Spinal Myoclonus Responding to Continuous Intrathecal Morphine Pump

Spinal myoclonus is a sudden, brief, and involuntary movement of segmental or propriospinal muscle groups. Spinal myoclonus has occasionally been reported in patients undergoing opioid therapy, but the pathophysiology of opioid-induced myoclonus has not been elucidated yet. Here, we present two patients with spinal segmental myoclonus secondary to ischemic and radiation myelopathy. Conventional medications did not help treat persistent myoclonus in both legs. Continuous intrathecal morphine infusion was implanted for pain control in one patient, which relieved spinal myoclonus entirely. This experience led to the application of this method with a second patient, leading to the same gratifying result. Spinal myoclonus reemerged as soon as the morphine pumps were off, which confirmed the therapeutic role of opioids. In contrast to the opioid-induced myoclonus, these cases show a benefit of opioids on spinal myoclonus, which could be explained by synaptic reorganization after pathologic insults in the spinal cord.

Effects of Smoking on Patients with Parkinson's Disease

BACKGROUND: The cause of idiopathic Parkinson's disease (IPD) is unknown. Recent studies suggest that IPD occurs less frequently in smokers than in non-smokers, but remains a controversial topic. We performed a case-control study to investigate the relationship between IPD and smoking in Korea. METHODS:The smoking histories of 624 IPD patients were compared with 622 age- and sex-matched control subjects at the Asan Medical Center. Detailed informa-tion on smoking behavior was identified from a questionnaire and self report. A conditional logistic regression was used to calculate the odds ratio (OR) and control for potential confounds. RESULTS: With "never-smokers" as the refer-ence category, there was an inverse association between past-smokers and IPD (OR 0.617, p=0.029), and a stronger inverse association of IPD with current-smokers (OR 0.389, p<0.001). When smokers were stratified by the interval "since quitting", there was an inverse association between those who stopped smoking more than 10 years ago and IPD (OR 0.753, p=0.31), and a greater inverse relationship with those who stopped smoking 1 to 10 years (OR 0.489, p=0.017). A significant trend of decreased risk of IPD with pack-years of smoking was detected. CONCLUSIONS: This study suggests that IPD occurs less often in smokers than in non-smokers. The inverse dose-response relationship between smoking and IPD provides indirect evidence that smoking is biologically protective.

Blink Reflex in Idiopathic Parkinson's Disease: Reduction of Habituation in Paired Stimulation

The habituation of early (R1) and late response (R2) of blink reflex was investigated in 44 patients with Parkinson's disease (PD) and 19 control subjects. The latency, duration and area of R1 and R2 components of blink reflex in single stimulation, and the percentage recovery of R1 in paired stimulation were not different between patients and control subjects. However, in PD patients, the latency of R2 evoked by test stimuli was shorter than that of conditioning stimuli, and the percentage recovery of R2 habituation was increased as compared to that of control subjects. The degree of early recovery of R2 habituation was slightly more evident in advanced PD patients and nonmedicated patients than that of control subjects. In addition, the early recovery of R2 was present in the test of asymptomatic side of PD patients. Our results suggests that blink reflex may be used as a method of evaluating the clinical status of PD patients.

Transluminal angioplasty and stenting for the intracranial and extracranial cerebral arterial stenosis: Preliminary experiences

PURPOSE: To report the preliminary results of percutaneous transluminal balloon angioplasty (PTA) and stenting for the intracranial or extracranial care bral arterial stenosis. METHODS: In 11 patient% a total of 12 hemodynamically significant arterial stenatic lesions were treated by tramluminal angioplasty with or without the we of stent ; 8 proiml internal carotid arteries (ICA), 2 middle cerebral arteries (MCA), I distal vertebral artery (VA) and I proximal VA. We performed stent placement for 7 ICA lesions, while we did PTA alone for 2 MCA stenoses. PTA for 1 ICA and 2 VA lesions was performed while we attempted intraarterial urokinam (IAUK) therapy. RESULTS: Mean residual stenosis measured immediately after the procedure was 7% (range 0-27%) in 7 ICA lesions (treated by slanting), 13% and 29% in 2 MCA lesions (PTA), and 38% (range 32 41%) in 1 ICA and 2 VA lesions (PTA after IALJK). During and immediately after the procedure, 2 patients with ICA stenwis developed a transient ischemic attack (TIA) and one patient with ICA stenosis showed the infarct progression. Two patients, who were treated by PTA during IAUK therapy, expired. During the follow-up period (range, 4-18 months; mean, 8.6 months), all patients but one with the MCA lesion were free from further ischemic events. CONCLUSIONS: The efficacy and safety of PTA and stenting were not sufficiently verified with the small number of cases in our series. However, our observations suggest that they may be used as an alternative treatment modality to endarterectomy or a new promising therapy for the extracranial or intracranial arterial stenosis.

Clinical Syndrome of Corticobasal Degeneration

Clinical features of corticobasal degeneration (CBD) can be characterized by an asymmetric akinetic-rigid syndrome with variable combinations of other deficits (corticospinal tract signs, supranuclear gaze palsy, cerebellar ataxia, cortical sensory loss, alien limb behavior, dystonia and myoclonus). Such unique combination of clinical features of CBD have lead to the general agreement that clinical diagnosis of CBD is reliable. We describe 6 patients presenting with clinical features compatible with CBD. Three had characteristic clinical features of CBD; one showed clinical features compatible with progressive supranuclear palsy, but also had apraxia and cortical sensory disturbances; one had an early CBD. The remaining one had clinical features compatible with CBD, but brain magnetic resonance imaging study showed multiple small lesions involving periventricular white matter and basal ganglia bilaterally.

Two Cases of Suspected Typhoid Encephalitis Treated with High Dose Dexamethasone

Typhoid fever is one of the important contagious diseases. Typhoid fever of severe category is defined as the condition in which a febrile patient shows shocks or an altered state of consciousness ranging from delirium to coma. High dose dexarnethasone therapy is considered very effective in these life-threatening conditions. We report two severe hrphoid fever cases, which were treated with high dose dexarnethasone (dexamethasone 3mg/kg IV and lmg/kg q6hrs for 48 hrs) with a great success and we believe that one of the two cases is the first Korean case in the literature who had cerebellar ataxia and cortical tremor as a manifestation of the CNS involvement of typhoid fever.

Spasmodic torticollis: medical and botulinum A toxin treatment

The exact pathophysiologic mechanisms of spasmodic torticollis and other idiopathic torsion dystonias remain largely unknown. Thus, a variety of drugs have been used alone or in combination on an empirical basis to treat these disorders, but to date none have efficacy that is proven and consistent. The drugs in use include anticholinergics, benzodiazepines, dopaminergics and dopamine antagonists with variable degrees of clinical improvement. Botulinum toxin A injection treatment for spasmodic torticollis is safe and efficacious with minimal adverse effect. However, it is expensive and beneficial effects are short-lasting. Only when a spasmodic torticollis patient's symptoms are refractory to combined treatment, using various drugs and Botulinum toxin injections, should the patient be considered a candidate for neurosurgical procedures.