Bradykinesia and hypokinesia in Parkinson's disease: what's in a name?

Because in the literature bradykinesia and hypokinesia are frequently confounded, we assessed the relation between these two fundamental aspects of altered movement and the influence of disease severity on these measures in 41 patients with Parkinson's disease (PD) and 24 age-matched healthy controls. Bradykinesia was measured with a test microcomputer interfaced with a response-board. Hypokinesia was assessed by activity monitoring at home over a period of 5 successive days. For each subject the choice reaction time and measures reflecting bradykinesia (tap rate, movement time) and hypokinesia (movement index, duration of immobility periods) were calculated. Patients with PD had a normal choice reaction time and a significantly impaired execution of voluntary movement and reduced amount of movement over time. Bradykinesia was clearly present in the less affected patients with PD, and worsened as the disease severity increased. Hypokinesia, however, emerged prominently only in the more affected patients. There was a striking lack of relation between the measures that reflect bradykinesia and hypokinesia. The use of levodopa or dopamine agonists did not confound these findings. Our findings show the very different character and course of two tiers of altered movement in patients with PD and question the causative mechanisms of both motor features in PD. A more precise use of the terms brady- and hypokinesia is a prerequisite for future studies that attempt to provide insight in the causative mechanisms of both motor features.

A comparison of topical and retrobulbar anesthesia for cataract surgery.

PURPOSE: To evaluate and compare the efficacy of topical and retrobulbar anesthesia for cataract extraction with intraocular lens implantation. METHODS: One hundred thirty-eight patients prospectively were assigned to the topical (group 1; n = 69) or retrobulbar (group 2; n = 69) anesthesia groups by permuted block restricted randomization. Group 1 received topical 0.75% bupivacaine and intravenous midazolam and fentanyl for anesthesia. Group 2 received intravenous methohexital followed by retrobulbar block with an equal mixture of 2% lidocaine and 0.75% bupivacaine plus hyaluronidase (150 U). A visual pain analogue scale was used to assess the degree of pain during the administration of anesthesia, during surgery, and post-operatively. The degree to which eye movement, touch, and light caused patient discomfort was assessed. Complications and surgical conditions were recorded. RESULTS: There was no difference in the surgical conditions (P = 0.5) or pain during surgery (P = 0.35) between the two groups. There was more discomfort during administration of topical anesthesia (P < 0.0001) and postoperatively (P < 0.05) in the topical group. Chemosis, subconjunctival hemorrhage, and eyelid hemorrhage were seen almost exclusively in the retrobulbar group. One patient in group 2 had a retrobulbar hemorrhage. Although eyeball movement and squeezing of the eyelids were present more frequently in the topical group, neither was a problem to the surgeon. CONCLUSION: Topical anesthesia can be used safely for cataract extraction. The degree of patient discomfort is only marginally higher during administration of the anesthesia and postoperatively. However, surgical training and patient preparation are the keys to the safe use of topical anesthesia.