Effects of Night-Time Use of Rotigotine on Nocturnal Symptoms in Parkinson's Disease.

Objectives. This open-label study assessed the efficacy and safety of exclusive night-time administration of transdermal rotigotine in patients with nocturnal and early morning PD symptoms. Methods.

[Efficacy and safety of posteroventral pallidotomy for the treatment of advanced Parkinson's disease].

Objectives: To analyze the results, efficacy and safety of unilateral microelectrode guided pallidotomy for the treatment of advanced Parkinson's disease, three months and one year after surgery.

Patients And Methods: 23 patients with advanced Parkinson's disease (mean age 58.9 years and mean disease duration 14.

Effects of unilateral posteroventral pallidotomy on 'on-off' cognitive fluctuations in Parkinson's disease.

In Parkinson's disease, cognitive performance can vary according to levodopa levels (on-off states). Both positive and negative effects of dopaminergic stimulation have been reported. Pallidotomy is also able to change cognitive performance, in addition to levodopa pharmacokinetics.

Pallidotomy and quality of life in patients with Parkinson's disease: an early study.

The purpose of this study was to analyze the effect of stereotactic neurophysiologically guided pallidotomy on health-related quality of life (QoL) of patients with Parkinson's disease (PD). Eleven patients with PD (seven men, four women; mean age, 57.2 years; mean duration of disease, 14 years) with motor complications refractory to medical therapy underwent unilateral pallidotomy.

Contribution of neurophysiological guidance to stereotactic posteroventral pallidotomy for Parkinson's disease.

The usefulness of microrecording guidance to adequately place pallidotomy lesions is not thoroughly accepted. We have analysed in 23 consecutive Parkinsonian patients the deviation of the first recording track (FRT), which was directed to the theoretical stereotactic target, from the sensorimotor area of the internal pallidum, the internal capsule and the center of the lesion. Standard stereotactic co-ordinates were calculated applying a digitized brain atlas adapted to neuro-imaging techniques.

Prepulse modulation of the startle reaction and the blink reflex in normal human subjects.

Blink reflexes are usually considered the most representative and consistent response of the auditory startle reaction (ASR), and they are often the only response evaluated in human psychophysiological studies. However, auditory stimuli also induce an auditory blink reflex (ABR), the physiological characteristics and brainstem circuitry of which may be different from those of the ASR. This study aimed to investigate whether there were differences between the orbicularis oculi (OOc) responses elicited with the ABR (OOcABR) and those elicited with the ASR (OOcASR) regarding their behavior to prepulse modulation.

Cognitive and behavioral changes after unilateral posteroventral pallidotomy: relationship with lesional data from MRI.

We investigated cognitive and behavioral changes after unilateral posteroventral pallidotomy, and their relationship with lesion size and location as identified in magnetic resonance image quantitative analysis. Fifteen consecutive patients with Parkinson's disease were assessed neuropsychologically before and after unilateral posteroventral pallidotomy (five right and 10 left). Immediate postsurgery evaluation (1 week) demonstrated significant worsening of memory, motor learning, motor speed, and verbal fluency.

Effects of a startling acoustic stimulus on reaction time in different parkinsonian syndromes.

Background: The functional assessment of the startle circuit is usually done by analyzing the acoustic startle response (ASR). However, a startling acoustic stimulus (SAS) also induces changes in the excitability of neural structures that can be demonstrated by studying the SAS-induced change in the behavior of certain neurophysiologic responses.

Objective: To examine the effects induced by an SAS on voluntary reaction time in patients with parkinsonian syndromes (StartReact effect) and to compare the results with those obtained in a group of age-matched healthy volunteers.

The acoustic startle response is normal in patients with multiple system atrophy.

We investigated the acoustic startle response in eight patients with MSA and compared the results with those from a group of age matched healthy subjects. Onset latency and amplitude of the responses obtained in the orbicularis oculi, masseter and sternocleidomastoid muscles were not different in patients and control subjects. We conclude that, in spite of the pathological derangement described in brainstem reticular nuclei in MSA, the neuronal circuits mediating the auditory startle reflex are functionally preserved.

Neurophysiological investigations in patients with head tremor.

We studied 30 patients whose primary complaint was head tremor in an attempt to characterize neurophysiological aspects of their abnormal movement. Based on family medical history and physical examination, 23 patients had definite or probable essential tremor (essential head tremor, EHT). The remaining seven had mild dystonic signs accompanying their head tremor (head tremor plus dystonic signs, HT + DS).

Habituation of the auditory startle reaction is reduced during preparation for execution of a motor task in normal human subjects.

The generalized acoustic startle reaction is a useful but labile phenomenon that undergoes a relatively rapid habituation with repeated stimuli and can be modified by changes in the environmental context. In the present work, we examined the influence of the experimental set on size, latency and habituation rate of auditory startle reactions in 15 normal volunteers. Series of 5 acoustic startling stimuli were applied on each of the following 4 conditions: (1) at rest in a quiet and dull ambience; (2) at rest but engaged in a busy environment; (3) being prepared to execute a reaction time task; and (4) focussing the attention to an impending visual stimulus.

Subdural hematoma as a cause of contralateral dystonia.

A 72-year-old patient was operated on for a right-sided chronic subdural hematoma. After removal of the drain he became somnolent and developed dystonia of the left arm. Computerised tomography demonstrated a new right-sided subdural hematoma with compression of the right hemisphere and a midline shift to the contralateral side.

Treatment of behavioural disturbances in Parkinson's disease.

Behavioural disorders in Parkinson's disease can grossly be subdivided in primary disturbances and those which are related to drug treatment. Depression and anxiety are a common feature in parkinsonian patients. Both occur independently of drug treatment.

Rotational behaviour and neurochemical changes in unilateral N-methyl-norsalsolinol and 6-hydroxydopamine lesioned rats.

In earlier studies the tetrahydroisoquinoline derivative N-methyl-norsalsolinol (2-MDTIQ) was discovered in lumbar cerebrospinal fluid and brain of patients with Parkinson's disease. To establish whether 2-MDTIQ is toxic to the dopaminergic system, 2-MDTIQ or 6-hydroxydopamine (6-OHDA) were stereotactically injected into the left medial forebrain bundle, and rotational behaviour and neurochemical changes were measured in female Wistar rats. Three weeks after lesioning rotational behaviour was assessed after administration of S(+)-amphetamine (5 mg/kg) and apomorphine (0.

Ballism not related to vascular disease: A report of 16 patients and review of the literature.

Sixteen patients with ballism not related to vascular disease are reported. Ballism was caused by subthalamic metastases and cerebral tumours in four patients, lesions after functional stereotaxy in three, presumed neurodegenerative disease in two, and by an ipsilateral intraventricular cyst after resection of a meningioma, cerebral toxoplasmosis with AIDS, severe head trauma and sepsis, late recurrence of rheumatic fever, meningoencephalitis, perinatal hypoxia, and conversion syndrome in one, respectively. Two patients had bilateral ballism, 11 had hemiballism, and three had monoballism.

Lesion of dentatothalamic pathways in severe post-traumatic tremor.

The present study investigates evidence of dentatothalamic pathway lesions in nineteen patients with severe kinetic post-traumatic tremor respectively by magnetic resonance imaging (MRI). Kinetic tremor is thought to be characteristic of lesions of the cerebellar outflow. While this hypothesis is supported by experimental data, neuropathological and neuroradiological findings have been limited.

Presence of N-methyl-norsalsolinol in the CSF: correlations with dopamine metabolites of patients with Parkinson's disease.

We could identify the MPTP-like compound and isoquinoline derivative N-methyl-norsalsolinol (2-MDTIQ) in cerebrospinal fluid (CSF) of patients with Parkinson's disease. The presence of 2-MDTIQ negatively correlated with the disease duration. In order to study the relationship between presence of 2-MDTIQ and dopamine metabolism, we examined 3-O-methyl-dopa (MDOPA) and homovanillic acid (HVA) levels in CSF of 15 normal control subjects and 34 patients with Parkinson's disease (PD).

The treatment of posttraumatic tremor by stereotactic surgery. Symptomatic and functional outcome in a series of 35 patients.

The authors report the long-term results of stereotactic surgery for severe posttraumatic appendicular tremor in 35 patients. The tremors developed after severe head trauma in 33 patients (94%) and after mild to moderate head trauma in two (6%). In all but one, the tremor was most evident during activity.

Evaluation of the effect of treatment on movement disorders in astrocytomas of the basal ganglia and the thalamus.

Twenty patients with movement disorders associated with astrocytomas (grade I-IV according to the WHO tumour classification) of the basal ganglia and the thalamus were evaluated for the effects of treatment. Five patients had more than one movement disorder when the histological diagnosis was verified by stereotactic biopsy. Twelve had tremors, eight hemidystonia, three hemichorea, and one hemichorea/ballismus, and myoclonus respectively.

Movement disorders in astrocytomas of the basal ganglia and the thalamus.

In a series of 225 patients with astrocytomas (grades I-IV) of the basal ganglia and the thalamus, 20 had a movement disorder. In all patients the histological diagnosis was verified by stereotactic biopsy. Tremor was observed in twelve patients, dystonia in eight, chorea in three, and chorea/ballismus and myoclonus in one.

Dystonia following head trauma: a report of nine patients and review of the literature.

We report nine patients who developed dystonia following head trauma. The most frequent form was hemidystonia only (six patients). One patient presented with hemidystonia plus torticollis, one with bilateral hemidystonia and one with torticollis only.

Bilateral ballismus in children.

Bilateral ballismus is extremely rare. We found 23 reported cases, and only 2 of these were in children. In older patients the movement disorder is usually due to cerebrovascular disease, but in younger patients a variety of aetiopathological causes may be found.

Hemidystonia due to a contralateral parieto-occipital metastasis: disappearance after removal of the mass lesion.

A patient presented with left-sided hemidystonia. CT revealed a contralateral parieto-occipital mass lesion compressing the basal ganglia, which were spared by the mass. After microsurgical resection of the tumor, which was verified histologically as a metastasis of a large-cell anaplastic carcinoma, the movement disorder dissolved completely.

[Internal medicine consultation].

Preoperative medical consultation may decrease the risk of surgery in multimorbid patients by an exact preoperative evaluation and pretreatment of all cardiopulmonary, hematologic and metabolic diseases. Excellent teamwork among internists, anaesthesiologists and surgeons is necessary. The increase in specialization in surgical and conservative medicine has produced a variety of alternative diagnostic and therapeutic procedures and so there should be a consensus as to which diagnostic and therapeutic procedure is best.