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Frontiers in Neuroscience 2019Although the occurrence of Parkinsonian akinesia and tremor is traditionally associated to dopaminergic degeneration, the multifaceted neural processes that cause these...
Although the occurrence of Parkinsonian akinesia and tremor is traditionally associated to dopaminergic degeneration, the multifaceted neural processes that cause these impairments are not fully understood. As a consequence, current dopamine medications cannot be tailored to the specific dysfunctions of patients with the result that generic drug therapies produce different effects on akinesia and tremor. This article proposes a computational model focusing on the role of dopamine impairments in the occurrence of akinesia and resting tremor. The model has three key features, to date never integrated in a single computational system: (a) an architecture constrained on the basis of the relevant known system-level anatomy of the basal ganglia-thalamo-cortical loops; (b) spiking neurons with physiologically-constrained parameters; (c) a detailed simulation of the effects of both phasic and tonic dopamine release. The model exhibits a neural dynamics compatible with that recorded in the brain of primates and humans. Moreover, it suggests that akinesia might involve both tonic and phasic dopamine dysregulations whereas resting tremor might be primarily caused by impairments involving tonic dopamine release and the responsiveness of dopamine receptors. These results could lead to develop new therapies based on a system-level view of the Parkinson's disease and targeting phasic and tonic dopamine in differential ways.
PubMed: 31191237
DOI: 10.3389/fnins.2019.00550 -
The Indian Journal of Medical Research Jan 2016Parkinson`s disease (PD) is the most common neurodegenerative disease and is characterized by tremor, rigidity and akinesia. Diagnosis is clinical in the majority of the... (Review)
Review
Parkinson`s disease (PD) is the most common neurodegenerative disease and is characterized by tremor, rigidity and akinesia. Diagnosis is clinical in the majority of the patients. Patients with PD may have stooped posture but some of them develop different types of postural and striatal deformities. Usually these deformities are more common in atypical parkinsonian disorders such as progressive supranuclear palsy and multisystem atrophy. But in many studies it has been highlighted that these may also be present in approximately one third of PD patients leading to severe disability. These include antecollis or dropped head, camptocormia, p0 isa syndrome, scoliosis, striatal hands and striatal toes. The pathogenesis of these deformities is a complex combination of central and peripheral influences such as rigidity, dystonia and degenerative skeletal changes. Duration of parkinsonism symptoms is an important risk factor and in majority of the patients these deformities are seen in advanced statge of the disease. The patients with such symptoms may initially respond to dopaminergic medications but if not intervened they may become fixed and difficult to treat. Pain and restriction of movement are most common clinical manifestations and these may mimick symptoms of musculoskeletal disorders like rheumatoid arthritis. Early diagnosis is important as the patients may respond to adjustment in dopaminergic medications. Recent advances such as deep brain stimulation (DBS) and ultrasound guided botulinum toxin injection are helpful in management of these deformities in patients with PD.
Topics: Brain; Congenital Abnormalities; Corpus Striatum; Humans; Parkinson Disease; Posture
PubMed: 26997007
DOI: 10.4103/0971-5916.178577 -
Asia-Pacific Journal of Ophthalmology... 2018Ocular regional blocks generally require blind instrumentation to the posterior orbit, leading to rare but serious complications. However, topical anesthesia does not...
PURPOSE
Ocular regional blocks generally require blind instrumentation to the posterior orbit, leading to rare but serious complications. However, topical anesthesia does not suppress eye or lid movements and may lead to more surgical complications. Advanced subconjunctival anesthesia (ASCAN) is a technique developed to provide reliable akinesia and anesthesia without anterior dissection or blind intrusion into the posterior orbit, while allowing visualization of the needle-tip position.
DESIGN
Nonrandomized case series at a rural health service.
METHODS
Advanced subconjunctival anaesthesia was performed on 60 elective adult patients undergoing phacoemulsification surgery. The technique involves piercing the conjunctiva and Tenon's capsule in the superior outer quadrant of the globe with a 25-gauge, 16 mm needle, using either lignocaine 2% plain or in equal mix with bupivicaine 0.5%. Up to 10 mL of anesthetic with hyaluronidase 30 IU/mL is injected in a posterior direction into the sub-Tenon's space. Ocular motor functions were assessed 10 minutes after ASCAN using a Brahma scale. Pain was assessed during surgery and at the end of surgery after subconjunctival injection of antibiotic and steroid using a verbal Numeric Rating Scale.
RESULTS
All patients completed surgery without needing supplemental anesthesia. Fifty-eight patients (97%) were pain free, whereas 2 patients experienced transient mild pain. Adequate globe akinesia and reliable lid paralysis was achieved comparable to other studies, with no major surgical or anesthetic complications.
CONCLUSIONS
Advanced subconjunctival anesthesia is a visually guided, minimally invasive technique, achieving satisfactory analgesia and akinesia for phacoemulsification surgery.
Topics: Adult; Aged; Anesthesia, Local; Anesthetics, Local; Bupivacaine; Female; Humans; Injections; Lidocaine; Male; Middle Aged; Oculomotor Muscles; Pain Measurement; Phacoemulsification
PubMed: 30264551
DOI: 10.22608/APO.2018231 -
Anesthesia, Essays and Researches 2022An ideal anesthetic solution should provide good anesthesia and akinesia with minimal pain on injection.
BACKGROUND
An ideal anesthetic solution should provide good anesthesia and akinesia with minimal pain on injection.
AIMS
The aim of this study is to determine the effect on pain perception and efficacy of sodium bicarbonate over hyaluronidase in the local anesthetic mixture during peribulbar anesthesia.
SETTINGS AND DESIGN
A prospective, randomized, double-blind study.
MATERIALS AND METHODS
An independent observer labeled two injections as A (hyaluronidase 1500 IU in 30 mL of lignocaine) and B (7.5% sodium bicarbonate 1 mL in 30 mL of lignocaine). Group 1 was injected with injection A while Group 2 was injected with injection B. The visual analog scale (VAS) was used to determine the intensity of pain. Onset and degree of anesthesia and akinesia were recorded.
STATISTICAL ANALYSIS
Computer software Microsoft Excel SPSS version 26 (Chicago Inc) for windows was used. The qualitative data and quantitative data were reported as proportions and mean ± (standard deviation), respectively. Chi-square test for proportions was used for the comparison of qualitative variables and unpaired Student's -test was used to test the significance between quantitative variables. < 0.05 was considered statistically significant. All were two-tailed.
RESULTS
Out of 123 patients, 23 were excluded from the study. Hundred patients were divided into Group 1 and Group 2. The mean age in Group 1 was 64.92 ± 10.77 years while in Group 2 was 62.86 ± 11.17 years. The mean heart rate and mean systolic blood pressure in both groups were statistically insignificant. Group 2 experienced very less pain (mean pain score VAS = 5.12 ± 1.17) as compared to Group 1 (mean pain score was 7.16 ± 1.09) and the difference between both the groups was found to be statistically significant. There was a significant difference in the onset of anesthesia in both groups ( = 0.001). In the sodium bicarbonate group, the onset was faster. The onset of akinesia was better in Group 1 (4.76 ± 2.06 min). Grading of akinesia was better in Group 1.
CONCLUSION
Sodium bicarbonate reduces pain on injection in peribulbar anesthesia and also results in a quicker onset of anesthesia.
PubMed: 36249141
DOI: 10.4103/aer.aer_128_21 -
Parkinsonism & Related Disorders Feb 2023Progressive supranuclear palsy (PSP) is associated with several clinical variants defined based on ocular motor dysfunction, postural instability, akinesia, and...
INTRODUCTION
Progressive supranuclear palsy (PSP) is associated with several clinical variants defined based on ocular motor dysfunction, postural instability, akinesia, and cognitive dysfunction, although little is known about how these features progress over time. We aimed to assess the evolution of these core clinical features across variants and assess baseline clinical and neuroimaging predictors of progression.
METHODS
Ninety-three PSP patients were recruited by the Neurodegenerative Research Group, Mayo Clinic, and underwent two visits 1-year apart, with baseline MRI and [F]flortaucipir PET. We compared baseline and annualized rates of clinical change on the PSP Rating Scale (total, ocular motor, gait/midline scores) and Montreal Cognitive Assessment, across PSP-Richardson's, PSP-Cortical and PSP-Subcortical variants and assessed relationships between rates of change and baseline regional imaging.
RESULTS
Ocular motor scores differed across groups at baseline and follow-up, with lowest scores observed in PSP-subcortical, but no differences were observed in rate of change across groups. PSP Rating Scale total and gait/midline scores differed across groups at follow-up and in rates of change, with PSP-subcortical showing the least impairment and slowest progression. Greatest cognitive impairment was observed in PSP-Cortical. Sample size estimates for treatment trials differed across PSP variants. Greater baseline flortaucipir uptake, but not volume, of midbrain and motor cortex correlated with faster rates of clinical decline.
CONCLUSION
The PSP Rating Scale and its subscores might be useful markers for the prognostic stratification of PSP variants. Flortaucipir imaging at baseline may help predict rate of decline.
Topics: Humans; Supranuclear Palsy, Progressive; Neuroimaging; Magnetic Resonance Imaging; Mesencephalon; Eye Movements
PubMed: 36682219
DOI: 10.1016/j.parkreldis.2023.105290 -
NeuroImage. Clinical 2019Akinesia is a major manifestation of Parkinson's disease (PD) related to difficulties or failures of willed movement to occur. Akinesia is still poorly understood and is... (Review)
Review
Akinesia is a major manifestation of Parkinson's disease (PD) related to difficulties or failures of willed movement to occur. Akinesia is still poorly understood and is not fully alleviated by standard therapeutic strategies. One reason is that the area of the clinical concept has blurred boundaries referring to confounded motor symptoms. Here, we review neuroimaging studies which, by providing access to finer-grained mechanisms, have the potential to reveal the dysfunctional brain processes that account for akinesia. It comes out that no clear common denominator could be identified across studies that are too heterogeneous with respect to the clinical/theoretical concepts and methods used. Results reveal, however, that various abnormalities within but also outside the motor and dopaminergic pathways might be associated with akinesia in PD patients. Notably, numerous yet poorly reproducible neural correlates were found in different brain regions supporting executive control by means of resting-state or task-based studies. This includes for instance the dorsolateral prefrontal cortex, the inferior frontal cortex, the supplementary motor area, the medial prefrontal cortex, the anterior cingulate cortex or the precuneus. This observation raises the issue of the multidimensional nature of akinesia. Yet, other open issues should be considered conjointly to drive future investigations. Above all, a unified terminology is needed to allow appropriate association of behavioral symptoms with brain mechanisms across studies. We adhere to a use of the term akinesia restricted to dysfunctions of movement initiation, ranging from delayed response to freezing or even total abolition of movement. We also call for targeting more specific neural mechanisms of movement preparation and action triggering with more sophisticated behavioral designs/event-related neurofunctional analyses. More work is needed to provide reliable evidence, but answering these still open issues might open up new prospects, beyond dopaminergic therapy, for managing this disabling symptom.
Topics: Brain; Gait Disorders, Neurologic; Humans; Magnetic Resonance Imaging; Parkinson Disease; Positron-Emission Tomography
PubMed: 30584015
DOI: 10.1016/j.nicl.2018.101644 -
Archive of Clinical Cases 2022As marijuana, the most widely-used illicit drug in adolescents and adults, has some unknown side effects, marijuana abuse has become a public health concern. Also,...
As marijuana, the most widely-used illicit drug in adolescents and adults, has some unknown side effects, marijuana abuse has become a public health concern. Also, marijuana affects different organs such as heart in its rate, rhythm and coronary flow; it eventually leads to events such as myocardial infarction and rarely myocarditis. A 24-year-old man without any medical history or cardiovascular risk factors presented with chest pain after marijuana consumption. Based on electrocardiogram, myocardial cytolysis and transthoracic echocardiography acute myocarditis diagnosis was established. A few days later, transthoracic echocardiography showed a small clot in apex with reduced left ventricle ejection fraction, in the absence of local akinesia. The patient was discharged with oral anticoagulant stable and without any symptoms. The myocarditis after marijuana abuse is rare. The physicians should include acute myocarditis in differential diagnosis of a patient with chest pain after using marijuana.
PubMed: 35813492
DOI: 10.22551/2022.35.0902.10206 -
Medical Science Monitor : International... Jun 2011Stress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or... (Review)
Review
Stress cardiomyopathy is characterised by reversible left ventricular dysfunction. It simulates an acute coronary syndrome (ACS), presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QTc interval on electrocardiogram, and raised cardiac enzymes. Typical findings are disturbances of segmental contractility (apical hypokinesia or akinesia), with normal epicardial coronary arteries. The true prevalence is unknown, as the syndrome may be under-diagnosed; it is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The electrocardiographic, echocardiographic, and ventriculographic changes resolve spontaneously over a variable period of time (from days to months). There are a number of pathophysiological theories, none of which has been shown to be definitive, suggesting that all of them may be involved to some extent. The prognosis is generally favourable, and recurrence is very rare.
Topics: Biomarkers; Cardiac Catheterization; Humans; Takotsubo Cardiomyopathy; Ultrasonography
PubMed: 21629203
DOI: 10.12659/msm.881800 -
The Application of Clinical Genetics 2018Pena-Shokeir syndrome (PSS) type 1, also known as fetal akinesia deformation sequence, is a rare genetic syndrome that almost always results in intrauterine or early... (Review)
Review
Pena-Shokeir syndrome (PSS) type 1, also known as fetal akinesia deformation sequence, is a rare genetic syndrome that almost always results in intrauterine or early neonatal death. It is characterized by markedly decreased fetal movements, intrauterine growth restriction, joint contractures, short umbilical cord, and features of pulmonary hypoplasia. Antenatal diagnosis can be difficult. Ultrasound features are varied and may overlap with those of Trisomy 18. The poor prognosis of PSS is due to pulmonary hypoplasia, which is an important feature that distinguishes PSS from arthrogryposis multiplex congenital without pulmonary hypoplasia, which has a better prognosis. If diagnosed in the antenatal period, a late termination of pregnancy can be considered following ethical discussion (if the law allows). In most cases, a diagnosis is only made in the neonatal period. Parents of a baby affected with PSS require detailed counseling that includes information on the imprecise recurrence risks and a plan for subsequent pregnancies.
PubMed: 30498368
DOI: 10.2147/TACG.S154643 -
Sensors (Basel, Switzerland) Sep 2020In Parkinson's disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which... (Review)
Review
In Parkinson's disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.
Topics: Actigraphy; Humans; Hyperkinesis; Hypokinesia; Movement; Parkinson Disease; Quality of Life; Sleep; Sleep Wake Disorders; Wearable Electronic Devices
PubMed: 32927816
DOI: 10.3390/s20185171