Movement Disturbances Research Articles

Surgical method and intraorbital foreign body extraction in 27 cases

To evaluate the surgical method and intraorbital foreign body extraction. Individualized plan was made based on radiology and foreign body extraction was performed in 27 cases (27 eyes). The outcome of extraction was analyzed. Visual acuity, eye movement, and ptosis were recorded before and after the operation. Intraorbital foreign bodies in the 27 eyes were extracted successfully, 24 eyes (88.9%) extracted once and the other 3 eyes (11.1%) twice. The follow-up was 3-24(9.39±6.25) months. Visual acuity increased in 13 eyes (48.1%), and invariable in 13 eyes (48.1%) at the last follow-up. Disturbance of eye movement was found in 18 (66.7%) and 15 (55.5%) eyes before and after the extraction, respectively. Ptosis was found in 2 eyes (7.4%) and 1 eye (3.7%) before and after the extraction, respectively. Individualized plan is helpful for the intraorbital foreign body extraction and eye recovery.

Ocular Adverse Effects of Common Psychotropic Agents

All psychotropic medications have the potential to induce numerous and diverse unwanted ocular effects. Visual adverse effects can be divided into seven major categories: eyelid and keratoconjunctival disorders; uveal tract disorders; accommodation interference; angle-closure glaucoma; cataract/pigmentary deposits in the lens and cornea; retinopathy; and other disorders. The disorders of the eyelid and of the keratoconjunctiva are mainly related to phenothiazines and lithium. Chlorpromazine, at high dosages, can commonly cause abnormal pigmentation of the eyelids, interpalpebral conjunctiva and cornea. It can also cause a more worrisome but rarer visual impairment, namely corneal oedema. Lithium can rarely lead to a bothersome eye irritation by affecting sodium transport. Uveal tract problems are mainly associated with tricyclic antidepressants (TCAs), typical antipsychotics, topiramate and selective serotonin reuptake inhibitors (SSRIs). TCAs, typical antipsychotics and SSRIs can all cause mydriasis that is often transient and with no major consequences, but that can promote closure of angles in susceptible patients. Topiramate has been frequently associated with a number of significant ocular symptoms including acquired myopia and angle-closure glaucoma. Problems with accommodation are related to TCAs and to low-potency antipsychotics. TCAs cause transient blurred vision in up to one-third of patients. Angle-closure glaucoma is a serious condition that has been mainly associated with TCAs, low-potency antipsychotics, topiramate and, to a lesser extent, SSRIs. When patients with narrow angles are given TCAs, they all appear to experience induction of glaucomatous attacks. Antipsychotics and SSRIs may lead to an added risk of developing angle-closure glaucoma, but only in predisposed eyes. Topiramate can lead to an allergic-type reaction whereby structures of the lens and ciliary body are displaced, which results in angle-closure glaucoma. Cataractous changes can result from antipsychotics, mainly from high dosages of chlorpromazine or thioridazine. These two drugs, when used at high dosages and for prolonged periods, frequently cause lenticular opacifications. Retinopathy has been shown to be related to high dosages of typical antipsychotics, mainly chlorpromazine and thioridazine. The frequency of occurrence of retinal effects seems to be proportional to the total amount of drug used over a long period of time. Other visual problems of special concern are the ocular dystonias, other eye movement disorders, and decreased ability to perceive colours and to discriminate contrast. Ocular dystonias can occur with antipsychotics (especially high-potency ones), carbamazepine (especially in polytherapy), topiramate and, rarely, with SSRIs. Disturbance in various eye movements is frequently seen with benzodiazepines, antiepileptic drugs and lithium. Impairment in the perception of colours and the discrimination of contrasts has been shown to occur not uncommonly with carbamazepine and lorazepam. Thus, typical antipsychotics, TCAs, lithium, benzodiazepines, carbamazepine, topiramate and SSRIs appear to produce most of the currently recognized ocular problems. Psychiatrists, ophthalmologists and patients need to be aware of and prepared for any medication-induced adverse effect. Early prevention and intervention can avoid most of the serious and potentially irreversible ocular toxicities.

Seizures, but not lowered seizure thresholds, results in larger neocortical motor maps and concomitant disruptions in skilled motor behaviour

Kindling of the sensorimotor neocortex has been found to result in reorganization of the somatotopic map of movement representations as well as disruptions of skilled forelimb behaviours. It has been suggested that the repeated seizures induced during kindling altered motor maps, thereby disrupting the motor engram necessary for the production of skilled movements. However, kindling leads to neural changes other than those associated with repeated seizures, and the role of these comorbid effects is often overlooked. Our lab has developed a stimulation paradigm, which allows for the dissociation of the two main effects of kindling; repeated seizures and the reduction of afterdischarge (seizure) threshold. In the current study, we have utilized this paradigm to examine the effects of electrical stimulation on motor maps and skilled forelimb behaviour. We found that repeated seizures with no concomitant reduction of afterdischarge threshold resulted in large motor maps, as well as task specific deficits in skilled forelimb use and deficiencies in task acquisition. Rats that had reduced seizure thresholds and few seizures did not show alterations in map size or skilled forelimb use. These results suggest that movement disturbances following kindling are the result of repeated seizures, and not other stimulation-induced effects such as reduction of afterdischarge threshold. These results also corroborate the relationship between the integrity of movement representations and the ability to perform skilled motor tasks.

Automated Event Detection of Epileptic Spikes using Neural Networks

Biomedical signals carry signatures of physiological events. The part of the signal related to specific event is called epoch. Epilepsy is one of the important brain disorders which can be diagnosed and monitored is characterized by sudden recurrent and transient disturbances of mental function and movements of body which is caused from excessive discharge of brain cell groups. This excessive discharge is shown in EEG as epileptic spikes which are complementary source of information in diagnosis and localization of epilepsy. Artificial Neural networks have been provided an effective approach for a broad spectrum of applications for EEG signals because of its self-adaption and natural way to organize and implement the redundancy. It is well known that back-propagation networks are very suitable for pattern recognitions. The algorithm tested on 100 normal and abnormal datasets showed expected classification.

Gamma Knife radiosurgery for hemangiomas of the cavernous sinus: a seven-institute study in Japan

Gamma Knife radiosurgery (GKS) is currently used for primary or postoperative management of cavernous sinus (CS) hemangiomas. The authors describe their experience with 30 cases of CS hemangioma successfully managed with GKS. Thirty patients with CS hemangiomas, including 19 female and 11 male patients with a mean age of 53 years (range 19-78 years) underwent GKS at 7 facilities in Japan. Pathological entity was confirmed using surgical specimens in 17 patients, and neuroimaging diagnosis only in 13. Eight patients were asymptomatic before GKS, while 22 had ocular movement disturbances and/or optic nerve impairments. The mean tumor volume was 11.5 cm(3) (range 1.5-51.4 cm(3)). The mean dose to the tumor periphery was 13.8 Gy (range 10.0-17.0 Gy). The mean follow-up period was 53 months (range 12-138 months). Among the 22 patients with symptoms prior to GKS, complete remission was achieved in 2, improvement in 13, and no change in 7. Hemifacial sensory disturbance developed following GKS in 1 patient. The most recent MR images showed remarkable shrinkage in 18, shrinkage in 11, and no change in 1 patient. Gamma Knife radiosurgery proved to be an effective treatment strategy for managing CS hemangiomas. Given the diagnostic accuracy of recently developed neuroimaging techniques and the potentially serious bleeding associated with biopsy sampling or attempted surgical removal, the authors recommend that GKS be the primary treatment in most patients who have a clear neuroimaging diagnosis of this condition.

Analysis of sagittal condyl inclination in subjects with temporomandibular disorders

Disturbances of mandibular border movements is considered to be one of the major signs of temporomandibular disorders (TMD). The purpose of this study was to evaluate the possible association between disturbances of mandibular border movements and the presence of symptoms of TMD in the young. This study included two groups of volunteers between 18 and 26 years of age. The study group included 30 examineers with signs (symptoms) of TMD, and the control group also included 30 persons without any signs (symptoms) of TMD. The presence of TMD was confirmed according to the craniomandibular index (Helkimo). The functional analysis of mandibular movements was performed in each subject using the computer pantograph. The results of this study did not confirm any significant differences between the values of the condylar variables/sagittal condylar inclination, length of the sagital condylar guidance, in the control and in the study group. The study did not confirm significant differences in the length and inclination of the protrusive condylar guidance, as well as in the values of the sagittal condylar inclination between the subjects with the signs and symptoms of TMD and the normal asymptomatic subjects.

The disturbance of gaze in progressive supranuclear palsy: implications for pathogenesis.

Progressive supranuclear palsy (PSP) is a disease of later life that is currently regarded as a form of neurodegenerative tauopathy. Disturbance of gaze is a cardinal clinical feature of PSP that often helps clinicians to establish the diagnosis. Since the neurobiology of gaze control is now well understood, it is possible to use eye movements as investigational tools to understand aspects of the pathogenesis of PSP. In this review, we summarize each disorder of gaze control that occurs in PSP, drawing on our studies of 50 patients, and on reports from other laboratories that have measured the disturbances of eye movements. When these gaze disorders are approached by considering each functional class of eye movements and its neurobiological basis, a distinct pattern of eye movement deficits emerges that provides insight into the pathogenesis of PSP. Although some aspects of all forms of eye movements are affected in PSP, the predominant defects concern vertical saccades (slow and hypometric, both up and down), impaired vergence, and inability to modulate the linear vestibulo-ocular reflex appropriately for viewing distance. These vertical and vergence eye movements habitually work in concert to enable visuomotor skills that are important during locomotion with the hands free. Taken with the prominent early feature of falls, these findings suggest that PSP tauopathy impairs a recently evolved neural system concerned with bipedal locomotion in an erect posture and frequent gaze shifts between the distant environment and proximate hands. This approach provides a conceptual framework that can be used to address the nosological challenge posed by overlapping clinical and neuropathological features of neurodegenerative tauopathies.

Parkinson's Disease: General Features, Effects of Levodopa Treatment and Future Directions

Parkinson's Disease: General Features, Effects of Levodopa Treatment and Future Directions

Splitting of the Oculomotor Nerve by the Posterior Communicating Artery -Case Report-

A 62-year-old woman presented with subarachnoid hemorrhage manifesting as sudden onset of headache, but without visual symptoms or extraocular movement disturbances. Computed tomography angiography showed a 7-mm size aneurysm originating from the internal carotid-posterior communicating artery (PcomA). After the neck of the aneurysm was clipped, the PcomA was confirmed to have split the oculomotor nerve. Splitting of the oculomotor nerve by the PcomA was probably caused by arterial blood pulsation in the tortuous PcomA.

Loss of laterality in chronic cocaine users: An fMRI investigation of sensorimotor control

Movement disturbances are often overlooked consequences of chronic cocaine abuse. The purpose of this study was to systematically investigate sensorimotor performance in chronic cocaine users and characterize changes in brain activity among movement-related regions of interest (ROIs) in these users. Functional magnetic resonance imaging data were collected from 14 chronic cocaine users and 15 age- and gender-matched controls. All participants performed a sequential finger-tapping task with their dominant, right hand interleaved with blocks of rest. For each participant, percent signal change from rest was calculated for seven movement-related ROIs in both the left and right hemisphere. Cocaine users had significantly longer reaction times and higher error rates than controls. Whereas the controls used a left-sided network of motor-related brain areas to perform the task, cocaine users activated a less lateralized pattern of brain activity. Users had significantly more activity in the ipsilateral (right) motor and premotor cortical areas, anterior cingulate cortex and the putamen than controls. These data demonstrate that, in addition to the cognitive and affective consequences of chronic cocaine abuse, there are also pronounced alterations in sensorimotor control in these individuals, which are associated with functional alterations throughout movement-related neural networks.

Association analysis of COMT polymorphisms with schizophrenia and smooth pursuit eye movement abnormality

Schizophrenia is a multifactorial disorder characterized by the contribution of multiple susceptibility genes that may act in conjunction with epigenetic processes and environmental factors. The catechol-O-methyltransferase (COMT) gene, which is located in the 22q11 microdeletion, has been considered as a candidate gene for schizophrenia because of its ability to degrade catecholamines, including dopamine. In a genetic analysis, neurophysiological endophenotype in schizophrenia, such as smooth pursuit eye movement (SPEM) disturbance, is considered to be a good trait marker, because it may be under more direct genetic control. This study was performed to examine the genetic association of COMT polymorphisms with the risk of schizophrenia and SPEM abnormality in a Korean population. Six single-nucleotide polymorphisms of COMT were genotyped by TaqMan assay. Their genetic effects on the risk of schizophrenia were analyzed in 354 patients and 396 controls using chi(2) analyses. Among the schizophrenic patients, 166 subjects were selected for association analyses of COMT polymorphisms with SPEM abnormality. From the six COMT polymorphisms, rs6267 showed an association with the reduced risk of schizophrenia after correction (P(corr) = 0.02). In analysis of SPEM abnormality, no significant associations were detected with COMT polymorphisms. The results of the present study provide the evidence that in a Korean population, COMT on the 22q11 locus is likely involved in the development of schizophrenia, but not in the SPEM function abnormality.

Cuprizone effect on myelination, astrogliosis and microglia attraction in the mouse basal ganglia

Multiple sclerosis is the leading cause of neurological disability in young adults affecting more than two million people worldwide. Although multiple sclerosis is generally considered as white matter disease, distinct pathological alterations are also found in the grey matter. Involvement of basal ganglia seems to be related to a set of symptoms such as fatigue, impaired cognition, and movement disturbance. Since no appropriate animal model for studying cortical deep grey matter demyelination is established, we reassessed the cuprizone mouse model to investigate basal ganglia demyelination. Mice were fed cuprizone for different time intervals. The myelin status was analyzed by classical histological staining and immunohistochemistry for myelin proteins and glia markers. Expression of oligodendrocyte and astroglia were investigated by PCR. Cuprizone intoxication induced a severe demyelination of distinct cortical deep grey matter sub-regions. Striosmomes, located within the caudate–putamen and the ventral part of the caudate nucleus displayed intense demyelination, whereas those within the globus pallidus and the head of the caudate nucleus were not affected. The matrix region, however, was equally affected in the medial and lateral region. Besides demyelination, we observed hypertrophic and hyperplastic astrocytosis and microglia cell invasion/local proliferation in the demyelinated areas. Young adult and aged mice were similarly affected as well as mice with different genetic backgrounds. We conclude that cuprizone-induced demyelination provides an adequate animal model to investigate appropriate therapy strategies for the prevention of cortical deep grey matter demyelination. The heterogeneity in local demyelination points at beginning remyelination during ongoing demyelination.

Folate Receptor Alpha Defect Causes Cerebral Folate Transport Deficiency: A Treatable Neurodegenerative Disorder Associated with Disturbed Myelin Metabolism

Sufficient folate supplementation is essential for a multitude of biological processes and diverse organ systems. At least five distinct inherited disorders of folate transport and metabolism are presently known, all of which cause systemic folate deficiency. We identified an inherited brain-specific folate transport defect that is caused by mutations in the folate receptor 1 (FOLR1) gene coding for folate receptor alpha (FRalpha). Three patients carrying FOLR1 mutations developed progressive movement disturbance, psychomotor decline, and epilepsy and showed severely reduced folate concentrations in the cerebrospinal fluid (CSF). Brain magnetic resonance imaging (MRI) demonstrated profound hypomyelination, and MR-based in vivo metabolite analysis indicated a combined depletion of white-matter choline and inositol. Retroviral transfection of patient cells with either FRalpha or FRbeta could rescue folate binding. Furthermore, CSF folate concentrations, as well as glial choline and inositol depletion, were restored by folinic acid therapy and preceded clinical improvements. Our studies not only characterize a previously unknown and treatable disorder of early childhood, but also provide new insights into the folate metabolic pathways involved in postnatal myelination and brain development.

Mouth Movement Disturbance as a Sequela of Bilateral Bell's Palsy

Bell's palsy rarely recurs or arises bilaterally. We describe unique oral motor sequelae that manifest with bilateral facial palsy. Two rare patients with alternating bilateral Bell's palsy experienced compromised mouth movement, affecting eating, speaking, and air exchange, and reduced quality of life. Rehabilitation programs. Electromyography and electroneuronography. On electromyography study, little activity of the orbicularis oris muscle was seen in any mouth or eye movement in Case 1. In Case 2, the electromyography activity of the depressor anguli oris and depressor labii inferioris muscles was stronger than that of the orbicularis oris muscle. The 2 cases demonstrated different patterns of recovery after the same subsequent treatment. Different patterns of reinnervation occur in bilateral Bell's palsy. Mouth movement disturbances after bilateral Bell's palsy are most disabling when incomplete reinnervation (as suggested by electroneuronography) of the orbicularis oris muscle occurs. Misdirection of regenerating nerve fibers produces lesser levels of oral motor impairment.

Nicht-epileptische paroxysmale Bewegungsstörungen des Säuglings

Paroxysmal non-epileptic disorders may cause episodic and paroxysmal symptoms that mimic true epileptic seizures and they must be considered in the differential diagnosis. Paroxysmal movement disorders are not uncommon in infants, but are probably under-recognised. These phenomena represent various clinical situations, characterised by intermitted and episodic disturbances of movement. Clinical experience and a detailed history and careful observation with video recording are often helpful to establish the correct diagnosis. In the large majority of the cases, paroxysmal movement disorders are benign situation. Most of the time, no treatment will be required, and the families will be informed of the good prognosis. These disorders in infants are discussed in the present review.

Event-related desynchronization/synchronization during discrimination task conditions in patients with Parkinson's disease.

Parkinson's disease is a neurodegenerative disorder with symptoms, which include movement disturbances and changes of cognitive information processing. The aim of the present study was to investigate the functional relationships between oscillatory electroencephalographic (EEG) dominant components with event-related desynchronization/synchronization (ERD/ERS) method for idiopathic non-demented Parkinson's patients (PP) and control subjects (CS) during auditory discrimination tasks within two post-stimulus intervals of 0-250 and 250-600 ms. When comparing the CS and PP during the first post-stimulus period, we found delta- and theta-ERS significantly pronounced in CS for both tone types (low--800, high--1,000 Hz) with the following exceptions: at Fz, PP displayed higher delta-ERS, while at C3' theta-ERD in response to a high tone. Alpha-ERS was found in PP in response to either tone at all electrodes and mainly alpha-ERD in CS. In the second post-stimulus interval, the significant differences between the groups were: (i) delta-ERS in CS and delta-ERD in PP in response to the low tone and (ii) delta-ERS for both groups in answer to the high tone, more prominent in CS at Cz and Pz, except for delta-ERD in PP at C3'. For both groups, we detected predominantly theta-ERD and alpha-ERD following both tone types within this second interval. PP showed more expressed theta-ERD at Fz and parietal theta-ERS. Alpha-ERD was significantly higher in CS, while frontal alpha-ERD was more prominent in the PP in response to both tones. The data obtained showed specific functional differences of event-related oscillatory activity in cognitive and sensory-motor information processing between the PP and CS.

Movement disturbances in the differential diagnosis of Creutzfeldt‐Jakob disease

Movement disturbances are common in dementia disorders and are a central feature of the clinical classification criteria of Creutzfeldt-Jakob disease (CJD). Polymorphism at codon 129 of the prion protein gene is known to determine the clinical picture of CJD. The frequency and characteristics of movement disturbances in other dementing disorders, such as Alzheimer's disease (AD), is barely known and leads to misdiagnoses. We investigated the occurrence and characteristics of movement disturbances in 143 patients neuropathologically confirmed with CJD (n = 100), AD (n = 29), dementia with Lewy bodies (DLB) (n = 7), or other diagnoses (n = 7). All patients had been referred with the differential diagnosis of prion disease. Ataxia and dysmetria were significantly more frequent in CJD than in AD or DLB patients, whereas hypokinesia was up to five times more frequent in AD or DLB (P < 0.05). Using an ordered logistic regression to identify constellations of movement disturbances, the diagnosis of CJD was likely in patients presenting ataxia but not hypokinesia. The reverse situation was statistically associated with AD. Ataxia and cogwheel rigidity were associated with valine-homozygosity and akinesia with methionine-homozygosity in the CJD patients. Our results indicate that the careful assessment of movement disturbances may be helpful in the differential diagnosis of Creutzfeldt-Jakob disease.

A novel ferritin light chain gene mutation in a Japanese family with neuroferritinopathy: Description of clinical features and implications for genotype–phenotype correlations

Neuroferritinopathy is a hereditary neurodegenerative disorder caused by mutations in the ferritin light chain gene (FTL1). The cardinal features are progressive movement disturbance, hypoferritinemia, and iron deposition in the brain. To date, five mutations have been described in Caucasian and Japanese families, but the genotype-phenotype correlations remain to be established. We identified a novel FTL1 mutation (exon 4, c.641/642, 4-nucletotide duplication) in a Japanese family and compared the clinical traits with those previously reported. All mutations but one are insertions in exon 4, resulting in frameshifts. Clinical features are similar among patients with the same mutations. Middle-age onset chorea is common in patients with insertions in the 5' portion of exon 4 including our cases, whereas patients with insertions in the 3' portion of exon 4 develop early-onset tremor, suggesting genotype-phenotype correlations. In this family, male predominance and normal serum ferritin levels are characteristic.

1213 エコ発進のマクロ交通流評価を目的とした自動車発進時の加速特性評価(OS5-2:自動車の安全技術,OS5:安全・安心・防災・環境負荷低減,オーガナイズド・セッション(OS),第18回交通・物流部門大会(TRANSLOG2009))

This paper aims to numerically evaluate acceleration behavior when vehicle starts to move in cooperate with the preceding vehicle. Since a microscopic disturbance of vehicle movement may affect macroscopic behavior of traffic flow in terms of emission, environment and safety, the authors firstly attempt to observe and analyze actual phenomenon of accelerating behavior through a test-track field data collection. Based on the fact that the accelerating behavior varied widely, the authors then assumed three representative types of ordinal, steep and moderate accelerations to extensively simulate general acceleration behavior using a car-following model. The acceleration behavior among three types of acceleration was compared in terms of acceleration rate, velocity and distance with preceding vehicles. The statistical comparison such as T-test and F-test showed that moderate and steep accelerations have a significant difference in acceleration rate and distance. This large difference in microscopic level of vehicle movement is believed to affect a large impact in a macroscopic system of traffic flow.

P01-105 Saccadic eye movements in dementia, major depression and healthy controls - relationship with cognitive functions

We compared horizontal saccadic eye movements in patients with dementia (n=18), and age-matched patients with major depression (n=18) or healthy controls (n=18). Cognitive functions were evaluated using Mini-Mental-State-Examination (MMSE) and ADAS-cog.Results:Saccadic latency and number of saccadic intrusions were significantly (p&lt; 0.001) higher in patients with dementia relative to healthy controls and depressed patients. There were significant correlations between MMSE total score and latency (r = -0.78, p&lt; 0.01) or number of saccadic intrusions (r = -0.80, p&lt; 0.001) in the demential group. In addition, both saccadic parameters were significantly associated with ADAS-cog total score of patients with dementia, whereas the subscale “orientation” showed the strongest correlation with latency (r = 0.71, p&lt; 0.01) and intrusions (r = 0.74, p&lt; 0.01).There were no significant differences in saccadic eye movements between healthy controls and patients with major depression as a whole, or a subgroup of depressed patients with the worst cognitive performance (n=9).Conclusions:It seems that disturbances in horizontal saccadic eye movements in patients with dementia are related to the degree of cognitive deficits in these patients. On the other hand, the lack of alterations in horizontal saccadic eye movements in depressed patients despite poor cognitive performance indicates different mechanism.