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Volume 2(1); April 2009
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Editorial
The Neuropathologic Substrate of Parkinson Disease Dementia
Kurt A. Jellinger
J Mov Disord. 2009;2(1):1-3.
DOI: https://doi.org/10.14802/jmd.09001
  • 7,908 View
  • 58 Download
  • 1 Citations
PDF
Invited Reviews
Apomorphine and Levodopa Infusion Therapies for Advanced Parkinson’s Disease
Angelo Antonini
J Mov Disord. 2009;2(1):4-9.
DOI: https://doi.org/10.14802/jmd.09002
  • 39,890 View
  • 145 Download
  • 10 Citations
AbstractAbstract PDF

Continuous infusion of levodopa or apomorphine provide constant dopaminergic stimulations are good alternatives to deep brain stimulation to control motor fluctuations in patients with advanced Parkinson’s disease (PD). Apomorphine provides motor benefit similar to dopamine, but its long-term use is limited by compliance, mostly injection site skin reactions. Administration of levodopa/carbidopa by continuous duodenal infusion allows replacement of all oral medications and permits achievement of a satisfactory therapeutic response paralleled by a reduction in motor complication severity. However, this procedure is more invasive than apomorphine as it requires a percutaneous endoscopic gastrostomy Clinical experience with infusions shows that continuous dopaminergic stimulation of dopaminergic medications reduces dyskinesia and widens the therapeutic window in advanced PD.

Dopamine Agonist Therapy in Advanced Parkinson’s Disease
Heinz Reichmann
J Mov Disord. 2009;2(1):10-13.
DOI: https://doi.org/10.14802/jmd.09003
  • 34,609 View
  • 113 Download
  • 3 Citations
PDF
Review Article
Electrophysiologic Assessments of Involuntary Movements: Tremor and Myoclonus
Hyun-Dong Park, Hee-Tae Kim
J Mov Disord. 2009;2(1):14-17.
DOI: https://doi.org/10.14802/jmd.09004
  • 10,617 View
  • 165 Download
  • 3 Citations
AbstractAbstract PDF

Tremor is defined as a rhythmical, involuntary oscillatory movement of a body part. Although neurological examination reveals information regarding its frequency, regularity, amplitude, and activation conditions, the electrophysiological investigations help in confirming the tremor, in differentiating it from other hyperkinetic disorders like myoclonus, and may provide etiological clues. Accelerometer with surface electromyogram (EMG) can be used to document the dominant frequency of a tremor, which may be useful as certain frequencies are more characteristic of specific etiologies than others hyperkinetic disorders. It may show rhythmic bursts, duration and activation pattern (alternating or synchronous). Myoclonus is a quick, involuntary movement. Electrophysiological studies may helpful in the evaluation of myoclonus, not only for confirming the clinical diagnosis but also for understanding the underlying physiological mechanisms. Electroencephalogram (EEG)-EMG correlates can give us important information about myoclonus. Jerk-locked back-averaging and evoked potentials with recording of the long-latency, long-loop reflexes are currently available to study the pathophysiology of myoclonus.

Original Articles
The Occurrence of Fatigue in Independent and Clinically Stable Filipino Patients with Idiopathic Parkinson’s Disease
Carter S. Rabo, Raymond L. Rosales, Ma. Lourdes P. Corrales
J Mov Disord. 2009;2(1):18-21.
DOI: https://doi.org/10.14802/jmd.09005
  • 7,374 View
  • 58 Download
  • 3 Citations
AbstractAbstract PDF
Background:

Fatigue is a multidimensional problem affecting patients suffering from Parkinson’s disease (PD). It is ranked as one of the most bothersome symptom of patients with Parkinson’s disease. The study primarily aims to determine the presence of fatigue among clinically stable and independent Filipino patients suffering from idiopathic PD.

Methods:

This study is a prospective cross-sectional study. Recruited patients and control group were all Filipinos. Only independent patients with idiopathic, stable and non-fluctuating PD were included in the study. Those eligible underwent a multitude of screening tests to rule out presence of dementia (Mini Mental Status Examination, MMSE), depression (Montgomery-Åsberg Depression Rating Scale, MADRS), anxiety (Hamilton Anxiety Scale, HAM-A) and sleep disturbance. Disease severity was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) and fatigue severity using both the Multicomponent Fatigue Index (MFI) and Fatigue Severity Inventory (FSI).

Results:

Twenty-eight patients underwent the study. The mean Hoehn and Yahr staging was 1.79. Patients with PD scored higher on both FSI and MFI (individual dimension scores and total score) as compared to the normal controls.

Conclusions:

The outcome of the study confirmed the presence of fatigue (general, physical, mental), even in clinically stable and independent patients suffering from idiopathic PD, when compared with age-matched healthy controls.

Comparison of Cerebral Glucose Metabolism between Possible and Probable Multiple System Atrophy
Kyum-Yil Kwon, Jae Seung Kim, Ki Chun Im, Myoung Chong Lee, Sun Ju Chung
J Mov Disord. 2009;2(1):22-28.
DOI: https://doi.org/10.14802/jmd.09006
  • 8,529 View
  • 80 Download
  • 2 Citations
AbstractAbstract PDF
Background:

To investigate the relationship between presenting clinical manifestations and imaging features of multisystem neuronal dysfunction in MSA patients, using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET).

Methods:

We studied 50 consecutive MSA patients with characteristic brain MRI findings of MSA, including 34 patients with early MSA-parkinsonian (MSA-P) and 16 with early MSA-cerebellar (MSA-C). The cerebral glucose metabolism of all MSA patients was evaluated in comparison with 25 age-matched controls. 18F-FDG PET results were assessed by the Statistic Parametric Mapping (SPM) analysis and the regions of interest (ROI) method.

Results:

The mean time from disease onset to 18F-FDG PET was 25.9±13.0 months in 34 MSA-P patients and 20.1±11.1 months in 16 MSA-C patients. Glucose metabolism of the putamen showed a greater decrease in possible MSA-P than in probable MSA-P (p=0.031). Although the Unified Multiple System Atrophy Rating Scale (UMSARS) score did not differ between possible MSA-P and probable MSA-P, the subscores of rigidity (p=0.04) and bradykinesia (p= 0.008) were significantly higher in possible MSA-P than in probable MSA-P. Possible MSA-C showed a greater decrease in glucose metabolism of the cerebellum than probable MSA-C (p=0.016).

Conclusions:

Our results may suggest that the early neuropathological pattern of possible MSA with a predilection for the striatonigral or olivopontocerebellar system differs from that of probable MSA, which has prominent involvement of the autonomic nervous system in addition to the striatonigral or olivopontocerebellar system.

Unilateral Standing Leg Tremor as the Initial Manifestation of Parkinson Disease
Suk Yun Kang, Sook-Keun Song, Jin-Soo Kim, Young Ho Sohn
J Mov Disord. 2009;2(1):29-32.
DOI: https://doi.org/10.14802/jmd.09007
  • 9,802 View
  • 86 Download
  • 1 Citations
AbstractAbstract PDF
Background:

The aim of this study was to analyze the different forms of leg tremors exhibited while standing in patients with Parkinson disease (PD), and to determine if the type of leg tremor exhibited is indicative of prognosis or treatment response in PD patients.

Methods:

We studied the clinical characteristics of five PD patients (all women; mean age, 59 years, range, 53–64 years) with unilateral standing leg tremor as the initial manifestation of PD, including their electrophysiological findings and the results of long-term follow-up.

Results:

For each patient, parkinsonism either existed at the time of onset of the initial symptoms or developed later. Patient responses to drugs were generally good, but one patient showed a poor response to drugs, even though she had only a low frequency leg tremor. For two patients whom we could observe during the 10-year follow-up period, neither the leg tremor nor parkinsonism was aggravated.

Conclusions:

There are two forms of unilateral standing leg tremor in PD. One form is high frequency, similar to the primary orthostatic tremor. The other is low frequency and similar to the parkinsonian resting tremor. Based on these observations, it appears that progression might be slow if PD patients have standing leg tremor as the initial manifestation.

Hyperhomocysteinemia in Patients with Parkinson’s Disease and Relationship to Vitamin B Level
Hae-Won Shin, Young Ho Sohn
J Mov Disord. 2009;2(1):33-36.
DOI: https://doi.org/10.14802/jmd.09008
  • 8,084 View
  • 78 Download
  • 3 Citations
AbstractAbstract PDF
Background:

Plasma homocysteine (Hcy) levels are increased in patients with Parkinson’s disease (PD) undergoing levodopa treatment. We measured the Hcy levels in PD patients and assessed the relationship between Hcy level and features of PD, cognitive function and vitamin B status.

Methods:

Concentrations of Hcy, vitamin B12 and folate were measured in 33 PD patients and 41 normal control individuals. Mini-mental Status Examination (MMSE) was assessed in all subjects. In PD patients, Hoehn & Yahr stage and Unified Parkinson Disease Rating Scale (UPDRS) motor scores were also examined.

Results:

Plasma Hcy levels were lower in PD patients than in control individuals. Hcy level was inversely correlated with vitamin B12 and folate levels in the PD group but not in control individuals. Age, symptom duration, UPDRS motor scores, MMSE score, levodopa dose and duration of treatment did not differ between patients with Hcy >14 μmol/L and those with Hcy <14 μmol/L.

Conclusions:

Plasma Hcy levels were increased in PD patients with levodopa treatment and were related to vitamin B level. These results indicate that vitamin supplementation may be beneficial in levodopa-treated PD patients, although hyperhomocysteinemia did not affect the motor and cognitive status of PD patients.

Case Reports
Generalized Chorea Induced by an Unilateral Anterior Cerebral Artery Territorial Infarction
Jae Hong Chang, Woo-Keun Seo, Moon-Ho Park, Jong-Mun Lee, Do-Young Kwon, Seong-Beom Koh
J Mov Disord. 2009;2(1):37-39.
DOI: https://doi.org/10.14802/jmd.09009
  • 6,838 View
  • 81 Download
  • 2 Citations
AbstractAbstract PDF

Generalized chorea caused by unilateral cerebral infarction has rarely been reported. A 58-year-old woman presented involuntary movement in her all extremities after acute cerebral infarction on her right anterior cerebral artery territory. The involuntary movements were diagnosed as generalized chorea. We didn’t find any cause of generalized chorea except the acute cerebral infarction. Here, we described the case of generalized chorea after unilateral cerebral infarction discussing the possible mechanisms.

Painless Legs and Moving Toes as an Initial Presentation of Ischemic Stroke
Se Mi Oh, Won Tae Yoon, Ji Youn Kim, Hee-Young Shin, Won Yong Lee
J Mov Disord. 2009;2(1):40-42.
DOI: https://doi.org/10.14802/jmd.09010
  • 37,018 View
  • 90 Download
  • 3 Citations
AbstractAbstract PDF

Painless legs and moving toes is an unusual syndrome, which has not previously been reported as an initial presentation of ischemic stroke. We encountered a 78-year-old woman who developed dysarthria and involuntary movement of her left toes that was clinically regarded as painless legs and moving toes. These symptoms appeared abruptly and simultaneously as the initial symptoms of stroke, and improved gradually with conservative management by intravenous hydration for a month. We suggest that, in our case, a cortical brain lesion caused by ischemic stroke might be associated with the development of painless legs and moving toes.

Parkinsonsim due to a Chronic Subdural Hematoma
Bosuk Park, Sook Keun Song, Jin Yong Hong, Phil Hyu Lee
J Mov Disord. 2009;2(1):43-44.
DOI: https://doi.org/10.14802/jmd.09011
  • 10,161 View
  • 75 Download
  • 3 Citations
AbstractAbstract PDF

Subdural hematoma is a rare cause of parkinsonism. We present the case of a 78-year-old man with right-side dominant parkinsonism about 3 months after a minor head injury. MRI reveals a chronic subdural hematoma on the left side with mildly displaced midline structures. The parkinsonian features were almost completely disappeared after neurosurgical evacuation of the hematoma without any anti-parkinson drug.

Novel Compound Heterozygous Mutations in the Pantothenate Kinase 2 Gene in a Korean Patient with Atypical Pantothenate Kinase Associated Neurodegeneration
Sung-Hyouk Kim, Young-Hee Sung, Kee-Hyung Park, Yeung-Bae Lee, Hyeon-Mi Park, Dong Jin Shin, Gu-Hwan Kim
J Mov Disord. 2009;2(1):45-47.
DOI: https://doi.org/10.14802/jmd.09012
  • 12,077 View
  • 74 Download
  • 2 Citations
AbstractAbstract PDF

Pantothenate kinase-associated neurodegeneration (PKAN) is an autosomal recessive disorder that is characterized by mutations in the pantothenate kinase 2 gene (PANK2) and typical magnetic resonance imaging findings. We report a case of atypical PKAN presenting with generalized dystonia. Our patient had compound heterozygous mutations in the PANK2 gene, including mutation in exon 3 (p.D268G) and exon 4 (p.R330P). To our knowledge, this patient is the first to have the p.R330P mutation and the second to have the p.D268G mutation.

Oculogyric Crisis Associated with Disulfiram-Induced Pallidonigral Lesion
Jae Hyeok Lee, Chul Hyoung Lyoo, Jin Goo Lee, Myung Sik Lee
J Mov Disord. 2009;2(1):48-49.
DOI: https://doi.org/10.14802/jmd.09013
  • 7,992 View
  • 62 Download
AbstractAbstract PDF

We report a man who developed oculogyric crisis one month after disulfiram intoxication. Brain MRI showed lesions involving bilateral globus pallidus and left substantia nigra. In our patient, neuronal discharges from pathologically reorganized basal ganglia circuit to the mid-brain ocular motor center might lead to tonic deviation of the eyes.

Adult Onset Familial Cherry-Red Spot Myoclonus
Chi Kyung Kim, Beom S. Jeon
J Mov Disord. 2009;2(1):50-52.
DOI: https://doi.org/10.14802/jmd.09014
  • 17,505 View
  • 53 Download
AbstractAbstract PDF

We report a case of a 36-year-old woman with progressive generalized myoclonus that first became apparent 9 years ago. Her younger brother had similar problems. Examination of her eyes revealed cherry-red spots. Hexosaminidase A, β-galactosidase and neuraminidase activity were normal. Although the laboratory findings were negative, cherry-red spots, progressive myoclonus and autosomal recessive inheritance pattern suggested that she had an unknown type of lysosomal storage disease.


JMD : Journal of Movement Disorders