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PubMedDate not supplied

[The effectiveness and tolerance of piribedil as adjunct therapy to levodopa in patients with Parkinson's disease: a nine month follow up].

INTRODUCTION: Piribedil is a D2 D3 dopamine agonist, which has been shown to be well tolerated and to improve Parkinsonian symptoms, particularly tremor. However, few studies have been published about this Dopamine Agonist as an adjunct to levodopa therapy in patients with Parkinson's disease (PD). This placebo controlled, parallel group study was undertaken to investigate the effects of piribedil in PD patients insufficiently controlled with levodopa in a nine months follow up. PATIENTS AND METHODS: We included 62 PD patients insufficiently controlled with levodopa and needed an increase in dopamine stimulation. Patients were randomized in two similar groups, one of them taking Piribedil and levodopa and the other group taking a placebo and levodopa. The primary efficacy measures were the items II and III of the UPDRS. The patients were evaluated prior to the start of therapy, and 3, 6 and 9 months after the start of the study. RESULTS: Patients taking Piribedil showed an average of improvement of 37,8% (p < 0.01) in the part II and 63,2% (p < 0.01) in the part III of the UPDRS at the end of the study. At 9 month evaluation, tremor at rest showed an average improvement of 68,6%, rigidity, fingers taps and legs agility improved substantially in their respective items of the UPDRS at the end of the study. CONCLUSIONS: We concluded that PD patients with functional worsening while on stable levodopa doses exhibit a steady improvement of the UPDRS part II and III with the adjunction of Piribedil 150 mg mean daily dose for 9 months.

Antiparkinson Agents↗
PubMed1986

Behavioral effects of phencyclidine and some of its metabolites in developing cats.

Chronic treatment with low doses (1-2 mg/kg) of phencyclidine (PCP) produces marked behavioral effects in the developing kitten. These effects are age-dependent. Under 21 days the major response consists of rostrocaudal forelimb movements. After this age the major responses are ataxic locomotion and waxy rigidity. In the present experiment the behavioral effect of subcutaneous injections of higher doses of PCP, two of its metabolites, phencylclohexylamine (PCA) and an alcohol (N-(5-hydroxypentyl)-1-phenycyclohexylamine) (AL) and one PCP analog (N-N-diethylaminophenylhexylamine (NND] were tested in kittens between 30-50 days of age. The behavior of the kittens was assessed from 10-15 min pre-injection to up to 5 hr postinjection and at 24 hr postinjection. The most intense responses were produced by PCP and NND and consisted of waxy rigidity (limbs in abnormal postures for extended time periods) with the animal completely immobile. PCA was less effective, producing only tremor and staggering followed by loss of hindlimb support. AL was the least effective producing minimal behavioral responses. These results indicate that some of the metabolites of PCP, while active, are not as potent as PCP itself. Subsequent testing indicated that behavioral tolerance to the effects of PCP, NND and PCA occurred after a single administration of these compounds.

Animals↗
PubMed2000

Lumbar segmental rigidity: can its identification with facet injections and stretching exercises be useful?

OBJECTIVES: To describe a method for observing lumbar segmental rigidity and to show how motion measurements and pain/disability questionnaires can be used to evaluate outcomes of combined facet injections and stretching exercises. DESIGN: Preliminary 2-part study: (1) presentation of a technique for, identifying lumbar segmental rigidity based on physical observation of the spine's lateral bending; and (2) repeated measures of motion and pain/disability self-report in a chronic lumbar spinal disorder cohort, performed before and after treatment with combined facet injections and stretching exercises. SETTING: An outpatient tertiary rehabilitation facility providing interdisciplinary functional restoration for chronic disabling work-related spinal disorders. PATIENTS: Chronically disabled patients with lumbar spinal disorder (n = 39; mean age, 41yr; 82% male) with segmental rigidity at 1 or more levels on physical examination. Subjects averaged 20 months of disability, and 51% had preinjection spine surgery (average, 1.7 procedures involving up to 3 spinal segments). Thirty-nine percent of the cohort had a fusion at levels 1 or 2. INTERVENTIONS: Bilateral facet injections were administered under fluoroscopy to all patients, and 2 or 3 levels were performed in 93% of cases (range, levels 1-4). Patients were instructed in an unsupervised stretching program and were reassessed 2 to 4 weeks later. After an intensive supervised resistance exercise training program as part of interdisciplinary functional restoration, a third set of motion, pain, and disability measures were collected. MAIN OUTCOME MEASURES: Changes in true lumbar sagittal and coronal motion (T12-S1), measured with inclinometers, and pain/disability self-report were compared statistically. RESULTS: Patients' mobility improved significantly (p < .01-.0001) across all 4 motions. A large majority (71%-97%) of individuals improved on motion. According to self-reports made over the postinjection period, most patients improved their disability (83%) and pain intensity (63%) ratings. CONCLUSIONS: A simple physical examination technique for assessing lumbar spine segmental rigidity was used in this preliminary study to select patients and levels for combined facet injection and stretching exercise, with resultant improvements in mobility and self-reported pain/disability that may extend beyond the pharmacologic duration of the corticosteroid. The efficacy of either the facet injection or stretching components alone in achieving objective mobility improvements cannot be determined from the present study, but warrants future investigation.

Adult↗
PubMed2003

A computer model of rigidity and related motor dysfunction in Parkinson's disease.

This work explores the involvement of spinal circuits in the generation of parkinsonian rigidity and related motor dysfunction. A computer model of spinal proprioceptive input processing, derived from previous work on spasticity modeling, was adapted to the simulation of parkinsonian rigidity. Model parameters were varied to generate simulations reproducing experimental data obtained using the pendulum test of the leg in 10 parkinsonian patients and 3 healthy subjects. Convenient reproductions of experimental traces in rigidity were obtained by the combination of a low reflex gain and a decrease in reflex threshold. These findings are consistent with studies reporting an increase of spinal interneuron excitability and proprioception deficits in Parkinson's disease (PD). Moreover, as the threshold parameter was much lowered, our model generated typical features of parkinsonian resting tremor, endorsing the hypothesis of a participation of a spinal oscillator in this disorder. Finally, tuning the reflex gain during simulations of rigidity resulted in the generation of active movement, opening some hypotheses on pathophysiology of motor dysfunction in PD, and notably, of akinesia. More generally, this work accredits the hypothesis of the involvement of an aperiodic, altered supra-spinal motor drive in PD, resulting in spinal dysfunction, through specific descending motor pathways. This may lead to a search for new (spinal) pharmacological targets in PD. It emphasizes further the value of computer modeling in understanding motor control in health and disease.

Computer Simulation↗
PubMed1993

[A study on truncal rigidity in parkinsonism--evaluation of diagnostic test and electrophysiological study].

Truncal rigidity is regarded as a cause of axial motor disturbances such as difficulty in turning around and in rising from a recumbent position in parkinsonism. However, methodology for clinical evaluation of truncal rigidity has not yet been established. This study aims at developing a suitable bed-side technique to evaluate truncal rigidity in parkinsonism. Forty normal adults and fifty-one patients with Parkinson's disease or juvenile parkinsonism were examined. We tried to evaluate truncal tonus by twisting the subjects' body axis in a supine position. The subjects' axis was passively rotated by the examiner supporting and twisting the subjects' (1) shoulder, (2) axillas, (3) hips, and (4) knees. In comparing these four procedures, the maximal rotation of the axis was obtained easily with twists supporting the knees, that is alternating tilts of the bending knees rightward and leftward in a supine position. By this method of alternating knee tilts, the examiner felt merely a little resistance in twisting the normal subjects. On the other hand, in patients with parkinsonism, a considerable degree of resistance against twists was elicited, and the patients' side-was passively elevated from a bed in accordance with knee tilts. Electrical activities of the truncal muscles (M. erector spinae, M. obliquus abdominis externus and internus) during the alternating knee tilts were studied in ten normal adults and seventeen parkinsonian patients. Continuous electrical activities were present in the axial muscles, particularly at the thoracic level, which were passively stretched by this procedure in parkinsonism but never present in normals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Marchiafava-Bignami disease: reversibility of neuroimaging abnormality.

Marchiafava-Bignami disease (MBD) was diagnosed in a malnourished 43-year-old patient with chronic alcoholism, severe generalized extrapyramidal rigid syndrome, and severe dyspraxia. Cranial CT and MRI demonstrated isolated lesions in the geno and splenium of the corpus callosum (CC) characteristic for MBD. On thiamine therapy, a slow but steady recovery of clinical symptoms occurred, and serial CT and MRI studies demonstrated marked reversibility of abnormalities in the CC. Besides clinical improvement with a good functional outcome, reversal of CT and MRI abnormalities may occur in MBD.

Adult↗
PubMed2006

Progression of Parkinson's disease following thalamic deep brain stimulation for tremor.

We assessed the long-term effect of thalamic deep brain stimulation (DBS) on motor symptoms and progression of Parkinson's disease (PD) in PD patients treated for resting and postural/action tremor. Thalamic DBS was performed in 17 patients with treatment-resistant resting and postural/action tremor. Nine patients were available for follow-up examination a mean of 5.5 years after surgery. Three had tremor-dominant PD. DBS produced marked improvement in resting and postural/action tremor in target upper extremity in all 9 patients, which persisted unchanged at the time of the last follow-up visit 5.5 years after surgery. PD severity with DBS 'on' and 'off' 1 year after surgery was compared to PD severity at the last follow-up visit using UPDRS (Unified Parkinson's Disease Rating Scale) III motor scores and individual motor item subscores. Patients were tested while on medication. There was no significant worsening of tremor, rigidity, speech, postural stability, gait, or axial bradykinesia with DBS either on or off at the last follow-up visit compared to the 12-month visit. UPDRS III motor scores were unchanged. However, global assessment of PD progression and increased mean L-dopa dose and L-dopa equivalent daily dose at the time of last follow-up visit indicated that a progression of PD had occurred.

Aged↗
PubMed1998

Osmotic demyelination syndrome with two-phase movement disorders: case report.

Osmotic demyelination syndrome (ODS) is characterized by regions of demyelination throughout the brain, which are most prominent in the pons. This demyelinating disease is associated with electrolyte disturbances and typically occurs in patients who are alcoholic or malnourished. Movement disorders are not frequently recognized in patients with ODS. This report describes a 22-year-old woman with ODS after correction of profound hyponatremia. The main neurologic symptom was two-phase movement disorder. First, she had acute onset dystonia, then the movement disorder transformed to generalized rigidity and tremors in the delayed second phase. Magnetic resonance imaging in the first phase revealed demyelinating lesions in the central pons, bilateral thalami and basal ganglia. In the second phase, the previous myelinolysis had been partially resolved. The clinical course of the two-phase movement disorder did not correlate with the resolving feature of neuroradiologic findings. During the second-phase movement disorder, the patient had a good response to propranolol and trihexyphenidyl.

Adult↗
PubMed2003

Neonatal dopa-responsive extrapyramidal syndrome in twins with recessive GTPCH deficiency.

The authors report two twin sisters, age 15 years, with recessive GTP cyclohydrolase deficiency, who presented with neonatal onset of rigidity, tremor, and dystonia but with no other symptoms suggestive of a diffuse CNS involvement. The plasma phenylalanine levels were normal. Treatment with L-dopa/carbidopa, started at age 1 year, was associated with sustained recovery from all neurologic signs. The patients were homozygous for a new recessive mutation in the GHI gene.

Adolescent↗
PubMed1997

Catatonia and other motor syndromes in a chronically hospitalized psychiatric population.

BACKGROUND: To determine the motor characteristics of chronic catatonia, catatonia and other motor disorders were systematically rated in a long-term hospitalized sample. METHOD: Chronically hospitalized psychiatric inpatients (N = 42) with a clinical diagnosis of catatonic schizophrenia (295.2X) were rated for catatonia with a novel 23-item catatonia rating scale, and for parkinsonism, dyskinesia and akathisia using standard rating scales with scale-based criteria for case definition. RESULTS: Catatonia was the sole motor syndrome in nine cases (21%), co-existed with parkinsonism in five (12%), tardive dyskinesia in four (10%), and both parkinsonism and tardive dyskinesia in 10 (24%). There was no correlation between total scores across the four rating scales. 'Rigidity' was the sole catatonic sign which overlapped with other scales. The symptom profile of catatonia in this chronic sample was similar to previous reports based on acutely ill patients. CONCLUSION: Catatonia is distinguishable from other motor disorders in chronic psychiatric patients using the 23-item catatonia rating scale. The features of chronic catatonia are described, and the distribution of catatonic signs is similar for chronic and acute catatonia.

Adult↗
PubMed1984

[Malignant neuroleptics syndrome].

The neuroleptic malignant syndrome is clinically characterised by the presence of severe muscular rigidity, altered consciousness, hyperthermia and by signs of autonomic dysfunction. A severe form of the syndrome lasting several weeks was observed in a 20-year-old, mentally retarded female patient while under fluphenazine treatment. Cerebrospinal fluid was examined for monoamine metabolites by high-performance liquid chromatography both during the acute and the convalescent phases of the disease. Since the disease carries a considerable mortality, early diagnosis and rapid withdrawal of all neuroleptic medication is of primary importance.

Adult↗
PubMed1998

Long-term effect of electrostimulation of the subthalamic nucleus in bradykinetic-rigid Parkinson's disease.

The motor effects of unilateral stimulation of the subthalamic nucleus on hypokinesia were studied in two patients 58 and 52 years old, both modified Hoehn and Yahr 2.5, at 16 and 15 months after the implantation of a quadripolar electrode (Medtronic). Motor UPDRS, time in the pegboard test, walking time, tapping, and serial reaction times were recorded. Chronic unilateral stimulation was associated with reversible improvement of measures of reaction time and hypokinesia > 1 year after the stereotactic electrode implantation. The beneficial effect was mainly contralateral to the stimulation. However, improvement of axial functions was also observed (phonation, walking).

Dominance, Cerebral↗
PubMed2000

[Clinical pathophysiology of parkinsonian symptoms: from experiences of stereotaxic surgery].

Pathophysiological mechanisms of major symptoms of Parkinson's disease are discussed from experiences of stereotaxic surgery. Tremor completely disappears by a lesion in the ventral intermediate nucleus(Vim) which receives proprioceptive sense from the periphery. Rigidity is alleviated by a lesion in the globus pallidus(GP) and the ventral lateral nucleus(VL) equally. Since GP projects to the prefrontal motor cortex via VL, surgery to either of those structures causes the same result. Akinesia is classified into three types: secondary akinesia, primary akinesia, and akinesia due to psychomotor dysfunction. Gradual spread of neuronal degeneration within the substantia nigra pars compacta may explain the progression of akinesia. Psychological or psychiatric disorder becomes major symptom in the late stage. Posteroventral pallidotomy may change emotional state in some cases by influencing the limbic motor circuit.

Animals↗
PubMed1995

[Startle disease: growing rigid with fear].

Hyperekplexia or startle disease was diagnosed in four patients, a girl of 14 months, two men of 45 and 61 years old, and a woman of 56 years old. This is an autosomal dominant inherited disorder, characterized by excessive startle reactions, notably to auditory stimuli. The four patients belong to a Dutch family in which two forms of the disorder occur. The first one is the major form, in which the startle reaction is followed by a temporary generalized stiffening of the body. These patients experience continuous generalized stiffness from birth to about the second year of life. They fall down frequently. The other is the minor form, characterized by an excessive startle reaction only.

Female↗
PubMed1992

Extrapyramidal signs in Alzheimer's disease: a 3-year follow-up study.

Occurrence of extrapyramidal signs was investigated in a follow-up study of 32 patients with probable Alzheimer's disease (AD). Bradykinesia and rigidity were observed in 39% and 11% of the neuroleptic-free patients at entry and in 72% and 61% at year 3, respectively. Tremor was not a predominant feature nor did its occurrence increase over time. Use of neuroleptics contributed to extrapyramidal signs; 75-100% of the neuroleptic-treated patients showed bradykinesia, rigidity or orofacial dyskinesia. The homovanillic acid (HVA) concentrations of the cerebrospinal fluid at entry were comparable to those of age-matched controls. Nor did HVA levels correlate with rigidity or bradykinesia in these early AD cases. Presence of bradykinesia or rigidity at the initial evaluation predicted more severe dementia and a poor prognosis over the period of 3 years, although interaction of initial clinical severity of dementia was significant. Of 15 patients with these signs 3 (20%) died and 8 (53%) needed institutional care, while of 17 patients without these signs only 1 (6%) died and 2 (12%) were institutionalized by year 3 (p less than 0.01).

Aged↗
PubMed1963

RESULTS OF THALAMOTOMY FOR PARKINSON'S DISEASE.

Surgical destruction of a portion of the ventrolateral nucleus of the thalamus is currently the procedure of choice for the treatment of incapacitating tremor and rigidity of parkinsonism. Seventy-three patients were treated by 105 thalamotomies at the University of Alberta Hospital and assessed one to four years later for improvement of function in everyday activities. Fifty-six patients were improved, 12 were unchanged, and five had died. Only two of the deaths were related to the operation. Paresis was permanent in only one patient. Twenty-five patients had bilateral operations and 22 of these showed improvement of function. Contraindications to operation include serious cardiovascular disease, mental deterioration, and those parkinsonian patients whose disability is chiefly due to akinesia, oculogyric crisis, dysphasia or dysarthria.

Cerebral Ventriculography↗
PubMed1983

Symptoms and side effects in the course of Parkinson's disease.

From our investigations, we are tempted to assume that all types of akinesia, including "freezing", off-phases, Yo-Yoing and akinetic crises, are primarily symptoms of PD, while hyperkinesia, stretch spasms and pharmacotoxic psychosis are "side-effects". Therefore side-effects can be triggered by antiparkinsonian therapy while they will disappear after withdrawal of the drugs inducing them. Antiparkinson drugs alleviate major symptoms like akinesia and rigidity but sometimes and especially as reflection of advanced parkinsonism, might amplify minor symptoms (freezing, off-phases, Yo-Yoing), which then predominantly at high drug doses occur earlier and more intensively. Therefore, minor symptoms can be observed more frequently in the advanced stages of PD. Depressed phases belong to the symptom complex as is bradyphrenia and dizziness. Bradyphrenia is the psychic correlate to akinesia. Dementia, if at all is a symptom, but more likely this disease occurs occasionally in combination with parkinsonism.

Autonomic Nervous System Diseases↗
PubMed1997

Studies on the safety of glucose and paraben-containing neostigmine for intrathecal administration.

Initial toxicity testing of neostigmine for intrathecal (IT) injection was performed with preservative-free isobaric solution, yet currently available formulations contain the preservatives methyl- and propylparaben and are usually mixed with glucose to yield hyperbaric solutions. Since it has been proposed that preservatives and hyperbaricity increase the risk of neurotoxicity after IT injection, we examined the safety of chronically administered IT neostigmine containing these additives in sheep and rats. Rats receiving daily IT injections of glucose alone or of glucose with preservative-containing neostigmine, 5 and 10 microg, exhibited dose-related antinociception, tremor, and rigidity. In comparison to our previously published study of neostigmine injection in solution without glucose, rats receiving IT neostigmine with glucose displayed less rigidity, tremor, and salivation. Sheep receiving daily injection of glucose alone or with preservative-containing neostigmine, 1 mg, for 14 days exhibited no histologic evidence of neurotoxicity, nor did they exhibit abnormalities in cerebrospinal fluid chemistry aside from those caused by inflammation. Spinal cord histologic examination in both species revealed fibrosis and inflammation secondary to the catheter without evidence of neuronal damage. These studies support the safety of paraben- and glucose-containing IT neostigmine.

Analgesia, Epidural↗