bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of resistance to botulinum toxin type A in patients with torticollis
Authors: Greene Paul , Fahn Stanley , Diamond Beverly 
Published: December 2004

AbstractBetween 1984 and 1992, 559 patients with torticollis were treated with botulinum toxin type A (btx) injections. Twenty‐four of these 559 patients (4.3%) had serological evidence of antibodies to btx by mouse neutralization assay. Some of the 559 patients had only one or two injection series, whereas others were lost to follow‐up, so that the actual prevalence of serologically detectable antibodies may be higher than 4%. In addition, some patients who improved after btx injections lost benefit and stopped developing muscle atrophy from adequate doses of btx, without serological evidence of antibodies. To evaluate the risk factors for btx resistance (loss of benefit and muscle atrophy after injections with or without serological evidence of antibodies), we reviewed the records of a cohort of torticollis patients injected over 2–45 months (mean, 23 months) beginning in 1988. Eight of 76 patients (10.5%) developed btx resistance. Compared to nonresistant patients from the same cohort, these eight patients received more frequent injections, had more “booster injections” 2–3 weeks after an initial injection, and received higher doses of btx per treatment. In order to minimize the risk of developing btx resistance, therefore, we recommend that physicians wait as long as possible (at least 1 month) between btx injections, avoid booster injections, and use the smallest possible doses.
Talipexole and adult Gilles de la tourette's syndrome: Double‐blind, placebo‐controlled clinical trial
Authors: Goetz Christopher G. , Stebbins Glenn T. , Thelen Jean A. 
Published: December 2004

AbstractTalipexole is a new dopamine autoagonist with putative preferential activity on presynaptic dopamine receptors. In a double‐blind, placebocontrolled study, we tested the drug's safety and efficacy in 13 adult men with Gilles de la Tourette's syndrome. The drug was poorly tolerated because of clinically significant sedation and dizziness. Tics did not improve at tolerable doses. These findings suggest that talipexole has no role in the regular management of tic disorders.
Pulmonary embolism: An under‐recognized yet frequent cause of death in parkinsonism
Authors: Mosewich R. K. , Rajput A. H. , Shuaib A. , Rozdilsky B. , Ang L. 
Published: December 2004

AbstractThere are very few detailed reports on the cause of death in patients with Parkinson syndrome, and most reports lack postmortem verification. Pulmonary embolism has been reported as an infrequent terminal event. We reviewed the results of 60 complete autopsies performed on patients with Parkinson syndrome personally cared for at our institution. Pulmonary embolism was second only to pneumonia as the most common cause of death overall.
Early onset Parkinson's disease: Are juvenile‐ and young‐onset different?
Authors: Muthane Uday B. , Swamy H. S. , Satishchandra P. , Subhash M. N. , Rao S. , Subbakrishna D. 
Published: December 2004

AbstractIt is controversial if early onset Parkinson's disease (EOPD) (onset at <41 years of age) is Parkinson's disease (PD) occuring at a younger age or a different disease. This controversy is due to some clinical and pathological differences between EOPD and PD. Within EOPD, there appear to be two groups namely: young onset Parkinson's disease (YOPD), with onset between 21 and 40 years, and juvenile parkinsonism (JP), with onset at <20 years. The two major clinical differences between these groups are a higher familial occurence of PD and dystonia in JP. In this study, we determine if the two groups have the classical features of PD, namely rest tremors, rigidity, bradykinesia, and postural instability, and have a meaningful response to levodopa. Furthermore, we compare their other clinical features, autonomic and cognitive functions, and levels of CSF monoamine metabolites to determine differences between these groups. We observe that all YOPD (100%) and JP (85%) patients had rest tremors. Most of these patients also had a meaningful response to levodopa (YOPD: 72%; JP: 100%). The prevalence of family history of PD was similar, whereas dystonia was more frequent in JP (43%) compared to YOPD (9%). Autonomic symptoms were twice as common in JP (42%) compared to YOPD (17%). However, bedside autonomic fuctions were abnormal in similar proportions and, like in PD, suggest involvement of parasympathetic nervous system. Congnitive dysfunction does occur but with no difference in severity between the two groups. The difference in number of patients between YOPD and JP groups makes statistical comparison of the occurence of clinical features like dystonia and autonomic dysfunction difficult. A similar situation exists in earlier studies on EOPD and could be a possible reason for the apparent difference between YOPD and JP; hence, combining two earlier studies with ours, we perform a meta‐analysis. The meta‐analysis did not confirm significant differences in the occurrence of dystonia or a positive family history of PD in the two groups. Besides clinical similarities between YOPD and JP, like in PD, these former two have dopaminergic deficiency demonstrated by significantly low mean CSF homovanillic acid level. Our study demonstrates that EOPD is similar to PD and there are no striking clinical differences between YOPD and JP. Hence, we suggest that EOPD is PD occuring at a younger age.
Akathisia in Parkinson's disease
Authors: Comella Cynthia L. , Goetz Christopher G. 
Published: December 2004

AbstractThis study evaluated the prevalence and clinical characteristics of akathisia in a tertiary care Parkinson's disease (PD) practice, and assessed the agreement between investigators for the diagnosis of akathisia in PD, and the sensitivity and specificity of a brief patient questionnaire. Fifty‐six consecutive PD patients completed an akathisia questionnaire and then were clinically evaluated for akathisia by two examiners blinded to the patient questionnaire. Overall, 45% of PD patients had akathisia as determined by clinical evaluation. Interrater reliability for the diagnosis of akathisia was high (K = 0.89). Patient self‐report of restlessness agreed with examiner diagnosis in 89% of the patients. The presence of akathisia was associated with the severity and age of onset of PD. Symptoms most frequently affected the legs, and associated movements were suppressible for brief periods.
Botulinum toxin a injections for the treatment of hand tremors
Authors: Trosch R. M. , Pullman S. L. 
Published: December 2004

AbstractWe conducted an open‐label study to determine the utility of treating severe hand tremors with intramuscular injections of botulinum toxin (BTX) in forearm and arm muscles in 26 patiets, 12 with Parkinson's disease (PD) and 14 with essential tremor (ET). The effect after 6 weeks for each patient was evaluated using two clinical rating scales, subjective evaluations of functional improvement and global disability, measures of weakness, and computer‐assisted quantitative assessments of tremor. Although none of the clinical scores averaged>3/4 point change, statistical significance was found on comparison of pre‐ and postinjection scores in the Webster Tremor and Global Disability Scales in the ET patients. Similarly, although average tremor amplitudes decreased by no more than 25% by quantitative analysis, amplitude decrease significantly correlated with patient subjective assessment in ET. In only two of 12 PD (17%) and three of 14 ET patients (21%) were major quantitative changes in tremor amplitude (>50% reduction) found after BTX injections. Nevertheless, 10 patients (38%; five PD and five ET) reported moderate to marked subjective improvement in functional benefit after BTX. These finding suggest that although there were no major changes in clinical ratings or objective measurements, BTX injections may subjectively improve tremor in some patients, particularly those with ET.
Familial levodopa‐responsive parkinsonian‐pyramidal syndrome
Authors: Nisipeanu P. , Kuritzky A. , Korczyn A. D. 
Published: December 2004

AbstractWe present four patients—two pairs of siblings—followed for many years, with pyramidal and parkinsonian features, who responded consistently to levodopa therapy. The patients belong to two unrelated consanguineous families, suggesting that this condition is genetically determined and recessively inherited.
Teaching tape for the motor section of the unified Parkinson's disease rating scale
Authors: Goetz Christopher G. , Stebbins Glenn T. , Chmura Teresa A. , Fahn Stanley , Klawans Harold L. , Marsden C. David 
Published: December 2004

AbstractWe developed a teaching tape of the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS) to provide investigators with a visual document of three raters' interpretations of the scoring system for each item except rigidity. The rate of agreement for the selected samples was always significant, with Kendall's coefficient of concordance W ranging between 0.97 and 0.62. We also provided full UPDRS ratings on sample patients that may be used for training and for multicenter studies to assure uniformity of rating. The study identified several items of the UPDRS motor examination for which written instructions were vague, including speech, action tremor, finger taps, rapid alternating movements, and postural stability. Future versions of the scale should address these problems and correct ambiguities. This project offers the first attempt to provide a visual analog for the UPDRS.
L‐Dihydroxyphenylalanine and complex I deficiency in Parkinson's disease brain
Authors: Cooper J. M. , Daniel S. E. , Marsden C. D. , Schapira A. H. V. 
Published: December 2004

AbstractThere is evidence for a 37% deficiency of complex I activity in Parkinson's disease (PD), which appears to be specific for PD amongst parkinsonian syndromes and selective for the substantia nigra within the central nervous system. Rat studies have shown that, in the context of a normal nigrostriatal dopaminergic cell population, L‐dihydroxyphenylalanine (L‐dopa) causes a reversible 25% defect of complex I activity in nigral and striatal tissue. Analysis of striatal tissue from PD patients after prolonged exposure to highdose L‐dopa does not show such a defect. Results of these and other studies suggest that L‐dopa therapy does not cause complex I deficiency in PD striatum. However, it cannot be excluded that, in the particular environment of the PD substantia nigra, L‐dopa may enhance a preexisting complex I defect.
A probe for intracerebral aromatic amino‐acid decarboxylase activity: Distribution and kinetics of [18F]6‐fluoro‐L‐m‐tyrosine in the human brain
Authors: Nahmias Claude , Wahl Lindi , Chirakal Raman , Firnau Gunter , Garnett E. Stephen 
Published: December 2004

AbstractPositron tomography, using [18F]6‐fluoro‐L‐dopa as a tracer, has been used for the study of Parkinson's disease. Unfortunately, the analysis of data obtained with this agent is bedeviled because it readily forms labeled methylated metabolites that enter the brain. We have evaluated [18F]6‐fluoro‐L‐m‐tyrosine (FmT) as an alternative tracer to study intracerebral dopamine metabolism with positron tomography. Imaging studies in humans showed specific accumulation of this tracer in the dopamine‐rich striatal regions. Reduced striatal uptake of the tracer was demonstrated in a patient suffering from Parkinson's disease. Increased retention of the tracer was demonstrated in a subject pretreated with the peripheral decarboxylase inhibitor carbidopa. Analysis of plasma samples for labeled metabolites of FmT revealed no methylated metabolites. Results of compartmental analysis showed that a twocompartment three rate constant model described adequately the time course of radioactivity in the striatum after an injection of FmT. decarboxylation rate constant (k21) was found to be 0.0108 min−1. Because the peripheral metabolism of FmT is simpler than that of [18F]6‐fluoro‐L‐dopa, we propose FmT as a superior agent with which to study intracerebral dopamine metabolism in health and disease in humans.
Mood and anxiety fluctuation in Parkinson's disease associated with levodopa infusion: Preliminary findings
Authors: Maricle Robert A. , Nutt John G. , Carter Julie H. 
Published: December 2004

AbstractPilot data on mood and anxiety changes in 15 Parkinson's disease patients with motor fluctuations are described based on ratings every 30 min for 5 h bracketing a 2‐h constant‐rate levodopa infusion. Robust mood and anxiety effects slightly preceded but temporally paralleled fluctuations in motor tapping scores. Research nurse ratings blind to patient ratings corroborated the changes. The magnitude of changes in mood and anxiety scores did not correlate with the magnitude of changes in tapping scores. The findings of this uncontrolled study suggest mood and anxiety fluctuations may be a common and potentially important component of levodopa‐induced fluctuation.
A defect of kinesthesia in Parkinson's disease
Authors: Klockgether Thomas , Borutta Maike , Rapp Herbert , Spieker Sybille , Dichgans Johannes 
Published: December 2004

AbstractPatients suffering from Parkinson's disease (PD) are more dependent on visual feedback during movement than are normals. Studying two‐dimensional pointing movements, we recently found that PD patients undershoot targets when vision of their own moving hand is occluded but not when complete vision is provided or when the target is extinguished immediately before movement onset. In the absence of vision, information about position of the moving hand may originate from peripheral kinesthetic feedback and from corollary discharges derved from the efferent motor signal. To find out which of both mechanisms–kinesthetic feedback or corollary discharge–is defective in PD, we compared active movements with imposed movements in which the hand is passively moved by the experimenter, whereas vision of the hand was occluded under either condition. In agreement with our earlier findings, slow, active pointing movements of PD patients were hypometric. In addition, PD patients terminated passively imposed movements of comparable speed earlier than did normals, with the consequence that imposed movements were equally hypometric. Our results make it unlikely that disturbed corollary discharge is responsible for hypometria under nonvisual conditions. Instead, the data suggest that PD patients have a defect of kinesthesia in slowly executed movements.
Double‐Blind trial of botulinum toxin for treatment of focal hand dystonia
Authors: Cole R. , Hallett M. , Cohen L. G. 
Published: December 2004

AbstractTen patients with focal dystonia of the hand, all of whom had benefited in an open‐label study of botulinum toxin, were treated with botulinum toxin‐A in a double‐blind study. Response was assessed by three measures: (a) subjective rating, provided by patients' reports of the effect of the injections on the dystonia; (b) objective testing, consisting of manual muscle testing (MRC scale) to measure muscle strength in all patients, timing of a writing sample and counting the number of errors of writing off‐the‐line in six patients with writer's cramp, counting the number of errors on a standard test of transcription in two patients with stenographer's cramp, and rating by professional musicians of the performances of two patients with musician's cramp; and (c) physicians'rating, provided by a review of the patients' videotaped performance by neurologists who were unaware of which treatment was administered. Eight of the 10 patients had greater subjective improvement with botulinum toxin than with placebo, and this impression was verified by at least one objective test in six patients. Two patients failed to have a better response to botulinum toxin than to placebo, and their reports were verified by the objective tests. This study confirms the efficacy of botulinum toxin in many patients with focal hand dystonia.
Masturbation mimicking paroxysmal dystonia or dyskinesia in a young girl
Authors: Mink Jonathan W. , Neil Jeffrey J. 
Published: December 2004

AbstractWe present the case of a young girl with periodic posturing during masturbation. The child had been evaluated by several physicians and underwent numerous diagnostic tests before the spells were seen by a physician and determined to be selfstimulatory and not paroxysmal dystonia. Masturbation is a normal and common behavior in young children and should be recognized as such. Failure to recognize this behavior can lead to unnecessary and invasive testing.
Striated anal sphincter denervation in patients with progressive supranuclear palsy
Authors: Valldeoriola F. , Valls‐Solé J. , Tolosa E. S. , Marti M. J. 
Published: December 2004

AbstractAnal sphincter electromyography may contribute to the differential diagnosis between Parkinson's disease (PD) and other parkinsonisms featuring autonomic dysfunction, such as multiple system atrophy (MSA). Although patients with progressive supranuclear palsy (PSP) do not normally exhibit clinical signs of autonomic dysfunction, a few may be first seen with urinary and fecal incontinence. We performed an electromyographic study of the anal sphincter in 12 patients with clinical criteria of probable or definite PSP, two of them with clinical manifestations of vesical and anal sphincter dysfunction. The results have been compared with those obtained from six patients with PD and six patients with MSA. An abnormal anal sphincter examination was present in five of 12 PSP patients (41.6%). The abnormal motor units of these patients were indistinguishable from those observed in patients with MSA. Patients with MSA had the largest, and patients with PD had the lowest, proportion of abnormal motor units. We conclude that some patients with PSP may have electromyographic signs of denervation in the anal sphincter, which make them indistinguishable by using this test alone from patients with MSA.
Ball experiments in 32 acute akinetic catatonic patients: Deficits of internal initiation and generation of movements
Authors: Northoff G. , Wenke J. , Krill W. , Pflug B. 
Published: December 2004

AbstractWe undertook ball experiments in 32 akinetic catatonic patients in order to determine specific functional deficits in the motor system in akinetic catatonia. Standardized ball experiments (catching, throwing, stopping, kicking) were conducted in 32 acute akinetic catatonic patients (23 without neuroleptics on admission), diagnosed according to Lohr, Rosebush, and the Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) on days 0 and 21. Additionally, associated psychopathology was evaluated using different scales on days 0 and 21: the Global Assessment Scale, the Brief Psychiatric Rating Scale, the Hamilton‐Anxiety Scale, the scale for the assessment of negative symptoms (SANS), and the Simpson scale for extrapyramidal side effects (SEPS). Significantly more patients were able to perform more externally guided tasks (catching, stopping) than internally guided tasks (throwing, kicking). Patients showed significantly more posturing and awkward movements on day 0 than on day 21. There was a significantly positive correlation between hypokinetic extrapyramidal features (SEPS) and negative symptoms with their cognitive alterations (SANS) on day 0. The findings suggest a deficit of internal initiation, as in parkinsonism, as well as a dysfunction in the generation of voluntary movements in akinetic catatonia. We assume an underactivity in the dorsolateral prefrontal cortex and the supplementary motor area with consecutive down‐regulation of the cortical‐striatal‐thalamic circuit, the “motor loop,” in catatonia.
Anorectal function in fluctuating (on‐off) Parkinson's disease: Evaluation by combined anorectal manometry and electromyography
Authors: Ashraf Waseem , Wszolek Zbigniew K. , Pfeiffer Ronald F. , Normand Marlene , Maurer Kenneth , Srb Faye , Edwards Loraine L. , Quigley Eamonn M. M. 
Published: December 2004

AbstractAnorectal dysfunction and constipation are well recognized in Parkinson's disease and may reflect the direct involvement of the gastrointestinal tract by the primary Parkinson's disease process. We hypothesized, therefore, that anorectal function would alter in parallel with fluctuations in motor function related to on‐ and off‐periods in Parkinson's disease, and employed combined anorectal manometry and electromyography to investigate anorectal function during both on‐ and off‐periods in patients with Parkinson's disease. Manometric recordings revealed a deterioration in voluntary sphincter squeeze during off‐periods (squeeze index, on versus off, mean ± SEM: 46.4 ± 11.1 versus 29.6 ± 7.9 mm Hg, p < 0.05); correspondingly, simultaneous electromyographic (EMG) recordings showed poor recruitment of external anal sphincter and puborectalis muscles during off‐periods. A hypercontractile (“paradoxical”) rectosphincteric reflex response occurred during both on‐ and off‐periods, and was associated with an increase in EMG activity in the external sphincter and/or the puborectalis muscle. These changes in manometric and EMG parameters paralleled changes in overall motor function. These findings provide further support for the involvement of the pelvic floor musculature in the Parkinson's disease process and also provide EMG correlates for some of the manometric abnormalities described in Parkinson's disease.
Postural finger tremor exhibited by Parkinson patients and age‐matched subjects
Authors: Palmer Suzanne S. , Hutton J. Thomas 
Published: December 2004

AbstractPhysiological correlates of postural tremor of the finger seen in Parkinson's disease patients are different from those seen in age‐matched control subjects. A significant correlation between the spectral peak of acceleration and the spectral peak of rectified electromyographic activity from the muscle responsible for finger extension was found in Parkinson's disease patients. This correlation was not seen in age‐matched control subjects. Any neural drive imposed on the motoneuron pool from supraspinal levels would enhance the electromyographic activity. Likewise, any feedback effects via spinal stretch reflexes or supraspinal stretch responses would be mediated through the motoneuron pool and electromyographic activity. The results of this research support the theory that Parkinson tremor is a centrally driven rhythm that may be influenced by feedback effects, whereas physiological tremor is due to a complex interaction of central, feedback, and mechanical effects.
A clinical and pharmacokinetic case study of an interaction of levodopa and antituberculous therapy in Parkinson's disease
Authors: Wenning G. K. , O'Connell M. T. , Patsalos P. N. , Quinn N. P. 
Published: December 2004

AbstractWe studied the relationship between levodopa response and antituberculous treatment in a patient with idiopathic Parkinson's disease whose parkinsonism deteriorated when treatment with rifampicin and isoniazid (Rifinah) for pulmonary tuberculosis was started. A levodopa challenge test with regular recording of motor function was performed during, and again after stopping, antituberculous treatment. Plasma levodopa and levodopa metabolite pharmacokinetic profiles were determined using standard techniques. “On” period duration was 75% longer after antituberculous treatment had been stopped. These clinical findings correlated with a 37% increase in area under the concentration versus time curve (AUC), a 103% increase in apparent elimination half‐life (t1/2), a 41% increase in time to maximum concentration (Tmax), and a 33% decrease in maximum concentration (Cmax) of levodopa. A concurrent increase in plasma 3‐O‐methyldopa (3‐OMD) and a decrease in plasma 3,4‐dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), the three major metabolites of levodopa, suggests an inhibition of the enzyme dopa decarboxylase, probably by isoniazid.