Botulinum toxin injections during the COVID-19 epidemic: A retrospective chart review

BACKGROUND AND AIM: Clinical services were severely affected globally during the COVID-19 pandemic. This study aimed to characterize the clinical experience of using botulinum toxin (BTX) injections during the COVID-19 pandemic. Method(s): This is a retrospective chart review of patients who received BTX injections from April 2019 to January 2022. Result(s): A total of 105 patients received an BTX injections, out of which 76 (72.4%) were men. The mean age of the patients was 47.9 +/- 15.1 years. The most common indication for receiving BTX injections was dystonia (n = 79;75.2%), followed by hemifacial spasm (n = 22;21%) and miscellaneous movement disorders (n = 4;3.8%). Focal dystonia (n = 45;57%) was the most frequent form of dystonia, followed by segmental dystonia (n = 24;30%). The percentage of generalized dystonia and hemidystonia was 12% and 1%, respectively. Cervical dystonia (44.4%), blepharospasm (17.8%), and writer's cramp (15.6%) were the most frequent forms of focal dystonia. The miscellaneous group included four patients (3.8%) with trigeminal neuralgia, Holmes tremor, dystonic tics, and hemimasticatory spasm. The mean ages of patients in the dystonia, hemifacial spasm, and the miscellaneous groups were 47.7 +/- 14.9 years, 49.2 +/- 14.0 years, and 44.2 +/- 26.0 years, respectively. The mean BTX dose was 131.6 +/- 104.1 U. The mean BTX doses for the dystonia group, hemifacial spasm, and the miscellaneous group were 158.7 +/- 105.3 U, 40.1 +/- 11.3 U, and 100.0 +/- 70.7 U, respectively. Conclusion(s): Most patients in our cohort had dystonia, followed by hemifacial spasm. Among the patients with dystonia, most had focal dystonia, with cervical dystonia being the most common movement disorder. The data obtained in our study is important to increase awareness of the effectiveness of BTX injections in patients with chronic disorders.Copyright © 2023 Annals of Movement Disorders.

Functional movement disorders during the COVID-19 pandemic

Functional movement disorders (FMDs) are a heterogenous group of movement abnormalities that greatly affect the quality of life of patients. They usually manifest as a result of underlying psychological or psychiatric illnesses without any known structural or neurochemical diseases. Various neurological disorders such as encephalitis, stroke, demyelination, seizures, and neuropathy have been reported by otherwise healthy individuals during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Here, we describe the case of a 27-year-old woman who presented to our outpatient department with episodes of deviation of angle of mouth with variability and distractibility. Following thorough clinical evaluation and appropriate investigation, the underlying etiology was identified as FMD secondary to the restrictions imposed during the COVID-19 pandemic to contain the transmission of the virus. The lockdown, isolation, financial strain, and other pandemic-related issues are stressors that may contribute to psychogenic disorders in people.Copyright © 2021 Annals of Movement Disorders Published by Wolters Kluwer - Medknow.

The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom.

STUDY OBJECTIVES: The aim of this mixed methods study was to gain an insight through qualitative and quantitative means into the impact of the COVID-19 pandemic on children with and without Tourette syndrome (TS). METHODS: Parents/guardians of children and adolescents with TS (n = 95; Mage = 11.2, SD = 2.68) and typically developing (TD) controls (n = 86; Mage = 10.7, SD = 2.8) in the UK and Ireland completed an online questionnaire examining sleep, with open-ended questions pertaining to their perceived impact of COVID-19 on the sleep of their children. Nine items from the SDSC were used to supplement qualitative data. RESULTS: A negative impact of the pandemic on the sleep of both groups was observed, including exacerbated tics, sleep deprivation, and anxiety, with particular disruption for children with TS. Parents of children with TS reported poorer sleep patterns than parents of TD children on the SDSC. Analyses showed that group and age predicted 43.8% of variance in sleep duration, F (4, 176) = 34.2, p < .001. CONCLUSIONS: Findings suggest that sleep patterns of children with TS may be more impacted by the pandemic than the average child. Given that there are generally more sleep issues reported in children with TS, further research is warranted in relation to the sleep health of children with TS in a post-pandemic era. By identifying sleep issues potentially persisting after COVID-19, the true impact of the pandemic on the sleep of children and adolescents with Tourette syndrome may be ascertained.

COVID19-associated new-onset movement disorders: a follow-up study.

BACKGROUND: Neurological symptoms are common manifestation in acute COVID-19. This includes hyper- and hypokinetic movement disorders. Data on their outcome, however, is limited. METHODS: Cases with new-onset COVID-19-associated movement disorders were identified by searching the literature. Authors were contacted for outcome data which were reviewed and analyzed. RESULTS: Movement disorders began 12.6 days on average after the initial onset of COVID-19. 92% of patients required hospital admission (mean duration 23 days). In a fraction of patients (6 of 27; 22%; 4 males/2 females, mean age 66.8 years) the movement disorder (ataxia, myoclonus, tremor, parkinsonism) was still present after a follow-up period of 7.5 ± 3 weeks. Severe COVID-19 in general and development of encephalopathy were risk factors, albeit not strong predictors, for the persistence. CONCLUSIONS: The prognosis of new-onset COVID-19-associated movement disorder appears to be generally good. The majority recovered without residual symptoms within several weeks or months. Permanent cases may be due to unmasking of a previous subclinical movement disorder or due to vascular/demyelinating damage. Given the relatively low response rate of one third only and the heterogeneity of mechanisms firm conclusions on the (long-term) outome cannot, however, be drawn.

Complex regional pain syndrome after mRNA-based COVID-19 vaccination.

We describe the case of a 17-year-old woman diagnosed with complex regional pain syndrome (CRPS) at a pain clinic after the second dose of the COVID-19 vaccine. She was referred to our department for surgical treatment of movement disorder seven months after the second inoculation. Baclofen (50 µg), administered intrathecally, improved the involuntary movements of her right hand. After administration of zolpidem (5 mg), involuntary movements of the right index finger almost disappeared. However, neither zolpidem nor intrathecal baclofen improved the limited range of motion of the first joint of the left-hand finger. Despite various reports on CRPS development after vaccination, only one case post COVID-19 vaccination has been reported. Therefore, healthcare providers should keep in mind that CRPS can appear after the COVID-19 vaccination.

Myoclonus associated with infections: A narrative review

Different movement disorders are reported in association with infectious diseases. In addition, myoclonus can be associated with different types of viral and bacterial infections. We screened three electronic databases for cases of myoclonus as a feature of different infections and collected cases and series describing myoclonus associated with infections. Data regarding study design, sample size, neurological assessment, and diagnostic workup including brain imaging and cerebrospinal fluid analysis were extracted from the identified studies. In this narrative review, we review different infections associated with myoclonus and discuss their salient features. The infections presenting with myoclonus include predominantly subacute sclerosing panencephalitis due to measles. In addition, we describe other viral infections that are reported to associated with myoclonus. Recently, coronavirus disease 2019 infections have been reported to be increasingly associated with myoclonus. The hypothesized mechanisms of infection-related myoclonus are vasculopathy, autoimmune reactions, and inflammation. Although myoclonus is considered to be a result of heredodegenerative, metabolic, or autoimmune disorders, infections may present with myoclonus, especially in tropical and developing countries. In this review, we describe the infections that are associated with myoclonus. © 2022 Annals of Movement Disorders ;Published by Wolters Kluwer - Medknow.

Unilateral total ophthalmoplegia with proptosis and loss of vision in a patient of herpes zoster ophthalmicus: A rare case report

Herpes zoster Ophthalmicus accounts for a minority of all patients with zoster infections. It leads to varied clinical presentations, but total unilateral ophthalmoplegia has rarely been reported in the literature. We hereby present a 50-year-old male patient presenting with the above combination for aiding the clinical diagnosis by dermatologists and ophthalmologists. Early initiation of treatment leads to a near total recovery of ophthalmoplegia in the majority of treated patients.

A case of restless legs syndrome after BNT162b2 mRNA COVID-19 vaccination.

Restless legs syndrome (RLS) can be secondary to several disorders. We present an 87-year-old woman who developed RLS 2 days after the first injection of BNT162b2 mRNA coronavirus disease 2019 vaccine. The symptoms of RLS tended to improve and eventually resolved with the administration of gabapentin.

The impact of recurrent Covid-19 waves on patients with Functional Movement Disorders: A follow-up study.

BACKGROUND: Functional Movement Disorders (FMDs) might exacerbate in stressful conditions. As the global health emergency due to Covid-19 rise and multiple waves hit the Italian population, the recurrent severe restrictions' periods imposed could represent important triggers and worsen the symptoms of FMDs. Through a follow-up study, we compare results on Motor Symptoms (MS), Non-Motor Symptoms (NMS), and Global Health Status (GHS) of two surveys, one referred to the first Covid-19 wave and the other to the third Covid-19 wave. METHODS: 60 FMDs patients responded to an online survey after the first and the third Covid-19 waves in Italy. Questions regarding sociodemographic, clinical and Covid-19 information, MS, NMS, and GHS were collected to assess severity of symptoms and changes in comparison to a period with less severe social restrictions. RESULTS: Patients showed minimal to mild motor symptoms' severity, and substantial stability through time in all collected measures, both for severity and changes of MS, NMS, and GHS in comparison at two time points (p > 0.050). The worsening of pain resulted as predictor factor for the worsening of Motor Symptoms (p = 0.042). CONCLUSIONS: Patients did not show a vulnerability due to the recurrent restrictions' periods: MS, NMS and GHS did not vary in comparison to the first wave, confirming the previous results and highlighting the role of the social context in those disorders. Further investigations are required to better disentangle the relationship between stressful events, motor symptoms, and pain.

Multi-centre development of a secure, cloud based, patient to clinician, neurology video transfer, classification and management syste

Purpose: A government funded;interactive cloud storage platform (www.vcreate.tv/neuro) allowing patients and carers to upload video and linked metadata for neurological diagnosis was established during the Covid-19 pandemic. We describe the utility for epilepsy and paroxysmal disorders in 16 centres with the first centre active from 01/05/2020. Method: Users are invited to register and utilise a password and passcode for access. Videos are uploaded with a structured history. The clinician classifies seizure type, syndrome, aetiology or other diagnosis using drop-down menus. Users and clinicians complete online evaluations. Postcode allows linkage to user index of deprivation score. Consents for teaching by the local clinical team and research within a national neurology video research database with research ethics approval are optional. All data, except the video file, transfer to the electronic patient record. Result: To 24/03/2021, 4582 video uploads (4024 paediatric, 558 adult), 1889 patients (1594 paediatric, 295 adult). 400-600 new videos per month. 323 physician and nurse users. Deprivation scores indicate equitable use across socio-economic groups. Paediatric classification: non-epileptic 55%, epileptic (36.5%), unknown (8.5%). Adult: non-epileptic 73.5% (34% dissociative, 41% movement disorders), epileptic 11%, unknown 15.5%. Paediatric seizure types include: focal impaired awareness (19%), generalised tonic clonic (18%), focal clonic (17%), epileptic spasms (13%). Non-epileptic events: tics (13%), normal behaviour (12%), sleep myoclonus (10%) gratification (8%), dissociative (5%). >95% carers ranked the system positively. Clinicians report video prevented face-to-face review in 57%, investigations in 44% and reduced time to diagnosis in 97%. Median time to review video and classify was 5 minutes. Conclusions: Remote care is facilitated, investigations prevented or prioritised, with rapid diagnosis and efficiencies in the patient pathway. A rapidly growing teaching resource and research database for semiology and machine learning diagnostics for paroxysmal disorders has been established. We plan to establish the system in low-income countries without cost.

Post-acute COVID-19 functional movement disorder.

Movement disorders are rare compared to other neurological manifestations of COVID-19. Patients who have recovered from acute severe acute respiratory syndrome coronavirus-2 infection continue to have multiple debilitating symptoms months later. We report a case of 54-year-old man who presented with repetitive flexion movement of head which started 2 months after severe acute respiratory syndrome coronavirus-2 infection. Extensive work-up including neurological examination, neuroimaging, cerebrospinal fluid analysis, and electroencephalogram were normal. The self-reported questionnaires for depression and anxiety were suggestive of severe anxiety and depression. The patient continued to have the jerky movements besides cognitive impairment, frequent headaches, intermittent shortness of breath, sleeping difficulties, fatigue, and dizziness at 1-year follow-up. This case highlights the presentation of functional movement disorder as one of the manifestations of underlying neuropsychiatric condition. Our patient had significant effect on quality of life with high symptom burden which further highlights the struggle and unmet needs of the patients with multiple symptoms after severe acute respiratory syndrome coronavirus-2 infection.

New-Onset Movement Disorders in COVID-19: Much Ado about Nothing?

This is an editorial commenting on the paper by Brandão and colleagues [Brandão PRP, Grippe TC, Pereira DA, Munhoz RP, Cardoso F. New-Onset Movement Disorders Associated with COVID-19. Tremor and Other Hyperkinetic Movements. 2021; 11(1): 26. DOI: http://doi.org/10.5334/tohm.595].

Post-COVID Opsoclonus Myoclonus Syndrome: A Case Report From Pakistan.

Background: Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2), is primarily a respiratory infection but has been recently associated with a variety of neurological symptoms. We present herewith a COVID-19 case manifesting as opsoclonus-myoclonus syndrome (OMS), a rare neurological disorder. Case Presentation: A 63-year-old male diagnosed with COVID-19 infection developed behavioral changes, confusion, and insomnia followed by reduced mobility and abnormal eye movements within 48 h of recovery from respiratory symptoms associated with COVID-19. On examination, he had rapid, chaotic, involuntary saccadic, multidirectional eye movements (opsoclonus), and limb myoclonus together with truncal ataxia. CSF analysis, MRI of the brain, and screening for anti-neuronal and encephalitis related antibodies were negative. Extensive testing revealed no underlying malignancy. The patient was successfully treated with intravenous immunoglobulin (IVIG) with complete resolution of symptoms within 4 weeks of treatment. Conclusion: COVID-19 infection can be associated with the manifestation of opsoclonus myoclonus syndrome, a rare neurological disorder that can be treated with IVIG if not responsive to corticosteroids.

YouTube Videos on Parkinson's Disease are a Relevant Source of Patient Information.

BACKGROUND: Parkinson's disease (PD) is the most frequent movement disorder. Patients access YouTube, one of the largest video databases in the world, to retrieve health-related information increasingly often. OBJECTIVE: We aimed to identify high-quality publishers, so-called "channels" that can be recommended to patients. We hypothesized that the number of views and the number of uploaded videos were indicators for the quality of the information given by a video on PD. METHODS: YouTube was searched for 8 combinations of search terms that included "Parkinson" in German. For each term, the first 100 search results were analyzed for source, date of upload, number of views, numbers of likes and dislikes, and comments. The view ratio (views / day) and the likes ratio (likes * 100 / [likes + dislikes]) were determined to calculate the video popularity index (VPI). The global quality score (GQS) and title - content consistency index (TCCI) were assessed in a subset of videos. RESULTS: Of 800 search results, 251 videos met the inclusion criteria. The number of views or the publisher category were not indicative of higher quality video content. The number of videos uploaded by a channel was the best indicator for the quality of video content. CONCLUSION: The quality of YouTube videos relevant for PD patients is increased in channels with a high number of videos on the topic. We identified three German channels that can be recommended to PD patients who prefer video over written content.

Parkinson's disease may worsen outcomes from coronavirus disease 2019 (COVID-19) pneumonia in hospitalized patients: A systematic review, meta-analysis, and meta-regression.

BACKGROUND: Parkinson's Disease (PD) is among one of the common comorbidities in older patients. People with PD may be more vulnerable to severe pneumonia, due to the impairment of pulmonary function. Currently, the association between PD and COVID-19 is not yet established. This study aims to analyze the relationship between PD and in-hospital outcomes of COVID-19. MATERIALS AND METHODS: We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 25th, 2020. All articles published on COVID-19 and Parkinson's Disease were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for cross-sectional studies. Statistical analysis was done using Review Manager 5.4 software. RESULTS: A total of 12 studies with 103,874 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that Parkinson's Disease was associated with poor in-hospital outcomes [[OR 2.64 (95% CI 1.75-3.99), p < 0.00001, I2 = 81%] and its subgroup which comprised of severe COVID-19 [OR 2.61 (95% CI 1.98-3.43), p < 0.00001, I2 = 0%] and mortality from COVID-19 [RR 2.63 (95% CI 1.50-4.60), p = 0.0007, I2 = 91%]. Meta-regression showed that the association was influenced by age (p = 0.05), but not by gender (p = 0.46) and dementia (p = 0.23). CONCLUSIONS: Extra care and close monitoring should be provided to Parkinson's Disease patients to minimize the risk of infections, preventing the development of severe and mortality outcomes.

Abnormal movements in hospitalized COVID-19 patients: A case series.

BACKGROUND: Abnormal movements in Covid-19 patients have been reported with varying degree of frequency, prompting neurologic consultation and additional diagnostic evaluation. We sought to evaluate the frequency and etiology of abnormal movements among hospitalized Covid-19 patients undergoing neurologic consultation. METHODS: We retrospectively analyzed the first 50 consecutive patients with confirmed Covid-19 hospitalized at our tertiary medical care center who underwent acute inpatient neurology consultation from March 2020 through May 2020. Indication for neurologic consultation and diagnostic studies performed were identified by electronic medical record review. RESULTS: Of the 50 initial consultation requests, 11 (22.0%) patients were evaluated for abnormal movements (nine male and two female). Myoclonus was diagnosed in 6/11 (54.5%) patients. Additionally, two patients were diagnosed with seizures (confirmed on EEG in one), while two additional patients were diagnosed with tremor (physiologic and probable functional). A single case of serotonin syndrome was also identified. CONCLUSION: Abnormal movements observed in hospitalized Covid-19 patients can have a wide range of etiologies and were a frequent initial indication for neurologic consultation. Myoclonus was the most frequent type of abnormal movement observed. Early clinical recognition and directed diagnostic work-up is essential for accurate diagnoses in these patients.