ABSTRACT
Globus pallidus deep brain stimulation (GPi-DBS) is a useful alternative in the treatment of dystonia. Patients selected for GPi-DBS were prospectively rated with the Unified Dystonia Rating Scale (UDRS). Also, "blinded" videotape assessments were performed. Eleven patients were identified. Compared with pre-DBS scores, there were improvements in mean total UDRS score (15.3%) and in the following subscores: neck (18.18%), trunk (32.9%), arm (17.9%), and leg (19.9%). One patient developed a skin infection and erosion requiring surgical debridement. GPi-DBS is a safe and effective treatment for generalized dystonia in patients who remained impaired, despite optimal medical therapy.
Subject(s)
Deep Brain Stimulation/methods , Dystonia/therapy , Globus Pallidus , Adolescent , Adult , Child , Dystonia/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Severity of Illness Index , Treatment OutcomeABSTRACT
The authors examined the glabellar reflex and the palmomental reflex in 100 subjects, including patients with Parkinson disease (n = 41), patients with progressive supranuclear palsy (n = 12), patients with multiple system atrophy (n = 7), and healthy, age-matched, controls (n = 40). The study provides evidence that these reflexes, particularly glabellar reflex, are relatively sensitive signs of parkinsonian disorders, but they lack specificity as they do not differentiate among the three most common parkinsonian disorders.
Subject(s)
Blinking , Multiple System Atrophy/physiopathology , Parkinson Disease/physiopathology , Reflex, Abnormal , Supranuclear Palsy, Progressive/physiopathology , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Multiple System Atrophy/diagnosis , Parkinson Disease/diagnosis , Predictive Value of Tests , Sensitivity and Specificity , Single-Blind Method , Supranuclear Palsy, Progressive/diagnosis , Videotape RecordingABSTRACT
We administered a questionnaire designed to probe for premonitory sensations associated with motor tics to 50 patients with Tourette's syndrome (TS). Premonitory sensations were reported by 46 (92%) patients, and the most common sensation was an urge to move and an impulse to tic ("had to do it"). Intensification of premonitory sensations, if prevented from performing a motor tic, was reported also in 37 patients (74%), 36 patients (72%) reported relief of premonitory sensations after performing the tic, and 27 of 40 (68%) described a motor tic as a voluntary motor response to an involuntary sensation, rather than a completely involuntary movement. The "just right" sensation correlated with the presence of co-morbid obsessive-compulsive disorder. We conclude that premonitory sensations are an important aspect of motor tics and some patients perceive motor tics as a voluntary movement in response to an involuntary sensation.
