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PubMed1999

Comparison of 1-year follow-up evaluations of patients with indication for pallidotomy who did not undergo surgery versus patients with Parkinson's disease who did undergo pallidotomy: a case control study.

UNLABELLED: Many reports published during the past 5 years have shown evidence of the beneficial effect of posteroventral pallidotomy (PVP) in large groups of patients for up to 3 years, but none of them have compared patients who underwent surgery with a control group. OBJECTIVE: To compare the evolution of Parkinson's disease symptoms at 1-year follow-up between patients who underwent surgery and those who did not. MATERIAL AND METHODS: Ten patients with idiopathic Parkinson's disease refractory to treatment who were included in the Core Assessment for Intracerebral Transplantation program for PVP did not undergo surgery because financial support was lacking. These patients were followed up for 1 year as if they had been operated on and were finally compared with 10 patients having similar characteristics in whom PVP had been performed during the same period of time. RESULTS: There were no significant differences at basal evaluation in the motor section scores of the Unified Parkinson's Disease Rating Scale between those patients who underwent surgery and those who did not, but a significant reduction in Unified Parkinson's Disease Rating Scale motor score in the group who underwent surgery at 1-year evaluation was found (P < 0.006). Dyskinesias, which was nonsignificantly different at basal evaluation, showed, at the 1-year follow-up, a significant reduction in the group who underwent surgery (P < 0.04). Scores from the subsets of the Unified Parkinson's Disease Rating Scale addressing rigidity, tremor, and bradykinesia also proved significantly different at the 1-year follow-up. The slope of the line generated by the two evaluations for each group showed a negative value in the group who underwent surgery (value of -0.21) and a positive value in the group who did not (value of 0.148). CONCLUSION: At the 1-year follow-up, microelectrode-guided PVP produced significant changes in patient motor status and disease progression versus a comparable group of patients who did not undergo surgery during the same period of time.

Aged↗
PubMed1963

Repair of large incisional hernias. A new anatomical technique.

Large upper abdominal incisional hernias have always been a vexing problem to surgeons because of the rigidity of the costal arches. With the increasing longevity of our population and the constant improvement in ways to sustain older patients during operative procedures, incisional hernias, especially of the upper abdominal area, will undoubtedly become more prevalent.A new anatomical procedure for repair, which was used in 16 cases, eliminates the necessity of the use of various prosthetic materials: extrapleural sectioning of the costal cartilages from approximately the seventh to the tenth rib permits the directional pull of the attached musculature to narrow the defect, thus allowing repair of the hernia without tension. The procedure is technically a simple one and postoperative complications are minimal.

Adult↗
PubMed1982

Similarities of the cataleptic state induced by beta-endorphin and morphine.

A variety of behavioral tests were used to characterize the cataleptic state induced by various treatments. Besides catalepsy, posture, locomotion, rigidity and the presence of reflexive responses were assessed. Measures of analgesia and body temperature were taken. The behavioral profiles of beta-endorphin, morphine, etonitazene, haloperidol, arecoline and GABA were compared at the time maximal catalepsy scores were obtained. Results indicated that, for an equivalent degree of catalepsy, the profile of beta-endorphin was similar to that of opiates, except for changes in body temperature; beta-endorphin's profile differed markedly from that of haloperidol, arecoline and GABA. Catalepsy was less pronounced with the latter two drugs. There were similarities in the behavioral profile of haloperidol and arecoline.

Analgesia↗
PubMed1978

[Experience in treating vascular parkinsonism with metamysil].

The paper is concerned with a study of the effect of metamizil in 45 patients with different forms of vascular parkinsonism. It was established that metamizil exerts a positive effect on the development of neurological symptoms (rigidity, bradykinesia, tremor) in mild and moderately expressed degrees of lesions. In most of the cases the drugs appeared effective in doses of 0.001 g thrice daily, and in separate cases 0.001 g 6 times daily. In the majority of patients metazil was tolerated without significant side effects. In some patients the side effects (vertigo, dryness in the mouth) were slightly expressed. The effect of treatment was seen after 2 days up to 2 weeks and lasted during the whole course of treatment and sometimes after it. Metamizil possessing a moderate sedative action, as well as spasmolytical and hypotensive is indicated for patients with vascular parkinsonism.

Aged↗
PubMedDate not supplied

Disinhibition of nigral GABA output neurons mediates muscular rigidity elicited by striatal opioid receptor stimulation.

Unilateral injection of bicuculline (12.5-50 ng) into the substantia nigra pars reticulata (SNR) dose-dependently produced a tonic activity in the electromyogram (EMG), which was antagonized by coadministered muscimol. Bilateral lesions of the caudate nucleus with kainic acid failed to affect the EMG activity produced by unilateral injection of bicuculline into the SNR. Administration of muscimol (12.5 and 25 ng) into the SNR antagonized the tonic activity in the EMG produced by morphine (15 mg/kg i.p.), whereas bicuculline (50 ng) enhanced it. These results suggest that an impairment in the GABAergic neurotransmission in the SNR is relevant for mediating the tonic activity in the EMG produced by morphine and that GABAergic mechanisms in the SNR play an important role in the modulating the opioid-induced alterations in the striatal function.

Animals↗
PubMed1995

Effect of age and disease duration on parkinsonian motor scores under levodopa therapy.

One hundred and fifty patients suffering from Parkinson's disease were analysed for the expression of the motor symptoms during optimum response to levodopa therapy (subscale III of the Unified-Parkinson's Disease Rating Scale). Patients were grouped according to age (< or = 64, 65-74, > or = 75 years). Disease duration and daily levodopa dosage were similar in the three groups. Pooled residual scores for posture and gait impairment (PGI), tremor (T), rigidity (R) and distal motor impairment (DMI; hand and foot movements) increased with age (Kruskal-Wallis ANOVA). The parkinsonian scores were significantly higher than the scores of 150 age-matched normal controls (Mann-Whitney U test). The differences between the patients' scores and the scores of the age-matched controls increased with age. In spite of a significant increase in the daily levodopa dosage with disease duration (linear regression), PGI aggravated age-dependently, and DMI age-independently with symptom duration (Spearman rank correlation). In contrast, T and R did not increase with disease duration.

Adult↗
PubMed1983

Traumatic decerebrate rigidity and neurological recovery: a case report.

Trauma is the most common cause of decerebrate rigidity (DR). DR has been incorrectly equated with extensor posturing alone, however, and the "classical" criteria of decerebration generally have not been incorporated in the neurological evaluation of head-injured patients. A high mortality rate is associated with extensor posturing in head injury, and there have been few reports detailing neurological recovery and the quality of survival of patients with traumatic DR. The criteria of Sherrington are applied to a case of DR caused by midbrain injury, accompanied by mild, diffuse, hemispheric white matter changes shown on computed tomographic scan. The neurological examination and recovery are discussed. The literature is reviewed and the potential of DR in the prognosis of head injury is suggested.

Adult↗
PubMed2005

Catatonia causing permanent cognitive impairment: a case study.

OBJECTIVE: We describe a case of psychogenic malignant catatonia resulting in permanent cognitive impairment. BACKGROUND: Catatonia is a neuropsychiatric syndrome characterized by catalepsy, negativism, mutism, muscular rigidity, and mannerisms, often accompanied by autonomic instability and fever. Little is known about the long-term cognitive consequences of the syndrome. METHOD: Medical history includes neurologic examination, neuropsychological evaluation, electroencephalographic data, magnetic resonance imaging, sodium amytal interview, and treatment with electroconvulsive therapy. RESULTS: Selective deficits in executive function and an anterograde amnesia were evident a week post-ECT treatment and continued to be present at follow-up after 2 years and 8 months. CONCLUSION: The permanent cognitive impairments are considered in the context of catatonia as a frontal lobe syndrome.

Amobarbital↗
PubMed2004

Adverse effects of risperidone and haloperidol treatment in schizophrenia.

PURPOSE: Side effects of pharmacological treatment in schizophrenia continue to be a major issue in spite of the development of new antipsychotics. The aim of this study is to explore the adverse effects of conventional and atypical antipsychotic drugs and their associated factors. METHODS: Over 3 months, 41 patients with schizophrenia were randomized to treatment with risperidone 1-12 mg (n=21) or haloperidol 2-20 mg (n=20) daily. Efficacy was assessed by improvement of psychotic symptoms, measured on the Positive and Negative Syndrome Scale (PANSS). The safety and tolerability were assessed with the Extrapyramidal Symptom Rating Scale, the UKU Side-Effect Rating Scale and clinical laboratory assessments. RESULTS: Each treatment reduced psychotic symptoms. PANSS total scores, positive scores, and general psychopathology scores declined as trial went on without significant differences between the two groups. While PANSS negative scores improved better in the risperidone group than in the haloperidol group. The tolerability of antipsychotics was statistical significantly better in the risperidone than in the haloperidol-treated patients. The most frequent adverse effects for both groups were tremor and rigidity. Antipsychotics, their doses, and hyperprolactinemia predict short-term extrapyramidal side effects. Serum prolactin levels could predict parkinsonism and dyskinesia severity. However, dyskinesia was best predicted by the doses of neuroleptics. The predictive factor of dystonia was the antipsychotic drug itself. After adjusting drug doses and concomitant medications, side effects could be markedly improved. CONCLUSIONS: This study suggested that risperidone was superior to haloperidol in improving negative symptoms and better tolerated during the 12 weeks' treatment of schizophrenia. Serum prolactin levels could predict the severity of parkinsonism and dyskinesia.

Adult↗
PubMed1998

Neuroleptic malignant syndrome: a review.

OBJECTIVE: Neuroleptic malignant syndrome is an uncommon side effect of antipsychotic medications characterized by severe rigidity, tremor, fever, altered mental status, autonomic dysfunction, and elevated serum creatinine phosphokinase and white blood cell count. This paper presents a concise and comprehensive review of neuroleptic malignant syndrome, written with the practitioner in mind, to provide information that will be useful in actual clinical settings. METHODS: MEDLINE was searched from 1966 to 1997 for key reviews, reports on series of cases of neuroleptic malignant syndrome, individual case reports, and other clinically and theoretically important information. RESULTS AND CONCLUSIONS: Virtually all neuroleptics are capable of inducing the syndrome, including the newer atypical antipsychotics. The standard of care for the recognition of neuroleptic malignant syndrome has shifted considerably over the past 15 years. Neuroleptic malignant syndrome belongs in the differential diagnosis of any patient receiving a neuroleptic who develops a high fever or severe rigidity. In addition to measurement of creatinine phosphokinase and white blood cell count, important tests to rule out other etiologies include urinalysis to measure electrolytes, including calcium and magnesium; kidney, liver, and thyroid function tests; lumbar puncture; an electroencephalogram; and a computed tomography or magnetic resonance imaging scan of the head. Although specific treatment remains controversial, supportive treatment such as antipyretics, a cooling blanket, and intravenous fluids to correct dehydration and electrolyte abnormalities is critical and widely supported by consensus. Most patients recover from neuroleptic malignant syndrome in two to 14 days without any cognitive impairment, and new dysfunction usually is attributable to very high fever, hypoxia, or other complications, rather than neuroleptic malignant syndrome per se.

Diagnosis, Differential↗
PubMed1996

Pallidal lesions. Structural and functional magnetic resonance imaging.

OBJECTIVE: To study noninvasively the functional anatomy and pathophysiologic characteristics of the globus pallidus external (GPe) and internal (GPi) divisions. DESIGN: Structural and functional neuroimaging using high-resolution magnetic resonance imaging. SETTING: University medical center research facility. SUBJECTS. Seven patients with pallidal lesions, 4 with an akinetic-rigid syndrome and 3 with a dystonic syndrome, and 15 age-matched volunteers. MAIN OUTCOME MEASURES: T2-weighted anatomical magnetic resonance imaging and number of activated voxels in the GP during rapid supination and pronation of the hand. RESULTS: T2-weighted images showed hyperintense bilateral lesions in the GP of all patients. Patients with dystonic syndromes had isolated lesions in the GPi. Patients with signs of akinetic-rigid syndromes showed abnormalities in the GPe or in central portions of the GP (GPc). Patients with lesions in both parts of the GP had akinetic-rigid or dystonic syndromes. All patients showed activation in the areas of the lesions. The number of activated voxels in the GP was significantly smaller (P < .005, Wilcoxon signed rank test) in patients than in control subjects. Activation of the GP was predominantly contralateral to the moving hand. CONCLUSIONS: Lesions in the GPi result in a loss of inhibitory pallidal projections to the thalamus, which may explain the hyperkinetic signs. Lesions in the GPe lead to an increased inhibition of the thalamus, which may explain the hypokinetic signs. Neuronal activation in lesion sites suggests the presence of remaining functionally vital tissue.

Aged↗
PubMed1975

Amphetamines in the treatment of Parkinson's disease.

Twenty-two patients with Parkinsonism were treated with levoamphetamine and 12 of these with dextroamphetamine. Levoamphetamine resulted in a significant improvement in disability from Parkinsonism, although the reduction in total disability, tremor, akinesia, and rigidity scores was slight (ca 20 percent). Dextroamphetamine in lower dosage also reduced disability by some 17 percent. The most disabled patients, including those also on levodopa, showed the greatest response to amphetamines. Previously, amphetamines have been reported to be a selective treatment for the oculogyric crises of post-encephalitic Parkinsonism. Amphetamines are thought to cause the release of catecholamines from central neurones. Their action in Parkinson's disease may be limited because of pre-existing striatal dopamine deficiency. Side-effects of amphetamines, anorexia, and CNS stimulation are different from those caused by levodopa in patients with Parkinson's disease.

Aged↗
PubMed1998

Medial temporal lobe epilepsy: videotape analysis of objective clinical seizure characteristics.

PURPOSE: The syndrome of temporal lobe epilepsy has been described in great detail. Here we focus specifically on the clinical manifestations of seizures originating in the hippocampus and surrounding mesial temporal structures. METHODS: Seizure origin was confirmed in 67 cases by depth EEG recording and surgical cure after mesial temporal resection. RESULTS: Among nonlateralized manifestations, we commonly found oral automatisms, pupillary dilatation, impaired consciousness, and generalized rigidity. Appendicular automatisms were often ipsilateral to the seizure focus, whereas dystonia and postictal hemiparesis were usually contralateral. Head deviation, when it occurred early in the seizure, was an ipsilateral finding, but was contralateral to the seizure focus when it occurred late. Clear ictal speech and quick recovery were found when seizures originated in the non-language-dominant hemisphere, but postictal aphasia and prolonged recovery time were characteristic of seizure origin in the language-dominant hemisphere. CONCLUSIONS: These signs help to define the mesial temporal lobe epilepsy (MTLE) syndrome and often provide information as to the side of seizure origin.

Automatism↗
PubMed1953

The 1952 outbreak of encephalitis in California; differential diagnosis.

Clinical data adequate for analysis were available in 386 laboratory-confirmed cases of arthropod-borne encephalitis - 38 St. Louis and 348 western equine. Consistently observed symptoms varied with the age of the patient. Symptoms that occurred in a high proportion of patients in each age group were:LESS THAN ONE YEAR OF AGE: Fever and convulsions. (None had the St. Louis disease.)ONE THROUGH FOUR YEARS: Fever, headache, vomiting, drowsiness, irritability, restlessness, nuchal rigidity, tremor, and sometimes convulsions. FIVE THROUGH FOURTEEN YEARS: Headache, fever, and drowsiness. Sometimes the disease progressed no further, but if it did, nausea, vomiting, muscular pain, photophobia and limitation of neck and back flexion often were noted; and sometimes convulsions and intention tremors. FIFTEEN YEARS AND OLDER: Drowsiness, lethargy, malaise, fever, stiffness at the back of the neck and, almost always, severe intractable occipital headache associated with nausea, disturbance of vision, photophobia and vertigo. The extreme difficulty of differential diagnosis on the basis of clinical observation was indicated by the wide range of diagnoses made in these cases before the invading organism was identified by laboratory studies.

Animals↗
PubMed1998

Atypical rigid form of Huntington's disease: a case with peripheral amyotrophy and congenital defects of a lower limb.

We describe a patient showing an atypical phenotype of Huntington's disease (HD), including prominent generalized dystonia, peripheral amyotrophy of the legs with an inverted champagne bottle configuration and pes equinus. The patient also had congenital defects of the lower left leg. Chorea and psychiatric symptoms were not prominent. Polymerase chain reaction assessment revealed 51 CAG repeats in gene IT 15. Magnetic resonance imaging of the brain demonstrated mild atrophy of the pons and cerebellum, and hyperintensity of the transverse pontine fibers and neostriatum on spin-echo images. Peripheral amyotrophy in this case might have resulted from axonal degeneration related to neuronal damage in the central nervous system, although at the present time we cannot confirm it as a new HD phenotype.

Adult↗
PubMed1986

An analysis of long-term L-dopa therapy in 122 cases of Parkinson's disease over 14 years--when should L-dopa therapy be initiated?

L-Dopa was administered to 122 patients with Parkinson's disease over a time period up to 14 years. The results were summarized below. The akinesia and postural instability scores were significantly improved up to the 9th year. The rigidity and static tremor scores and the Parkinson score were significantly improved up to the 11th year. The Yahr stage was significantly improved up to the 8th year. The time course of Parkinson score was investigated in three groups, Yahr stage I/II group, Yahr stage III group, and Yahr stage IV/V group, taking into account the time interval between the onset of the disease and initiation of L-dopa therapy. No significant difference was found among the three groups. The above results suggested that the long-term prognosis of patients on L-dopa therapy in Japan was better than in Western countries. It was also though that L-dopa therapy should be instituted at the earliest possible stage of the disease.

Adult↗
PubMed1979

Dementia-Parkinsonism syndrome with numerous Lewy bodies and senile plaques in cerebral cortex.

Five cases of age range 62-72 years with progressive dementia and muscular rigidity are reported and discussed from the clinicopathologic point of view. The neuropathology of these cases was characterized by the widespread occurrence of Lewy bodies (LB) in the CNS as well as the presence of senile changes. The presence of numerous LB in the cerebral cortex and basal ganglia was especially characteristic, although their distribution pattern in the diencephalon and brain stem was identical to that found in paralysis agitans. On the other hand, the presence of senile changes in the cerebral cortex was almost identical to the neuropathology of senile dementia or Alzheimer's disease. Nosologically, the present cases may represent either a combination of atypical paralysis agitans with senile dementia and Alzheimer's disease, or a new disease.

Aged↗
PubMed2006

Corticobasal degeneration and progressive aphasia.

OBJECTIVE: To describe language impairment in the corticobasal degeneration syndrome (CBDS) presenting as either a cognitive or motor disorder, to compare the evolution of aphasia in CBDS with primary progressive aphasia (PPA), and to examine whether the side of maximal cerebral atrophy or akinesia reflects the severity of aphasia. METHODS: We divided 40 patients with CBDS according to motor or cognitive onsets and conducted detailed language assessments with the Western Aphasia Battery (WAB). We analyzed scores according to the side of atrophy and motor rigidity. Longitudinal performance over three annual assessments was compared against matched patients with PPA and Alzheimer disease. RESULTS: Language at baseline was more impaired in cognitive than motor-onset CBDS but there was no correlation between the side of atrophy or motor impairment and the WAB. Serial assessment (n = 19) showed a similar evolution of aphasia in cognitive-onset CBDS and PPA and delayed aphasia in motor-onset CBDS. CONCLUSION: Aphasia is common in the corticobasal degeneration syndrome but there is little correlation with the laterality of clinical deficits. Cognitive-onset corticobasal degeneration syndrome and primary progressive aphasia are similar such that their aphasia appears identical.

Aged↗