1/14. Postural and action myoclonus in patients with parkinsonian type multiple system atrophy.patients with a parkinsonian syndrome and features of multisystem atrophy (pMSA) may exhibit abnormal movements of the hands and fingers, which are reported in the literature either as "jerky" tremor or myoclonus. We studied clinically and electrophysiologically these movements in 11 consecutive patients with pMSA. No abnormal movements were observed when the patients were at complete rest, except for a characteristic parkinsonian "pill-rolling" tremor in one patient. Abnormal small-amplitude, nonrhythmic movements involving just one or a few fingers, or more rarely the whole hand, were observed in nine patients when holding a posture or at the beginning of an action. Accelerometric recordings showed small-amplitude irregular oscillations which, contrary to those of patients with tremor, had no predominant peak in the Fast Fourier frequency spectrum analysis. Electromyographic recordings in the forearm and hand muscles showed brief jerks of less than 100 ms duration which were synchronous in antagonist muscles of the forearm and alternated with brief periods of silence. Electrical stimulation of the digital nerves evoked consistent reflex responses in the wrist flexor and extensor muscles at a latency of 55.3 /-4.1 ms (range, 50-63 ms). Routine electroencephalographic (EEG) and somatosensory evoked potentials to median nerve stimulation were normal. back-averaging of the EEG activity time-locked to the jerks was performed in two patients with no evidence of abnormal cortical activity. Two patients had episodes of transient respiratory failure related to pneumonia. This caused a long-lasting enhancement of the abnormal hand and finger movements, which became larger and more widespread, with features of posthypoxic myoclonus. We conclude that the abnormal hand and finger movements of patients with pMSA are a form of postural and action myoclonus, and can be described as mini-polymyoclonus.- - - - - - - - - - ranking = 1keywords = movement (Clic here for more details about this article) |
2/14. dystonia in a patient treated with propranolol and gabapentin.We present a 68-year-old patient with essential tremor who was treated with propranolol hydrochloride (80 mg daily) and gabapentin (900 mg daily) after a history of mild success of gabapentin alone in relieving his symptoms. The patient had several daily episodes of paroxysmal dystonic movements in both hands. After reducing the propranolol dose to 40 mg daily, the dystonic movements resolved. This case suggests a synergistic effect between propranolol and gabapentin.- - - - - - - - - - ranking = 0.33333333333333keywords = movement (Clic here for more details about this article) |
3/14. Emergence of complex, involuntary movements after gamma knife radiosurgery for essential tremor.Gamma knife radiosurgery is generally considered a safer alternative to traditional pallidotomy or thalamotomy. We report the case of a 59-year-old patient with essential tremor who developed a complex, disabling movement disorder following gamma knife thalamotomy. This case illustrates the need for long-term follow-up to fully evaluate the potential for complications following radiosurgery.- - - - - - - - - - ranking = 33.470637052888keywords = involuntary movement, movement (Clic here for more details about this article) |
4/14. Voluntary palatal tremor is associated with hyperactivation of the inferior olive: a functional magnetic resonance imaging study.Voluntary palatal tremor in a patient with essential palatal tremor induced activation predominantly within regions corresponding to the inferior olive, adjacent brainstem, and dentate nuclei. Finger movements elicited only ipsilateral lobular cerebellar activation, suggesting a dysfunctional nuclear activation by palatal tremor.- - - - - - - - - - ranking = 0.16666666666667keywords = movement (Clic here for more details about this article) |
5/14. Orthostatic tremor: report of a case and review of the literature.Orthostatic tremor is a rare movement disorder characterized by tremulousness of the lower limbs on standing that disappears on walking, sitting or on lying down and a distinctive electromyographic burst of 14 to 16 Hz. On inspection, fine ripples can sometimes be seen over the quadriceps on standing. The tremor has a tendency to reappear even in the supine posture if the lower limb muscles are put to an isometric contraction state, indicating thereby that in spite of the fact that the tremor occurs on standing, it is essentially 'orthostasis independent' and the central factor is the contraction of the muscles. As a matter of fact, the tremor is abolished if the subject is suspended by harness, thus relieving him of muscle contraction. Doubts are being cast whether it is a variant of essential tremor since a number of families are being reported to be suffering from this disease as well. Positron emission tomography reveals hyperactivity of cerebellum in orthostatic tremor as it shows in essential tremor, therefore lending credence to such a hypothesis. However, lack of response to alcohol, propranolol and primidone in orthostatic tremor stands out as a serious challenge to such a view. Lack of positive family history, synchrony of contracting group of muscles and negative 'resetting' of the tremor by increasing peripheral load-phenomena consistently observed in orthostatic tremor and not in essential tremor, are other features that often help to distinguish between the two conditions. We report a case of orthostatic tremor that presented with the classical clinical and electromyographic features. Relevant literature in this regard is also being reviewed.- - - - - - - - - - ranking = 0.16666666666667keywords = movement (Clic here for more details about this article) |
6/14. Bilateral high-frequency electrical impulses to the thalamus reduce voice tremor: acoustic and electroglottographic analysis. A case report.An 81-year-old female patient suffering from disabling Holmes' tremor affecting both upper extremities, the head and additionally the vocal apparatus underwent bilateral thalamic ventralis intermedius nucleus (v.i.m.) stimulation. With the stimulation ON, the patient experienced complete suppression of the limb and head tremor and thorough voice normalization. Acoustic and electroglottographic (EGG) analysis showed a tendency towards hyperfunctional phonation with the stimulation ON as well as OFF, but a less disturbed vocal cord vibration pattern with the stimulation ON in comparison with a group of normal female speakers. This example shows that long-term monitoring of the vocal apparatus under deep brain stimulation therapy (DBS) of movement disorders must be planned in order to modify the stimulation parameters, if necessary, or to initiate logopaedic treatment.- - - - - - - - - - ranking = 0.16666666666667keywords = movement (Clic here for more details about this article) |
7/14. Asterixis and toxic encephalopathy induced by gabapentin.PURPOSE: To date, only one case of asterixis associated with the use of gabapentin (GBT) has been reported. No data, instead, are available on the occurrence of asterixis related to a dementing encephalopathy during GBT therapy in the elderly. methods: case reports of two elderly patients, one with asterixis, the other with asterixis and encephalopathy, associated with the use of GBT, as adjunctive therapy, at dosages of 900 to 3600 mg/day are given. In one patient, GBT was added to oxcarbazepine (OXCBZ). FINDINGS: Both patients experienced resolution of the clinically apparent asterixis, and of the toxic encephalopathy, on discontinuation or reduction of GBT dosages. One patient developed asterixis after drug rechallenge. In the patient on OXCBZ, the analysis of the electromyogram (EMG) activity showed the occurrence of a subclinical asterixis. CONCLUSIONS: Our study indicates that high doses of GBT may induce asterixis related to a reversible encephalopathy. Low doses of GBT, instead, may induce a disabling asterixis when given in combination with OXCBZ because of a synergistic interaction between these drugs.- - - - - - - - - - ranking = 245.46499749132keywords = asterixis (Clic here for more details about this article) |
8/14. A case report of complete disappearance of essential tremor after Gamma Knife radiosurgery.Pharmacological therapy for essential tremor (ET), the most common movement disorder, remains largely unsatisfactory. Surgical options such as radiofrequency or thermocoagulation are only suitable for a select group of patients, the young and those free of pre-existing medical conditions. radiosurgery using the Leksell Gamma Knife has recently gained acceptance as a viable treatment option for tremor control in ET patients. We describe our experience with the first reported ET patient treated with radiosurgery in louisiana.- - - - - - - - - - ranking = 0.16666666666667keywords = movement (Clic here for more details about this article) |
9/14. Differential electrocardiographic artifact from implanted thalamic stimulator.Electrocardiographic (ECG) artifacts may interfere in ECG interpretation. Body movement, tremors, poor skin-electrode contact, recorder malfunction, electromagnetic interference and implantable electronic devices are the main reasons for ECG artifacts. Transcutaneous nerve and implanted spinal cord stimulators have been reported to result in ECG artifacts. With availability of newer implantable electronic devices, different ECG artifact patterns are being seen. Tremor control device is a newer implanted device used for suppression of tremors in patients with essential tremors or Parkinsonian tremors not adequately controlled by medications and where the tremor causes a significant functional incapacity. A differential pattern of ECG artifacts due to use of an implanted tremor control device is reported.- - - - - - - - - - ranking = 0.16666666666667keywords = movement (Clic here for more details about this article) |
10/14. Bilateral subthalamic nucleus deep brain stimulation in a patient with cervical dystonia and essential tremor.The role of subthalamic nucleus (STN) deep brain stimulation (DBS) is well established in Parkinson's disease, but experience with STN DBS in other movement disorders is limited. We report on a patient with medically refractory cervical dystonia and essential tremor resulting in dystonic head tremor and action tremor of the hands who obtained complete tremor suppression and near resolution of her cervical dystonia with bilateral STN stimulation. The results in this case demonstrate that STN DBS can dramatically improve dystonia and tremor in nonparkinsonian movement disorders.- - - - - - - - - - ranking = 0.33333333333333keywords = movement (Clic here for more details about this article) |
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