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   Table of Contents - Current issue
May-August 2020
Volume 3 | Issue 2
Page Nos. 71-124

Online since Tuesday, July 28, 2020

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COVID-19 and the future of movement disorders in India p. 71
Pramod Kumar Pal
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Clinical signs in movement disorders: Phenomenology of mirror movements p. 73
Chandra S Rawat, Sanjay Pandey
Mirror movements are involuntary movements that accompany the voluntary movement of the contralateral homologous body part. Etiologically, these movements could be broadly divided into two main groups: congenital and acquired mirror movements. The pathogenesis of mirror movements is different in both these groups. Minor physiological mirroring is seen in normal healthy individuals and can occur during normal childhood development, whereas apparent mirroring in adults can be present in many movement disorders. Interestingly in these neurological disorders, mirror movements are seen in a particular limb at a particular time course of the disease. This may help in making an early diagnosis and could help in the differentiation between the various movement disorders. The coordinative behavior of the central nervous system is an inherent need for an adult to work with both hands, interruption of which makes a person unable to do the coordinated task with hands. Examination of mirror movements also contributes to our understanding of movement disorders, their clinical clues, and associated pathophysiology.
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Rehabilitation in Parkinson’s disease: Current status and future directions p. 79
Divyani Garg, Rajinder K Dhamija
Parkinson’s disease is a common progressive neurodegenerative disease. Apart from pharmacological treatment, nonpharmacological management in the form of rehabilitation, counselling, and supportive care is an equally important therapeutic pillar. A MEDLINE search strategy using the following terms (1998–2019) was adopted for this review. Limits of “Human” and “English” were applied. Search terms included “Parkinson’s Disease” AND “rehabilitation,” “physical therapy,” “exercise therapy,” “physiotherapy,” and “dance.” Review articles, practice parameters, guidelines, systematic reviews, meta-analyses, randomized controlled trials, and cohort studies were included. Rehabilitation strategies in the management of Parkinson’s disease form a vital component of therapy. There is mounting evidence to support physical therapy in these patients. Rehabilitation should be offered to these patients right from the start to encourage an active lifestyle and to improve quality of life.
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Bupropion-associated movement disorders: A systematic review p. 86
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Bupropion (BPP) was originally an antidepressant, but now it is also used for seasonal affective disorder and smoking cessation. The aim of this systematic review was to evaluate the clinical epidemiological profile, pathological mechanisms, and management of BPP-associated movement disorders. Relevant reports in six databases were identified and assessed by two reviewers without language restriction. A total of 63 reports of 710 cases from 16 countries were assessed. The movement disorders associated with BPP found clearly defined were: dyskinesia (8), dystonia (7), parkinsonism (7), myoclonus (6), tic (6), stuttering (3), rapid eye movement sleep disorders (2), and ballism (1); the not clearly defined cases included 488 tremors, 80 slurred speech, 48 ataxia, 20 abnormal movements, 19 falls, 4 akathisia, 3 dyskinesia, 2 hyperkinesia, 2 poor coordination, and the rest was only reported once (dystonia, myoclonus, motor tic, and rigidity). The mean age was 46 years (7–85 years). The male was predominant sex (52.77%). The mean BPP dose was 248.38 mg, and the most common indication was a major depressive disorder (73.68%). The average time of onset was 3.47 weeks and of recovery was 2.71 weeks. The most common management was BPP withdrawal. In the literature, the majority of the cases did not clearly report the clinical neurological examination and lacked electrodiagnostic studies. Future studies about adverse effects with BPP should describe at least the clinical characteristics and the physical exam of the individuals, especially when fall and slurred speech are observed.
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Clinical spectrum of focal dystonias: Experience from a tertiary care center p. 99
Rupesh Prasad, Deepika Joshi, Vijay N Mishra, Rameshwar N Chaurasia, Abhishek Pathak
BACKGROUND: There is a paucity of literature in patients with focal dystonia from our country with certain differences in the clinical characteristics as compared to the Western population. OBJECTIVES: The aim of this study was to evaluate the clinical spectrum of patients with focal dystonia attending the neurology outpatient department and of admitted patients in neurology ward of a tertiary care hospital. MATERIALS AND METHODS: All consecutive patients of focal dystonia from October 2017 to September 2019, fulfilling the inclusion criteria were enrolled. Patients were subjected to a detailed history and thorough examination as per a predesigned pro forma. RESULTS: Of a total of 88 patients with focal dystonia, 62.5% were male. Majority of the focal dystonia (51.1%) had late adulthood onset (>40 years). Writer’s cramp was the most common type of focal dystonia (n = 38; 43.2%), but in patients older than 40 years, focal cranial dystonias (n = 28 of 43, 65.1%) were the most common. Oromandibular dystonia and blepharospasm had significantly older mean age of onset compared to focal upper limb (57.0 ± 14.05, 44.9 ± 13.83 vs. 31.5 ± 17.67; P < 0.001, P = 0.032, respectively). Most of the focal dystonias were isolated (87.5%, n = 77) and idiopathic (66%). Among the acquired causes, drugs were the most common (n = 9; 10.1%), followed by perinatal birth insult (n = 4; 4.5%). All of the drug-induced focal dystonias were oromandibular. CONCLUSION: Focal dystonia was more prevalent in males, and it had an earlier age of onset by a decade as compared to the Western population. Writer’s cramp was the most common type of focal dystonia, but in patients older than 40 years, cranial dystonias were the most common. In patients presenting with oromandibular dystonia, a drug history should be carefully sought.
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Re-emergent tremor in patients with Parkinson’s disease: an imaging study p. 106
Pooja Mailankody, Lija George, Rajini M Naduthota, Jitender Saini, K Thennarasu, Ravi Yadav, Pramod K Pal
BACKGROUND AND PURPOSE: Re-emergent tremor (ReT) is the tremor that reappears after a variable period of latency while maintaining posture. Little is known about the mechanisms that contribute to the origin of this silent period (SP). Our aim was to compare the imaging characteristics of patients with and without ReT and find the structural correlate of SP if any. MATERIALS AND METHODS: Fifteen patients with ReT (Group 1) and eighteen patients without ReT (patients with rest tremor and postural tremor, but no latency) were evaluated clinically, electrophysiologically, with diffusion tensor imaging (DTI) and voxel-based morphometry (VBM). DTI parameters of different regions of interest were analyzed and compared with that of 37 healthy age- and gender-matched controls. RESULTS: No statistically significant difference was observed between the two groups in terms of age, duration of disease, levodopa equivalent dose, or severity of the disease. However, in the left supplementary motor area (SMA), there was a significant reduction of fractional anisotropy and an increase of radial diffusivity and mean diffusivity in patients with ReT (Group 1) as compared to patients without ReT (Group 2) and healthy controls. The results of the VBM analysis were not significant. CONCLUSION: The presence of abnormality of SMA suggests that patients with ReT have a different pathophysiological mechanism as compared to patients without ReT. This is a novel finding implicating a possible contribution of the frontal lobe to the genesis of SP in ReT. ReT could be a distinct clinical entity within the tremor dominant subtype.
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Immune-mediated chorea in a patient with kappa light-chain monoclonal gammopathy p. 112
Amrita J Gotur, Roopa Rajan, Rishi Dhawan, Ajay Garg
The objective of this paper was to report on a case of steroid-responsive chorea in a patient with κ light-chain monoclonal gammopathy. In addition to subacute-onset generalized chorea, evidence of peripheral neuropathy in this elderly gentleman led us to investigate for paraproteinemia. We treated the patient with intravenous steroids in view of elevated κ light-chain assay and bone marrow biopsy, suggestive of monoclonal gammopathy of undetermined significance. There was a remarkable improvement of paresthesias and chorea at 6 months follow-up with no evidence of evolution to malignancy at 1 year. Autoimmune chorea is a treatable condition if identified and treated timely.
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Ocular mutilation associated with sensory phenomena in Tourette’s syndrome p. 115
Sujoy Ray, Abel Thamby, Chethana Kishore, Harsh Pathak, Shyam Sundar Arumugham, Janardhanan C Narayanaswamy
Self-injurious behaviors (SIBs) have been known to occur with Tourette’s syndrome (TS). We present two cases with ocular self-mutilation associated with TS. The first case had significant impulsivity and emotional dysregulation and was found to be resistant to all forms of treatment. The second case had an onset in adulthood with good response to pharmacotherapy. The SIB in both cases was associated with the underlying sensory phenomenon (SP) which may have treatment implications.
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Movement disorders associated with hypoglycemia and hyperglycemia p. 118
Jamir Pitton Rissardo, Ana L Fornari Caprara
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An ongoing search for “biomarkers in Parkinson’s disease” p. 121
Shweta Pandey, Ravindra K Garg
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Role of DJ-1 and Apo A1 as biomarkers in Parkinson’s disease: an observational case–control study p. 123
Ritu Shree, Sahil Mehta
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