bluuebunny/crossref_metadata_2025 huggingface dataset:
A tourette‐like syndrome following cardiopulmonary bypass and hypothermia: MRI volumetric measurements
Authors: Singer Harvey S. , DelaCruz Pablito S. , Abrams Michael T. , Bean S. Charles , Reiss Allan L.
Published: May 2005

We present the case of an adolescent boy who developed a variety of simple and complex motor and vocal tics (Tourette‐like syndrome), along with inattentiveness and obsessive‐compulsive behaviors after cardiac surgery with cardiopulmonary bypass and profound hypothermia. A single photon emission computed tomography study 2 months after surgery showed reduced uptake in the left hemisphere and 2 years later a perfusion defect in the basal ganglia. Serial magnetic resonance imaging (MRI) studies were normal. Volumetric MRI studies were obtained 4 years after surgery and compared with published values for normal individuals and children with Tourette syndrome (TS), including subsets matched for age, sex, and handedness. Measurement of basal ganglia structures showed a right‐dominant asymmetry of the caudate and putamen, in part similar to findings previously reported in patients with TS. Other volumetric abnormalities included a >2‐SD reduction of cortical gray matter, a small decrease of total cerebral volume, and increase in cerebral white matter. Although a variety of neurological problems may occur after cardiopulmonary bypass, to our knowledge this case represents the first report of a chronic tic disorder following cardiac surgery with cardiopulmonary bypass and hypothermia.
Myoclonus in corticobasal degeneration
Authors: Carella Francesco , Ciano Claudia , Panzica Ferruccio , Scaioli Vidmer
Published: May 2005

Five patients with unilateral myoclonus and a clinical diagnosis of corticobasal degeneration (CBD) were studied. All patients showed enhanced long‐loop responses in their myoclonic arms without enlarged somatosensory potentials. The cortical relay time of the long‐loop responses was studied in three patients, in two of whom it was <2 ms, even in the nonmyoclonic arm. Myoclonus in CBD is probably related to an enhanced long‐loop reflex whose pathway is unlikely to be the same as that in classic cortical reflex myoclonus.
Cerebellar hypermetria: Reduction in the early component of the antagonist electromyogram
Authors: Wild Barbara , Corcos Daniel M.
Published: May 2005

Several articles have described the electromyographic (EMG) patterns underlying cerebellar hypermetria. However, the description of the EMG associated with hypermetria is not consistent between studies. It is hypothesized that the reason for this concerns the criteria used to define and describe the antagonist latency. Several studies on neurologically normal individuals have shown that there are two components to the antagonist EMG: an early component and a late component. However, many studies have identified only one component and have not defined whether it was the early or late component. A reanalysis of one published data set that had previously identified only one antagonist component was performed. The reanalysis suggests that hypermetria can be caused by an absence of an early antagonist EMG component, a delayed late component, or both. In addition, a new measure is suggested that allows this hypothesis to be further evaluated.
Globus pallidus internus pallidotomy for generalized dystonia
Authors: Lozano Andres M. , Kumar R. , Gross R. E. , Giladi N. , Hutchison W. D. , Dostrovsky J. O. , Lang Anthony E.
Published: May 2005

The authors present a young boy with severe generalized dystonia treated with bilateral simultaneous pallidotomy. Microelectrode recordings with the patient under propofol anesthesia showed that the mean discharge rate of globus pallidus internus (GPi) neurons was between 21 and 31 Hz. This contracts sharply with the mean GPi neuronal firing rates of approximately 80 Hz that are characteristic of Parkinson's disease. The patient had no immediate benefit from surgery, but a progressive improvement in both axial and limb dystonia began within 3 days. The Burke‐Fahn‐Marsden scores were 75 (maximum possible = 120) at baseline, 52 at 5 days, and 16 at 3 months after surgery. The mechanism of action of pallidotoy for dystonia and the reasons for the delayed and progressive improvement are unknown. Nevertheless, the magnitude of the improvement and the safety of the procedure in this one patient warrant a careful evaluation of pallidotomy for dystonia.
Symptoms and duration of the prodromal phase in parkinson's disease
Authors: Gonera Ed G. , Hof Martin Van't , Berger Hans J. C. , van Weel Chris , Horstink Martin W. I. M.
Published: May 2005

To investigate the duration of a prodromal phase before the onset of the classic symptoms of idiopathic Parkinson's disease the authors conducted a retrospective case control study of 60 patients with Parkinson's disease and 58 age‐ and sex‐matched control subjects, covering the decade preceding the onset of classic Parkinson's disease. The symptoms were derived from files of the patients general practitioners. Compared with control subjects, patients pre‐Parkinson's disease had more central nervous system, psychologic, musculoskeletal, and cardiovascular (i.e., autonomic) symptoms. Patients pre‐Parkinson's disease also made more visits to general practitioners and medical specialists. The results indicate that the onset of classic parkinsonism is frequently precede by a prodromal phase lasting from 4–6 years.
[123]IBZM Binding predicts dopaminergic responsiveness in patients with parkinsonism and previous dopaminomimetic therapy
Authors: Schwarz Johannes , Tatsch K. , Gasser T. , Arnold G. , Oertel W. H.
Published: May 2005

We investigated the cases of 55 patients with parkinsonism and prior dopaminomimetic therapy in whom the response to this treatment was questionable or reported to be negative. None of these patients had shown motor fluctuations prior to this study. We compared the results of imaging of dopamine‐D2 receptors by using [123l]iodobenzamide‐single‐photon‐emission computed tomography (IBZM‐SPECT) with the improvement in motor signs following a subcutaneous injection of apomorphine and a subsequent increase in oral dopaminomimetic therapy. IBZM‐SPECT accurately predicted a positive or negative response to apomorphine in 37 (84%) of 44 patients. The sensitivity/specificity was calculated as 96.3%/64.7%. The sensitivity/specificity of IBZM‐SPECT for the response to oral treatment with levodopa (L‐dopa) was calculated as 100%/75%. After a follow‐up period of 2–4 years, 25 patients developed motor fluctuations. All of these patients had normal IBZM binding. Nine developed clinical signs indicating a basal ganglia disorder other than Parkinson's disease. Eight of these nine patients had reduced, and one patient had normal, IBZM binding. We conclude that normal IBZM binding is a useful predictor of a good response to dopaminergic drugs in patients with parkinsonism and a questionable response to previous dopaminomimetic therapy. Reduced IBZM binding seems to exclude a diagnosis of Parkinson's disease, because none of the latter patients clearly benefited from L‐dopa and 66.7% developed clinical signs indicating another disorder of the basal ganglia.
Sexuality in women with parkinson's disease
Authors: Welsh Mickie , Hung Lynn , Waters Cheryl H.
Published: May 2005

There is a renewed interest in sexuality in chronic disease states. Whereas there is some literature on male sexuality in Parkinson's disease (PD), no study has been devoted exclusively to women. We compared 27 women who had PD with community controls matched for age and marital status by using the Brief Index of Sexual Functioning in Women. Approximately 50% of both samples were sexually active. The women with PD were more likely to be dissatisfied with the quality of the sexual experiences. There were significant differences in the two groups with respect to anxiety or inhibition, vaginal tightness, and involuntary urination. Preoccupation with health problems interfering with sex and dissatisfaction with body appearance were also more prevalent in parkinsonian women, but not statistically different from controls. The PD patients were less satisfied with their sexual relationships and with their partners, and were more depressed as a group when compared with controls (Beck Depression Inventory of 11.8 vs 6.3). In both groups, age was associated with significant changes in satisfaction and activity. In summary, qualitative differences exist in the sexual experiences of women with PD compared with controls.
Efficacy of a patient‐training videotape on motor fluctuations for on‐off diaries in parkinson's disease
Authors: Goetz Christopher G. , Stebbins Glenn T. , Blasucci Lucy M. , Grobman Mitchell S.
Published: May 2005

Patient on‐off diaries are used in clinical trials, but a method to assure agreement between patient and examiner has never been developed. We tested whether a patient‐teaching tape increased the rate of agreement between patient diary ratings and simultaneous neurologic assessment by a trained professional. A total of 32 consecutive patients who had Parkinson's disease with motor fluctuations independently completed a 4‐h on‐off diary (nine ratings) at the same time as an examiner. Those with <80% agreement with the examiner (n = 20) were randomized to view either a training tape that showed motor fluctuations (experimental group) or another videotape of general patient educational material (control group). All patients then underwent the same 4‐h assessment of motor fluctuations. To test for long‐term retention, they returned 1 month later and, without reviewing the videotape, underwent a final 4‐h correlation assessment. After the training tape, the experimental group showed significant improvement, whereas the control group showed no improvement. Furthermore, another month later, the improvement in the experimental group was retained. Based on these findings, we suggest that future clinical trials assessing motor fluctuations incorporate this tape into their basic methodology.
Quantitative study of mitochondrial complex I in platelets of parkinsonian patients
Authors: Blandini Fabio , Nappi Giuseppe , Timothy Greenamyre J.
Published: May 2005

Activity of mitochondrial enzyme complex I (NADH‐ubiquinone oxidoreductase) is reduced in the substantia nigra of patients with Parkinson's disease (PD). A less pronounced decrease in the activity of this enzyme has also been reported in platelets of PD patients. To obtain quantitative information on platelet complex I in PD, we studied platelet complex I in 16 PD patients and 16 age‐matched controls by using a newly developed technique based on the binding of [3H]dihydrorotenone ([3H]DHR), an analog of the pesticide rotenone, to complex I. We also investigated the inhibitory effect of MPP+ (1‐methyl‐4‐phenyl‐pyridinium) on [3H]DHR specific binding to platelet complex I. PD patients and controls showed similar levels of [3H]DHR specific binding; preincubation of platelets with MPP+ caused the same degree of inhibition of [3H]DHR specific binding in the two groups. In PD patients, we observed a direct correlation between MPP+‐induced inhibition of [3H]DHR specific binding and the daily intake of levodopa, which may be related to drug‐induced changes in the transport of MPP+ into the platelet or in its binding to complex I. These findings demonstrate that the reported reduction in complex I activity in platelets of PD patients can not be accounted for by an abnormality at the level of the rotenone binding site (putatively the ND‐1 gene product), although they do not exclude differences in complex I activity between PD patients and controls.
123I‐IBZM binding compared with long‐term clinical follow up in patients with de novo parkinsonism
Authors: Schwarz Johannes , Tatsch Klaus , Gasser Thomas , Arnold Guy , Pogarell Oliver , Künig Gais , Oertel Wolfgang H.
Published: May 2005

We performed a prospective clinical follow up (mean follow up, 36 months; range, 24–56 months) of 65 patients with de novo parkinsonism in whom imaging of dopamine D2 receptors was performed before the initiation of dopaminomimetic therapy by means of 123I‐iodobenzamidesingle‐photon‐emission computed tomography (IBZM‐SPECT). The results of IBZM‐SPECT were comared with the long‐term response to dopaminomimetic drugs, the development of motor fluctuations, and the development of clinical signs incompatible with Parkinson's disease (PD). A total of 55 patients had normal and 10 patients had reduced IBZM binding; 45 patients showed a good response to levodopa (L‐dopa), 11 showed an equivocal response, and nine did not respond; 31 patients developed a fluctuating response to dopaminomimetic drugs and seven patients developed clinical signs indicative of multiple‐system atrophy (n = 5), progressive supranuclear palsy (n = 1), or corticobasal ganglionic degeneration (n = 1). Chi‐squared analysis showed a significant correlation of the results of IBZM‐SPECT with the long‐term response to dopaminomimetic therapy (p < 0.0001) and the development of motor fluctuations (p < 0.0001) or clinical signs incompatible with PD (p < 0.0001). We conclude that IBZM‐SPECT can help to differentiate between patients who will show a good response to L‐dopa and will develop motor fluctuations (most likely patients with PD) and those patients who will not respond to L‐dopa and might develop clinical signs compatible with another hypokinetic disorder of the basal ganglia.
Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions
Authors: van Zagten Marian , Lodder Jan , Kessels Fons
Published: May 2005

Vascular parkinsonism is thought to be a distinct parkinsonian syndrome associated with small deep infarcts and white matter lesions (WMLs). We studied the prevalence of parkinsonian features (bradykinesia, rigidity, tremor, and gait disorder) in relation to small deep or territorial infarcts and WMLs on computed tomography (CT) in 62 lacunar and 41 territorial stroke patients, at 3.0 (median) years of follow up. One or more parkinsonian signs were found in 36% of these patients; 11% clinically had parkinsonism. parkinsonian signs were found more frequently in lacunar than in territorial stroke patients: bradykinesia in 45% and 7%, rigidity in 13% and 7%, tremor in 6% and 7%, and gait disorder in 16% and 7%, respectively. Patients with WMLs at study entry (n = 16) were compared with those without WMLs (n = 87): 56% and 25% had bradykinesia, 25% and 8% rigidity, 25% and 3% tremor, and 38% and 8% gait disorder, respectively. Regression analysis with adjusted odds ratios ([a]OR) showed that WMLs at study entry were associated with bradykinesia ([a]OR 8.0, 95% confidence interval [CI] 1.6‐41.6), gait disorder ([a]OR 7.1, 95% CI 1.5‐33.7), and tremor ([a]OR 7.0, 95% CI 1.2‐40.3). Bradykinesia was associated with lacunar stroke at study entry ([a]OR 11.5, 95% CI 2.4‐54.9). Thus, one third of our storke patients had one or more parkinsonian signs, and 10% clinically had a parkinsonian syndrome that differed from Lewy body parkinsonism: infrequent resting tremor, but frequent gait disorder. Parkinsonian signs were associated with WMLs and lacunar storke. Therefore, this study favors a distinct vascular parkinsonian syndrome.
Electrophysiological studies of early stage corticobasal degeneration
Authors: Lu C. S. , Ikeda A. , Terada K. , Mima T. , Nagamine T. , Fukuyama H. , Kohara N. , Kojima Y. , Yonekura Y. , Chen R. S. , Tsai C. H. , Chu N. S. , Kimura J. , Shibasaki H.
Published: May 2005

We conducted electrophysiological studies in two Asian patients with probable corticobasal degeneration (CBD). The duration of illness from onset was 16 and 20 months, respectively. The clinical manifestations were markedly asymmetric and characterized by cortical sensory loss, apraxia, action myoclonus, action tremor, and akinetic‐rigid parkinsonism. Neither patient responded to levodopa therapy. Simple photon‐emission computed tomography (SPECT) study showed significantly decreased regional cerebral blood flow in the frontoparietal areas and thalamus opposite to the predominantly affected limb. A series of electrophysiological studies failed to identify giant somatosensory evoked potentials (SEPs), enhanced long latency electromyography (EMG) reflex, and cortical spikes preceding myoclonic jerk. However, the earliest cortical component of the median nerve SEP was exclusively enlarged in one patient and preserved with depression of the subsequent components in the other patient. Significantly shorter postmotor‐evoked potential (MEP) silent period was found after the transcranial magnetic stimulation of the motor cortex in both patients. CBD is a unique clinical entity characterized by action myoclonus probably the result of the pathologic hyperexcitability of the motor cortex, based on a loss of inhibitory input form the sensory cortex.
Costs of drug treatment in Parkinson's disease
Authors: Dodel Richard C. , Eggert Karla M. , Singer Marika S. , Eichhorn Tobias E. , Pogarell Oliver , Oertel Wolfgang H.
Published: May 2005

Parkinson's disease (PD) has a major socioeconomic impact on society. The chronic, progressive course of the disease, which often leads to severe disability, results in high expenses for the medical resources used for treatment, care, and rehabilitation of patients as well as reduced or lost productivity as a result of illness or premature death. In Great Britain, it has been estimated that the National Health Service spends up to $383 million (1992) annually for the care of PD. This emphasizes the importance of assessing the costs related to this disease. A detailed knowledge of the cost allocation would provide a solid basis on which health care priorities can be rationally set. Next to hospitalization, drug treatment accounts for the highest expense for direct medical costs of PD. Therefore, this analysis focuses on the costs of drug treatment for PD. The cost analysis was based on a retrospective study of 409 patients with PD who were seen over a 1‐year period in our movement disorders clinic. The cost of therapy varied considerably depending on the severity of the condition (assessed in the “off” phase), the incidence of motor fluctuations, and the type of PD. In the early stage of the disease (Hoehn and Yahr stage I [HY I]), mean daily costs for therapy were DM (German marks) 6.60, which increased in later stages of the disease (HYV) to DM 22.00. If rare cases requiring continuous subcutaneous apomorphine infusion were included, mean daily costs of patients in HY V rose to DM 32.50 (the mean daily costs of subcutaneous apomorphine‐treated patients in HY V: DM 74.30). Patients with motor fluctuations accounted for higher costs (DM 16.50) compared with those without motor fluctuations (DM 7.80). With respect to the three subtypes of PD, the mean daily expenditure was DM 7.00 for the tremor‐dominant type, DM 12.40 for the akinetic‐rigid type, and DM 10.80 for the mixed type. In the group of 409 PD patients included in this analysis, the average daily expenditure for drug treatment totaled DM 10.70 per patient (including patients on subcutaneous apomorphine).
Differential diagnosis of parkinsonism with [18F]fluorodeoxyglucose and PET
Authors: Antonini Angelo , Kazumata Ken , Feigin Andrew , Mandel Francine , Dhawan Vijay , Margouleff Claude , Eidelberg David
Published: May 2005

The clinical differentiation between typical idiopathic Parkinson's disease (IPD) and atypical parkinsonian disorders (APD) is complicated by the presence of signs and symptoms common to both forms of parkinsonism. Metabolic brain imaging with [18F]fluorodeoxyglucose (FDG) and positron emission tomography (PET) may be a useful adjunct in differentiating APD from IPD. To explore this possibility, we studied 48 parkinsonian patients suspected as having possible APD because of a deteriorating response to dopaminergic treatment, the development of autonomic dysfunction, or both. A group of 56 patients with likely IPD served as control subjects. We used quantitative FDG/PET to measure regional rates of cerebral glucose use in IPD and APD patients. We used discriminant analysis to categorize IPD and APD patients based on their regional metabolic data. We found that a linear combination of caudate, lentiform, and thalamic values accurately discriminated APD from IPD patients (p < 0.0001). Significant metabolic abnormalities were present in the striatum and the thalamus of 36 of 48 (75%) APD patients. Our findings show that measurements of regional glucose metabolism can be used to discriminate patients with suspected APD from their counterparts with classic IPD. FDG/PET may be a useful adjunct to the clinical examination in the differential diagnosis of parkinsonism.
Imaging the pre‐ and postsynaptic side of striatal dopaminergic synapses in idiopathic cervical dystonia: A SPECT STUDY Using [123I] epidepride and [123I] β‐CIT
Authors: Naumann Markus , Pirker Walter , Reiners K. , Lange Klaus W. , Becker Georg , Brücke Thomas
Published: May 2005

There is increasing evidence that a dysfunction of the dopaminergic system may be involved in the pathogenesis of idiopathic dystonia. To visualize possible alterations of the pre‐ and postsynaptic side of striatal dopaminergic synapses, SPECT studies using the radiotracers [123I] epidepride and [123I] β‐CIT were performed in 10 patients with idiopathic cervical dystonia. Eleven age‐ and sex‐matched subjects served as controls. [123I] Epidepride is a new highly affine marker of D2 receptors, and [123I] β‐CIT binds to dopamine transporters on dopaminergic nerve endings. [123I] Epidepride binding was significantly reduced in both striata of dystonia patients compared with controls (p < 0.05). In contrast, striatal [123I] β‐CIT uptake did not differ from controls. We conclude that dopaminergic dysfunction in idiopathic focal dystonia mainly involves postsynaptic mechanisms and suggest a disturbance of the indirect pathway of the motor circuit resulting in a disinhibited thalamocortical stimulation.
Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome
Authors: Montplaisir Jacques , Boucher Sylvie , Nicolas Alain , Lesperance Paul , Gosselin Anik , Rompré Pierre , Lavigne Gilles
Published: May 2005

Patients with restless leg syndrome (RLS) complain of motor restlessness, usually occurring while they rest in the evening. Two immobilization tests have been described to assess leg restlessness in these patients. In the first test, the patient sits in bed with his or her legs outstretched while electromyograms are recorded from right and left anterior tibialis muscles for an hour (Suggested Immobilization Test [SIT]); in the second test, the legs are immobilized in a stretcher (Forced Immobilization Test [FIT]). In the current study, the SIT and the FIT were compared in patients with RLS and normal control subjects matched for age and sex. More leg movements were seen in patients than in controls during immobilization tests, especially the SIT. These movements were periodic, occurring at a frequency of approximately one every 12 seconds. The SIT (index > 40) was found to discriminate between RLS and control subjects better than the FIT (index > 25). Patients were also recorded during two consecutive nights to measure periodic leg movements in sleep (PLMS). A SIT index greater than 40 and a PLMS index greater than 11 (highest PLMS index of 2 consecutive nights) were found to discriminate patients with RLS from control subjects with similar power. With each of these two measures, the clinical diagnosis was correctly predicted in 81% of patients and 81% of the control subjects. The SIT has several advantages over the measure of the PLMS index; it does not require an all‐night polygraphic recording and can be administered several times a day to measure circadian fluctuation of motor restlessness.
Ten years' experience with enteral levodopa infusions for motor fluctuations in Parkinson's disease
Authors: Syed Nadir , Murphy John , Zimmerman Thomas , Mark Margery H. , Sage Jacob I.
Published: May 2005

We report our long‐term experience using enteral levodopa infusions in 22 patients with Parkinson's disease and severe motor fluctuations. Amelioration of intractable dyskinesias was the most important factor that determined whether patients chose to continue using the infusion pump system. Mechanical and physical problems associated with enteral access were the most common reasons for which patients discontinued pump use. Nearly all patients continued to have dramatically increased on time for the duration of follow up, suggesting that technically less‐cumbersome systems that provide continuous dopaminergic stimulation are worthwhile and should be developed.
Hypometria in Parkinson's disease: Automatic versus controlled processing
Authors: Oliverira Rosinda M. , Gurd Jennifer M. , Nixon Phillip , Marshall John C. , Passingham Richard E.
Published: May 2005

Objectives: The aim was to investigate whether patients with Parkinson's disease (PD) make movements that are of smaller amplitude when required to attend to a secondary task at the same time as performing a motor task.

Methods: Thirteen patients with idiopathic Parkinson's disease (mean age, 67.1 yrs) and 14 healthy control subjects (mean age, 66.2 yrs) were tested. The motor task was repeated opposition of the thumb and forefinger and the secondary task was a lexical decision task.

Results: The PD patients made hypometric movements, and the amplitude was further decreased when they performed the secondary task at the same time. There was no significant change for the control subjects.

Conclusion: The unpaced motor task was less automatic for the PD patients than for the control subjects, and hence more subject to interference from a secondary task. We relate this to the underactivation of the supplementary motor cortex (SMA).
Limb‐kinetic apraxia
Authors: Denes Gianfranco , Mantovan Maria Cristina , Gallana Alessandra , Cappelletti Jee Yun
Published: May 2005

Five cases of limb‐kinetic apraxia following primary degenerative cerebral pathology are reported. Apraxia appeared as the main symptom and was not concomitant to aphasia or to widespread cognitive impairments. Apraxia was not a consequence of elementary motor or sensory deficits, lack of coordination, or the result of the presence of rigid‐akinetic symptoms. The apraxia was usually unilateral, being present in both routine activities and testing sessions and consisting of the coarse, unilateral, awkward execution of correctly planned movements. Conceptual knowledge of the movements and their ideational plan was spared. The characteristics of apraxia fit the definition of limb‐kinetic apraxia originally proposed by Liepmann. The pertinent literature is reviewed.
Clinical comparison of tardive and idiopathic cervical dystonia
Authors: Molho Eric S. , Feustel Paul J. , Factor Stewart A.
Published: May 2005

It has been suggested that tardive cervical dystonia may be clinically indistinguishable from the idiopathic form and that the diagnosis rests solely on documenting an exposure to dopamine antagonist medications. To investigate this, we performed a retrospective evaluation of patient records on 102 patients with idiopathic and 20 patients with tardive cervical dystonia seen in our Movement Disorder Clinic over the past 8 years. Several clinical and demographic variables were compared and a number of differences were observed. The presence of extracervical involvement, retrocollis, and spasmodic head movements were individually found to be predictive of tardive cervical dystonia. Torticollis, laterocollis, and trick maneuvers were predictive of idiopathic cervical dystonia. Head tremor (42.2%) and family history of dystonia (9.8%) were present only in the idiopathic group. Cervical muscle hypertrophy was significantly more common in the idiopathic group (100% versus 75%). No difference was found between the two groups in their response to treatment with botulinum toxin A. These results indicate that clinical differences between idiopathic and tardive cervical dystonia exist. These differences may help to distinguish them in the clinical setting, improve diagnostic accuracy, and support the existence of a causal relationship between exposure to dopamine antagonist medications and chronic dystonia.
Extensor truncal dystonia: Successful treatment with botulinum toxin injections
Authors: Comella Cynthia L. , Shannon Kathleen M. , Jaglin Jeana
Published: May 2005

Patients with truncal extension dystonia, manifested by involuntary back arching, often associated with pain and severe motor disability, have not consistently responded to pharmacologic agents. We evaluated 4 women and 1 man (mean age, 41.8 years; dystonia duration, 9.8 years) with severe idiopathic (2 patients) or tardive (3 patients) truncal and cervical dystonia. Using electromyographic guidance, we injected botulinum toxin into the paravertebral muscles of the lumbar region in four to six sites using 25–50 U per site. We reevaluated patients 2–4 weeks after injection. The mean dose of botulinum toxin into back muscles was 210 U (range, 150–300 U). By blinded videotape evaluation, objective improvement was found in three patients with a mean truncal dystonia score improving by 37%. Patient evaluation showed improvement in movement ranging from 20–80% (mean, 46%) after botulinum toxin. In all patients with pain as a result of dystonia, there was substantial improvement. None of the patients worsened and no adverse effects occurred. Botulinum toxin injections offer a potent new treatment for truncal dystonia.
Inhibition of levodopa effects by internal pallidal stimulation
Authors: Krack Paul , Pollak Pierre , Limousin Patricia , Hoffmann Dominique , Benazzouz Abdelhamid , Benabid Alim‐Louis
Published: May 2005

We report three patients with bilateral GPi stimulation for stage 4 Parkinson's disease (PD) with severe levodopa‐induced dyskinesias (LID). In all three it was possible to completely inhibit LID using high‐stimulation parameters. Parallel to complete inhibition of LID, an inhibition of the anti‐akinetic effect of levodopa was observed, whereas, at the same time, rigidity was markedly improved. GPi stimulation is adaptable over time, and stimulation parameters have to be programmed according to off‐and on‐period motor symptoms. The main interest of stimulation is the possibility of finding a compromise between LID alleviation in on‐phase without loss of the beneficial motor effects and improvement in parkinsonism in off‐phase. In some patients, residual dyskinesias have to be accepted so as not to aggravate on‐period motor symptoms by a presumed overinhibition of basal ganglia outflow.
Dysfunction of Ib (Autogenic) spinal inhibition in patients with progressive supranuclear palsy
Authors: Fine Edward J. , Hallett Mark , Litvan Irene , Tresser Nancy , Katz David
Published: May 2005

We compared the activity of Ib spinal interneurons in five patients with progressive supranuclear palsy (PSP) with six age‐matched control subjects. Stimulation of the medial gastrocnemius nerve at motor threshold intensity activated Ib afferents that in turn inhibit H reflexes from the soleus muscle. Maximum inhibition occurred at interstimulus intervals of 6 and 8 ms for both control subjects and PSP patients and was significantly greater in the PSP patients. Increased Ib activity of PSP patients may be caused by loss of inhibition of Ib interneurons through degeneration of the medullary reticulospinal pathway. The corticospinal pathways, unopposed by the medullary reticulospinal tract, may excessively activate Ib internurons.
Neurosurgical intervention for cervical disk disease in dystonic cerebral palsy
Authors: Pollak Lea , Schiffer Juana , Klein Colin , Mirovsky Yigal , Copeliovich Lionel , Rabey José Martin
Published: May 2005

We report five young patients with athetoid‐spastic cerebral palsy who had deteriorated neurologically. Magnetic resonance imaging (MRI) was used to investigate suspected compressive cervical spine lesion. Cervical spondylosis with disk protrusions was found in all patients. Four patients under went surgery by an anterior approach with insertion of a bone graft resulting in substantial clinical improvement. The other patient, diagnosed 8 years after onset of symptoms, was treated conservatively. The availability of MRI makes early recognition of cervical cord compression possible, allowing effective surgical intervention in this special group of patients.
DNA fragmentation in human substantia nigra: Apoptosis or perimortem effect?
Authors: Kingsbury Ann E. , David Mardsen C. , Foster Oliver J. F.
Published: May 2005

DNA fragmentation was examined in situ in flashfrozen human postmortem midbrain as a marker for programmed cell death. A large series of cases comprising 16 pathologically confirmed idiopathic Parkinson's disease (IPD) cases, 14 control cases without brain pathology, and a group of 6 patients with other parkinsonian movement disorders were examined using TdT‐mediated dUTP‐biotin 3′ end‐labeling histology. Labeling of neurons and glia was seen in the substantia nigra of control and IPD cases and in other movement disorder cases. Labeled nuclei were seen in melanized nigral neurons; apoptotic bodies were also found but were more commonly associated with nigral glia. In the control group, labeling of neurons and glia was strongly associated with poor agonal status, assessed by tissue pH, a marker for antemortem hypoxia. The mean tissue pH of the control group with neuronal labeling was 6.28 (SEM .057), which was significantly different from that of the unlabeled group 6.55 (SEM .055). Mean tissue pH for all cases was 6.38. There was no association of nigral neuronal labeling with poor agonal status in the IPD cases, which showed labeling throughout the range of pH values. However, extranigral labeling, seen in the mesencephalon, red nucleus, superior colliculus, rostral pons, and periaqueductal gray matter, in all three subject groups was associated with tissue pH values of less than 6.3.

These findings suggest that DNA fragmentation is influenced by antemortem hypoxia and that apoptosis‐like changes seen in the postmortem nigra may parallel those seen in experimental ischemia in the animal brain. The likely influence of perimortem factors on these changes indicates that results from postmortem studies of apoptotic cell death in neurodegenerative disease should be treated with caution and underlines the importance of determining postmortem markers for agonal status in human brain.
Curing theory on the Aai–Bbj type polycondensation (III). The gelation range
Authors: Zheng Fu‐an , Tang Xin‐yi
Published: May 2005

By means of the gelation equation containing both inter‐ and intramolecular reaction parameters obtained by the authors, this paper deduces the gelation range of Aai–Bbj type polycondensation. The experimental data are essentially in agreement with our theoretical results.
Investigation of radiation grafting of vinyl acetate onto (tetrafluoroethylene–perfluorovinyl ether) copolymer films
Authors: El‐Sawy Naeem M. , Hegazy El‐Sayed A. , Rabie A. M. , Hamed A. , Miligy G. A.
Published: May 2005

A study has been made of radiation‐induced grafting of vinyl acetate (VAc) on to (tetrafluoroethylene–perfluorovinyl ether) copolymer (PFA). Effects of grafting conditions such as inhibitor and monomer concentrations and irradiation dose on the grafting yield were investigated. In this grafting system, ammonium ferrous sulphate (Mohr′s salt) was added to the monomer‐solvent mixture to minimize the homopolymerization of VAc and the most suitable concentration was found to be 2.0 wt%. It was found that the dependence of the initial grafting rate on monomer concentration is of the order 1.5. The degree of grafting tends to level off at high irradiation doses due to the recombination of formed free radicals without initiating graft polymerization. Some properties of the prepared graft copolymer such as swelling behaviour, electrical conductivity, thermal and mechanical properties were also investigated. The electrical conductivity was improved by hydrolysis of poly(vinyl acetate) in the grafted chains to their respective vinyl alcohols. The tensile properties were improved by grafting; however, the elongation percent decreased. The DTA data showed thermal stability of such graft copolymers for temperatures up to 300°C, but stability decreased at higher temperatures.
Thermosetting polyethersulphone oligomers
Authors: Parker D. G. , Wheatley G. W.
Published: May 2005

Routes to thermosetting polyethersulphones (PES) by endcapping an hydroxy terminated oligomer with thermally reactive propargyl, vinylbenzyl and cyanate groups were investigated. Model compounds were prepared to establish suitable routes to the reactive oligomers. DSC was used to study curing behaviour of oligomers and model compounds.
Solid state NMR study of the polymerisation of poly(ether sulphone)
Authors: Clayden Nigel J. , Parker David G. , Thorogood Adrian S. , Rose John B.
Published: May 2005

The synthesis of poly(ether sulphone) using the ‘carbonate’ route based on the reaction of 4,4′‐dihydroxydiphenylsulphone, 4,4‐dichlorodiphenylsulphone and potassium carbonate dispersed in diphenylsulphone has been studied by 13C CPMAS NMR spectroscopy. In the initial reaction the half potassium salt of 4,4′‐dihydroxydiphenylsulphone is formed. No evidence for a stable full salt was found at any time during the polymerisation cycle and no appreciable oligomer formation took place before the polymerisation itself took place.
Radiation effects of an electron beam on the microhardness of poly(methyl methacrylate): Poly(chlorotrifluoroethylene) polyblends
Authors: Bajpai R. , Agrawal Pragyesh , Datt S. C.
Published: May 2005

Specimens of poly(methyl methacrylate) (PMMA): poly(chlorotrifluoroethylene) (PCTFE) polyblends with different weight percentage ratios were subjected to electron beam irradiation (1–10 Mrad). The effect of irradiation on the strength of the blend specimens was studied by measuring the surface microhardness using a Vicker's microhardness tester attached to a Carl Zeiss NU 2 Universal research microscope. Significant changes were observed in the Vicker's hardness number, Hv. An irradiation dose of 3 Mrad was found to enhance greatly the microhardness level of the specimens. An increase of approximately 78% in microhardness was observed as the radiation dose was increased from 1 to 3 Mrad. Electron irradiation was also found to induce crosslinking and degradation in the material. The degree of crosslinking was found to be maximum at a dose of 3 Mrad. Specimens incorporating 10 wt% PCTFE were found to exhibit the highest level of microhardness at all radiation doses.
Microencapsulation by coacervation of poly(lactide‐co‐glycolide). III. Characterization of the final microspheres
Authors: Nihant N. , Stassen S. , Grandfils C. , Jérome R. , Teyssié Ph. , Goffinet G.
Published: May 2005

This paper deals with protein microencapsulation by coacervation of poly(lactide‐co‐glycolide) solutions in CH2Cl2 induced by the addition of silicone oils of various viscosities.

This coating technique proceeds along three steps: phase separation of the coating polyester, adsorption of the coacervate droplets around the protein phase, and hardening of microparticles. Size distribution, surface morphology and internal porosity of the final microspheres clearly depend on the main characteristics of the coacervate, particularly the viscosity, in a direct connection with the CH2Cl2 content. Indeed, the whole porosity (which may be as high as 80%), average pore size and broadness of pore size distribution decrease as the coacervate is more viscous. Hardening of the coacervate droplets is thus so fast that the organic solvent is entrapped within the polymer matrix and predetermines the internal porosity. Finally, size distribution of microspheres is bimodal in a clear relation with the coacervate viscosity. A less viscous coacervate favours smaller microspheres (within the 7–90 μm range), contaminated with a minor population of microparticles below 4 μm.
Dispersion polymerization of styrene in aqueous alcohol solution: Effects of reaction parameters on the polymer particle formation
Authors: Uyama Hiroshi , Kobayashi Shiro
Published: May 2005

Dispersion polymerization of styrene in an aqueous alcohol solution using poly(2‐ethyl‐2‐oxazoline) as a polymeric stabilizer was performed to prepare micron‐size monodisperse polystyrene particles. As the water content of the solvent increased, the polymerization rate and the molecular weight of the polymer particles increased and the particle size decreased. Effects of concentrations of stabilizer and initiator upon the polymerization and the size of the resulting polystyrene particles have been examined in the solvent containing different water contents.
Monomer‐Isomerization polymerization. XXVIII. Catalytic activity of transition metals and alkylaluminums in monomer‐isomerization polymerization of 2‐butene
Authors: Endo Kiyoshi , Ueda Ryuichi , Otsu Takayuki
Published: May 2005

Monomer‐isomerization polymerization of cis‐2‐butene (c2B) with Ziegler–Natta catalysts was studied to find a highly active catalyst. Among the transition metals [TiCl3, TiCl4, VCl3, VOCl3, and V (acac)3] and alkylauminums used, TiCl3R3Al (R = C2H5 and i‐C4H9) was found to show a high‐activity for monomer‐isomerization polymerization of c2B. The polymer yield was low with TiCl4(C2H5)3Al catalyst. However, when NiCl2 was added to this catalyst, the polymer yield increased. With TiCl3(C2H5)3Al catalyst, the effect of the Al/Ti molar ratio was observed and a maximum for the polymer yields was obtained at molar ratios of 2.0–3.0, but the isomerization increased as a function of Al/Ti molar ratio. The valence state of titanium on active sites for isomerization and polymerization is discussed.
Monomer‐Isomerization polymerization. XXX. Influence of type of TiCl3 on monomer‐isomerization polymerization of 2‐butene with TiCl3 and alkylaluminum catalyst
Authors: Endo Kiyoshi , Ueda Ryuichi , Otsu Takayuki
Published: May 2005

Monomer‐isomerization polymerization of cis‐2‐butene with four types of TiCl3 in combination with alkylaluminum compounds was investigated. The catalytic activities for monomer‐isomerization polymerization were found to be influenced by the type of TiCl3 employed: systems containing hydrogen‐activated‐TiCl3 and Solvay‐TiCl3 in combination with R3Al (R = C2H5 and i‐C4H9) showed high catalytic activity for both isomerization and polymerization, whereas (C2H5)2AlCl in combination with any type of TiCl3 did not induce the monomer‐isomerization polymerization. The addition effect of NiCl2 to the TiCl3(C2H5)3Al catalyst was examined. Catalytic activities for both polymerization and isomerization reactions were found to depend on the amount of NiCl2 added.
Copolymerization of new pyrazolone‐containing monomers with certain vinyl comonomers
Authors: Todorova Olga G. , Gitsov Ivan , Borissov Georgi , Terebenina Alevtina
Published: May 2005

The polymerization ability of two new pyrazolone‐containing monomers—3‐methyl‐1‐phenyl‐4‐crotonoyl‐pyrazolone‐5 (Cr) and 3‐methyl‐1‐phenyl‐4‐(3′‐phenyl‐acryloyl) pyrazolone‐5 (Cy)—was investigated. The monomers were obtained by acylation of 3‐methyl‐1‐phenyl‐pyrazolone‐5 with crotonyl chloride or cinnamoyl chloride, respectively. It was established that the two monomers do not homopolymerize either under the action of ionic and radical initiators nor with γ‐rays (doses between 2 and 10 MRad). In contrast to this, the two monomers copolymerize with other vinyl comonomers. Copolymers of Cr and Cy with methacrylic acid (MAA), methyl methacrylate (MMA), and Styrene (St) were synthesized by radical copolymerization. The molecular weights of the polymer products obtained were in the 10,000–65,000 range. It was established that the molecular weight characteristics of the copolymers were affected by the concentration of the pyrazolone‐containing monomer and by the chemical nature of the solvent used. The copolymerization of Cr and Cy with MAA was investigated in detail in order to evaluate the relative activity of the new monomers during copolymerization. The reactivity ratios (r) were calculated by three different methods with good agreement. The values obtained for the monomer pairs are: rMAA = 0.61 ± 0.01, rCr = 0.04 ± 0.01; rMAA = 0.64 ± 0.05, rCy = 0.02 ± 0.02. The Q/e values for Cr and Cy were determined using the reactivity ratios of both monomers.
Vibrational analysis for the all‐trans ferroelectric phase conformation of P (VDF) homopolymer and of P(VDF/TrFE) copolymer: A cluster‐lattice calculation
Authors: Ordejón P. , Martínez E. , Plans J.
Published: May 2005

Green's functions formalism and transfer matrix method have been used to predict the spectra of all‐trans poly(vinylidene fluoride) and the expected changes for poly(vinylidene fluoride/trifluoroethylene) copolymers with the same chain conformation. We find that the use of a simple cluster‐lattice calculation, where the impurity cluster is a trifluoroethylene (TrFE) unit immersed in a poly(vinylidene fluoride) [P(VDF)] regular chain, can explain the main features observed by infrared and Raman spectroscopy in the frequency range 800 to 1450 cm−1. The bands associated to vibration modes of regular VDF sequences, like the 880, 1070, 1280, and 1430 cm−1 ones, are predicted to decrease or even to disappear with increasing TrFE content. The appearance of new peaks at 970, 1300, 1330, and 1410 cm−1 is also discussed.
The bending recovery of polymer films. I. A phenomenological model
Authors: Greener J. , Tsou A. H. , Ng K. C. , Chen W. A.
Published: May 2005

When a flat film is bent to some fixed curvature, held at this state for some time, and then released, its curvature is usually observed to drop instantaneously to some finite value and then gradually decrease with time. This phenomenon, generally referred to as bending recovery, has been modeled by simple extension of the classical plate‐bending theory to linear‐viscoelastic materials. The model assumes that the relaxation spectra in tension and compression are dissimilar but are interrelated through a simple temporal shift. Experimental data, including instantaneous recovery at ambient and elevated temperatures as well as recovery over extended times, have been generated for four films with widely different relaxation characteristics. The data are in reasonable agreement with predictions of the model if a constant value of the compressive shift parameter (see text) is used for all materials. The model indicates that the bending recovery of a polymer film is intimately related to its relaxation spectrum and can be effectively manipulated by changes in temperature and winding time.
Solid polymers doped with rare earth metal salts. I. Complex formation and morphology in the neodymium chloride–poly(ethylene oxide) system
Authors: Twomey Conor J. , Chen Shaw H.
Published: May 2005

The complex formation and morphology of the NdCl3−PEO system have been investigated. Peak shifts, peak broadening, and the appearance of new peaks in the 800–1200 cm−1 range of the infrared (IR) spectra, by comparison with what is observed with pure PEO, unequivocally demonstrates complex formation. Although the NdCl3−PEO complex is found to be highly hygroscopic, residual moisture can be removed reversibly, thereby permitting the role of water in affecting the morphology of the solid film to be examined. As elucidated with infrared, differential scanning calorimetry, thermogravimetric analysis, and hot‐stage polarized optical microscopy, under anhydrous conditions the resultant complex is amorphous at an EO/NdCl3 ratio approximately less than ca. 8; but above this critical value the PEO in excess of the stoichiometric ratio required for complexation tends to form a separate crystalline phase. Furthermore, water was found to compete with the ethylene oxide unit for complexation with Nd3+, resulting in phase‐separated PEO with a tendency toward crystallinity. The glass transition temperature of the complex is found to increase sigmoidally with the NdCl3 content, an observation further substantiating complexation between NdCl3 and PEO.