- Resting state fMRI reveals the altered synchronization of BOLD signals in essential tremor. [Journal Article]
- JNJ Neurol Sci 2018 Jul 10; 392:69-76
- Essential tremor (ET) is one of the most common movement disorders in humans. Nevertheless, there remain several controversies surrounding ET, such as whether it is a disorder of abnormal neuronal os...
Essential tremor (ET) is one of the most common movement disorders in humans. Nevertheless, there remain several controversies surrounding ET, such as whether it is a disorder of abnormal neuronal oscillations within the tremor network. In this work, the resting-state fMRI data were collected from 17 ET patients and 17 age- and gender-matched healthy controls. First, using FOur-dimensional (spatiotemporal) Consistency of local neural Activities (FOCA) the abnormal synchronization of fMRI signals in ET patients were investigated. Then, global functional connectivity intensity (gFCI) and density (gFCD) were analyzed in the regions exhibiting significant FOCA differences. Compared with healthy controls, patients with ET showed the increased FOCA values found in the bilateral cuneus, the left lingual gyrus, the left paracentral lobule, the right middle temporal gyrus, the bilateral precentral gyrus, the right postcentral gyrus, the pallidum and putamen. Decreased FOCA values in ET patients were located in the frontal gyrus, the bilateral anterior cingulate and the medial dorsal nucleus of right thalamus. In ET patients, significant changes in gFCI and gFCD were located in the cuneus, the middle temporal gyrus and the middle frontal gyrus. Changes in gFCI were also found in the medial frontal gyrus and thalamus in addition to changes in gFCD in the precentral gyrus. Our results provided further evidence that ET might present with abnormal spontaneous activity in the tremor network, including motor-related cotex, basal ganglia and thalamus, as well as distributed non-motor areas. This work also demonstrated that FOCA and functional connectivity have the potential to provide important insight into the pathophysiological mechanism of ET.
- Index Finger Pointing (Likely a Subtle Form of Hand Dystonia): Prevalence Across Movement Disorders. [Journal Article]
- FNFront Neurol 2018; 9:542
- Objective: To investigate the prevalence of index finger pointing (IFP) while walking, which is likely a subtle form of hand dystonia, in cranio-cervical focal dystonia syndromes, Parkinson's diseas...
Objective: To investigate the prevalence of index finger pointing (IFP) while walking, which is likely a subtle form of hand dystonia, in cranio-cervical focal dystonia syndromes, Parkinson's disease (PD), essential tremor (ET), and controls. Methods: We recruited patients with an established diagnosis of PD, dystonia, or ET and healthy controls. All participants were videotaped while walking. Videotapes were evaluated by the authors, blinded to diagnosis, to assess the presence or absence of IFP. Results: Two-hundred-fifty participants included 50 dystonia, 50 PD, 80 ET and 70 controls. IFP was present in 29/250 (11.6%) participants: 10 dystonia (20.0%), 8 PD (16.0%), 8 ET (10.0%), and 3 controls (3.8%) (p = 0.03). There was a significant evidence of a trend in the odds of having this sign among disorders with higher risk of dystonic features (dystonia>PD>ET>control; test for trend = 0.004). Among the 180 patients (dystonia, PD, and ET, i.e., excluding the 70 controls), IFP was present in 26 (14.4% prevalence). Conclusion: IFP during gait, likely a subtle form of hand dystonia, was observed in 14.4% of movement disorder patients. The highest prevalence was in dystonia, the second highest in a disease that is often accompanied by dystonia (PD), a lower prevalence among individuals with a disease that is rarely accompanied by dystonia (ET), and the lowest in controls.
- Comparison of botulinum toxin and propranolol for essential and dystonic vocal tremors. [Journal Article]
- CClinics (Sao Paulo) 2018 Jul 16; 73:e87
- CONCLUSIONS: Essential and dystonic vocal tremors responded differently to treatment. Dystonic vocal tremors responded significantly to treatment with botulinum toxin but not oral propranolol. Essential vocal tremors did not respond significantly to either treatment, perhaps due to the small number of patients, which is a limitation of this research.
- Analysis of the clinical features of early Parkinson's disease with comparatively integrated intestinal function. [Journal Article]
- NSNeurol Sci 2018 Jul 17
- CONCLUSIONS: These results suggest that PD without constipation in early stage may represent a unique clinical phenotype, which may be more benign than PD with constipation.
- FDA Supplemental Approval: Blinatumomab for Treatment of Relapsed and Refractory Precursor B-Cell Acute Lymphoblastic Leukemia. [Journal Article]
- OOncologist 2018 Jul 17
- CONCLUSIONS: In TOWER, a randomized trial in patients with relapsed or refractory Philadelphia chromosome (Ph)-negative precursor B-cell acute lymphoblastic leukemia (ALL), treatment with blinatumomab showed superiority over conventional chemotherapy for complete remission (CR) rate (34% vs. 16%) and survival (3.7-month improvement in median; hazard ratio, 0.71). In ALCANTARA, a single-arm trial of blinatumomab for treatment of relapsed or refractory Ph-positive precursor B-cell ALL, the CR rate was 31%. Blinatumomab is now approved for treatment of relapsed or refractory precursor B-cell ALL that is Ph positive or Ph negative.
- Head and trunk stability during gait before and after levodopa intake in Parkinson's disease subtypes. [Journal Article]
- EGExp Gerontol 2018 Jul 03; 111:78-85
- CONCLUSIONS: People with the PD PIGD subtype exhibit impaired gait stability that is not improved and frequently worsened by levodopa. New non-pharmaceutical approaches, technological (e.g. cueing) or exercise-based (e.g. balance training) are required to improve or compensate for mediolateral gait instability in this subtype and ultimately prevent falls.
- Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson's disease: a multi-country Delphi-panel approach. [Journal Article]
- CMCurr Med Res Opin 2018 Jul 17; :1-38
- CONCLUSIONS: Identifying patients progressing to APD and suitable for device-aided therapies will enable general neurologists to assess the need for referral to movement disorder specialists and improve the quality of care and patient outcomes.
- Identifying therapeutic targets from spontaneous beneficial brain lesions. [Journal Article]
- ANAnn Neurol 2018 Jul 16
- Brain damage can occasionally result in paradoxical functional benefit, which could help identify therapeutic targets for neuromodulation. However, these beneficial lesions are rare and lesions in mu...
Brain damage can occasionally result in paradoxical functional benefit, which could help identify therapeutic targets for neuromodulation. However, these beneficial lesions are rare and lesions in multiple different brain locations can improve the same symptom. Using a technique called lesion network mapping, we show that heterogeneous lesion locations resulting in tremor relief are all connected to common nodes in the cerebellum and thalamus, the latter of which is a proven deep brain stimulation target for tremor. These results suggest that lesion network mapping can identify the common substrate underlying therapeutic lesions and effective therapeutic targets. This article is protected by copyright. All rights reserved.
- Movement Disorders and Syndromic Autism: A Systematic Review. [Journal Article]
- JAJ Autism Dev Disord 2018 Jul 16
- Movement disorders are reported in idiopathic autism but the extent to which comparable movement disorders are found in syndromic/co-morbid autism is unknown. A systematic search of Medline, Embase, ...
Movement disorders are reported in idiopathic autism but the extent to which comparable movement disorders are found in syndromic/co-morbid autism is unknown. A systematic search of Medline, Embase, PsychINFO and CINAHL on the prevalence of specific movement disorder in syndromic autism associated with specific genetic syndromes identified 16 papers, all relating to Angelman syndrome or Rett syndrome. Prevalence rates of 72.7-100% and 25.0-27.3% were reported for ataxia and tremor, respectively, in Angelman syndrome. In Rett syndrome, prevalence rates of 43.6-50% were reported for ataxia and 27.3-48.3% for tremor with additional reports of dystonia, rigidity and pyramidal signs. However, reliable assessment measures were rarely used and recruitment was often not described in sufficient detail.
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- Abnormal Blink Reflex and Intermuscular Coherence in Writer's Cramp. [Journal Article]
- FNFront Neurol 2018; 9:517
- Background: Writer's cramp (WC) is a task-specific focal hand dystonia presenting with pain, stiffness and/or tremor while writing. We explored the involvement of cortical and brainstem circuits by ...
Background: Writer's cramp (WC) is a task-specific focal hand dystonia presenting with pain, stiffness and/or tremor while writing. We explored the involvement of cortical and brainstem circuits by measuring intermuscular coherence (IMC) and pre-pulse inhibition (PPI) of the blink reflex. Methods: IMC was measured in 10 healthy controls and 20 WC patients (10 with associated tremor) while they performed a precision grip task at different force levels. Blink responses were evaluated in 9 healthy controls and 10 WC patients by stimulating the right supraorbital nerve and recording surface EMG from the orbicularis oculi muscles bilaterally. PPI involved conditioning this stimulation with a prior shock to the right median nerve (100 ms interval), and measuring the reduction in the R2 component of the blink reflex. Results: Significant IMC at 3-7 Hz was present in WC patients, but not in healthy controls. Compared to healthy controls, in WC patients the R2 component of the blink reflex showed significantly less PPI. IMC at 3-7 Hz could reliably discriminate WC patients from healthy controls. Conclusion: Cortical or sub-cortical circuits generating theta (3-7 Hz) oscillations might play an important role in the pathogenesis of WC. Moreover, the lack of PPI implicates abnormalities in brainstem inhibition in the emergence of WC. IMC may merit further development as an electrodiagnostic test for focal dystonia.