Movement Disorders From the Use of Metoclopramide and Other Antiemetics in the Treatment of Migraine

Nausea and vomiting are a frequent accompaniment of migraine and anti‐nausea medications are frequently used in its management. The majority of anti‐nausea medications that are used in migraine are dopamine receptor blocking agents and therefore have the potential to cause drug‐induced movement disorders. This article explores the risk of such drug‐induced movement disorders in migraineurs who were treated with these medications.     

Regions of botulinum neurotoxin A light chain recognized by human anti-toxin antibodies from cervical dystonia patients immunoresistant to toxin treatment. The antigenic structure of the active toxin recognized by human antibodies

This work was aimed at determining the BoNT/A L-chain antigenic regions recognized by blocking antibodies in human antisera from cervical dystonia patients who had become immunoresistant to BoNT/A treatment. Antisera from 28 immunoresistant patients were analyzed for binding to each of 32 overlapping synthetic peptides that spanned the entire L-chain. A mixture of the antisera showed that antibodies bound to three peptides, L11 (residues 141-159), L14 (183-201) and L18 (239-257). When mapped separately, the antibodies were bound only by a limited set of peptides. No peptide bound antibodies from all the patients and amounts of antibodies bound to a given peptide varied with the patient. Peptides L11, L14 and L18 were recognized predominantly. A small but significant number of patients had antibodies to peptides L27 (365-383) and L29 (379-397). Other peptides were recognized at very low and perhaps insignificant antibody levels by a minority (15% or less) of patients or had no detectable antibody with any of the sera. In the 3-dimensional structure, antibody-binding regions L11, L14 and L18 of the L-chain occupy surface areas and did not correlate with electrostatic potential, hydrophilicity/hydrophobicity, or temperature factor. These three antigenic regions reside in close proximity to the belt of the heavy chain. The regions L11 and L18 are accessible in both the free light chain and the holotoxin forms, while L14 appears to be less accessible in the holotoxin. Antibodies against these regions could prevent delivery of the L-chain into the neurons by inhibition of the translocation.     

LINGO1 rs9652490 variant in Parkinson disease patients

Essential tremor (ET) has been hypothesized to be a risk factor for the development of Parkinson disease (PD). Recently, rs9652490 variant in the leucine-rich repeat and Ig domain containing 1 gene (LINGO1) was found to be associated with ET susceptibility. To evaluate whether the same variant is associated also with PD susceptibility, we investigated the association between the LINGO1 rs9652490 variant and PD phenotype in Caucasian and Chinese PD subjects. We found no significant differences in genotypic and allele distribution between patients and control subjects (χ(2)=1.931, p=0.381 for genotypic distribution; χ(2)=0.001, p=0.973 for allele distribution), suggesting this variant is not associated with PD.     

Mozart's movements and behaviour: a case of Tourette's syndrome?

In this review, we intend to explore the often asked question: “Did Mozart have Tourette''s syndrome?” Although there are numerous reports attributing Mozart''s peculiar personality and behaviour to a spectrum of neurobehavioural disorders such as Tourette''s syndrome, autistic disorder, Asperger''s syndrome, attention deficit hyperactivity disorder, obsessive–compulsive disorder and paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, the evidence for any of these disorders is lacking. Whether Mozart''s behaviour was nothing more than a reflection of his unique personality or a more complex neurological disorder, aggravated later in life by enormous demands by his father and society, his behaviour has been the subject of many biographies. It will also remain unknown to what extent his accomplishments and failures were shaped by his childhood experiences, pressured lifestyle, and his innate genius and extraordinary talent. Lessons from his life may have important implications for other gifted individuals and savants whose special attributes may lead them to succeed or, on the other hand, suppress their emotional growth and make them more vulnerable to stress and failure.The 250th anniversary of the birth of one of the greatest musical geniuses of all times, Wolfgang Amadeus Mozart (1756–1791), provides an opportunity not only to reflect on his immeasurable contributions to the world of classical music, but also to examine him as a man of exceptional creative power. Mozart''s biographical accounts often comment on his peculiar behaviour which has been interpreted by some as a manifestation of an underlying neurobehavioural disorder, such as Tourette syndrome (TS). Once considered a rare psychiatric curiosity, TS is now recognised as a relatively complex neurobehavioural disorder, affecting approximately 2% of the general population.^1,2 Some studies have suggested that TS affects up to 3.8% of children, and two‐thirds of them have coexistent attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD) or other behavioural comorbidities.³ Although learning disabilities have been suggested to be present in some patients with TS,^4,5 most reach their full potential without any residual psychiatric or neurological handicap. Many notable figures, such as Dr Samuel Johnson, have made extraordinary contributions to the arts and sciences despite, or perhaps because of, their TS.⁶ Several reports have drawn attention to the observation that some TS patients possess unique talents and skills, similar to individuals with autism and savant syndrome.^7,8 Various structural and functional imaging studies of brains of musicians have found that in contrast with non‐musicians, the musicians'' brains tend to have increased gray matter in Broca''s area and in certain portions of the auditory cortex, such as the Heschl''s gyrus and planum temporale.^9,10 Studies of developmental and acquired disorders of musical listening and interpretation have shown that brain plasticity is involved in musical perceptions and integration with cognitive and emotional responses,¹¹ and that music could have both evocative and suppressive effects on some patients with movement disorders such as TS and parkinsonism.¹²Although many individuals with unique talents have been carefully studied, no unified theory has emerged to explain the neurological basis of such exceptional creative or interpretive abilities, as demonstrated by some people with autism or some savant artists. It is beyond the scope of this review to discuss the neurobiology of savant and the reader is referred to other sources,^13,14 but the brain mechanisms giving rise to savant‐like features may be relevant to the understanding of the neurobiology of a genius mind, such as that of Mozart. Whether savant is more frequently observed in patients with TS or whether some savant cases manifest features of TS, such as tics and OCD, has not been systematically studied.Insanity and exceptional musical talent have often been thought to be linked, but the mechanism of this relationship is unknown.¹⁵ As an example, David Helfgott, a prodigious pianist featured in the movie “Shine,” has been thought to suffer from a mild form of schizophrenia with positive symptoms. He grunts, mutters, sings, talks to himself very loudly and exhibits other tic‐like mannerisms as he plays.¹⁶ Creativity has often been associated with bipolar disorder and some composers, artists, authors and other creative geniuses of the past have observed loss of their creative talents with pharmacological treatment of their bipolar disorder. Vincent van Gogh, who committed suicide at the age of 37 years, in the last few years of his life suffered from episodes of mania and depression. Despite the mood swings and mental torment, he completed more than 300 of his best paintings, suggesting that his manic state may have facilitated his creativity.¹⁷ There is a lengthy list of other famous figures such as Ludwig von Beethoven, Robert Schumann, Peter Ilyich Tchaikovsky, Sergei Rachmaninoff, Ernest Hemingway, Leo Tolstoy, Jonathan Swift, Oliver Cromwell, Abraham Lincoln, Theodore Roosevelt, John Nash, Nikolai Gogol, Edgar Allan Poe and many more who have suffered from a variety of mental or personality disorders.^15,18,19 Besides Samuel Johnson and Mozart, many celebrities such as Howard Hughes, Marc Summers, David Beckham, Tim Howard, Jim Eisenreich, Chris Jackson (Mahmoud Abdul‐Raul), David Aldridge, Michael Wolff, Dan Ackroyd, Howie Abdul‐Rauf Mandel and Mel Gibson are among those thought to manifest some features of TS and its comorbidities, particularly OCD.^16,20,21     

Prevalence of cervical dystonia and spasmodic torticollis in the United States general population

PURPOSE: To examine the prevalence of cervical dystonia (CD) in the US population. METHOD: A survey consisting of relevant demographic and CD-related questions was e-mailed to 2 million people selected from the Shopper's Voice database. RESULTS: Across a census-weighted sample, 0.280% of 60,062 respondents (79% female, 92% Caucasian) reported a diagnosis of CD and 0.170% reported a diagnosis of ST, indicating possible prevalence of 0.390% of either/both diagnoses. Less than half (42.7%) of those who reported either diagnosis were receiving treatment. CONCLUSIONS: CD is potentially under-diagnosed and under-treated; approaches to increase awareness of CD and its treatments are needed.