Tardive gait

Tardive dyskinesia (TD) is a hyperkinetic movement disorder induced by dopamine receptor blocking drugs (DRBDs). TD typically presents with stereotypy or dystonia, but may also cause akathisia, myoclonus, or tremor. However, no detailed reports of gait abnormalities have been documented. We report three patients exposed to DRBDs who developed "tardive gait" and conclude that gait dysfunction may be part of the TD spectrum.     

Effect of bilateral subthalamic deep brain stimulation on diphasic dyskinesia

OBJECTIVES: The goal of this study was to assess the effect of bilateral subthalamic deep brain stimulation (STN DBS) on levodopa-induced diphasic dyskinesia in patients with Parkinson disease (PD). PATIENTS AND METHODS: Six PD patients with diphasic dyskinesia were included in this study. Prior to surgery, the duration and severity of dyskinesia were determined in each patient, along with the Unified Parkinson Disease Rating Scale score and Hoehn and Yahr stage. Bilateral STN electrode implantation was performed during a single operation. RESULTS: The median duration of the follow-up period was 21.5 months (range 14-24 months). STN DBS had a beneficial effect on diphasic dyskinesia in all patients. At the last follow-up, 3 patients had no dyskinesia and 1 had only a small amount of peak-dose dyskinesia. One patient showed a reduction in the duration of diphasic dyskinesia, despite a lack of reduction in the total duration of dyskinesia. In the last patient, although the total duration of dyskinesia increased, the pattern of dyskinesia changed from severe painful disabling dyskinesia to the less severe peak-dose type of dyskinesia. There were no intraoperative or postoperative surgical complications. CONCLUSIONS: Bilateral STN DBS is good at reducing diphasic dyskinesia, and it can be a good therapeutic option for patients with diphasic dyskinesia.     

Yi-gan san for the treatment of neuroleptic-induced tardive dyskinesia: an open-label study

BACKGROUND: Recent studies indicate that the traditional Japanese herbal medicine yi-gan san (YGS, yokukan-san in Japanese), a serotonin modulator, may be safe and useful in treating behavioral and psychological symptoms in dementia and borderline personality disorder patients. The authors examined the efficacy, tolerability, and safety of YGS in patients with tardive dyskinesia. METHODS: Twenty-two patients with schizophrenia who had neuroleptic-induced tardive dyskinesia were given 7.5 g/day of YGS for 12 weeks in an open-label study. RESULTS: Administration of YGS resulted in a statistically significant improvement in tardive dyskinesia and psychotic symptoms. CONCLUSIONS: YGS may be an effective and safe therapy to control tardive dyskinesia and psychosis in patients with schizophrenia, that should be further tested in double-blind, placebo-controlled trials.     

脑出血病人上肢运动功能障碍相关弥散张量成像研究简

目的探讨利用弥散张量成像（diffusion tensor imaging,DTI）技术评估与高血压脑出血病人上肢运动功能障碍相关的皮质脊髓束（corticospinaltract,CST）受损情况。方法运用DTI技术三维重建21例高血压脑出血病人病变侧CST,分析CST受损情况与病侧Brunnstrom上肢评分以及美国国立卫生院神经功能缺损评分（national institutes of health stroke scale,NIHSS）之间的关系。结果DTI所显示的CST受损程度与Bmnnstrom上肢评分呈负相关（Rs=-0．83,P〈0．001）,与NIHSS评分呈正相关（Rs：0．79,P〈0．001）。结论DTI可直观显示与脑出血病人上肢功能障碍密切相关的CST受损情况,有助于病情的客观评估。     

Antipsychotic drug binding in the substantia nigra: An examination of high metoclopramide binding in the brains of normal,Alzheimer's disease,Huntington's disease,and Multiple Sclerosis patients,and its relation to tardive dyskinesia

This project was done in order to determine why the annual incidence of metoclopramide‐associated tardive dyskinesia is much higher than that for the commonly used antipsychotics. To test the hypothesis that metoclopramide tardive dyskinesia may be associated with high concentrations of metoclopramide in the substantia nigra under clinical conditions, the nonspecific binding of tritiated antipsychotics to the dissected melaninized regions of postmortem human substantia nigra was measured. The nonspecific binding at 1 nM [³H]ligand was 7.3, 4.2, 2.6, 0.91 and 0.66 fmoles/mg for [³H]haloperidol, [³H]clozapine, [³H]raclopride, [³H]metoclopramide, and [³H]olanzapine, respectively. After adjusting these values for the known free concentrations of these drugs in plasma or spinal fluid, the amounts that would be bound under clinical conditions would be 231, 113, 15, 11, and 3.4 fmoles/mg for metoclopramide, clozapine, raclopride, haloperidol, and olanzapine, respectively. Using rat striatum as baseline to define antipsychotic binding to nonnigral tissue, the excess amount of binding to the Alzheimer nigral tissue under clinical conditions would be 209, 19, 0, 3.4 and 0.8 fmole/mg for metoclopramide, clozapine, raclopride, haloperidol, and olanzapine, respectively, with a similar pattern for nigral tissues from Huntington and Multiple Sclerosis patients. The high accumulation of metoclopramide is sufficiently high to cause nigral nerve cell membrane damage by metoclopramide's detergent‐like action, possibly explaining metoclopramide's toxic ability to elicit early tardive dyskinesia. In addition, the nonspecific binding of metoclopramide was much higher in Alzheimer‐diseased substantia nigra, consistent with the fact that older individuals are relatively more vulnerable to metoclopramide tardive dyskinesia. Synapse, 2011. © 2010 Wiley‐Liss, Inc.     

血浆同型半胱氨酸与迟发性运动障碍的关系

目的:探讨血浆同型半胱氨酸(Hey)与迟发性运动障碍(TD)的关系.方法:对33例伴TD的精神分裂症患者(TD组)与33例不伴,TD的精神分裂症患者(非TD组)进行血浆Hey与血清维生素B12、叶酸水平检测.结果:TD组血浆Hey水平显著高于非TD组,而血清叶酸水平显著低于非TD组.两组血浆Hey水平均与血清维生素B1...     

White matter alterations in Parkinson's disease with levodopa-induced dyskinesia

IntroductionLevodopa-induced dyskinesia is a complication of levodopa therapy and negatively impacts the quality of life of patients. We aimed to elucidate white matter alterations in Parkinson's disease with levodopa-induced dyskinesia using advanced diffusion magnetic resonance imaging techniques.MethodsThe enrolled subjects included 26 clinically confirmed Parkinson's disease patients without levodopa-induced dyskinesia, 25 Parkinson's disease patients with levodopa-induced dyskinesia, and 23 healthy controls. Subjects were imaged using a 3-T magnetic resonance scanner. Diffusion tensor imaging, diffusion kurtosis imaging, and neurite orientation dispersion and density imaging findings were compared between groups with a group-wise whole brain approach and a region-of-interest analysis for each white matter tract. Additionally, logistic regression analysis was used to calculate odds ratios for levodopa-induced dyskinesia.ResultsGroup-wise tract-based spatial statistical analysis revealed significant white matter differences in isotropic diffusion, complexity, or heterogeneity, and neurite density between healthy controls and Parkinson's disease patients without levodopa-induced dyskinesia and between patients with and without levodopa-induced dyskinesia. Region-of-interest analysis revealed similar alterations using a group-wise whole-brain approach in the external capsule, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus. These tracts had an odds ratio of approximately 2.3 for the presence of levodopa-induced dyskinesia.ConclusionsOur findings suggest that Parkinson's disease with levodopa-induced dyskinesia produces less white matter microstructural disruption, especially in temporal lobe fibers, than Parkinson's disease without levodopa-induced dyskinesia. These fibers has a more than 2-fold odds ratio for the presence of levodopa-induced dyskinesia and might be associated with the pathogenesis of the sequela.     

Prevalence of tardive dyskinesia in samples of elderly people in Hong Kong

The prevalence of dyskinesia was studied in 4 samples of elderly Chinese people in Hong Kong – a psychogeriatric clinic, a mental hospital, a geriatric day hospital and a senior citizen centre. Research Diagnostic Criteria were used to identify cases of tardive dyskinesia. The overall prevalence of spontaneous dyskinesia was 2.4% and tardive dyskinesia was 25.9%. The rate of spontaneous dyskinesia differs across the study samples and is related to nervous system conditions associated with increased age. On the other hand, the rate of dyskinesia associated with antidepressants may not be significantly different from that of spontaneous dyskinesia.     

Clinical and scientific perspectives on movement disorders: Stanley Fahn's contributions

Dr. Stanley Fahn, the H. Houston Merritt Professor of Neurology and Director Emeritus of the Center for Parkinson's Disease and Other Movement Disorders at Columbia University, one of the founders of the field of movement disorders, was the first president of the Movement Disorders Society (subsequently renamed as the International Parkinson and Movement Disorder Society). Together with his friend and colleague, Professor David Marsden, he also served as the first co‐editor of the journal Movement Disorders. By emphasizing phenomenology as the key element in differentiating various hypokinetic and hyperkinetic movement disorders, Dr. Fahn drew attention to the clinical history and the power of observation in the diagnosis of movement disorders. Dr. Fahn had major influence on the development of classifications and assessments of various movement disorders and in organizing various research groups such as the Parkinson Study Group. As the founder and president of the World Parkinson Coalition and an organizer of the initial three World Parkinson Congresses, he has demonstrated his long‐standing commitment to the cause of including patients as partners. The primary goal and objective of this invited review is to highlight some of Dr. Fahn's most impactful scientific and clinical contributions to the understanding and treatment of Parkinson's disease, dystonia, and other movement disorders. © 2015 International Parkinson and Movement Disorder Society