1,721,104 research outputs found
Use of botulinum toxin type A in the management of patients with neurological disorders: a national survey.
No full textThe aim of this survey was to provide an overview of important issues relating to therapeutic strategies based on botulinum toxin type A injection for the treatment of patients with neurological disorders. Two hundred and ten physicians from neurology and neurorehabilitation units in Italian hospitals answered a questionnaire exploring some clinical aspects of the use of botulinum toxin type A in patients with spasticity/dystonia. 66% of the physicians treated patients with dystonia, 80% treated adults with spasticity, and 35% treated children with cerebral palsy. Palpation with no instrumental guidance was the injection technique most commonly used for treating patients with dystonia, spasticity and cerebral palsy; 57% of the physicians evaluated patients instrumentally before toxin injection, while 45% assessed postinjection improvements by instrumental means; 78% of the physicians prescribed (when appropriate) rehabilitation procedures after toxin injection. Our results seem to show that the routine use of botulinum toxin in clinics is far from standardized
The diagnostic importance of the isolated downward gaze ophtalmoplegia in progressive supranuclear palsy
No full textPhenotypic variability of DYT1-PTD: Does the clinical spectrum include psychogenic dystonia?
No full textPrimary torsion dystonia (PTD) is a clinically and genetically heterogeneous group of movement disorders, usually inherited in an autosomal dominant manner with reduced (30-40%) penetrance. The DYT1 gene on chromosome 9q34 is responsible for most cases of early limb-onset PTD. DYT1-PTD clinical spectrum is broad, as the disease may present with several degrees of body involvement and severity. We identified an Italian family with 4 members definitely affected by PTD, genetically diagnosed as carriers of the GAG mutation at DYT1 gene. Phenotype was homogeneous when considering the presentation at onset (limb involvement and early onset), the disease progression was variable; in the subjects of the last generation, the disease progressed to a severe, generalized PTD; in the remaining 2 subjects, dystonia presented with writer's cramp or upper body segmental dystonia of mild severity. One family member, carrier of the GAG mutation on DYT1 gene and mother of the most severely affected individual, presented with a clinically established psychogenic movement disorder resembling dystonia initially diagnosed as a severe generalized PTD. Psychogenic movement disorders are among the most controversial and challenging diseases to diagnose, in particular when the affected individual belongs to a family with an inherited movement disorder. (C) 2002 Movement Disorder Society
Levodopa effect on electromyographic activation patterns of tibialis anterior muscle during walking in Parkinson's disease
No full textPrevious studies have reported that patients with Parkinson's disease (PD) show, in the " off medication" state, a reduced activation of tibialis anterior (TA) in the late swing-early stance phase of the gait cycle. In PD patients the pathophysiological picture may cause differences among the stride cycles. Our aims were to evaluate how frequently TA activity is reduced in the late swing-early stance phase and if there is a relationship between the TA pattern and the clinical picture.Thirty PD patients were studied 2. h after Levodopa administration (" on-med" ) and 12. h after Levodopa wash-out (" off-med" ). They were evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS III) and surface electromyography of TA and gastrocnemius medialis (GM). The root mean square (RMS) of the TA activity in late swing-early stance phase (RMS-A) was normalized as a percent of the RMS of the TA activity in late stance-early swing (RMS-B).RMS-A was reduced in 30% of patients in the " off-med" condition. Within these patients, the percentage of stride cycles with reduced RMS-A, ranged between 28% and 83%. After Levodopa intake, no stride cycle showed reduced RMS-A. Patients with reduced RMS-A had a lower UPDRS III total score in the " on-med" rather than in the " off-med" condition (p=0.02).Our data confirm and extend previous observations indicating that, in " off-med" the function of TA is impaired in those patients clinically more responsive to Levodopa. TA activation is reduced in a relatively high percent of gait cycles in the " off-med" state. Since the variability of TA activation disappears after Levodopa administration, this phenomenon could be the expression of an abnormal dopaminergic drive. © 2010 Elsevier B.V
Transient mania with hypersexuality after surgery for high frequency stimulation of the subthalamic nucleus in Parkinson's disease.
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Clinical characterization of Italian families affected by purely focal idiopathic torsion dystonia
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Occurrence of Writing Tremor in Patients With Scans Without Evidence of Dopaminergic Deficit
No full textAsymmetric rest tremor is one of the main features of patients diagnosed with scans without evidence of dopaminergic deficit (SWEDD). Clinical and neurophysiological evidence suggests a dystonic origin of this tremor, although the underlying pathophysiology is still unclear. Dystonic tremor has a great tendency to vary with different postures or voluntary motor tasks. Here, we performed a phenomenological analysis of tremor in 14 patients with normal scans and in 14 tremor-dominant Parkinson's disease (PD) patients by assessing the presence of writing tremor. The Wilcoxon-Mann-Whitney's test revealed that patients with normal scans exhibit writing tremor more frequently, regardless of the side mostly affected by motor disturbances in handwriting (P < 0.01) and drawing (right hand: P = 0.01; left hand: P < 0.05). Our findings show that patients with asymmetric rest tremor and normal scans, contrarily to PD patients, present more commonly action tremor during writing tasks. This feature may thus be helpful to distinguish the two conditions
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