1/18. Bilateral contemporaneous posteroventral pallidotomy for the treatment of Parkinson's disease: neuropsychological and neurological side effects. Report of four cases and review of the literature.The authors report the underestimated cognitive, mood, and behavioral complications in patients who have undergone bilateral contemporaneous pallidotomy, as seen in their early experience with functional neurosurgery for Parkinson's disease (PD) that is accompanied by severe motor fluctuations before pallidal stimulation. Four patients, not suffering from dementia, with advanced (Hoehn and Yahr Stages III-IV), medically untreatable PD featuring severe "on-off" fluctuations underwent bilateral contemporaneous posteroventral pallidotomy (PVP). All patients were evaluated according to the Core Assessment Program for Intracerebral Transplantations (CAPIT) protocol without positron emission tomography scans but with additional neuropsychological cognitive, mood, and behavior testing. For the first 3 to 6 months postoperatively, all patients showed a mean improvement of motor scores on the Unified Parkinson's Disease Rating Scale (UPDRS), in the best "on" (21%) and worst "off" (40%) UPDRS III motor subscale, a mean 30% improvement in the UPDRS II activities of daily living (ADL) subscore, and 60% on the UPDRS IV complications of treatment subscale. Dyskinesia disappeared almost completely, and the mean daily duration of the off time was reduced by an average of 60%. Despite these good results in the CAPIT scores, one patient experienced a partially regressive corticobulbar syndrome with dysphagia, dysarthria, and increased drooling. No emotional lability was found in this patient, but he did demonstrate severe bilateral postoperative pretarsal blepharospasm (apraxia of eyelid opening), which interfered with walking and which required treatment with high-dose subcutaneous injections of botulinum toxin. No patient showed visual field defects or hemiparesis, but postoperative depression, changes in personality, behavior, and executive functions were seen in two individuals. Postoperative abulia was reported by the family of one patient, who lost his preoperative aggressiveness and drive in terms of ADL, speech, business, family life, and hobbies, and became more sleepy and fatigued. One patient reported postoperative mental automatisms, such as compulsive mental counting, and circular thoughts and reasoning during off phases; postoperative depression was found in two patients. However, none of the patients demonstrated these symptoms during intraoperative microelectrode stimulation. These findings are compatible with previous reports on bilateral pallidal lesions. A progressive lowering of UPDRS subscores was seen after 12 months, consistent with the progression of the disease. Bilateral simultaneous pallidotomy may be followed by emotional, behavioral, and cognitive deficits such as depression, obsessive-compulsive disorders, and loss of psychic autoactivation-abulia, as well as disabling corticobulbar dysfunction and apraxia of eyelid opening, in addition to previously described motor and visual field deficits, which make this surgery undesirable even though significant improvement in motor deficits can be achieved.- - - - - - - - - - ranking = 1keywords = lateral, motor (Clic here for more details about this article) |
2/18. The management of drooling problems in children with neurological dysfunction: a review and case report.Drooling in children with neurological dysfunction indicates neurogenic failure to coordinate the muscles of the tongue, soft palate, and face which act in the first stage of swallowing. This causes excessive pooling of saliva in the anterior part of the mouth and consequent overspill. Treatment for drooling includes behavioral, pharmacological, and surgical modalities. Correcting a malocclusion has also been reported to help eliminate drooling. This paper describes the treatment of a child with neurofibromatosis, psychomotor, developmental, and neurologic retardation, and difficulty with speech. The patient was referred to our clinic to correct his drooling. Simple orthodontic treatment succeeded in eliminating the drooling and improving his speech.- - - - - - - - - - ranking = 0.02378394369524keywords = motor (Clic here for more details about this article) |
3/18. MRI in a patient with the Worster-Drought syndrome.We describe a patient with the Worster-Drought syndrome (congenital suprabulbar paresis), thought to be a failure of development of the corticobulbar tracts. MRI showed bilateral perisylvian cortical dysplasia.- - - - - - - - - - ranking = 0.0978978090582keywords = lateral (Clic here for more details about this article) |
4/18. Transient oromotor deficits in children with benign childhood epilepsy with central temporal spikes.PURPOSE: To describe transient oromotor deficits in benign childhood epilepsy with centrotemporal spikes (BCECTS), an idiopathic age-specific epileptic syndrome with a benign course. methods: Five children with BCECTS and intermittent dysarthria and drooling not in the context of typical clinical seizures are presented. RESULTS: The periods of oromotor deficits correlated with increased seizure frequency in all children. Concomitant EEGs that were recorded during periods of dysarthria in four of the children revealed focal electrographic seizures. The reported children did not differ from other patients with BCECTS in any other respect. CONCLUSIONS: Transient oromotor dysfunction is a rare ictal phenomenon that occurs in children with BCECTS with no other unique clinical features.- - - - - - - - - - ranking = 0.16648760586668keywords = motor (Clic here for more details about this article) |
5/18. Recurrent jaw dislocation after botulinum toxin treatment for sialorrhoea in amyotrophic lateral sclerosis.Botulinum toxin (BTX) has been used successfully to treat various movement disorders, and is increasingly used for many other medical conditions. Sialorrhoea is a disabling symptom in many neurological patients including those with Parkinson's disease, stroke and amyotrophic lateral sclerosis (ALS). BTX has recently been shown to be effective for treating sialorrhoea.We report an ALS patient who developed recurrent jaw dislocation following BTX treatment for sialorrhoea to highlight the observation that intraparotid BTX may be complicated by jaw dislocations in some at-risk ALS patients. Clinicians using BTX to treat sialorrhoea in ALS need to be aware of this potentially serious complication.- - - - - - - - - - ranking = 5364.3410061887keywords = amyotrophic lateral sclerosis, amyotrophic lateral, lateral sclerosis, amyotrophic, sclerosis, lateral (Clic here for more details about this article) |
6/18. Botulinum toxin as an effective treatment of clozapine-induced hypersalivation.Hypersalivation is a common and frequently disabling side effect of atypical neuroleptics such as clozapine. Current treatment options of this adverse advent are limited by lack of efficacy or additional side effects. Botulinum toxin (BTX) injections into the parotid glands have been shown to be very effective in treating sialorrhea in the context of various neurological disorders, such as Parkinson's and motor neuron disease. Surprisingly, BTX treatment of drug-induced sialorrhea has not yet been described. We here report a patient with clozapine-induced hypersalivation and a good response to BTX injections lasting for more than 12 weeks, resulting in a marked reduction of the hypersalivation and consequently of his social withdrawal. Our patient serves to alert clinicians to the frequent problem of drug-induced sialorrhea and suggests that BTX injections should be considered as an effective and safe treatment for hypersalivation in psychiatric patients treated with clozapine.- - - - - - - - - - ranking = 12.702627988983keywords = motor neuron disease, neuron disease, motor neuron, motor, neuron (Clic here for more details about this article) |
7/18. Surgical management of drooling. Case report.Drooling occurs when excessive quantities of saliva dribble from the opened mouth. This distressing condition affects many mentally handicapped patients who are unable to effectively clear their normal salivary flow by swallowing. Any method employed for the control of drooling must still allow a sufficient volume of flow for mastication, deglutition and oral hygiene. Surgery is generally indicated for marked or severe cases of drooling and Wilkie's operation involving redirection of the parotid flow into the oropharynx is the most commonly performed surgical procedure. This operation may be combined with bilateral removal of the submandibular salivary glands if the problem is severe.- - - - - - - - - - ranking = 0.0978978090582keywords = lateral (Clic here for more details about this article) |
8/18. An intraoral prosthesis to control drooling in a patient with amyotrophic lateral sclerosis.Many alternatives exist for treating chronic drooling. The treatment of a patient with amyotrophic lateral sclerosis who complained of chronic drooling and lack of retention of fluids while drinking is presented. In this case, an alternative type of intraoral prosthesis, not previously reported in the dental literature, was used to treat chronic drooling. A lip plumper prosthesis was fabricated to approximate the partially incompetent lips and create an oral seal. The results of the prosthesis therapy for this patient are encouraging both physically and psychologically.- - - - - - - - - - ranking = 5364.3410061887keywords = amyotrophic lateral sclerosis, amyotrophic lateral, lateral sclerosis, amyotrophic, sclerosis, lateral (Clic here for more details about this article) |
9/18. Plunging ranula following bilateral submandibular duct transposition.Submandibular duct transposition is now a standard surgical procedure for the treatment of severe drooling. However, this is our first experience of a plunging ranula arising as a complication of the technique. In the surgical management of this complication, the single most important step is excision of the sublingual gland to prevent recurrence.- - - - - - - - - - ranking = 0.3915912362328keywords = lateral (Clic here for more details about this article) |
10/18. Decreasing drooling with oral motor stimulation in children with multiple disabilities.Many persons with severe and profound disabilities exhibit chronic and excessive drooling, which can have unfavorable effects on their socialization and health. Few treatments to reduce this behavior, however, have been evaluated systematically. In the present investigation, oral motor stimulation was used with 2 children who attended a residential educational facility for students who are blind and who have multiple disabilities. The treatment involved the brushing of the hard palate, the upper and lower gums, the tongue, and the inside of both cheeks at 1-hr intervals during the school day. The efficacy of this approach was demonstrated with a withdrawal experimental design. Because this treatment did not eliminate drooling, vibration was applied to the chin and neck, first in conjunction with the oral motor stimulation and then contingent on the subject's having a dry face. vibration did not have additional therapeutic effects. The results of this study are discussed in relation to the existing literature on modification of drooling and the difficulty of effecting change in the behavior of persons with severe and profound mental and physical disabilities.- - - - - - - - - - ranking = 0.14270366217144keywords = motor (Clic here for more details about this article) |
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