ji Young Kim, Hye Young Kim, Hui Young So, Sun Ju Chung
J Mov Disord. 2021;14(2):133-143.   Published online May 3, 2021
DOI: https://doi.org/10.14802/jmd.20147
  • 3,145 View
  • 89 Download
  • 2 Citations
AbstractAbstract PDFSupplementary Material
Objective
Medication beliefs are a significant determinant of medication adherence in chronic illness. This study aimed to identify demographic, clinical, and medication-related factors associated with medication beliefs in patients with Parkinson’s disease (PD).
Methods
We used a descriptive cross-sectional design with a convenience sample of 173 PD patients who had been taking antiparkinson drugs for more than one year.
Results
The subjects who believed PD medication was more necessary had more severe illness, younger age of onset, longer illness duration, and longer duration of levodopa therapy. They had higher levels of non-motor symptoms and depression, number of medication uses, number of drugs, and levodopa equivalent dose, and they reported fluctuation of motor symptoms and dyskinesia. The subjects who used catechol-O-methyltransferase (COMT) inhibitors, dopamine agonists, amantadine, and monoamine oxidase-B (MAO-B) inhibitors had significantly higher necessity scores than those who did not use them. The subjects who had higher concerns about PD medications had higher levels of non-motor symptoms and depression. The subjects using amantadine and anticholinergics had significantly higher concern scores than those who did not use them. Positive necessity-concerns differentials were associated with severe illness, the presence of motor fluctuation and dyskinesia, and the use of COMT inhibitors. Based on stepwise multiple regression, the most significant factors influencing necessity beliefs were severe illness, followed by depression and motor fluctuation.
Conclusion
Severe illness, higher levels of depression, and motor fluctuation are independent factors influencing patients’ beliefs regarding medication necessity. Therefore, these characteristics should be considered in medication belief assessment and interventions for PD patients.
Brief communications
Content Analysis of Korean Videos Regarding Restless Legs Syndrome on YouTube
Joohwan Kim, Ryul Kim, Jin-Sun Jun, So-Hyun Ahn, San Jung, Yang-Ki Minn, Sung Hee Hwang
J Mov Disord. 2021;14(2):144-147.   Published online May 3, 2021
DOI: https://doi.org/10.14802/jmd.20137
  • 2,757 View
  • 70 Download
  • 1 Citations
AbstractAbstract PDFSupplementary Material
Objective
To evaluate the accuracy and quality of Korean videos associated with restless legs syndrome (RLS) on YouTube.
Methods
A YouTube search was performed on April 1, 2020 using the term “restless legs syndrome” in the Korean language. Two reviewers coded the source, content, and demographics of the included videos. Video quality was assessed using the modified DISCERN (mDISCERN) instrument.
Results
Among the 80 videos analyzed, 44 (55.0%) were reliable, and 36 (45.0%) were misleading. There was a trend toward a higher number of mean daily views in the misleading videos than in the reliable videos. Most of the misleading videos (72.2%) advocated complementary and alternative medicine as a primary treatment for RLS. Although the reliable videos had higher mDISCERN scores than the misleading videos, the overall quality of the reliable videos was low.
Conclusion
Many Korean videos regarding RLS on YouTube involve a risk of exposure to misinformation and are of unsatisfactory quality.
Changes in Cerebral Gray and White Matter in Patients with Pantothenate Kinase-Associated Neurodegeneration: A Long-Term Magnetic Resonance Imaging Follow-Up Study
Pedro Roa-Sanchez, Pamela Bido, Jairo Oviedo, Hans-Jürgen Huppertz, Herwin Speckter, Peter Stoeter
J Mov Disord. 2021;14(2):148-152.   Published online May 26, 2021
DOI: https://doi.org/10.14802/jmd.20102
  • 2,175 View
  • 56 Download
  • 1 Citations
AbstractAbstract PDFSupplementary Material
Objective
To determine the volume changes in gray and white matter during a long-term follow-up in patients suffering from pantothenate kinase-associated neurodegeneration (PKAN).
Methods
Magnetic resonance imaging was repeated in 13 patients and 14 age-matched controls after a mean interval of more than 7 years. T1-weighted sequences were evaluated by fully automated atlas-based volumetry, compared between groups and correlated with disease progression.
Results
The patients did not show generalized cerebral atrophy but did show a significantly faster volume reduction in the globus pallidus during follow-up (between -0.96% and -1.02% per year, p < 0.05 adjusted for false discovery rate) than controls, which was significantly related to the progression in their dystonia scores (p = 0.032).
Conclusion
The volume loss in the globus pallidus over time—together with the accumulation of iron known as the “tiger’s eye”—supports the pathophysiologic concept of this nucleus as a center of inhibition and its severe malfunction in PKAN.
Case Reports
Myoclonus-Ataxia Syndrome Associated with COVID-19
Kuldeep Shetty, Atul Manchakrao Jadhav, Ranjith Jayanthakumar, Seema Jamwal, Tejaswini Shanubhogue, Mallepalli Prabhakar Reddy, Gopal Krishna Dash, Radhika Manohar, Vivek Jacob Philip, Vikram Huded
J Mov Disord. 2021;14(2):153-156.   Published online April 6, 2021
DOI: https://doi.org/10.14802/jmd.20106
  • 4,106 View
  • 148 Download
  • 4 Citations
AbstractAbstract PDFSupplementary Material
Neurological manifestations of coronavirus disease (COVID-19) have increasingly been reported since the onset of the pandemic. Herein, we report a relatively new presentation. A patient in the convalescence period following a febrile illness with lower respiratory tract infection (fever, myalgia, nonproductive cough) presented with generalized disabling myoclonus, which is phenotypically suggestive of brainstem origin, along with additional truncal cerebellar ataxia. His neurology work-ups, such as brain MRI, electroencephalography, serum autoimmune and paraneoplastic antibody testing, were normal. His CT chest scan revealed right lower lung infiltrates, and serological and other laboratory testing did not show evidence of active infection. COVID-19 titers turned out to be strongly positive, suggestive of post-COVID-19 lung sequelae. He responded partially to antimyoclonic drugs and fully to a course of steroids, suggesting a para- or postinfectious immune-mediated pathophysiology. Myoclonusataxia syndrome appears to be a neurological manifestation of COVID-19 infection, and knowledge regarding this phenomenon should be increased among clinicians for better patient care in a pandemic situation.
Dystonia Responsive to Dopamine: POLG Mutations Should Be Considered If Sensory Neuropathy Is Present
Jessica Qiu, Kishore Raj Kumar, Eloise Watson, Kate Ahmad, Carolyn M. Sue, Michael W. Hayes
J Mov Disord. 2021;14(2):157-160.   Published online May 26, 2021
DOI: https://doi.org/10.14802/jmd.20159
  • 3,299 View
  • 107 Download
  • 4 Citations
AbstractAbstract PDFSupplementary Material
The POLG gene encodes mitochondrial DNA polymerase, and mutations in this gene cause a spectrum of disorders related to mitochondrial DNA depletion or deletion. Dystonia has only rarely been reported as an early and prominent manifestation of POLG mutations. We report a case of a 30-year-old male presenting with lower limb dystonia with peripheral neuropathy and demonstrate that the dystonia was levodopa responsive (with video findings). Whole-genome sequencing revealed biallelic variants in the POLG gene: a known pathogenic variant [NM_001126131.2:c.2209G>C (p.Gly737Arg)] and a novel likely pathogenic variant [NM_001126131.2:c.3305A>C (p.Gln1102Pro)]. A genetic diagnosis was made before the appearance of more readily recognizable features of mitochondrial disease, allowing us to avoid invasive tissue biopsies or potentially deleterious treatments, such as sodium valproate. A POLG-related disorder should be suspected in cases of dystonia with peripheral neuropathy, and this diagnosis may have implications for further investigations and management.
Letters to the editor
A Case of Delayed Oculo-Palato-Brachial Tremor after Pontine Infarction
Ho-Sung Ryu, Minsub Cho, Daeun Shin, Yang-Ha Hwang
J Mov Disord. 2021;14(2):161-163.   Published online September 21, 2020
DOI: https://doi.org/10.14802/jmd.20077
  • 3,944 View
  • 78 Download
PDFSupplementary Material
Levodopa-Associated Barking Vocalizations
Shweta Prasad, Pramod Kumar Pal
J Mov Disord. 2021;14(2):164-165.   Published online October 31, 2020
DOI: https://doi.org/10.14802/jmd.20086
  • 2,547 View
  • 54 Download
PDFSupplementary Material
Peak-Dose Ballism Associated with Declining Implantable Pulse Generator Battery Life in Deep Brain Stimulation for Parkinson’s Disease
Denzel Chong Jen-Rei, Lim Thien Thien, Lee Hock Keong, Hoe Wei Leng, Onanong Phokaewvarangkul, Roongroj Bhidayasiri
J Mov Disord. 2021;14(2):166-169.   Published online December 7, 2020
DOI: https://doi.org/10.14802/jmd.20078
  • 2,693 View
  • 71 Download
PDFSupplementary Material
TNR Gene Mutation in Familial Parkinson’s Disease: Possible Implications for Essential Tremor
Michel Sáenz-Farret, Renato Puppi Munhoz, Alfonso Fasano, Carlos Zúñiga-Ramírez
J Mov Disord. 2021;14(2):170-172.   Published online December 7, 2020
DOI: https://doi.org/10.14802/jmd.20057
  • 2,925 View
  • 69 Download
  • 2 Citations
PDF
Encephalopathy and Complex Hyperkinesia in a Patient with Severe Acute Respiratory Syndrome Coronavirus-2 Infection
Wenyang Li, Elif Pinar Coskun, Rolando Berger, John Thomas Slevin, Luther Creed Pettigrew
J Mov Disord. 2021;14(2):173-175.   Published online January 12, 2021
DOI: https://doi.org/10.14802/jmd.20084
  • 2,897 View
  • 51 Download
PDFSupplementary Material

JMD : Journal of Movement Disorders