Effects of comprehensive rehabilitation nursing based on guided education and training on rehabilitation treatment in school-age children with drug-resistant epilepsy undergoing epileptogenic focus resection / 中国实用护理杂志

Objective:To evaluate the effects of comprehensive rehabilitation nursing based on guided education and training on rehabilitation treatment in school-age children with drug-resistant epilepsy undergoing epileptogenic focus resection.Methods:Fifty movement disorders school-age children with drug-resistant epilepsy undergoing epileptogenic focus resection in Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University from January 2017 to December 2019 were enrolled in this study. The child patients were divided into the control group and the observation group according to the order of admission, with 25 cases in each group, and the control group was from January 2017 to June 2018 while the observation group was from July 2018 to December 2019. In the control group, routine nursing after epileptogenic focus resection and functional exercise were conducted. The observation group was treated with comprehensive rehabilitation nursing based on guided education and training. On the third day after operation, the day of discharge respectively, the motor function and activity of daily living of the two groups were evaluated. The satisfaction of children′s parents on nursing was compared between the two groups.Results:The scores of motor function on the third day after operation and the day of discharge were (57.0 ± 6.8), (73.0 ± 5.4) points respectively in the observation group, and those in the control group were (55.0 ± 5.6), (65.6 ± 5.9) points. There were significant differences intra group comparison ( t=-9.26, -6.48, both P<0.05). The activity of daily living scores on the third day after operation and the day of discharge were (45.2 ± 5.9), (74.2 ± 8.3) points respectively in the observation group, and those in the control group were (44.0 ± 5.8), (60.2 ± 7.6) points. There were significant differences intra group comparison ( t=-14.33, -8.51, both P<0.05). There were significant differences between the scores of motor function and the ability of daily living scores on the day of discharge in the observation group and the control group ( t values were -4.65, -6.25, both P<0.05). The satisfaction of children′s parents on nursing in the observation group and the control group were 96.0% (24/25), 72.0% (18/25) respectively. There was significant difference between the two groups ( χ 2=8.78, P<0.05). Conclusions:Rehabilitation nursing based on guided education and training can improve motor function and ability of daily living in movement disorders school-age children with drug-resistant epilepsy undergoing epileptogenic focus resection, promote the functional recovery of children after surgery and increase the satisfaction of children′s parents on nursing.

Relación entre el sexo y los síntomas motores y no motores en pacientes con Parkinson / Relationship between sex and motor and non - motor symptoms in Parkinson's patients

Introducción: La enfermedad de Parkinson es una entidad neurodegenerativa caracterizada por bradicinesia, temblor en reposo y rigidez. Objetivo: Determinar la relación entre el sexo y los síntomas motores y no motores en pacientes con enfermedad de Parkinson. Métodos: Se realizó un estudio observacional analítico transversal sobre la relación entre el sexo y los síntomas motores y no motores en pacientes con enfermedad de Parkinson en el Hospital Clínico Quirúrgico Lucía Íñiguez Landín en el año 2018. El universo estuvo constituido por los 675 pacientes con Parkinson atendidos en consulta. La muestra fue de 110 pacientes. Resultados: Predominó el grupo etario 60-69 años (34,55 por ciento). Los síntomas no motores al inicio de la enfermedad fueron mayores para un 68,18 por ciento. Dentro de los síntomas motores, prevalecieron el temblor (80 por ciento) y la rigidez (72,72 por ciento). El síntoma más prevalente en el sexo masculino fue el temblor y en el femenino la rigidez. Dentro de los síntomas no motores destacaron los trastornos del sueño para un 92,72 por ciento y alteraciones neuropsiquiátricas para un 86,36 por ciento. Conclusiones: En el presente estudio se encontraron diferencias significativas entre hombres y mujeres en la prevalencia de algunos síntomas motores y no motores(AU)

Introduction: Parkinson's disease is a neurodegenerative entity characterized by bradykinesia, tremor at rest and rigidity. Objective: To determine the relationship between sex and motor and non-motor symptoms in patients with Parkinson's disease. Methods: A cross-sectional analytical observational study was carried out on the relationship between sex and motor and non-motor symptoms in patients with Parkinson's disease at Lucía Íñiguez Landín Clinical Surgical Hospital in 2018. The universe consisted of 675 Parkinson's patients seen in consultation. The sample consisted of 110 patients. Results: The age group 60-69 years (34.55percent) predominated. Non-motor symptoms predominated at the beginning of the disease in 68.18percent. Tremor (80percent) and rigidity (72.72percent) predominated within the motor symptoms. The most prevalent symptom in males was tremor and rigidity in females. While as the non-motor symptoms, sleep disorders predominated in 92.72percent and neuropsychiatric disorders in 86.36percent. Conclusions: In the present study, significant differences were found between men and women in the prevalence of some motor and non-motor symptoms(AU)

Espasmo hemifacial: experiencia en un centro terciario

Resumen El espasmo hemifacial consiste en un infrecuente trastorno del movimiento que afecta a la musculatura inervada por el nervio facial, en especial la de la hemicara superior. Existen dos formas clínicas, una primaria en la que la causa subyacente está representada por un conflicto neurovascular, y una secundaria, en la que la alteración del nervio facial es producida por algún tipo de lesión ocupante de espacio. Resulta de especial interés para el otorrinolaringólogo conocer esta entidad y ser capaz de diferenciar ambas formas clínicas dado el diferente enfoque terapéutico que pueden requerir. Aportamos una visión general de esta patología repasando su epidemiología y fisiopatología, además, de nuestra experiencia en forma de una serie de cuatro casos que ilustran las variadas formas de presentación de esta entidad, así como los signos y síntomas de alarma que pueden ayudar a realizar un correcto diagnóstico y manejo.

Abstract Hemifacial spasm consists of an unfrecuent movement disorder involving facial muscles, especially those from the upper half of the face. Two different clinical presentations are described. Primary hemifacial spasm is defined by a neurovascular conflict, and secondary occurs when facial nerve is damaged by a space occupying lesion. It is of special interest for the otorhinolaryngologist to get to know about this condition and to be able to acknowledge its clinical presentations due to the different therapeutical approach that may be needed for each of them. We contribute with a general vision of this entity reviewing its epidemiology and patophysiology. Furthermore, we show our experience by sharing a four-case series which we believe to illustrate the different ways of presentation as well as the alarm signs and symptoms that may be helpful in order to accomplish an accurate diagnose and treatment.

Transtorno do movimento estereotipado associado ao atraso da linguagem: dados de estudos de caso que contribuem para o diagnóstico diferencial / Stereotyped movement disorder associated with language delay -: data from case report that contribute to differential diagnosis / Trastorno del movimiento estereotipado asociado con el retraso del lenguaje: datos de estudios de casos que contribuyen al diagnóstico diferencial

Introdução: Movimentos repetitivos associados a alterações de linguagem representam dois importantes sinais de alerta para os TEA (Transtornos do Espectro do Autismo). Ainda que, segundo pesquisas atuais, o atraso na aquisição da linguagem não faça parte do conjunto de características comumente observadas em crianças na primeira infância com Transtorno do Movimento Estereotipado (TME), a sua coocorrência pode ser mais comum do que se imagina, o que pode levar a diagnósticos falso positivo para os TEA. Objetivo: Caracterizar o processo desviante de aquisição da linguagem associado ao TME, buscando diferenciar das características específicas aos TEA. Método: A presente pesquisa apresenta o relato de caso de duas crianças, na faixa etária dos 30 aos 36 meses, com importante atraso na aquisição da fala associado à presença de movimentos estereotipados, com perfis considerados de risco para o autismo. Resultados: Na primeira avaliação as duas crianças apresentavam escore médio referente ao número de sinais de alerta para os TEA. Após intervenção de 6 meses, para diagnóstico diferencial, houve queda no número de sinais de risco, como remissão de alguns comportamentos característicos dos TEA, melhora na intensidade dos movimentos repetitivos e aumento do repertório de fala. Conclusão: Ainda que a presença de movimentos repetitivos ou estereotipadas seja um dos sinais clássicos dos TEA, mesmo que coocorra com outras alterações igualmente sugestivas a este diagnóstico, como o atraso na fala, para que o diagnóstico seja conclusivo, é necessária a observação da presença de outros sintomas que se manifestam de forma persistente ao longo do desenvolvimento.

Introduction: The repetitive movements associated with language disorders represent two important warning signs for ASD (Autism Spectrum Disorders). Even if, according to current research, the delay in language acquisition may not be part of the set of characteristics commonly observed in toddlers with Stereotyped Movement Disorder (SMD), this co-occurrence of language impairment and Stereotyped Movement Disorder may be more common than can be imagined, which leads to mistaken ASD diagnoses. Objective: To characterize the deviant language acquisition process associated with SMD, seeking to differentiate the specific characteristics of ASD. Method: This research presents a case report of two toddlers, aged 30 to 36 months, with an important delay in the acquisition and development of speech associated with the presence of stereotyped movements, with profiles considered at risk for autism. Results: The first assessment showed important results indicating ASD for both children. After a 6-month intervention, there was a decrease in the number of risk signs, such as remission of some behavior characteristic of ASD, improvement in the intensity of repetitive movements and increase of the speech repertoire. Conclusion: Although the presence of repetitive or stereotyped movements is one of the classic signs of ASD, even if it co-occurs with other disorders equally suggestive to this diagnosis, such as delayed speech, for a conclusive diagnosis it is necessary the observation of other symptoms that manifest themselves persistently throughout development.

Introducción: Los movimientos repetitivos asociados con los cambios de lenguaje representa importantes señales de advertencia para los TEA (Trastornos del Espectro Autista). Aunque, según la investigación actual, el retraso en la adquisición del lenguaje no es parte del conjunto de características comúnmente observadas en niños en la primera infancia con trastorno de movimientos estereotipados, su coocurrencia puede ser más común de lo imaginado, lo que conduce a diagnósticos falsos positivos de TEA. Objetivo: Caracterizar el proceso de adquisición del lenguaje desviado asociado al Trastorno de Movimientos Estereotipados (TME), buscando diferenciar las características específicas de los TEA. Método: Esta investigación presenta el caso clínico de dos niños, de 30 a 36 meses, con un importante retraso en la adquisición y desarrollo del habla asociado a la presencia de movimientos estereotipados, con perfiles considerados en riesgo de autismo. Resultados: En la primera evaluación, los dos niños obtuvieron una puntuación media con respecto al número de señales de advertencia de TEA. Después de una intervención de 6 meses, diagnóstico diferencial, hubo una disminución en el número de signos de riesgo, como la remisión de algunos comportamientos característicos de los TEA, una mejora en la intensidad de los movimientos repetitivos y un aumento en el repertorio del habla. Conclusión: Si bien la presencia de movimientos repetitivos o estereotipados es uno de los signos clásicos de los TEA, aunque concurra con otros cambios igualmente sugestivos para este diagnóstico, como el retraso en el habla, para que el diagnóstico sea concluyente es necesaria la observación de la observación. otros síntomas que se manifiestan de forma persistente a lo largo del desarrollo.

Manifestaciones neuroftalmológicas en pacientes con enfermedad cerebrovascular isquémica / Neuro-ophthalmological manifestations in patients with ischemic cerebrovascular disease

La enfermedad cerebrovascular isquémica tiene una elevada incidencia y prevalencia en Cuba, y constituye la tercera causa de muerte en el país. Existen diferencias anatómicas y clínicas entre el infarto de la circulación anterior y la posterior. En ocasiones, los elementos distintivos que ayudan al diagnóstico topográfico de la enfermedad cerebrovascular isquémica son las manifestaciones neuroftalmológicas. Con el objetivo de profundizar en el conocimiento actual sobre las alteraciones neuroftalmológicas que se asocian a la enfermedad cerebrovascular isquémica, se realizó una revisión bibliográfica, donde se consultaron un total de 69 fuentes de información digital de los últimos 5 años. La circulación cerebral se divide de manera general en anterior y posterior. Los síntomas y signos principales del ictus que afecta la circulación anterior son la desviación conjugada de la mirada, la afectación de las sácadas, la hemianopsia homónima, la heminegligencia y la apraxia de la apertura ocular; mientras que las alteraciones asociadas a la afectación de la circulación posterior son el nistagmo, las anormalidades en la alineación y los movimientos oculares, así como la hemianopsia homónima con conservación macular. Se concluye que en la enfermedad cerebrovascular isquémica aparecen síntomas y signos como consecuencia de la afectación, tanto de la vía visual aferente, como de la eferente. La hemianopsia homónima es el signo más frecuente reportado(AU)

Ischemic cerebrovascular disease has a high incidence and prevalence in Cuba, and it is the third cause of death in the country. A number of anatomical and clinical differences distinguish anterior from posterior circulation infarction. On certain occasions the distinguishing elements that aid in the topographic diagnosis of ischemic cerebrovascular disease are its neuro-ophthalmological manifestations. With the purpose of gaining insight into the current knowledge about the neuro-ophthalmological alterations associated to ischemic cerebrovascular disease, a bibliographic review was conducted based on the analysis of 69 digital information sources from the last five years. Cerebral circulation is generally divided into anterior and posterior. The main symptoms and signs of the stroke that affects anterior circulation are conjugate gaze deviation, altered saccades, homonymous hemianopsia, heminegligence and eyelid opening apraxia, whereas the alterations associated to posterior circulation involvement are nystagmus, eye movement and alignment abnormalities, and homonymous hemianopsia with macular preservation. It is concluded that ischemic cerebrovascular disease presents symptoms and signs related to both the afferent and the efferent visual pathways. Homonymous hemianopsia is the most common sign reported(AU)

Effects of a multimodal physical exercise program on physical and mental health indicators in males with substance use disorder / Efeitos de um programa multimodal de exercícios físicos na saúde física e mental em homens com dependência química

INTRODUCTION: Substance use disorder (SUD) is seen as a serious and growing public safety and health problem worldwide. Long-term sequelae may involve permanent damage to physical fitness, body balance, and coordination skills, with a severe motor, functional, and emotional consequences. OBJECTIVE: To verify the effect of 16 sessions of a multimodal physical exercise program on physical fitness, body balance, and internalized stigma of inpatients for the treatment of Substance use disorder. METHODS: Forty-three males with Substance use disorder (aged 33.9±12.4 years) were divided into an Intervention Group (IG, n=21) and Control Group (CG, n=22). The IG was submitted to eight weeks of training with physical exercises. Participants were submitted to the evaluation of internalized stigma, body balance, agility, and flexibility, before and after the intervention period. RESULTS: Positive results were observed in physical fitness (agility, p=0.001) and body balance variables (center of pressure path with closed eyes, p=0.050, and ellipse area with closed eyes, p=0.031). The time of substance use correlated with lower performance in agility and body balance tests. CONCLUSION: The data seem to support the potential benefit of physical exercise as an adjunct in Substance use disorder rehabilitation process, particularly for physical fitness and body balance variables.

INTRODUÇÃO: A dependência química (DQ) é vista como um problema grave e crescente de saúde e segurança pública ao redor do mundo. As sequelas a longo prazo podem envolver prejuízos à aptidão física, equilíbrio corporal e capacidades coordenativas, com consequências motoras, funcionais e emocionais severas. OBJETIVO: Verificar o efeito de 16 sessões de um programa multimodal de exercícios físicos na aptidão física, equilíbrio corporal e estigma internalizado em pacientes internados para o tratamento de dependência química. MÉTODOS: Foram avaliados 43 homens com dependência química (idade 33,9±12,4 anos), divididos em Grupo Intervenção (GI, n=21) e Grupo Controle (GC, n=22). O GI foi submetido a oito semanas de treinamento com exercícios físicos. Os participantes foram submetidos à avaliação do estigma internalizado, equilíbrio corporal, agilidade e flexibilidade, antes e após o período de intervenção. RESULTADOS: Resultados positivos foram observados na aptidão física (agilidade, p=0,001) e variáveis do equilíbrio corporal (centro de pressão com os olhos fechados, p=0,050, e área da elipse com os olhos fechados, p=0,031). O tempo de uso de substância correlacionou-se com os piores desempenhos nos testes de agilidade e equilíbrio corporal. CONCLUSÃO: Os dados parecem corroborar os potenciais benefícios do exercício físico como um adjuvante no processo de reabilitação da dependência química, particularmente para as variáveis da aptidão física e equilíbrio corporal.

A feasibility study of the incidence and symptoms of the throwing yips in college baseball players / 体力科学

The yips represent a disorder that makes it challenging for an individual to perform automatic and coordinated movements in sports activities. The cause of the yips is not sufficiently clarified, and limited information is available regarding throwing yips in baseball. Therefore, this study was designed to clarify the incidence and characteristics of the throwing yips among college baseball players. Total 107 players of the college baseball team participated in the study and completed the questionnaire by answering questions about their experience of the yips (loss of control to throw the ball accurately for more than 1 month), the symptom intensity, and changes observed in the symptoms in different situations. The 47.1% of players met the definition of throwing yips. The symptoms of the yips were more pronounced with short-distances and low intensity of throwing. Moreover, there were various subjective symptoms, such as the issue about co-contraction of the upper limb, sensory function, body ownership, and movement planning. Various physical symptoms associated with throwing yips suggest that the yips are not only a disorder of motor skills, but result from movement disorders. The present results show that the occurrence of the yips depends on the throwing condition; this finding provides useful insights into the mechanism and the treatment of the yips. Interdisciplinary studies that aim to elucidate the cause of the yips and develop effective intervention are necessary.

Tratamiento efectivo de la toxina botulínica tipo A en el espasmo hemifacial, Guantánamo 2018-2019 / Botulinum toxin type A efficient treatment in patients with hemifacial spasm, Guantanamo 2018-2019

RESUMEN Introducción: No se encuentran antecedentes de investigaciones que aborden resultados de la aplicación de toxina botulínica tipo A en pacientes con espasmo hemifacial en la provincia Guantánamo. Objetivo: Evaluar los resultados terapéuticos de la aplicación de toxina botulínica tipo A en pacientes con espasmo hemifacial atendidos en consulta de Neurología. Método: Se realizó un estudio descriptivo longitudinal de 21 pacientes atendidos en servicio de Neurología con espasmo hemifacial y tratamiento con toxina botulínica tipo A, desde enero 2018 hasta enero 2019. Las variables estudiadas fueron: edad, sexo, hemicara afectada, periodo de latencia, duración, desaparición del efecto clínico de toxina botulínica tipo A, y porciento de incapacidad funcional en pacientes al aplicar la escala de discapacidad antes y después de la aplicación del tratamiento. Resultados: Predominó el sexo femenino con 57,1%, edad mayor de 55 años con 57,14 %, lado afectado predominante el izquierdo con 57,14 %, el periodo de latencia de la toxina botulínica tipo A fue entre el tercer y décimo día con 14 pacientes para un 66,67 %, el tiempo máximo de duración del tratamiento fue de uno a dos meses con un 57,14 %, y la desaparición del efecto terapéutico de la toxina fue entre el tercer y cuarto mes con un 52,38%. Luego de la aplicación de la escala de evaluación clínica del espasmo hemifacial se evidenció disminución del porcentaje de pacientes con incapacidad funcional. Conclusiones: La toxina botulínica tipo A es efectiva en el tratamiento del espasmo hemifacial.

ABSTRACT Introduction: No research records were founded dressing the results of the application of botulinum toxin type A in patients with hemifacial spasm in Guantanamo province. Objective: to evaluate the therapeutic results of the application of botulinum toxin type A in patients with hemifacial spasm treated in a Neurology consultation. Method: a descriptive and longitudinal study was carried out in 21 patients attended in Neurology service with hemifacial spasm and botulinum toxin type A treatment, fromJanuary 2018 to January 2019. The variables studied were: age, gender, hemiface affected, latency period, duration, disappearance of the clinical effects of botulinum toxin type A, and percentage of functional disability in patients when applying the disability scale before and after the treatment. Results: Female cases predominated (57.1%), agesover 55 years (57.14 %), the most common affected side of the face was the left, with 57.14 %, the latency period of botulinum toxin type A was between the third to the tenth day in 14 of the patients (66.67 %), the maximum time of duration of treatment ranged from one to two months (57.14 %), and the disappearance of the therapeutic effect of the toxin in the patients was between the third to the fourth month (52.38%). After the application of the clinical assessment scale of hemifacial spasm, a decrease in the percentage of patients with functional disability was evidenced. Conclusions: Botulinum toxin type A is effective in the treatment of hemifacial spasm.

Hemichorea-Hemiballism Syndrome Caused by Nonketotic Hyperglycemia in a Newly Diagnosed Diabetes Mellitus Type 2 Patient with Euglycemia at Presentation

@#INTRODUCTION: Nonketotic hyperglycemia among type 2 diabetic patients have recently been documented to cause the rare movement disorder called Hemichorea-hemiballism syndrome which is a hyperkinetic movement disorder presenting as a continuous, non-patterned, involuntary movements caused by a basal ganglia dysfunction. METHODS: A 76-year-old male with a known history of hypertension and no history of stroke and diabetes presented with a 10-day history of increasingly persistent involuntary movements of the right extremities. On admission, the patient was conscious with stable vital signs and unremarkable neurologic findings except for the involuntary flailing movements of the right extremities. Diagnostic testing revealed first documentation of hyperglycemia with brain MRI changes on T1 hyperintensity signals on the basal ganglia and T2/FLAIR weighted imaging showing mixed hypointense and hyperintense signals which is a classical MRI finding in patients with HC-HB syndrome caused by nonketotic hyperglycemia. The patient was treated for diabetes and was maintained on anti-dopaminergic medications for the uncontrollable involuntary movements. After five months, resolution of the hemiballism-hemichorea syndrome was noted after appropriate treatment. CONCLUSION: This case report highlights hemichoreahemiballism syndrome in a newly diagnosed type 2 diabetic patient who had normal glucose levels at presentation. The prompt recognition and correction of uncontrolled newly diagnosed diabetes and administration of anti-dopamine agents lead to a rapid improvement of symptoms, less neurologic sequelae and an overall favorable prognosis.

Reliability and validity of floor transfer test in subjects with idiopathic Parkinson’s disease

@#Objective: To determine the validity and reliability of the floor transfer test (FTT) in people with Parkinson’s disease (PD). Methods: The sample was 25 subjects with PD. The concurrent and convergent validity of FTT was determined by correlation with scores of timed up and go test (TUG), movement disorder society- unified Parkinson’s disability rating scale-III [motor component] (MDS-UPDRS), Schwab and England activities of daily living scale (SEADL). The intra rater reliability (ICC 3, 1), SEM, MDC, Bland & Altman limit of agreement (LOA) were determined. Results: FTT scores were positively correlated with TUG (ρ= 0.59, p=0.02), MDS UPDRS III (ρ= 0.69, p=0.001) and negatively correlated with SEADL (ρ= -0.79, p=0.001) showing moderate concurrent and convergent validity. ICC (3,1) was 0.92, SEM and MDC were 1.28 and 3.54 respectively. Conclusion: FTT is a valid and reliable tool to assess functional mobility in people with mild PD.

Hemicorea de larga duración asociada a trastorno metabólico

RESUMEN La corea asociada a la hiperglucemia representa un síndrome neurológico poco frecuente, mucho más común entre las mujeres asiáticas mayores. La fisiopatología sigue siendo controvertida y poco comprendida. Sin embargo, se han propuesto teorías como el aumento de la sensibilidad del receptor de dopamina, el infarto del núcleo estriado, el aumento del metabolismo del ácido gamma-aminobutírico y una alteración de la barrera hematoencefálica. Informamos que una mujer de 75 años de edad, de raza indígena, fue ingresada en el Departamento de emergencias debido a movimientos aleatorios, involuntarios y continuos severos en su brazo y pierna derecha que comenzaron 3 días antes, acompañados de síntomas osmóticos (polidipsia y poliuria). El nivel de glucosa capilar al ingreso fue 470,5 mg/dL, sin rastros de cetona en sangre u orina, mientras que el valor de hemoglobina glicosilada fue 15,4%. La resonancia magnética nuclear reportó hiperintensidad en T1 del núcleo lenticular izquierdo predominantemente a nivel del putamen sin otras alteraciones. Describimos los aspectos de la larga duración de los síntomas a pesar del tratamiento y el control metabólico adecuado.

ABSTRACT Chorea associated with hyperglycemia represents a rare neurological syndrome, much more common among older Asian women. The pathophysiology remains controversial and poorly understood. However, theories have been proposed such as increased dopamine receptor sensitivity, striated nucleus infarction, increased gamma-aminobutyric acid metabolism and an alteration of the blood-brain barrier. We report that a 75-year-old woman, of indigenous race, was admitted to the Emergency Department due to severe random, involuntary and continuous movements in her right arm and leg that began 3 days earlier, accompanied by osmotic symptoms (polydipsia and polyuria). The level of capillary glucose at admission was 470.5 mg/dL, without traces of ketone in blood or urine, while the value of glycosylated hemoglobin was 15.4%. Nuclear magnetic resonance imaging reported hyperintensity in T1 of the left lenticular nucleus predominantly at the putamen level without other alterations. We describe aspects of the long duration of symptoms despite adequate treatment and metabolic control.

Movement Disorder Early in the Presentation of Two Children with Subacute Sclerosing Pan-Encephalitis

Subacute sclerosing panencephalitis(SSPE) is a progressive degenerative disease caused by measles infection with overall poor prognosis in spite multiple modalities of treatment. The course of the disease is characterized by progressive neurological decline in the form of behavioral and personality changes followed by a stage of characteristic periodic myoclonic spasms followed by a stage of quadriplegia movement disorder, vegetative state and frequently early death. Here we report two cases with atypical presentation of early rather than late movement disorder during illness and the unusual association of central precocious puberty preceding the course of illness in one of the cases

Resting Tremor after Mild Head Injury: Case Report

Over the past few decades, it has been recognized that traumatic brain injury (TBI) may result in various movement disorders. However, moderate or mild TBI only rarely causes persistent post-traumatic movement disorders. In the present report, we describe a case of secondary tremor due to amild head injury with a transitory loss of consciousness. A 26- year-old man developed an isolated rest tremor of the hands and legs without other neurologic signs. The interval between the head trauma and the onset of the symptomswas 4 months. Neuroimaging studies reveled gliosis in the lentiform nucleus. Haloperidol administration resulted in tremor reduction. A rest tremor, similar to essential tremor, can be a rare complication of head trauma. Haloperidolmay be an effective and safe treatment modality for post-traumatic tremor. Further studies are needed to clarify the optimal drug for the treatment of post-traumatic tremor.

Diffusion kurtosis imaging characteristics of brain gray matter nucleus microstructure in Parkinson's disease with different movement disorder subtypes / 中华行为医学与脑科学杂志

Objective@#To investigate the difference in the microstructure of gray matter nucleus in different movement subtypes of Parkinson’s disease (PD) by diffusion kurtosis imaging (DKI) technique, and to analyze the correlation with clinical manifestations.@*Methods@#Ninety-seven patients with PD and 83 healthy controls performed conventional MRI sequence and DKI sequence scan. The PD patients were classified into gait disorder subtype (PIGD, n=57) and tremor dominant subtype (TD, n=40)subtypes according to motor symptoms. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Da), radial diffusivity(Dr), mean kurtosis (MK), axial kurtosis (Ka) and radial kurtosis (Dr) maps and data were generated by software after processing. DKI was performed for all subjects and data was collected from different brain regions in both hemispheres, including red nucleus(RN), substantia nigra pars reticulate(SNr), substantia nigra pars compacta(SNc), putamen(PUT), globus pallidus(GP), head of caudate nucleus (CN)and thalamus(THA).@*Results@#TD showed a higher MMSE score(P=0.019), but lower modified Hoehn-Yahr score than that in PIGD (P<0.001), there was no significant difference of age of onset, sex, limbs of onset or disease duration between two PD subgroups. Compared with healthy controls, both TD and PIGD showed down-regulated MD, Da and Dr and up-regulated Ka values(P<0.001); MK(0.83±0.26, 0.80±0.18) was increased in SNr both in TD and PIGD, while SNc, PUT and GP (0.84±0.20, 0.75±0.07, 0.81±0.14)were decreased only in TD (P=0.017, P=0.010, P=0.020, P<0.001, P=0.002). The Kr values of PUT and CN(0.71±0.17, 0.72±0.14) were reduced in PIGD, while CN(0.70±0.14) were reduced in TD respectively (P=0.002, P=0.031, P=0.007). The MK was lower in TD than that in PIGD (t=-2.214, P=0.029), and no significant difference was found in other grey matter nuclei between TD and PIGD(P>0.05). Moreover, there was no significant correlation between DKI value and disease duration, MMSE score or Hoehn-Yahr scale (P>0.05) in TD and PIGD.@*Conclusion@#There is heterogeneity of clinical symptoms between these two subgroups of PD. DKI can quantify the microstructural changes of grey matter nucleus in different type PD patient.

Diffusion kurtosis imaging characteristics of brain gray matter nucleus microstructure in Parkinson's disease with different movement disorder subtypes / 中华行为医学与脑科学杂志

Objective To investigate the difference in the microstructure of gray matter nucleus in different movement subtypes of Parkinson’s disease (PD) by diffusion kurtosis imaging ( DKI) technique, and to analyze the correlation with clinical manifestations. Methods Ninety-seven patients with PD and 83 healthy controls performed conventional MRI sequence and DKI sequence scan. The PD patients were classi-fied into gait disorder subtype (PIGD,n=57) and tremor dominant subtype (TD,n=40)subtypes according to motor symptoms. Fractional anisotropy (FA),mean diffusivity (MD),axial diffusivity (Da),radial diffu-sivity(Dr),mean kurtosis (MK),axial kurtosis (Ka) and radial kurtosis (Dr) maps and data were genera-ted by software after processing. DKI was performed for all subjects and data was collected from different brain regions in both hemispheres,including red nucleus(RN),substantia nigra pars reticulate( SNr),sub-stantia nigra pars compacta(SNc),putamen(PUT),globus pallidus(GP),head of caudate nucleus (CN)and thalamus(THA). Results TD showed a higher MMSE score(P=0. 019),but lower modified Hoehn-Yahr score than that in PIGD (P<0. 001),there was no significant difference of age of onset,sex,limbs of onset or disease duration between two PD subgroups. Compared with healthy controls, both TD and PIGD showed down-regulated MD,Da and Dr and up-regulated Ka values(P<0. 001); MK(0. 83±0. 26,0. 80±0. 18) was increased in SNr both in TD and PIGD,while SNc,PUT and GP (0. 84± 0. 20,0. 75± 0. 07,0. 81± 0. 14) were decreased only in TD (P=0. 017,P=0. 010,P=0. 020,P<0. 001,P=0. 002). The Kr values of PUT and CN(0. 71±0. 17,0. 72±0. 14) were reduced in PIGD,while CN(0. 70±0. 14) were reduced in TD re-spectively (P=0. 002,P=0. 031,P=0. 007). The MK was lower in TD than that in PIGD (t=-2. 214,P=0. 029),and no significant difference was found in other grey matter nuclei between TD and PIGD ( P>0. 05). Moreover,there was no significant correlation between DKI value and disease duration,MMSE score or Hoehn-Yahr scale (P>0. 05) in TD and PIGD. Conclusion There is heterogeneity of clinical symptoms between these two subgroups of PD. DKI can quantify the microstructural changes of grey matter nucleus in different type PD patient.

Clinical Characteristics of Involuntary Movement in Hospitalized Patients

OBJECTIVE: Neurological symptoms in hospitalized patients are not rare, and neurological consultation for movement disorders is especially important in evaluating or managing those with various movement disorders. Therefore, we investigated a clinical pattern of in-hospital consultations for various movement disorders in a tertiary care university hospital. METHODS: Over two years, a total of 202 patients (70.7 ± 11.8 years of age) presenting with movement disorders referred to movement disorder specialists were investigated. RESULTS: The main symptoms referred by nonneurologists were tremor (56.9%), parkinsonism (16.8%), and gait disturbance (8.9%). The most frequent diagnostic category was toxic/metabolic-caused movement disorder (T/MCMD) (35%) with regard to medications, followed by Parkinson’s disease (PD) (16%). Regarding the mode of onset, T/MCMD was the leading cause for acute (68%) and subacute onset (46%), while PD was the leading disorder (31%) for chronic onset. CONCLUSION: The current study showed a characteristic pattern of inpatients presenting with movement disorders. Furthermore, our findings highlighted the clinical significance of drug use or metabolic problems for treating this patient population.

Multi-Parametric Quantitative MRI for Measuring Myelin Loss in Hyperglycemia-Induced Hemichorea

Hyperglycemia-induced hemichorea (HGHC) is a rare but characteristic hyperkinetic movement disorder involving limbs on one side of the body. In a 75-year-old woman with a left-sided HGHC, conventional brain MR imaging showed very subtle T1-hyperintensity and unique gadolinium enhancement in the basal ganglia contralateral to movements. Multi-parametric MRI was acquired using pulse sequence with quantification of relaxation times and proton density by multi-echo acquisition. Myelin map was reconstructed based on new tissue classification modeling. In this case report of multi-parametric MRI, quantitative measurement of myelin change related to HGHC in brain structures and its possible explanations are presented. This is the first study to demonstrate myelin loss related to hyperglycemic insult in multi-parametric quantitative MR imaging.

Evaluation for Parkinson's Disease with Chinese Version of MDS-UPDRS and Original UPDRS / 中国康复理论与实践

Objective:To evaluate the reliability and validity of Chinese version of International Parkinson and Movement Disorder Society (MDS)-Unified Parkinson's Disease Rating Scale (UPDRS), and then do comparative analysis with original UPDRS. Methods:From May, 2016 to December, 2018, 225 patients with Parkinson's disease were respectively evaluated by MDS-UPDRS and UPDRS, and then the reliability and validity of MDS-UPDRS were evaluated. Correlation between two scales was analyzed. Results:The Cronbach's coefficient of the total MDS-UPDRS was 0.734. Rank correlation's coefficient was 0.905. For factor analysis, KMO was 0.728. Pearson's correlation analysis showed that the correlation's coefficient of the common factor of the two scales was 0.969, while the correlation's coefficient of the total score of the two scales was 0.972. Compared with UPDRS, MDS-UPDRS added a number of non-motor symptoms, which adjusted the standard of measurement and increased the accuracy degree of evaluation at early stage of disease. Besides, MDS-UPDRS added a lot of instructions to evaluate the standards to make the evaluation normatively. Conclusion:Chinese version of MDS-UPDRS has high reliability and validity, and highly correlate with the original UPDRS. It is more suitable for Chinese patients with Parkinson's disease in clinical evaluation than UPDRS.

Association of Mycoplasma Pneumoniae with Anti NMDA Receptor Autoimmune Encephalitis in a Female Child: A Case Report

A 6 year old female child presented with movement disorder, cognition impairment, insomnia and restlessness. She was diagnosed with NMDA receptor autoimmune encephalitis triggered by Mycoplasma pneumoniae and was treated successfully with high dose steroids, Intravenous immunoglobulin and Clarithromycin. A 6 year old Female child of Indian origin presented with visual hallucinations, intermittent jerky movements of left leg and left arm, agitation, screaming episodes and insomnia. On examination she had cognition impairment with truncal ataxia. MRI Brain was Normal. EEG showed epileptiform activity over right hemisphere. Mycoplasma antibody titre was strongly seropositive .Serum and CSF NMDA Receptor antibody was positive. MRI STIR was negative. After appropriate investigations, she was diagnosed with NMDA Receptor autoimmune encephalitis triggered by Mycoplasma pneumoniae and was treated successfully with high dose steroids, Intravenous immunoglobulin and Clarithromycin. NMDA Receptor encephalitis is the most common cause of autoimmune encephalitis in children. 6% to 50% of patients with anti-NMDAR encephalitis have been found to have an associated underlying tumor. Mycoplasma pneumoniae are the main presumed infectious pathogens associated with majority of the autoimmune encephalitis. It is suggested that early onset encephalitis is a direct type extrapulmonary manifestation involving cytokines and late onset encephalitis is of the indirect type involving autoimmunity.Mycoplasma infection affecting children can lead to neurological complications like autoimmune encephalitis. Further studies in this area can help to lighten the etiology of autoimmune disorders.

Paroxysmal Dyskinesia in Children: from Genes to the Clinic

BACKGROUND AND PURPOSE: Paroxysmal dyskinesia is a genetically and clinically heterogeneous movement disorder. Recent studies have shown that it exhibits both phenotype and genotype overlap with other paroxysmal disorders as well as clinical heterogeneity. We investigated the clinical and genetic characteristics of paroxysmal dyskinesia in children. METHODS: Fifty-five patients (16 from 14 families and 39 sporadic cases) were enrolled. We classified them into three phenotypes: paroxysmal kinesigenic dyskinesia (PKD), paroxysmal nonkinesigenic dyskinesia (PNKD), and paroxysmal exercise-induced dyskinesia (PED). We sequenced PRRT2, SLC2A1, and MR-1 in these patients and reviewed their medical records. RESULTS: Forty patients were categorized as PKD, 14 as PNKD, and 1 as PED. Thirty-eight (69.1%) patients were male, and their age at onset was 8.80±4.53 years (mean±SD). Dystonia was the most common symptom (38 patients, 69.1%). Pathogenic variants were identified in 20 patients (36.4%): 18 with PRRT2 and 2 with SLC2A1. All of the patients with PRRT2 mutations presented with PKD alone. The 2 patients carrying SLC2A1 mutations presented as PNKD and PED, and one of them was treated effectively with a ketogenic diet. Six mutations in PRRT2 (including 2 novel variants) were identified in 9 of the 13 tested families (69.2%) and in 8 patients of the 25 tested sporadic cases (32.0%). There were no significant differences in clinical features or drug response between the PRRT2-positive and PRRT2-negative PKD groups. CONCLUSIONS: This study has summarized the clinical and genetic heterogeneity of paroxysmal dyskinesia in children. We suggest that pediatric paroxysmal dyskinesia should not be diagnosed using clinical features alone, but by combining them with broader genetic testing.