News Update on Movement Disorders : Nov 2020

Primate models of movement disorders of basal ganglia origin

Movement disorders associated with basal ganglia dysfunction comprise a spectrum of abnormalities that range from the hypokinetic disorders (of which Parkinson’s disease is the best-known example) at one extreme to the hyperkinetic disorders (exemplified by Huntington’s disease and hemiballismus) at the other. Both extremes of this movement disorder spectrum can be accounted for by postulating specific disturbances within the basal ganglia-thalamocortical ‘motor’ circuit. In this paper, Mahlon DeLong describes the changes in neuronal activity in the motor circuit in animal models of hypo- and hyperkinetic disorders. [1]

Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for Parkinsonian disorders

As there are no biological markers for the antemortem diagnosis of degenerative parkinsonian disorders, diagnosis currently relies upon the presence and progression of clinical features and confirmation depends on neuropathology. Clinicopathologic studies have shown significant false-positive and false-negative rates for diagnosing these disorders, and misdiagnosis is especially common during the early stages of these diseases. It is important to establish a set of widely accepted diagnostic criteria for these disorders that may be applied and reproduced in a blinded fashion. This review summarizes the findings of the SIC Task Force for the study of diagnostic criteria for parkinsonian disorders in the areas of Parkinson’s disease, dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration. In each of these areas, diagnosis continues to rest on clinical findings and the judicious use of ancillary studies. [2]

Antineuronal Antibodies in Movement Disorders

Objective. To determine whether children with recent onset of movement disorders (Tourette syndrome, motor and/or vocal tics, chorea, choreiform movements) show evidence of serological antibodies directed against the human central nervous system as previously documented in research on Sydenham’s chorea.

Methods. Serum antibodies against previously frozen human caudate nucleus sections were analyzed using a blinded design and immunofluorescent staining methods. The sera of one group of 50 children referred for evaluation of attention deficit hyperactivity disorder, behavior disorders, and learning disabilities (24 with an associated movement disorder) seen between June 1989 and June 1990 were analyzed. The study was replicated in 33 children (21 with an associated movement disorder) seen between June 1990 and November 1990.

Results. In the original sample of 50 children, those with movement disorders were significantly more likely to have evidence of antineuronal antibodies than were those without movement disorders (odds ratio [OR] 4.80, 95% confidence interval [CI] 2.58 to 8.93). Results of the replication were similar (OR 6.00, 95% CI 2.56 to 14.03). For the total group, the OR was 5.50, (95% CI 3.54 to 8.99), which is highly significant. The percentage of children with a movement disorder whose sera were strongly positive for antineuronal antibodies (44%) was very similar to that previously found in children with Sydenham’s chorea (46%). Children with movement disorders were also more likely than children without movement disorders to have at least one antistreptococcal titer elevated.

Conclusions. The data strongly suggest an association between antecedent group A β-hemolytic streptococcal infection as inferred from elevated antistreptococcal titers and the presence of serum antineuronal antibodies, which may, in turn, be linked to childhood movement disorders. [3]


Twenty Year and Still Isolated Form of Restless Arm with Hypometabolism of Brain in Caudate Bilaterally

We reported a patient with restless arm but without any other extremity involvement during 20 year period. There was hypometabolism of brain in caudate bilaterally. Interestingly, the restlessness had not progressed to involve other hand or his legs during this long time period. Only restless arm syndrome (RAS) is very rare. In describing the patient, we hope to raise awareness about RAS and avoid misdiagnoses and inappropriate investigations. [4]

Gait Disturbance as Conversion Reaction Accompanying Anorexia Nervosa in a Young Adult: A Case Report and Literature Review

Aim: Conversion disorder is a situation where psychological stress is expressed physically. This health problem is usually triggered by a stressful or a mental crisis. When involving a physical problem it is named as ’conversion disorder’. Psychogenic gait disturbance is a common conversion disorder. Anorexia nervosa is a totally different disease than conversion disorder by its clinical presentation and characteristics.

We present a patient suffering from anorexia nervosa and developing conversion disorder in form of a gait disturbance.

Presentation of Case: A 35 year-old woman was suffering from excessive obsessions about her body. She had avoidance of eating and loss of 18 kilograms. She was admitted to our hospital for obtaining a disabled certificate for her walking disability that continued for 6 months. Her gait disturbance was indeterminate as to being neurological or orthopedic and was aggravated by stress.

Discussion: Even though anorexia nervosa and conversion disorder are two different pathologies, they may be seen together, meaning that patients with one disease may develop symptoms of another disease as means of secondary gain. However, a psychogenic movement disorder is a rare presentation in this situation.

Conclusion: Psychogenic gait disturbances are relatively rare psychogenic movement disorders. Conversion disorder may be the underlying problem. In our case, patient was masking, involuntarily, her primary problem (anorexia nervosa) by attracting attention to her gait. Such situations complicate the diagnosis and treatment of both diseases, which should be kept in mind. [5]

Reference

[1] DeLong, M.R., 1990. Primate models of movement disorders of basal ganglia origin. Trends in neurosciences, 13(7), pp.281-285.

[2] Litvan, I., Bhatia, K.P., Burn, D.J., Goetz, C.G., Lang, A.E., McKeith, I., Quinn, N., Sethi, K.D., Shults, C. and Wenning, G.K., 2003. Movement Disorders Society Scientific Issues Committee report: SIC Task Force appraisal of clinical diagnostic criteria for parkinsonian disorders. Movement disorders: official journal of the Movement Disorder Society, 18(5), pp.467-486.

[3] Kiessling, L.S., Marcotte, A.C. and Culpepper, L., 1993. Antineuronal antibodies in movement disorders. Pediatrics, 92(1), pp.39-43.

[4] Abdulkadir, K., Asuman, V., Buket, S., Muhammed Emin, Özcan and Erhan, V. (2016) “Twenty Year and Still Isolated Form of Restless Arm with Hypometabolism of Brain in Caudate Bilaterally”, International Neuropsychiatric Disease Journal, 7(2), pp. 1-3. doi: 10.9734/INDJ/2016/25810.

[5] Balkuv, E., Basaran, R. and Caliskan, M. (2013) “Gait Disturbance as Conversion Reaction Accompanying Anorexia Nervosa in a Young Adult: A Case Report and Literature Review”, Journal of Scientific Research and Reports, 3(4), pp. 583-591. doi: 10.9734/JSRR/2014/6783.

Leave a Reply

Your email address will not be published. Required fields are marked *