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Journal of Clinical Movement Disorders

Onanong Jitkritsadakul, Roongroj Bhidayasiri
BACKGROUND: Physicians are usually at the forefront when the issue of driving ability is raised by Parkinson's disease (PD) patients or their family members, even though few have been formally trained in this area. OBJECTIVES AND METHODS: To identify relevant literature on driving assessment tools in patients with PD by performing a systematic review on this subject in order to provide background information for physicians on what types of driving assessment are available, and to delineate the role of physicians in providing fitness to drive recommendations...
2016: Journal of Clinical Movement Disorders
Halil Onder
Here, I discuss the report by Dale et al. and present some relevant comments, hoping that it will allow a better understanding of the patient's situation as well as freezing of gait phenomenon. I will also discuss other disorders for differential diagnosis those should be kept in mind.
2016: Journal of Clinical Movement Disorders
Elan D Louis, Stephanie Cosentino, Edward D Huey
BACKGROUND: Embarrassment can be a considerable problem for patients with essential tremor (ET) and is a major motivator for treatment. Depression is also a common feature of ET; as many as 35 % of patients report moderate to severe depressive symptoms. Our goal was to assess the associations between these motor and psychosocial factors (tremor, depression, embarrassment) in ET, with a particular interest in more fully assessing the possible association between depression and embarrassment...
2016: Journal of Clinical Movement Disorders
Ruth H Walker
A 45-year-old woman reported automatic behaviors and communication whilst she was being treated with pramipexole. These episodes vanished after the medication was tapered and she was started on levodopa/carbidopa. I hypothesize that the episodes were related to disordered awareness due to sleep disruption related to this medication.
2016: Journal of Clinical Movement Disorders
Steven J Frucht
BACKGROUND: Embouchure dystonia is an unusual focal task-specific dystonia affecting the muscles that control the flow of air into the mouthpiece of a brass or woodwind instrument. The complexity of the embouchure and the relative rarity of the condition pose barriers for recognition and management of the disorder. METHODS: Case review and video survey. RESULTS: This paper presents four video compilations that illustrate the rich phenomenology of embouchure dystonia, in order to enhance recognition and diagnosis...
2016: Journal of Clinical Movement Disorders
Leonard L Sokol, Michael J Young, Alberto J Espay, Ronald B Postuma
Most Parkinson's disease (PD) patients present without known family history and without a diagnosed prodromal phase, underscoring the difficulty of employing primary (neuroprevention) and secondary (neuroprotection) preventions. In cases of monogenic forms, however, potential gene-carrying family members of a proband could engage in neuroprevention, such as exercise or diet modifications, to attenuate the risk of, or delay, disease development. However, a historical lack of recognized disease-modifying interventions has limited clinicians' ability to recommend reliable preventive measures in caring for at-risk populations...
2016: Journal of Clinical Movement Disorders
Tuhin Virmani, Sirinan Tazan, Pietro Mazzoni, Blair Ford, Paul E Greene
BACKGROUND: The modulation of levodopa transport across the blood brain barrier by large neutral amino acids is well documented. Protein limitation and protein redistribution diets may improve motor fluctuations in patients with Parkinson's disease but the pharmacokinetics and pharmacodynamics of levodopa and amino acids are highly variable. METHODS: Clinical records of 1037 Parkinson's disease patients were analyzed to determine the proportion of patients with motor fluctuations related to protein interaction with levodopa...
2016: J Clin Mov Disord
Ruth H Walker
A patient with right-side-predominant Parkinson's disease presented visual artwork which improved in resemblance to the model which he was copying with increasing doses of levodopa. I propose that increased dopaminergic replacement resulted in improved attention to detail, mediated by circuitry in the left hemisphere.
2016: Journal of Clinical Movement Disorders
Clara Warden, Jaclyn Hwang, Anisa Marshall, Michelle Fenesy, Kathleen L Poston
BACKGROUND: Parkinson's disease patients are at an elevated risk of developing cognitive impairment. Although cognitive impairment is one of the strongest predictors of quality of life, dopaminergic anti-parkinsonian medications are designed to target motor symptoms. However, there is substantial evidence that dopamine also impacts cognition, in particular working memory. It is therefore critical for movement disorders physicians to understand the potential dopaminergic effects on working memory when prescribing these medications...
2016: Journal of Clinical Movement Disorders
Hatice N Eken, Elan D Louis
BACKGROUND: Lack of awareness of involuntary movements is a curious phenomenon in patients with certain movement disorders. An interesting anecdotal observation is that patients with essential tremor (ET) often seem unaware of their own head tremor. In the current study, we asked ET patients whether they were aware of head tremor while it was occurring on examination, thereby allowing us to gauge real-time awareness of their involuntary movement. METHODS: ET cases enrolled in an ongoing clinical research study at the Columbia University Medical Center (2009-2014)...
2016: Journal of Clinical Movement Disorders
Leonard L Sokol, Alberto J Espay
Clinical signs are critical in ascertaining the functional nature of a gait disorder. Four signs of gait impairment have been documented in the course of examining patients with clinically definite functional (psychogenic) movement disorders: "huffing and puffing" during standing and walking, manipulation-resistance dorsiflexion of the first toe, fixed plantar flexion and inversion, and marked discrepancy between ambulation with and without swivel chair assistance. While large studies are needed to ascertain their prevalence, sensitivity, and specificity, the identification of these signs may help elevate the diagnostic certainty of functional gait disorders...
2016: J Clin Mov Disord
Marian L Dale, Martina Mancini, Carolin Curtze, Fay B Horak, Brett W Fling
Freezing of gait (FoG) is a debilitating feature of Parkinson's disease and other parkinsonian disorders. This case demonstrates a variant of freezing of gait in a non-parkinsonian patient with a lesion of the anterior corpus callosum. The freezing improved with increased upper extremity sensory input, suggesting that compensatory circuits for use of somatosensory inputs from the arms to postural and locomotor centers were intact.
2016: Journal of Clinical Movement Disorders
Fumihito Yoshii, Yusuke Moriya, Tomohide Ohnuki, Masafuchi Ryo, Wakoh Takahashi
BACKGROUND: Various postural deformities appear during progression of Parkinson's disease (PD), but the underlying pathophysiology of these deformities is not well understood. The angle abnormalities seen in individual patients may not be due to distinct causes, but rather they may have occurred in an interrelated manner to maintain a balanced posture. METHODS: We measured the neck flexion (NF), fore-bent (FB), knee-bent (KB) and lateral-bent (LB) angles in 120 PD patients, and examined their mutual relationships, and correlations with clinical predictors such as sex, age, disease duration, Hoehn and Yahr (H&Y) stage, medication dose (levodopa equivalent dose, LED; total dose of dopamine agonists, DDA)...
2016: Journal of Clinical Movement Disorders
Pichet Termsarasab, Thananan Thammongkolchai, Steven J Frucht
Spinal-generated movement disorders (SGMDs) include spinal segmental myoclonus, propriospinal myoclonus, orthostatic tremor, secondary paroxysmal dyskinesias, stiff person syndrome and its variants, movements in brain death, and painful legs-moving toes syndrome. In this paper, we review the relevant anatomy and physiology of SGMDs, characterize and demonstrate their clinical features, and present a practical approach to the diagnosis and management of these unusual disorders.
2015: J Clin Mov Disord
William G Ondo, Sana Sarfaraz, MinJae Lee
BACKGROUND: Organic psychosis effects up to 70 % of patients with PD at some point yet no widely accepted scale for this entity exists. METHODS: We developed a 10 question PD specific psychosis severity scale that we feel has good content validity. It asks about the presence, severity, frequency, and consequences of the hallucinations (visual, auditory, olfactory) and delusions. RESULTS: Fifty different PD patients with psychosis and 25 PD patients without psychosis were included, and serial information was available in 21 of those encounters with psychosis...
2015: Journal of Clinical Movement Disorders
Steven J Frucht
Focal task-specific dystonia is an unusual movement disorder that may affect musicians specifically when they perform on their instruments. Muscles of the lower face, lower limb and upper limb may be involved depending on the nature of the instrument. We illustrate the rich phenomenology of focal task-specific dystonia affecting the upper limb in musicians, and present a practical approach for evaluating patients in the office.
2015: Journal of Clinical Movement Disorders
Peter W Iltis, Jens Frahm, Dirk Voit, Arun Joseph, Erwin Schoonderwaldt, Eckart Altenmüller
BACKGROUND: This paper describes the use of real-time magnetic resonance imaging in visualizing and quantifying oral cavity motor strategies employed by 6 healthy, elite horn players and 5 horn players with embouchure dystonia. METHODS: Serial images with an acquisition time of 33.3 ms were obtained from each performer during execution of an 11-note harmonic series encompassing 2.5 octaves on a magnetic resonance imaging-compatible horn. A customized MATLAB toolkit was employed for the extraction of line profiles from magnetic resonance imaging films allowing comparative analyses between elite and dystonic horn players...
2015: Journal of Clinical Movement Disorders
Pichet Termsarasab, Thananan Thammongkolchai, Janet C Rucker, Steven J Frucht
Saccades are rapid eye movements designed to shift the fovea to objects of visual interest. Abnormalities of saccades offer important clues in the diagnosis of a number of movement disorders. In this review, we explore the anatomy of horizontal and vertical saccades, discuss practical aspects of their examination, and review how saccadic abnormalities in hyperkinetic and hypokinetic movement disorders aid in diagnosis, with video demonstration of classic examples. Documentation of the ease of saccade initiation, range of motion and conjugacy of saccades, speed and accuracy of saccades, dynamic saccadic trajectory, and the presence or absence of saccadic intrusions and oscillations are important components of this exam...
2015: Journal of Clinical Movement Disorders
P K Chattha, P E Greene, Ritesh A Ramdhani
Pseudobulbar affect is a common symptom in neurodegenerative diseases and can also result from lesions in cortical, subcortical and brainstem regions. In Parkinson's disease (PD), pseudobulbar affect (PBA) can occur as a wearing off phenomenon, manifested usually as crying without emotionality. In addition, subthalamic (STN) deep brain stimulation (DBS) has been reported to induce PBA in PD patients with no prior history of such episodes. We present a case of inappropriate laughter lacking mirth as a levodopa OFF phenomenon in a patient with PD, whose laughter also worsened with STN-DBS in his non-medicated state...
2015: Journal of Clinical Movement Disorders
Ruth H Walker
The syndrome of the jerky dystonic hand is recognized as a consequence of infarction of the posterior thalamus. A patient with multiple risk factors for stroke developed jerky dystonia of more proximal involvement, affecting the shoulder and speech, several months after a stroke affecting the posterior thalamic region. The cause for the proximal, rather than distal, upper limb involvement, is unclear, and is not apparent from the distribution of the lesion on neuroimaging. Injections of botulinum toxin significantly improved the symptoms...
2015: Journal of Clinical Movement Disorders
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