Persistent hand spasm: movement disorder or seizure?

Dystonia is a movement disorder characterized by involuntary, sustained or repetitive, patterned muscle contractions or spasms, frequently causing squeezing and twisting movements or abnormal postures. Dystonic posturing could be one of the accompanying features of epilepsy. We report an elderly lady with intractable focal seizure who presented with more than a year of persistent hand spasms. The clinical importance of differentiating epilepsy from movement disorders is discussed.     

Cheek-biting disorder: another stereotypic movement disorder?

Recurrent cheek biting, a form of self-injurious behavior is a rare entity which presents mostly to dentists and dermatologists. We report a case of recurrent severe cheek biting in an adult male leading to mucosal ulceration. The stereotypic pattern of cheek biting and associated behavior bears striking resemblance to other impulse control disorders.     

The relationship of major depressive disorder to bipolar disorder: Continuous or discontinuous?

Recent studies have questioned current diagnostic systems that split mood disorders into the independent categories of bipolar disorders and depressive disorders. The current classification of mood disorders runs against Kraepelin’s unitary view of manic-depressive insanity (illness). The main findings of recent studies supporting a continuity between bipolar disorders (mainly bipolar II disorder) and major depressive disorder are presented. The features supporting a continuity between bipolar II disorder and major depressive disorder currently are 1) depressive mixed states (mixed depression) and dysphoric (mixed) hypomania (opposite polarity symptoms in the same episode do not support a splitting of mood disorders); 2) family history (major depressive disorder is the most common mood disorder in relatives of bipolar probands); 3) lack of points of rarity between the depressive syndromes of bipolar II disorder and major depressive disorder; 4) major depressive disorder with bipolar features such as depressive mixed states, young onset age, atypical features, bipolar family history, irritability, racing thoughts, and psychomotor agitation; 5) a high proportion of major depressive disorders shifting to bipolar disorders during long-term follow-up; 6) a high proportion of major depressive disorders with history of manic and hypomanic symptoms; 7) factors of hypomania present in major depressive disorder episodes; 8) recurrent course of major depressive disorder; and 9) depressive symptoms much more common than manic and hypomanic symptoms in the course of bipolar disorders.     

The interictal dysphoric disorder of epilepsy: Legend or reality?

For a long time, the relationships between epilepsy and mood disorders captured the attention of clinicians and neuroscientists. The existence of a peculiar clinical presentation for mood disorders in epilepsy has been a matter of debate since the early reports of Kraepelin and Bleuler. The interictal dysphoric disorder (IDD) represents the modern reinterpretation of such early observations. This paper reviews current research on this topic discussing clinical implications, phenomenological observations, and directions for future research.     

Schizoaffective disorder: a form of schizophrenia or affective disorder?

BACKGROUND: The diagnostic status of schizoaffective disorder continues to be controversial. Researchers have proposed that schizoaffective disorder represents a variant of schizophrenia or affective disorder, a combination of the 2, or an intermediate condition along a continuum between schizophrenia and affective disorder. METHOD: We compared outpatients aged 45 to 77 years with DSM-III-R diagnosis of schizoaffective disorder (N = 29), schizophrenia (N = 154), or nonpsychotic mood disorder (N = 27) on standardized rating scales of psychopathology and a comprehensive neuropsychological test battery. A discriminant function analysis was used to classify the schizoaffective patients based on their neuropsychological profiles as being similar either to schizophrenia patients or to those with nonpsychotic mood disorder. RESULTS: The schizoaffective and schizophrenia patients had more severe dyskinesia, had a weaker family history of mood disorder, had been hospitalized for psychiatric reasons more frequently, were more likely to be prescribed neuroleptic and anticholinergic medication, and had somewhat less severe depressive symptoms than the mood disorder patients. The schizophrenia patients had more severe positive symptoms than the schizoaffective and mood disorder patients. The neuropsychological performances of the 2 psychosis groups were more impaired than those of the nonpsychotic mood disorder patients. Finally, on the basis of a discriminant function analysis, the schizoaffective patients were more likely to be classified as having schizophrenia than a mood disorder. CONCLUSION: These findings suggest that schizoaffective disorder may represent a variant of schizophrenia in clinical symptom profiles and cognitive impairment.     

Parasomnia overlap disorder: a distinct pathophysiologic entity or a variant of rapid eye movement sleep behavior disorder? A case series

Background

Parasomnia overlap disorder (POD) currently is classified by the International Classification of Sleep Disorders, Second Edition (ICSD-2) as a variant of rapid eye movement (REM) sleep behavior disorder (RBD), and therefore its diagnosis also implies counseling the patients on the increased risk for developing neurodegenerative disorders. POD pathophysiology is not clear to date.

Methods

The authors report 5 cases of POD, review the literature, and analyze previously published cases of POD.

Results

In all 5 reported cases sleep-related activity was clearly demonstrated, though the RBD component was mild or incidentally discovered. None of the patients had Parkinsonian clinical features. Based on ICSD-2 criteria, there are 139 more POD cases reported in the literature and 69. 2% are idiopathic. The POD patients had an earlier age of onset than the patients with RBD. The RBD component was milder than the disorder of arousal (DOA) in most cases. Recently an updated classification was published, which included new categories of POD. The features mentioned above and the revised classification suggests that POD is not just a subtype of RBD.

Conclusions

We propose that POD is a distinct pathophysiologic parasomnia. Further research to identify the underlying mechanism is needed. Proper counseling is necessary for patients presenting with POD at a young age of onset.     

Writer's cramp--focal dystonia or psychogenic movement disorder? A critical literature study

For more than 100 years there has been a discussion as to whether writer's cramp is caused by a disease of the central nervous system, or if it is to be considered as a disturbance of psychogenic origin. Whereas before 1982 there seemed to be a lot of evidence for the psychogenic theory many authors now tend to stress the opinion of Sheehy and Marsden who had explained that "writer's cramp" should be seen as a "focal dystonia". This article discusses the statements of Sheehy and Marsden in comparison with other scientific findings regarding the occupational cramps--above all "writer's cramp". It is concluded that there are different therapeutic approaches derived from the respective theory and which are considered to lessen the movement disorder. Scientific literature suggests that psychotherapy or some therapeutic approaches of behaviour therapy are more effectful in mastering this "mysterious" disorder than any pharmacological substance tested upto now.     

The seeming paradox of adenosine receptors as targets for the treatment of Alzheimer's disease: agonists or antagonists?

<正>Alzheimer’s disease(AD)is the most common neurodegenerative disorder,and its incidence is relatively high among elderly people,affecting about 1–2%of the population between 60–65 years old and rising dramatically(about 30%)in people aged 80 years or older(Selkoe,2002).Nowadays,considering the increasing mean lifespan of populations in developed countries,the disease     

The deficit for the word-class "verb" in corticobasal degeneration: linguistic expression of the movement disorder?

We describe five patients with corticobasal degeneration who had apraxia with an ideational component and reduced action/verb naming ability. Patients also had difficulty in a series of tasks devised to explore the conceptual representation of actions associated with manipulable objects, such as action recognition, action miming and pantomime recognition; however, their ability to name manipulable objects was comparatively preserved. According to the current interpretation of ideational apraxia [De Renzi, E., & Lucchelli, F. (1988). Ideational apraxia. Brain, 111, 1173-1185] we considered the patients' apraxic disorder as the motor expression of decay of the action representation and we hypothesized that this may also have contributed to the action-naming deficit. The results are discussed within a "multimodal model" of semantic memory in which the concept of action is seen as the product of the integration between sensorial and motor attributes. We suggest that corticobasal degeneration might offer a unique opportunity to validate this model because it is typically characterized by a frontoparietal damage [Gibb, W. R., Luthert, P. J., & Marsden, C. D. (1989). Corticobasal degeneration. Brain, 1, 1171-1192] that prevents integration of sensory and motor information. We conclude that the selective impairment of action/verb should also be studied from the point of view of a movement disorder and not only in terms of a lexical-semantic deficit.