Movement Disturbances Research Articles

ブレインバンクの構築と課題

We have established a brain bank for the prevention and treatment of aging-related movement and cognitive disturbances, as a joint project between a rural care hospital and a research institute. The resources of the bank are to be used for collaborative studies approved by the bank's committee. The collaborative investigators should also be qualified by the institute to conduct the research jointly. The collaborative studies require authorization by the institutional review board (IRB) of the institute, the hospital and each facility involved in collaborative studies. The bank continues to have the responsibility for the resources, after the transfer of the resources to the facilities of collaborative investigators, pursuant to Article 18 of the Cadaver Autopsy and Preservation Act Thus, the status of resource utilization and outcomes from their use in studies will be monitored periodically (every 6 months). We shared the philosophy with the brain banks in the United States that the resources of the bank, donated on the basis of a charitable spirit, belong to the public domain and are regarded as public resources to be used to contribute to promoting public welfare.

Endoscopic Transmaxillary Reduction and Balloon Technique for Blowout Fractures of the Orbital Floor

The indications for and timing of surgical treatment of blowout fractures of the orbital floor remain controversial. We report good results with the endoscopic transmaxillary reduction and balloon technique for blowout fractures of the orbital floor in the early stage after trauma in a consecutive series of 29 patients treated over the last 3 years, based on the following criteria: 1) diplopia observed by ophthalmological examination, 2) entrapment of intraorbital tissue at the fracture site on diagnostic imaging, mainly using CT scans, and 3) no improvement of diplopia during the acute phase (within one week of injury). Even in the presence of eyelid swelling, this method allows reduction and fixation of the fracture and impacted tissues simply and in a short time. Disappearance of diplopia was reported by 27 patients (93 %) within three months after surgery, and all 20 patients with enophthalmos were cured. There were only 4 cases with transient minor operative complications. Re-entrapment at the fracture site or relapse of symptoms was not seen during follow-up for 5 to 39 months (mean: 23.4 months). The combination of endoscopic transmaxillary reduction and the balloon technique for blowout fractures of the orbital floor is an effective and minimally invasive treatment with a high rate of improvement, not just for disturbances of ocular movement, but also for enophthalmos, which is often a problem in the long term.

Relationship between exploratory eye movements and brain morphology in schizophrenia spectrum patients

The exploratory eye movements of schizophrenia patients and their relatives have been shown to differ from those of patients without schizophrenia and healthy controls. However the mechanism of exploratory eye movement disturbances in schizophrenia patients remains elusive. We investigated the relationship between the exploratory eye movements and brain morphology in 39 schizophrenia spectrum patients. Voxel-based morphometric analysis on three-dimensional magnetic resonance imaging was conducted by means of statistical parametric mapping 99. The decrease in the responsive search score, which is the total number of sections on which the eyes fixed in response to questioning in a comparison task, was significantly correlated with the decreased gray matter in the right frontal eye field (rFEF) including the right supplementary eye field (rSEF), right parietal eye field (rPEF), and right inferior frontal region. These results suggest that disturbance in exploratory eye movement in schizophrenia spectrum patients may be related to neural network dysfunction in FEF, SEF and PEF, which are the eye movement related areas, and in the inferior frontal region that may be related to information organization.

High‐resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry

High-resolution manometry (HRM) is a recent development in oesophageal measurement; its value in the clinical setting remains a matter of controversy. (i) We compared the accuracy with which bolus transport could be predicted from conventional manometry and HRM. (ii) The clinical value of HRM was assessed in a series of patients with endoscopy-negative dysphagia in whom conventional investigations had been non-diagnostic. (i) Control subjects and patients with endoscopy-negative dysphagia underwent concurrent HRM and video-fluoroscopy. Ninety-five records were reviewed using HRM with spatiotemporal plot and conventional line plots of the pressure data derived from the same recording. (ii) The HRM and notes of patients with endoscopy-negative dysphagia and abnormal bolus transport were analysed to identify additional information provided by the new technique. (i) Receiver operating characteristic analysis demonstrated that HRM predicts the presence of abnormal bolus transport more accurately than conventional manometry. (ii) HRM identified clinically important motor dysfunction not detected by manometry and radiography. These included localized disturbances of peristalsis and abnormal movement of the lower oesophageal sphincter during oesophageal spasm. The HRM predicts bolus movement more accurately than conventional manometry and identifies clinically relevant oesophageal dysfunction not detected by other investigations including conventional manometry.

Huntington Disease: A Case Study of Early Onset Presenting as Depression

Huntington disease is a dominantly inherited, neurodegenerative disease characterized by choreiform movement disturbances and dementia, usually with adult onset. The rare juvenile-onset Huntington disease differs from the adult phenotype. A case presenting twice, at age 10 with all the signs of a major depression and age 14 with mutism and rigidity, is reported. Meanwhile, the father developed the adult variant of Huntington disease. The boy's diagnosis was confirmed by molecular genetic analysis and magnetic resonance imaging. It is important to be aware of hereditary conditions such as Huntington disease and to provide family counseling before genetic testing and after the diagnosis is confirmed.

Autism: mind and brain

Introduction 1. Understanding autism: insights from mind and brain 2. A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans Asperger and his team at the University Children's Hospital, Vienna 3. Identifying neurocognitive phenotypes in autism 4. Why is joint attention a pivotal skill in autism? 5. Does the perception of moving eyes trigger reflexive visual orienting in autism? 6. The pathogenesis of autism: insights from congenital blindness 7. The enactive mind, or from actions to cognition: lessons from autism 8. The systemizing quotient: an investigation of adults with Asperger syndrome or high-functioning autism and normal sex differences 9. Towards an understanding of the mechanisms of weak central coherence effects: experiments in visual configural learning and auditory perception 10. Disentangling weak coherence and executive dysfunction: planning drawing in autism and attention-deficit/hyperactivity disorder 11. Autism and movement disturbance 12. Investigating individual differences in brain abnormalities in autism 13. The role of the fusiform face area in social cognition: implications for the pathobiology of autism

Lower limb motor restlessness in Asperger's disorder, measured using actometry

The movement disturbances and brain imaging findings in Asperger's disorder (AD) suggest a dopaminergic deficit in movement regulation. Movement disorders of different etiologies have been quantified and specified with actometry. We compared 10 AD patients with 10 healthy controls, measuring their rest-activities by actometry. The lower limb motor activity was significantly higher in the AD group. They also displayed a rhythmic, periodic movement pattern similar to akathisia. These findings suggest a hypothesis of idiopathic akathisia and a special sensitivity to adverse effects of neuroleptic drugs.

Eshkol-Wachman movement notation in diagnosis: the early detection of Asperger's syndrome.

The diagnostic criteria of Asperger's syndrome (AS), considered a part of the autistic spectrum disorder, are still unclear. A critical marker, which distinguishes AS from autism, is the presence of language. The ability of a child with AS to acquire and use language early results in the fact that AS usually is diagnosed much later than autism. Autism is not usually diagnosed until around the age of 3, whereas AS usually is not diagnosed until the child is 6 or 7 years of age. In the present article, using Eshkol-Wachman movement notation, we present evidence that abnormal movement patterns can be detected in AS in infancy. This finding suggests that AS can be diagnosed very early, independent of the presence of language. As shown earlier by us, almost all of the movement disturbances in autism can be interpreted as infantile reflexes "gone astray"; i.e., some reflexes are not inhibited at the appropriate age in development, whereas others fail to appear when they should. This phenomenon appears to apply to AS as well. Based on preliminary results, a simple test using one such reflex is proposed for the early detection of a subgroup of children with AS or autism.

Hématome orbitaire spontané chez l’adulte: À propos d’un cas

Spontaneous orbital hematoma is uncommon, especially in adults. It produces proptosis which progress rapidly and is often associated with ocular movement disturbance. The Authors report a case of spontaneous orbital hematoma in a 45-year-old woman, who had had no previous disease and had experienced sudden onset diplopia associated with moderate proptosis and pain in her right orbit. The diagnosis of orbital hematoma was made by computed tomographic scan. Further investigations revealed arterial hypertension. After a needle aspiration of this hematoma, proptosis resolved, ocular movement began to improve as well as visual acuity. Orbital hematoma revealing arterial hypertension is exceptional. It could be associated with ocular and orbital complications that lead the patient to consult an ophthalmologist. The diagnosis is based essentially on radiology. The other causes of orbital process, inflammation, tumor or vascular malformation, should be considered in the differential diagnosis. Therapeutic management could require surgical evacuation when visual function is compromised (compressive optic neuropathy).

Decline of Vertical Gaze and Convergence with Aging

Background: Disturbance of vertical eye movement and ocular convergence is often observed in elderly people, but little is known about its frequency. Objective: The purpose of this study was to investigate age-associated changes in vertical eye movement and convergence in healthy elderly people, using a digital video camera system. Methods: We analyzed vertical eye movements and convergence in 113 neurologically normal elderly subjects (mean age 70 years) in comparison with 20 healthy young controls (mean age 32 years). The range of vertical eye movement was analyzed quantitatively and convergence was analyzed qualitatively. Results: In the elderly subjects, the angle of vertical gaze decreased with advancing age and it was significantly smaller than that of the younger subjects. The mean angle of upward gaze was significantly smaller than that of downward gaze for both young and elderly subjects. Upward gaze impairment became apparent in subjects in their 70s, and downward gaze impairment in subjects in their 60s. Disturbance in convergence also increased with advancing age, and was found in 40.7% of the elderly subjects. Conclusion: These findings indicate that the mechanisms of age-related change are different for upward and downward vertical gaze. Digital video camera monitoring was useful for assessing and monitoring eye movements.

Impairment of motor function after frontal lobe resection with preservation of the primary motor cortex

Clinical course and characteristics of the motor deficits were investigated in patients who underwent surgical resection of the frontal lobe for tumorous lesions. The extent of resection was classified into four groups. In Group A, resection was limited within the area above the superior frontal sulcus and posterior to a line vertical to the AC-PC line at the AC (VCA line). Resection was extended anterior to the VCA line in Group B or below the superior frontal sulcus in Group C. In Group D, resection was extended to both of these two boundaries. In results, permanent and severe motor deficit is rarely induced when resection of the frontal lobe is limited to only the SMA proper (corresponding roughly to Group A), the SMA proper and pre-SMA (corresponding roughly to Group B), or the SMA proper and premotor cortex (corresponding roughly to Group C), insofar as the primary motor cortex is preserved. Disturbance in fine movements of the upper extremity is frequently induced for the long term when wide areas of the SMA proper, pre-SMA as well as premotor cortex are resected all together (corresponding roughly to Group D).

Disturbances in programming goal‐directed arm movements in children with ADHD

We investigated in children with attention‐deficit‐hyperactivity disorder (ADHD) the ability to programme and execute goal‐directed arm movements. The sample consisted of 25 males with ADHD (mean age 11 years 6 months, SD1 year 11 months, range 8 to 15 years) and 25 age‐matched typically developing males. The children moved a cursor on a screen by moving a hand‐held indicator on a horizontal digitizing tablet. Start and target positions on the screen were always visible during the movement. The screen cursor, however, could either be visible throughout the movement (visual feedback) or blanked at movement initiation (without visual feedback). Analysis showed that movement control was impaired in children with ADHD and that their problems were especially pronounced during the without‐visual‐feedback condition. In this condition, the children with ADHD exhibited large end‐point errors and prolonged movement durations. As there can be no visual corrections of the movement during this condition, results indicate poorer motor programming in children with ADHD. Moreover, children with ADHD performed jerky movements and showed a reduced capacity to select a movement speed that met with the accuracy demands of the movement.

Smooth pursuit neck torsion test in whiplash-associated disorders: relationship to self-reports of neck pain and disability, dizziness and anxiety

The smooth pursuit neck torsion test is thought to be a measure of neck afferent influence on eye movement control and is useful in assessing subjects with whiplash, especially those complaining of dizziness. Nevertheless, it is not known whether impairments identified relate only to abnormal cervical afferentation or are influenced by levels of anxiety or neck pain. A prospective, 3-group, observational design. One hundred subjects with persistent whiplash (50 complaining of dizziness, 50 not complaining of dizziness) and 50 healthy controls. The smooth pursuit neck torsion test was performed and analysed taking into account subjects' reported levels of pain, anxiety and dizziness. The results confirm that there are significant (p<0.01) differences in the smooth pursuit neck torsion test between subjects with persistent whiplash both with dizziness (mean 0.11) and without dizziness (mean 0.07) compared with healthy control subjects (mean 0.01). The results suggest that the test is not influenced by a patients' level of anxiety, but may be influenced by both nocioceptive and proprioceptive factors. The results provide further evidence of the usefulness of the smooth pursuit neck torsion test to identify eye movement disturbances in patients with whiplash, which are likely to be due to disturbed cervical afferentation.

Disturbances in programming goal-directed arm movements in children with ADHD.

We investigated in children with attention-deficit-hyperactivity disorder (ADHD) the ability to programme and execute goal-directed arm movements. The sample consisted of 25 males with ADHD (mean age 11 years 6 months, SD 1 year 11 months, range 8 to 15 years) and 25 age-matched typically developing males. The children moved a cursor on a screen by moving a hand-held indicator on a horizontal digitizing tablet. Start and target positions on the screen were always visible during the movement. The screen cursor, however, could either be visible throughout the movement (visual feedback) or blanked at movement initiation (without visual feedback). Analysis showed that movement control was impaired in children with ADHD and that their problems were especially pronounced during the without-visual-feedback condition. In this condition, the children with ADHD exhibited large end-point errors and prolonged movement durations. As there can be no visual corrections of the movement during this condition, results indicate poorer motor programming in children with ADHD. Moreover, children with ADHD performed jerky movements and showed a reduced capacity to select a movement speed that met with the accuracy demands of the movement.

A quantitative measure of postural sway deficits in schizophrenia

Clinicians rely on observational methods to assess obvious signs of postural abnormalities in schizophrenia, yet subtle signs of postural deficits may go unnoticed. Posture is controlled, in large part, by the cerebellum, which has been implicated in numerous reports of structural and functional deficits in schizophrenia. Given the possibility of an underlying disruption of cerebellar function in schizophrenia, this study used an objective, quantitative measure to assess the magnitude of postural stability in this disorder. A total of 36 schizophrenia patients and 36 non-psychiatric age-matched controls stood on a pressure-sensitive platform that recorded shifts in weight (body sway) through pressure points in the feet. Patients demonstrated more postural sway than did healthy controls ( p<0.01). When patients with noticeable signs of tardive dyskinesia were removed from analyses, group differences remained ( p<0.01). There was no significant correlation between neuroleptic medication level and degree of postural sway ( r=0.16, p=0.37). These results indicate that patients with schizophrenia have subtle, yet quantifiable, disturbances in the control of posture and balance. Quantitative measures of postural sway may provide a more sensitive means of detecting disturbances of movement than do standard clinical observations alone.

P.1.138 Eye movement disturbances in patients with bipolar illness

P.1.138 Eye movement disturbances in patients with bipolar illness

Developmental Coordination Disorder

For the last 100 years, poor motor coordination in children has been recognized as a developmental problem.1 As early as 1937, these children were classified as “clumsy.”1 Since then, other terms such as “motorically awkward,” “motor impaired,” and “physically awkward” have been used to describe these children, and the terms “developmental apraxia” and “perceptual motor difficulties” have been used to characterize this developmental problem.2,3 Since the 1994 International Consensus Conference on Children and Clumsiness, the term “developmental coordination disorder” (DCD) has been used to describe the condition of children with motor incoordination.1,4 The purpose of this article is to provide the following information about DCD: (1) definition, (2) prevalence, (3) etiology, (4) discussion regarding the difficulties in classifying these children, (5) common characteristics, (6) long-term prognosis, and (7) brief review of treatment approaches. Developmental coordination disorder , a chronic and usually permanent condition found in children, is characterized by motor impairment that interferes with the child's activities of daily living and academic achievement.3,5 In order for a child to be diagnosed with DCD, these motor impairments must negatively affect some other aspect of his or her life.6 Impairment alone, however, does not qualify a child for the diagnosis of DCD; the motor impairment must not be caused by or have the symptoms of an identifiable neurological problem.2,5 That is, the child must not have any disturbances of muscle tone (ataxia or spasticity), sensory loss, or involuntary movements. If mental retardation is present, the testable IQ of the child must be greater than 70 and the motor impairments must be greater than what would normally be expected for children with mental retardation.5 Finally, a child diagnosed with DCD must not meet the criteria for a …

Protein labeling reactions in electrochemical microchannel flow: Numerical simulation and uncertainty propagation

This paper presents a model for two-dimensional electrochemical microchannel flow including the propagation of uncertainty from model parameters to the simulation results. For a detailed representation of electroosmotic and pressure-driven microchannel flow, the model considers the coupled momentum, species transport, and electrostatic field equations, including variable zeta potential. The chemistry model accounts for pH-dependent protein labeling reactions as well as detailed buffer electrochemistry in a mixed finite-rate/equilibrium formulation. Uncertainty from the model parameters and boundary conditions is propagated to the model predictions using a pseudo-spectral stochastic formulation with polynomial chaos (PC) representations for parameters and field quantities. Using a Galerkin approach, the governing equations are reformulated into equations for the coefficients in the PC expansion. The implementation of the physical model with the stochastic uncertainty propagation is applied to protein-labeling in a homogeneous buffer, as well as in two-dimensional electrochemical microchannel flow. The results for the two-dimensional channel show strong distortion of sample profiles due to ion movement and consequent buffer disturbances. The uncertainty in these results is dominated by the uncertainty in the applied voltage across the channel.

Rett Syndrome -- an update.

Rett syndrome is a progressive, usually sporadic and rarely familial, disabling neurodevelopmental disorder with onset in early childhood presenting clinically with mental retardation, behavioral changes, late movement disturbances, loss of speech and hand skills, ataxia, apraxia, irregular breathing with hyperventilation while awake, and frequent seizures. It occurs almost exclusively in females with an estimated prevalence of 1 in 10-22000 births and is considered a manifestation of defective brain maturation caused by dominant mutation of the MeCP2 gene encoding the transcriptional repressor methyl-CpG-binding protein 2 related to the Xq28 locus. Although many different mutations of this protein are being studied in humans and in mice, the molecular pathogenesis of this disorder remains unclear. Electroencephalography is abnormal in the final stages of the syndrome. Neuroimaging showing brain atrophy may be required for differential diagnosis that includes neurodegenerative and metabolic disorders. Neuropathology shows decreased brain growth and reduced size of individual neurons, with thinned dendrites in some cortical layers and abnormalities in substantia nigra (decreased neuromelanin content), suggestive of deficient synaptogenic development, probably starting before birth. Neurometabolic changes include reduced levels of dopamine, serotonin, noradrenalin, choline acetyltransferase (ChAT), nerve growth factors, endorphines, glutamate, and other amino acids and their receptor levels in brain. Current treatment includes symptomatic, anticonvulsive and physiotherapy.

Surgery of Parkinson's disease: inclusion criteria and follow-up.

Parkinson's disease (PD) is a progressive disturbances of movement that affects mainly the motor system. Prolonged pharmacological administration may result in insufficient control of symptoms and significant side effects. Deep brain stimulation (DBS), targeted at the STN, is a recent surgical procedure that, according to the symptoms response, allows modification of stimulation parameters; its effects are also reversible. In this paper management of surgical patients is reported. It includes patient selection, inclusion and exclusion criteria, postoperative clinical protocol. The evaluation rating scale such as UPDRS, Dyskinesias Rating Scale and Self-Reporting Questionnaire usually administrated on PD patients are analyzed. Surgical inclusion criteria are (1) idiopathic PD, (2) IV or V Hoehn-Yahr stage, (3) severe motor disability, and (4) no dementia or psychiatric abnormalities. Postoperative clinical protocol is analyzed and parameter of stimulation after surgery and at the follow up are reported. Generally DBS allows an improvement of rigidity and tremor; bradykinesia also improves with high frequency stimulation. Results obtained by continuous stimulation show a mean improvement of UPDRS of about 60% and a significant reduction in the drug intake.