Eight of the first 15 patients with advanced Parkinson's disease who underwent microelectrode guided posteroventral pallidotomy developed transient abnormal involuntary movements during thermolesion, four of whom also did so during high frequency macrostimulation. Abnormal involuntary movements found before thermolesion were choreic, ballistic, or choreoathetoid in nature, usually persisted less than 60 minutes, and were contralateral to the site of thermolesion in six and bilateral in two of them. The appearance of abnormal involuntary movements during macrostimulation or thermolesion of the internal globus pallidus correlated with better surgical outcome as measured by UPDRS motor items and CAPIT timed test, so that they seem to be of prognostic value.
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http://dx.doi.org/10.1136/jnnp.63.2.210 | DOI Listing |
Rinsho Shinkeigaku
January 2025
Department of Neurology, Gifu Prefectural General Medical Center.
A 49-year-old female presented with the primary complaint of hand tremors. Neurological examination on admission revealed signs of cognitive impairment, bulbar palsy, dystonia, cerebellar ataxia, and pyramidal tract disease. T-weighted brain MRI revealed hyperintense signals in the subcortical white matter, basal ganglia, and cerebellar dentate nucleus, with no atrophy of the brainstem or corpus callosum.
View Article and Find Full Text PDFPsychiatr Clin North Am
March 2025
Department of Neurology, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8514, St. Louis, MO 63108, USA.
Tourette syndrome is defined by motor and vocal tics, yet our understanding of the pathophysiology of tics remains limited. Functional MRI (fMRI) can localize brain function related to the clinical phenomenology of tics. Here, we review extant fMRI studies examining brain activity during the premonitory urge, tic release, and tic suppression.
View Article and Find Full Text PDFPsychiatr Clin North Am
March 2025
Department of Neurology, Johns Hopkins University School of Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.
The pathophysiology of tic disorders involves an alteration in the transmission of messages through the cortico-basal ganglia-thalamo-cortical circuit. A major requirement for the passage of a message through this circuit is an intact chemically mediated synaptic neurotransmitter system (ie, neurotransmitters and second messengers). This article reviews the scientific evidence supporting the involvement of a variety of neurotransmitters (ie, dopamine, glutamate, gamma-aminobutyric acid, serotonin, acetylcholine, and the opioid system).
View Article and Find Full Text PDFPsychiatr Clin North Am
March 2025
Kennedy Krieger Institute, Department of Child Psychiatry, 707 North Broadway, Baltimore, MD 21205, USA; Johns Hopkins School of Medicine, Department of Child and Adolescent Psychiatry, 600 North Wolfe Street, Baltimore, MD 21205, USA.
Functional tic-like behaviors (FTLBs) are a manifestation of functional neurologic disorder that can be mistaken for neurodevelopmental tic disorders like Tourette syndrome. Much information was gained about FTLBs because of an outbreak of FTLBs spreading among adolescents and young adults via social media during the coronavirus disease 2019 pandemic. In comparison to neurodevelopmental tic disorders, FTLBs have an older age of onset, more abrupt symptom onset, and more complex tics as well as other features that would be atypical of Tourette syndrome.
View Article and Find Full Text PDFPsychiatr Clin North Am
March 2025
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Kennedy Krieger Institute, Baltimore, MD, USA.
The underlying pathophysiology of tics in Tourette syndrome is a topic of major scientific interest. To date, there is an absence of consensus among researchers regarding the precise anatomic location responsible for tics. The goal of this article is to review the current understanding of these brain circuits and data supporting specific anatomic regions.
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