ABSTRACT
Psychogenic movement disorders (PMDs) often result in disability and diminished quality of life, yet medical therapies are presently limited and largely ineffective. On the basis of previous reports that transcutaneous electrical nerve stimulation (TENS) is helpful for certain patients with organic movement disorders, the authors studied the effects of TENS in 19 patients with PMDs, utilizing the Psychogenic Movement Disorder Rating Scale (PMDRS) as well as patient-rated assessments of PMD magnitude, persistence, and disability. The PMDRS Severity score significantly improved after a mean follow-up of 6.9 months, and short duration of PMD was found to be the only identifiable predictor of a favorable outcome. Although the tingling sensation produced by TENS makes it poorly suited for a controlled clinical trial, the device has a favorable side-effect profile and is an acceptable palliative treatment for a subset of PMD patients.
Subject(s)
Movement Disorders/therapy , Somatoform Disorders/therapy , Transcutaneous Electric Nerve Stimulation , Adolescent , Adult , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Treatment OutcomeSubject(s)
Parkinson Disease/complications , Parkinson Disease/diagnosis , Shoulder Pain/etiology , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVES: The primary aim of this article is to critically review the clinical features and comorbidities, epidemiology, pathophysiology, and treatment of impulse control disorder (ICD) associated with Parkinson disease (PD). METHODS: References for this review were identified by searches of PubMed from 1980 until January 2008 with the terms "Parkinson disease," "impulse control," "pathologic gambling,""hypersexuality," "levodopa," and "dopamine agonists." Articles were also identified through searches of the authors' own files. Only papers published in English were reviewed. RESULTS: Pathologic gambling has emerged as one of the most prominent ICDs, although hypersexuality, compulsive shopping and other manifestations of obsessive-compulsive disorder may also dominate PD-related behavioral manifestations. Affected patients may demonstrate a pattern of self-escalation of dopaminergic medication dosing which may lead to a state of dependency. CONCLUSIONS: Patients most commonly affected by ICD, such as pathologic gambling and hypersexuality, are males who develop PD at a younger age, and those with a previous history of mood disorder, alcohol abuse, or obsessive-compulsive disorder. Dopaminergic drugs, particularly dopamine agonists, play an important role in triggering these nonmotor symptoms.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders/etiology , Gambling , Parkinson Disease/psychology , Aged , Antiparkinson Agents/adverse effects , Disruptive, Impulse Control, and Conduct Disorders/therapy , Female , Humans , Male , Middle Aged , Parkinson Disease/drug therapySubject(s)
Facial Muscles/physiopathology , Hemifacial Spasm/diagnosis , Hemifacial Spasm/physiopathology , Reflex, Babinski/diagnosis , Reflex, Babinski/physiopathology , Aged , Blepharospasm/diagnosis , Blepharospasm/physiopathology , Diagnosis, Differential , Eyebrows/physiopathology , Eyelids/physiopathology , Facial Muscles/innervation , Facial Nerve/physiopathology , Facial Nerve Diseases/diagnosis , Facial Nerve Diseases/physiopathology , Female , Forehead/physiopathology , Humans , Male , Middle AgedABSTRACT
Idiopathic cervical dystonia (ICD) is the most common adult-onset focal dystonia. It is characterised by relatively sustained, involuntary contractions of neck muscles. Injections of botulinum toxin (BTX)-A are safe and effective for the treatment of ICD, and have substantially improved its treatment. BTX-A is manufactured by Allergan Pharmaceuticals in the US and Ireland, and is distributed as Botox. In Europe, BTX-A is manufactured and distributed by Ipsen Pharmaceuticals as Dysport. Success rates for BTX-A injections for ICD ranges 64-90%, with 76-93% of injected patients experiencing pain reduction. Side effects are generally mild and include dysphagia and neck weakness.
