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Brain and Behavior Dec 2017We aim to report and evaluate the associations between serum sodium and chloride and dyskinesia in patients with Parkinson's disease. One hundred and two patients with...
OBJECTIVE
We aim to report and evaluate the associations between serum sodium and chloride and dyskinesia in patients with Parkinson's disease. One hundred and two patients with Parkinson's disease were enrolled in this study.
METHODS
Patients' serum electrolytes including sodium, calcium, potassium, magnesium, and chloride were measured. Other demographic information was collected, and Unified Parkinson's disease rating scale and Hoehn and Yahr stage scale were also performed.
RESULTS
Patients with dyskinesia tended to have longer duration of disease, higher daily levodopa-equivalent dose, and Hoehn-Yahr stage, with lower serum sodium than those without dyskinesia. Spearman correlation analyses showed that serum sodium inversely correlated with duration of disease ( = -.218, =.028), and positively correlated with serum chloride levels ( = .565, <.001). Univariate logistic regression analysis found that duration of disease, daily levodopa-equivalent dose, serum sodium, and serum chloride were associated with dyskinesia in Parkinson's disease patients (<.05 for all). After adjusting for age, sex, age at onset of Parkinson's disease, medical history, and other covariates, serum sodium and chloride were still associated with dyskinesia, with corresponding Odd ratios 0.783 (95% confidence intervals, 0.642-0.955) and 0.796 (95% confidence intervals, 0.652-0.972), respectively.
CONCLUSION
Our findings indicated that serum sodium and chloride levels were inversely associated with dyskinesia in patients with Parkinson's disease. Further studies with large samples and range of serum sodium and chloride are needed.
Topics: Age of Onset; Aged; Antiparkinson Agents; Chlorides; Dyskinesias; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Retrospective Studies; Sodium; Time Factors
PubMed: 29299386
DOI: 10.1002/brb3.867 -
Neurotherapeutics : the Journal of the... Oct 2015Cannabis has been used for many medicinal purposes, including management of spasms, dystonia, and dyskinesias, with variable success. Its use for tetanus was described... (Review)
Review
Cannabis has been used for many medicinal purposes, including management of spasms, dystonia, and dyskinesias, with variable success. Its use for tetanus was described in the second century BCE, but the literature continues to include more case reports and surveys of its beneficial effects in managing symptoms of hyperkinetic movement disorders than randomized controlled trials, making evidence-based recommendations difficult. This paper reviews clinical research using various formulations of cannabis (botanical products, oral preparations containing ∆(9)-tetrahydrocannabinol and/or cannabidiol) and currently available preparations in the USA (nabilone and dronabinol). This has been expanded from a recent systematic review of cannabis use in several neurologic conditions to include case reports and case series and results of anonymous surveys of patients using cannabis outside of medical settings, with the original evidence classifications marked for those papers that followed research protocols. Despite overlap in some patients, dyskinesias will be treated separately from dystonia and chorea; benefit was not established beyond individual patients for these conditions. Tics, usually due to Tourettes, did respond to cannabis preparations. Side effects reported in the trials will be reviewed but those due to recreational use, including the dystonia that can be secondary to synthetic marijuana preparations, are outside the scope of this paper.
Topics: Animals; Cannabinoids; Cannabis; Dyskinesias; Dystonia; Humans; Tics
PubMed: 26271953
DOI: 10.1007/s13311-015-0376-4 -
Arquivos de Neuro-psiquiatria Jan 2023Levodopa is the most used and effective medication for motor symptoms of Parkinson disease (PD), its long-term use is associated with the appearance of levodopa-induced...
BACKGROUND
Levodopa is the most used and effective medication for motor symptoms of Parkinson disease (PD), its long-term use is associated with the appearance of levodopa-induced dyskinesia (LID). Uric acid (UA) is believed to play an important neuroprotective role in PD.
OBJECTIVE
To investigate if serum UA levels are related with the presence of LIDs in PD patients. Also, we investigated the associations among UA levels and clinical features of PD.
METHODS
We enrolled 81 PD patients (dyskinesia = 48; no dyskinesia = 33) in the present study. A blood sample was collected to evaluate serum UA levels, clinical evaluation included the following instruments: Montreal Cognitive Assessment (MoCA), Beck Depression Inventory II (BDI-II), MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr (HY), and the sub-item 4.1 of MDS-UPDRS IV (score ≥ 1). Additional relevant clinical information was obtained by a clinical questionnaire.
RESULTS
Serum UA levels were lower in the dyskinesia group when compared with the no dyskinesia group. The same result was found in the UA levels of both men and women. The multivariate analysis showed lower uric acid levels were significantly associated with having dyskinesia (odds ratio [OR] = 0.424; 95% confidence interval [CI]: 0.221-0.746; = 0.005). Additional analysis verified that serum UA levels are inversely correlated with depressive symptoms, disease duration, MDS-UPDRS IV and time spent with dyskinesia. A positive correlation was found with age at onset of PD symptoms.
CONCLUSIONS
The present study provides a possible role of serum UA levels in LID present in PD patients.
Topics: Male; Humans; Female; Parkinson Disease; Levodopa; Uric Acid; Antiparkinson Agents; Dyskinesias
PubMed: 36918006
DOI: 10.1055/s-0043-1761294 -
Effect of acupuncture treatment on nonketotic hyperglycemic hemichorea-hemiballismus: a case report.Journal of Traditional Chinese Medicine... Aug 2023Nonketotic hyperglycemic hemichorea-hemiballismus is a rare syndrome in the clinic, and treatment is often delayed. Hypoglycemic therapy is the most widely used and...
Nonketotic hyperglycemic hemichorea-hemiballismus is a rare syndrome in the clinic, and treatment is often delayed. Hypoglycemic therapy is the most widely used and effective treatment, but some patients experience a slower improvement. Other symptomatic treatment medicines have some degree of side effects. Acupuncture treatment is beneficial for hemichorea-hemiballismus. A male patient, aged 59 years, first visited our hospital outpatient department due to motor agitation with involuntary movements of the right limb. He had a history of type 2 diabetes mellitus and poor blood glucose control. His serum glucose was 26.5 mmol/L (normal: 4.4-6.1 mmol/L), and magnetic resonance imaging demonstrated an irregular area of high signal intensity in T1-weighted imaging, low signal intensity on T2-weighted imaging, and high signal intensity in the left corpus striatum in T2-FLAIR imaging. Hospitalization was recommended for the patient. After ruling out other possibilities, he was eventually diagnosed with nonketotic hyperglycemic hemichorea-hemiballismus. Intensive glycemic control was immediately started with subcutaneous injection and acupuncture treatment at "governor vessel 13 acupoints", and the involuntary movements completely disappeared on the ninth day of hospitalization. The pathophysiology of nonketotic hyperglycemic hemichorea-hemiballismus is unclear. Different patient histories lead to different brain tissue conditions, and relapses and uncontrolled blood glucose add difficulties to treatment. According to Traditional Chinese Medicine theory, insufficient kidney essence leads to brain dystrophy and causes the symptoms of hemichorea-hemiballismus. Research evidence has shown that acupuncture at "governor vessel 13 acupoints" has a beneficial treatment effect on nonketotic hyperglycemic hemichorea-hemiballismus.
Topics: Humans; Male; Diabetes Mellitus, Type 2; Dyskinesias; Chorea; Brain; Acupuncture Therapy
PubMed: 37454270
DOI: 10.19852/j.cnki.jtcm.20230308.004 -
Epilepsia 2002Nonepileptic events (NEE) are common in children, and can be difficult to distinguish from epileptic events. Several strategies can assist in differentiation. The first... (Review)
Review
Nonepileptic events (NEE) are common in children, and can be difficult to distinguish from epileptic events. Several strategies can assist in differentiation. The first is an age-based approach to the differential of commonly presenting EEs in neonates, infants, and adolescents. The next strategy is to identify key elements of the patient's history to narrow the possibilities, and third is a rational approach to ancillary testing. There are additional challenges to the diagnosis and evaluation of NEEs in patients with cognitive impairments or mental retardation (MR). Twenty to 25% of neurologically normal patients (34), and up to 60% of children with MR (35) referred for an evaluation of seizures, have NEE. In most instances, the clinical history leads to the diagnosis, and ancillary testing serves as confirmation. But in certain populations, neonates, children with concurrent epilepsy, children in whom pseudoseizures are suspected, and children with MR, early use of video-EEG telemetry is indicated to establish the diagnosis and avoid overtreatment with antiepileptic drugs (AEDs).
Topics: Adolescent; Adult; Age Factors; Child; Child Behavior Disorders; Child, Preschool; Cognition Disorders; Comorbidity; Diagnosis, Differential; Dyskinesias; Electroencephalography; Female; Humans; Infant; Infant, Newborn; Intellectual Disability; Male; Movement Disorders; Myoclonus; Seizures; Telemetry; Videotape Recording
PubMed: 12060007
DOI: 10.1046/j.1528-1157.43.s.3.13.x -
Journal of Feline Medicine and Surgery Jun 2022The aim of this study was to identify the phenotypic features of a paroxysmal dyskinesia observed in Sphynx cats.
OBJECTIVES
The aim of this study was to identify the phenotypic features of a paroxysmal dyskinesia observed in Sphynx cats.
METHODS
The owners of affected Sphynx cats were invited to provide video footage of abnormal episodes for review. Those that demonstrated episodes consistent with paroxysmal dyskinesia were then invited to complete an online questionnaire designed to allow further characterisation.
RESULTS
Ten Sphynx cats were included in the study. All affected cats were <4 years of age at the onset of the episodes (range 0.5-4.0). The episodes had a duration of <5 mins in 9/10 cats (range 0.5-10), while episode frequency was variable between and within individual cats. The episodes were characterised by impaired ambulation due to muscle hypertonicity, most commonly affecting the hips and pelvic limbs (9/10) and shoulders and thoracic limbs (8/10). The head and neck (6/10), tail (5/10), and back and abdomen (3/10) were also involved in some cats. Sudden movement, excitement and stress were identified as possible triggers for the episodes in three cats. Therapeutic intervention was not attempted in 7/10 cases, although two cats were reported to become free of the episodes while receiving acetazolamide. The two cats that were followed beyond 2 years from onset entered spontaneous remission. None of the owners believed that the abnormal episodes had affected the quality of life of their cat.
CONCLUSIONS AND RELEVANCE
The phenotype of paroxysmal dyskinesia in Sphynx cats presented in this study appears to share similarities with paroxysmal kinesigenic dyskinesia described in human classification systems. Some cats appear to achieve episode freedom spontaneously. Subsequent research should focus on evaluating response to treatment and determining an underlying genetic cause.
Topics: Animals; Cat Diseases; Cats; Chorea; Dystonia; Phenotype; Quality of Life
PubMed: 34313487
DOI: 10.1177/1098612X211032123 -
International Journal of Molecular... May 2020Paroxysmal movement disorders (PMDs) are rare neurological diseases typically manifesting with intermittent attacks of abnormal involuntary movements. Two main... (Review)
Review
Paroxysmal movement disorders (PMDs) are rare neurological diseases typically manifesting with intermittent attacks of abnormal involuntary movements. Two main categories of PMDs are recognized based on the phenomenology: Paroxysmal dyskinesias (PxDs) are characterized by transient episodes hyperkinetic movement disorders, while attacks of cerebellar dysfunction are the hallmark of episodic ataxias (EAs). From an etiological point of view, both primary (genetic) and secondary (acquired) causes of PMDs are known. Recognition and diagnosis of PMDs is based on personal and familial medical history, physical examination, detailed reconstruction of ictal phenomenology, neuroimaging, and genetic analysis. Neurophysiological or laboratory tests are reserved for selected cases. Genetic knowledge of PMDs has been largely incremented by the advent of next generation sequencing (NGS) methodologies. The wide number of genes involved in the pathogenesis of PMDs reflects a high complexity of molecular bases of neurotransmission in cerebellar and basal ganglia circuits. In consideration of the broad genetic and phenotypic heterogeneity, a NGS approach by targeted panel for movement disorders, clinical or whole exome sequencing should be preferred, whenever possible, to a single gene approach, in order to increase diagnostic rate. This review is focused on clinical and genetic features of PMDs with the aim to (1) help clinicians to recognize, diagnose and treat patients with PMDs as well as to (2) provide an overview of genes and molecular mechanisms underlying these intriguing neurogenetic disorders.
Topics: Ataxia; Chorea; Genetic Testing; Humans; Mutation; Phenotype
PubMed: 32443735
DOI: 10.3390/ijms21103603 -
BMJ Case Reports Apr 2018Non-ketotic hyperglycaemic hemichorea-hemiballismus (NHHH) is commonly seen among elderly Asian women with type 2 diabetes mellitus. Here, we present a case of a...
Non-ketotic hyperglycaemic hemichorea-hemiballismus (NHHH) is commonly seen among elderly Asian women with type 2 diabetes mellitus. Here, we present a case of a 16-year-old Filipina with type 1 diabetes mellitus who is poorly compliant to her medications and subsequently developed right hemichorea-hemiballismus (HH). She was initially admitted with hyperglycaemia but was negative for ketonuria or metabolic acidosis. Neuroimaging showed bilateral lentiform nuclei and left caudate hyperdensities on CT and T1-weighted hyperintensity on MRI. Blood glucose was controlled with insulin. Haloperidol and clonazepam were started for the HH with gradual resolution of symptoms in 6 weeks. This is the fifth reported case of NHHH seen among the paediatric age group. NHHH in the paediatric population is clinically and radiographically similar to NHHH seen among adults. Correction of hyperglycaemia results in clinical improvement and radiographic resolution of lesions but persistent cases may necessitate specific treatment targeted towards the abnormal movements.
Topics: Adolescent; Anti-Dyskinesia Agents; Blood Glucose; Chorea; Clonazepam; Diabetes Mellitus, Type 1; Dyskinesias; Female; Haloperidol; Humans; Hypoglycemic Agents; Insulin; Neuroimaging; Patient Compliance; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29622707
DOI: 10.1136/bcr-2017-223429 -
Revista de Neurologia Sep 2013This study describes the clinical and electroencephalographic characteristics of epileptic spasms, and more especially those that occur during the first two years of... (Review)
Review
This study describes the clinical and electroencephalographic characteristics of epileptic spasms, and more especially those that occur during the first two years of life (infantile spasms). West syndrome has been clearly defined as the association between infantile spasms with an electroencephalographic pattern of hypsarrhythmia. Although intellectual deficit appears in almost all cases in which infantile spasms are not controlled with medication, this is a developmental aspect of the condition and not a manifestation that must necessarily be present in order to define the syndrome. The analysis of the interictal and ictal electroencephalogram readings, together with the clinical characteristics of the spasms and the neurological examination of patients, provides some orientation as regards the causations. Despite the spectrum that the title of this work focuses on, the study does not cover the treatment of early infants with West syndrome. Emphasis is placed on the differential diagnoses of West syndrome with other epileptic syndromes that manifest in the first two years of life, and more especially with a series of abnormal non-epileptic motor phenomena that occur in early infants. All these last non-epileptic disorders are displayed in a table, but benign myoclonus of early infancy or Fejerman syndrome is given as a paradigmatic example for the differential diagnosis. The primordial aim is to prevent neurologically healthy early infants from receiving antiepileptic drugs and even adrenocorticotropic hormone or corticoids due to a mistaken diagnosis.
Topics: Age of Onset; Brain Diseases; Child, Preschool; Diagnosis, Differential; Dyskinesias; Dystonia; Electroencephalography; Epilepsy, Benign Neonatal; Humans; Infant; Myoclonus; Parasomnias; Spasms, Infantile
PubMed: 23897139
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Jul 2012The management of choreic disorders presents significant challenges, including identifying the etiology of the disorder, treating and preventing motor symptoms, and... (Review)
Review
The management of choreic disorders presents significant challenges, including identifying the etiology of the disorder, treating and preventing motor symptoms, and managing a range of other neurologic and behavioral complications. Chorea may occur in several neurodegenerative, genetic, or drug-related conditions, and a thorough diagnostic evaluation is needed to identify the specific underlying causes. Some choreic disorders have specific treatable underlying etiologies, such as vitamin B(12) deficiency or drug-induced dyskinesia. Autoimmune disorders such as Sydenham chorea may be treated with penicillin, corticosteroids, intravenous immunoglobulin, or plasma exchange. Heredodegenerative choreas such as Huntington disease often respond to treatment with tetrabenazine or amantadine. Many other agents may be used nonspecifically for symptom control, including benzodiazepines, neuroleptics, and antiepileptic medications. In addition to motor symptoms, patients with Huntington disease or other choreic disorders often experience increasing depression, bradykinesia, cognitive impairment, aggressive behaviors, and other complications as the disease progresses. Caring for the caregiver is also a significant concern in the long-term treatment of choreic disorders.
Topics: Chorea; Humans; Huntington Disease
PubMed: 22761268
DOI: 10.3949/ccjm.79.s2a.06