Motor Phenomena Research Articles

A case of differential diagnosis of REM sleep behavior disorder and sleep-related hypermotor epilepsy

Aim. To describe a clinical case of differential diagnostics of motor phenomena during sleep. Materials and methods. Patient B., 37 years old. Visit to a somnologist at the University Clinic. Complaints were mainly made by the patient’s wife, since the patient himself does not remember these episodes. According to the wife, sudden sweeping movements of the arms and legs, incoherent speech are noted during sleep, then the patient gets up, can grab his hands, behaves aggressively, shifts things. These complaints have been noted for more than 10 years, with a gradual worsening of symptoms. A neurologist at the place of residence suggested a possible epileptic nature of these episodes,but no further examination was carried out. Results. From a semiological point of view, motor phenomena during sleep can imitate epileptic seizures, parasomnias, rapid eye movement behavior disorders, and normal sleep motor phenomena such as fragmentary sleep myoclonus, periodic limb movements, bruxism, etc. A differential diagnostic search is provided, a comparative characteristic of motor phenomena during sleep and wakefulness is given, as well as a scale of frontal epilepsy and parasomnia, which can help the doctor in making the correct diagnosis. Conclusion. Conducting a comprehensive examination of the patient and clarifying the clinical diagnosis made it possible to choose the correct management tactics, avoid unjustified prescription of antiepileptic drugs, and reduce emotional stress in the family due to the ambiguity of the manifestations of night motor phenomena. The established clinical diagnosis allows monitoring the patient in terms of the possible debut of a neurodegenerative disease.

Early Polytherapy for Probably Benzodiazepine Refractory Naïve Status Epilepticus (Stage 1 Plus).

Stage 1 Plus is defined here as a naïve, previously untreated, status epilepticus (SE) that is probably refractory to Benzodiazepines (BDZ). These cases include not only prolonged SE as previously proposed by the author (SE lasting > 10 min) but also other cases notoriously associated with BDZ refractoriness such as the absence of prominent motor phenomena and acute etiology (especially primary central nervous system etiology). Interestingly, the absence of prominent motor phenomena as is the case of non convulsive SE might implicitly fall in the category of prolonged SE due to the delay in recognition and treatment. Future studies should help identify other factors associated with BDZ refractoriness, therefore widening the definition of Stage 1 Plus. The appropriate timing for defining prolonged SE may also differ depending on different etiology. Consequently, in future tailored models of SE, the definition of prolonged SE could be enhanced by defining it for a longer duration than Tx, a time point that changes based on different etiologies (x), Tx being much shorter than 10 min in acute etiologies. These cases of naïve probably BDZ refractory SE (Stage 1 Plus) might require a different approach: combined polytherapy from the start. The objective of this review is to provide pathophysiological and pre-clinical evidence, mostly from animal studies, for the different approach of combined polytherapy from the start for those cases of SE falling in the definition of Stage 1 Plus.

Voluntary and involuntary motor behaviours in the varieties of religious experience

Abstract Religion is a widespread feature of human life. Religions typically include both distinctive varieties of experience, and also a set of foundational beliefs. An additional, but often overlooked, part of many religions is their expression through specific actions, which we here designate religious motor behaviours. Here we describe these religious motor behaviours, and offer a taxonomy based on the conceptual schemes of movement neuroscience and neurology. Thus, religious rituals include both behaviours characterised by decreased motor output (e.g., ritualistic silence), and behaviours characterised by increased motor output (e.g., ritual dances). Neurology often also distinguishes between movements that are experienced as voluntary or involuntary. We show that this same distinction can also apply to religious experiences, since these may be characterised either by a heightened sense of personal control, or a sense of being controlled by an external, divine source. We then use these conceptual structures of movement neuroscience to investigate examples from a wide range of religious contexts. We thereby categorise religious motor behaviours into different classes, focussing on specific examples: repetitive ritual actions; motor behaviours where the experience of volition is altered, such as automatisms; and possession-like states. We suggest that a scientific approach to these behaviours should include their predominant phenomenological presentation, the accompanying subjective experience of volition, and the underlying neurocognitive mechanisms. This investigation shows rich parallels between religious motor behaviours and motor behaviours observed in neurological disorders, including those that present with functional neurological symptoms. Our approach does not and should not pathologise religious motor behaviours, but rather draws attention to a rich set of non-clinical motor phenomena that highlight important social, cultural and psychological elements of human movement control. Movement neuroscience and religious activity have unexplored overlaps and can usefully learn from each other.

Evaluating the Differential Effects of Dopamine Agonists and Clonazepam on Large Muscle Group Movements in Restless Legs Syndrome.

This study aimed to investigate the effect of dopamine agonists (DA) and Clonazepam on Large Muscle Group Movements during sleep (LMM), a distinct motor phenomenon, in Restless Legs Syndrome (RLS). A retrospective analysis was conducted on 51 drug-free adult patients with RLS, divided into three groups: 33 received a DA (pramipexole or ropinirole), 15 received clonazepam, and 18 received a placebo. Each patient underwent two consecutive nocturnal polysomnographic (PSG) recordings: one baseline and one following treatment administration. LMM and periodic leg movements during sleep (PLMS) were scored. Differences between groups were analyzed using ANCOVA, with the International Restless Legs Syndrome Study Group severity scale as a covariate, and within-group changes were assessed using paired t-tests. At baseline, no significant difference in LMM or PLMS was observed between groups. Following treatment, DA significantly reduced PLMS and periodicity indexes but did not significantly alter LMM indexes, except for a small increase in LMM duration. The placebo group exhibited a significant decrease in LMM index during the second night, potentially reflecting a first-night effect (FNE). Clonazepam did not significantly affect either PLMS or LMM. DA effectively reduced PLMS but did not significantly impact LMM, suggesting that LMM may involve different neurophysiological mechanisms. The potential FNE observed in the placebo group underscores the need for careful consideration of adaptation effects in sleep studies. Future research should explore alternative or adjunctive therapies targeting LMM and residual sleep disturbances in RLS.

Validity and reliability of the Turkish version of the Innsbruck RBD-9 diagnostic inventory (IRBD-9-TR).

Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is characterized by loss of the normal atonia of REM sleep accompanied by repetitive motor and behavior phenomena of dream content. To evaluate the reliability and validity of the Turkish version of the original form of the Innsbruck Rapid Eye Movement Sleep Behavior Disorder Diagnostic Inventory (IRBD-9) scale (IRBD-9-TR) and ensure that this screening test can be easily used in the Turkish language. The present is a multicenter and prospective study involving 184 patients: 51 with iRBD and 133 healthy controls. The iRBD patients were not diagnosed before submitted to video polysomnography (vPSG) and filling out the IRBD-9-TR. The optimal cut-off value for the IRBD-9-TR symptom score was of 0.28, with a sensitivity of 0.941 and a specificity of 0.947, and 94.4% of the patients were correctly diagnosed. The rotated factor loadings for the diagnostic accuracy of each individual question showed that the short version of the IRBD-9-TR (questions 1, 2, 3, 6, and 8) presented higher specificity and excellent discrimination of iRBD patients from healthy controls. The Cronbach's α coefficient for the symptom section of the IRBD-9-TR was of 0.857, and the Kappa coefficient, of 0.885. The short version of the IRBD-9-TR presents good validity and reliability to be used as a screening test to assess iRBD patients. It is convenient and potentially useful in both outpatient clinical and epidemiologic research settings.

Ictal SPECT Imaging Findings in Parkinson's Disease with Rapid Eye Movement Sleep Behavior Disorder.

Rapid eye movement sleep behavior disorder (RBD) is an established prodrome and symptom of synucleinopathies. The pathophysiology of this disorder has been well studied but there is a lack of functional imaging data to illustrate the dysfunction in vivo. We aimed to investigate the functional changes of RBD, by performing ictal REM sleep SPECT, comparing subjects with Parkinson's Disease (PD) and evidence of RBD to subjects with PD and no RBD. Participants underwent a targeted clinical assessment, followed by video polysomnography (vPSG). Ictal 99mTc-HMPAO SPECT was performed by injecting the tracer during vPSG confirmed REM sleep in seven cases (PD with RBD) and five controls (PD without RBD). Voxel-wise, whole brain regional relative perfusion changes between both groups were assessed using statistical parametric mapping. No difference in relative regional brain perfusion was demonstrated at a family wise error corrected p-value of 0.05 between the case and control groups. At an uncorrected P-value of <0.01, combined with a cluster extent threshold of 300 voxels, four clusters of increased perfusion were identified in the case group compared to the control group. The clusters were seen in the motor, somatosensory association, and prefrontal cortices. The reverse contrast did not show any significant clusters. Increased perfusion of the motor cortex is in keeping with previous publications and motor phenomena seen in RBD. However, clusters included additional cortical regions. These findings demonstrate RBD as a wider sleep network dysfunction, rather than a manifestation of simple pontomedullary interruption.

Beyond sleep disturbance: Structured analysis of sleep habits, chronotype and sleep disorders in adults with glioma. A cross-sectional exploratory study

ObjectiveTo evaluate the prevalence of the whole spectrum of sleep disorders as well as sleep related motor phenomena and chronotype in adults with glioma and to analyze their link with tumor localization and grade. MethodsThis prospective cross-sectional exploratory study included 79 patients with glioma irrespective of localization and type. Sleep habits, sleep disorders of any kind and chronotype were evaluated in structured interviews using validated disease specific scales. ResultsFor the whole sample the PSQI score was not increased, and specific insomnia severity was low. Patients with frontal tumors had worse sleep quality according to the PSQI and were more often allocated to worse ISI categories. The prevalence of EDS was markedly increased (ESS >10 in 17.7 % of patients), and 43 % scored ≥3 on STOPBANG. The predominant chronotype was a moderate morning type (54.4 %). Seven patients fulfilled RLS criteria and 9 fulfilled criteria for probable RBD, a self-report of hypnic jerks and nightmares were most common (45.6 % and 31.6 % respectively). According to regression analyses tumor relapse, depressive symptoms and fatigue determined poor sleep quality (Nagelkerke's R2: 0.511 p < 0.001), while performance-status, fatigue and anti-seizure medication contributed to excessive daytime sleepiness (Nagelkerke's R2: 0.600, p < 0.001), and age, BMI, and tumor localization contributed to the risk of sleep apnea (Nagelkerke's R2: 0.556, p < 0.001). ConclusionsThis study shows the broad range of sleep symptoms in glioma patients, and a complex association with tumor grade and localization. This underlines the need for a comprehensive evaluation of sleep related symptoms in glioma patients.

The Possible Involvement of Glucagon-like Peptide-2 in the Regulation of Food Intake through the Gut-Brain Axis.

Food intake regulation is a complex mechanism involving the interaction between central and peripheral structures. Among the latter, the gastrointestinal tract represents one of the main sources of both nervous and hormonal signals, which reach the central nervous system that integrates them and sends the resulting information downstream to effector organs involved in energy homeostasis. Gut hormones released by nutrient-sensing enteroendocrine cells can send signals to central structures involved in the regulation of food intake through more than one mechanism. One of these is through the modulation of gastric motor phenomena known to be a source of peripheral satiety signals. In the present review, our attention will be focused on the ability of the glucagon-like peptide 2 (GLP-2) hormone to modulate gastrointestinal motor activity and discuss how its effects could be related to peripheral satiety signals generated in the stomach and involved in the regulation of food intake through the gut-brain axis. A better understanding of the possible role of GLP-2 in regulating food intake through the gut-brain axis could represent a starting point for the development of new strategies to treat some pathological conditions, such as obesity.

Machine learning model comparison for freezing of gait prediction in advanced Parkinson's disease.

Freezing of gait (FOG) is a paroxysmal motor phenomenon that increases in prevalence as Parkinson's disease (PD) progresses. It is associated with a reduced quality of life and an increased risk of falls in this population. Precision-based detection and classification of freezers are critical to developing tailored treatments rooted in kinematic assessments. This study analyzed instrumented stand-and-walk (SAW) trials from advanced PD patients with STN-DBS. Each patient performed two SAW trials in their OFF Medication-OFF DBS state. For each trial, gait summary statistics from wearable sensors were analyzed by machine learning classification algorithms. These algorithms include k-nearest neighbors, logistic regression, naïve Bayes, random forest, and support vector machines (SVM). Each of these models were selected for their high interpretability. Each algorithm was tasked with classifying patients whose SAW trials MDS-UPDRS FOG subscore was non-zero as assessed by a trained movement disorder specialist. These algorithms' performance was evaluated using stratified five-fold cross-validation. A total of 21 PD subjects were evaluated (average age 64.24 years, 16 males, mean disease duration of 14 years). Fourteen subjects had freezing of gait in the OFF MED/OFF DBS. All machine learning models achieved statistically similar predictive performance (p < 0.05) with high accuracy. Analysis of random forests' feature estimation revealed the top-ten spatiotemporal predictive features utilized in the model: foot strike angle, coronal range of motion [trunk and lumbar], stride length, gait speed, lateral step variability, and toe-off angle. These results indicate that machine learning effectively classifies advanced PD patients as freezers or nonfreezers based on SAW trials in their non-medicated/non-stimulated condition. The machine learning models, specifically random forests, not only rely on but utilize salient spatial and temporal gait features for FOG classification.

Exploring the Genetic Landscape of Chorea in Infancy and Early Childhood: Implications for Diagnosis and Treatment.

Chorea is a hyperkinetic movement disorder frequently observed in the pediatric population, and, due to advancements in genetic techniques, an increasing number of genes have been associated with this disorder. In genetic conditions, chorea may be the primary feature of the disorder, or be part of a more complex phenotype characterized by epileptic encephalopathy or a multisystemic syndrome. Moreover, it can appear as a persistent disorder (chronic chorea) or have an episodic course (paroxysmal chorea). Managing chorea in childhood presents challenges due to its varied clinical presentation, often involving a spectrum of hyperkinetic movement disorders alongside neuropsychiatric and multisystemic manifestations. Furthermore, during infancy and early childhood, transient motor phenomena resembling chorea occurring due to the rapid nervous system development during this period can complicate the diagnosis. This review aims to provide an overview of the main genetic causes of pediatric chorea that may manifest during infancy and early childhood, focusing on peculiarities that can aid in differential diagnosis among different phenotypes and discussing possible treatment options.

Understanding the Micro, Meso, and Macro Worlds of User Experience

Overview: The article presents a framework for holistically understanding a product’s user experience (UX). Informed by the author’s experience as a UX researcher and manager at Google, it is intended to demystify the competencies that UX researchers can bring to organizations to help propel successful innovation. The framework outlines how users simultaneously inhabit three nested scale dimensions of experience with products (Worlds of UX) and demonstrates that engendering user-centered thinking within organizations requires integrating knowledge from each. The Micro World of UX comprises moment-by-moment experiences: direct sensory and motor phenomena, tasks, tools, and decision-making moments users encounter when using a product to accomplish lower-order goals. The Meso World of UX consists of user journeys: sequences of lower-order goals that form pathways toward higher-order goals. The Macro World of UX is the realm of user–product relationships: how users experience successive user journeys and how user segments orient toward products longitudinally.

The risk of unprovoked seizure occurrence after status epilepticus in adults.

Status epilepticus (SE) may lead to long-term consequences. This study evaluated the risk and predictors of seizure occurrence after SE, with a focus on SE due to acute symptomatic etiologies. Prospectively collected data about adults surviving a first non-hypoxic SE were reviewed. The outcome was the occurrence of unprovoked seizures during the follow-up. Kaplan-Meier survival curve analysis and log-rank test were used to analyze the time to seizure occurrence and determine the statistical significance between etiological groups. Three subcategories within acute etiology were considered according to the presence of the following: (1) structural lesion (acute-primary); (2) brain involvement during systemic disorders (acute-secondary); and (3) drug or alcohol intoxication/withdrawal (acute-toxic). Cox proportional hazards model was adopted to estimate hazard ratios (HRs) with the 95% confidence intervals (CIs). Two hundreds fifty-seven individuals were included. Fifty-four subjects (21.0%) developed seizures after a median of 9.9 (interquartile range 4.3-21.7) months after SE. The estimated 1-, 2-, and 5-year rates of seizure occurrence according to acute SE etiologies were 19.4%, 23.4%, and 30.1%, respectively, for acute-primary central nervous system (CNS) pathology; 2.2%, 2.2%, and 8.7%, respectively, for acute-secondary CNS pathology; and 0%, 9.1%, and 9.1%, respectively, for acute-toxic causes. Five-year rates of seizure occurrence for non-acute SE causes were 33.9% for remote, 65.7% for progressive, and 25.9% for unknown etiologies. In multivariate Cox regression model, progressive etiology (adjusted HR [adjHR] 2.27, 95% CI 1.12-4.58), SE with prominent motor phenomena evolving in non-convulsive SE (adjHR 3.17, 95% CI 1.38-7.25), and non-convulsive SE (adjHR 2.38, 95% CI 1.16-4.90) were independently associated with higher hazards of unprovoked seizures. Older people (adjHR .98, 95% CI .96-.99) and people with SE due to acute-secondary CNS pathology (adjHR .18, 95% CI .04-.82) were at decreased risk of seizure occurrence. SE carries a risk of subsequent seizures. Both the underlying cause and epileptogenic effects of SE are likely to contribute.

Ремиссии при периодической кататонии

At the current stage of the formation of concepts of endogenous psychoses, due to the change in the clinical paradigm – the expansion of the boundaries of catatonia to a level involving the inclusion of a wide range of periodically manifesting motor disorders (varying in severity), the study of remissions that form after attacks of periodic catatonia is of particular relevance. The aim of the study is to develop a typology of remissions formed after the onset of periodic catatonia attacks, which occur in the clinical space of schizophrenia and schizophrenic spectrum disorders (RSHS). Research methods: clinical and catamnestic (observation for more than 3 years after the onset of seizures), psychometric (BFCRS, SANS, GAF), statistical. The study material consisted of 30 patients diagnosed with schizophrenia and RSHS (ICD-10; DSM-5) who are under outpatient supervision after inpatient treatment of periodic catatonia attacks in departments 1 and 2 of the Federal State Budgetary Institution of the National Clinical Hospital. Results: within the framework of this study, a new approach to the systematics of remissions has been developed, which is based not only on remissions reflecting a certain stage in the development of the endogenous process (slowing down, stabilization, reduction of symptoms) and social and labor maladaptation, but also remissions, in the formation of which the dynamics of personality disorders participates. In accordance with this, 2 types of remissions are distinguished: 1) remissions with personalized motor phenomena – type of personality development (psychasthenic/hypochondriac circle), prolonged; 2) symptomatic remissions, with signs of ongoing course, with symptoms of catatonia mitis.

Post-hypoxic status epilepticus - A distinct subtype of status epilepticus with poor prognosis.

To evaluate the clinical outcome of patients with possible and definitive post-hypoxic status epilepticus (SE) and to describe the SE types in patients with definitive post-hypoxic SE. Patients with definitive or possible SE resulting from hypoxic brain injury after cardiac arrest (CA) were prospectively recruited. Intermittent EEG was used for the diagnosis of SE according to clinical practice. Two raters blinded to outcome analyzed EEGs retrospectively for possible and definitive SE patterns and background features (frequency, continuity, reactivity, and voltage). Definitive SE was classified according to semiology (ILAE). Mortality and Cerebral Performance Categories (CPC) score were evaluated 1 month after CA. We included 64 patients of whom 92% died. Among the survivors, only one patient had a good neurological outcome (CPC 1). No patient survived with a burst suppression pattern, low voltage, or electro-cerebral silence in any EEG. Possible or definitive SE was diagnosed in a median of 47 h (IQR 39-72 h) after CA. EEG criteria for definitive electrographic SE were fulfilled in 39% of patients; in 38% - for electroclinical SE and in 23% - for ictal-interictal continuum (IIC). The outcome did not differ significantly between the three groups. The only patient with good functional outcome belonged to the IIC group. Comatose non-convulsive SE (NCSE) without subtle motor phenomenon occurred in 20% of patients with definitive electrographic SE and outcome was similar to other types of SE. Possible or definitive SE due to hypoxic brain injury is associated with poor prognosis. The outcome of patients with electrographic SE, electroclinical SE, and IIC did not differ significantly. Outcome was similar in patients with definitive electrographic SE with and without prominent motor features.

Ketamine to Prevent Endotracheal Intubation in Adults with Refractory Non-convulsive Status Epilepticus: A Case Series.

Non-convulsive status epilepticus (NCSE) is defined as status epilepticus (SE) with no obvious motor phenomenon and is diagnosed based on electroencephalogram (EEG). Refractory SE (RSE) is the persistence of seizures despite treatment with an adequately dosed first-line and second-line agents. Although guidelines for convulsive RSE include third-line agents such as intravenous anesthetic drugs (midazolam, propofol, or barbiturates), the therapeutic approach to NCSE is not well outlined. Treatment with traditional anesthetics invariably includes endotracheal intubation, which is associated with significant adverse events. Comparatively, ketamine, a non-competitive N-methyl-D-aspartate receptor antagonist is not associated with significant cardiorespiratory depression and may help in avoiding intubation. In this case series, we describe our experience with the early use of intravenous ketamine as the first anesthetic agent in patients with refractory NCSE to avoid endotracheal intubation. We present a case series of nine patients managed in the Neurointensive Care Unit at a university-affiliated tertiary care hospital. The study was approved by the hospital and university institutional review boards and the requirement for informed consent was waived for retrospective analysis of existing data, per institutional policy. All cases of SE were identified from a prospective database, and a subsequent retrospective chart review identified all patients with a diagnosis of refractory NCSE in whom ketamine was used as the first anesthetic agent. The primary endpoint was the avoidance of endotracheal intubation while on ketamine infusion. The secondary endpoint was defined as cessation of both clinical and electrographic seizures recorded on continuous EEG within 24h of ketamine administration. A total of nine patients experiencing refractory NCSE were included in this case series, with a median age of 61 (range 26-72) years and seven patients were male. The primary endpoint, avoiding intubation, was achieved in five out of nine (55%)cases. Six patients experienced resolution of refractory NCSE with ketamine administration as the sole anesthetic agent. Four patients required endotracheal intubation and three patients had a failure of seizure cessation with ketamine. Hypersalivation and pneumonia were the most common ketamine associated adverse events. In non-intubated patients, no deaths occurred. One patient was discharged home, four to subacute rehabilitation, one to along term acute care hospital, and one patient to hospice. The use of ketamine as the primary anesthetic agent may be a reasonable option to avoid endotracheal intubation in a subset of patients with refractory NCSE. This study is limited by its small sample size, retrospective design, and reliance on information obtained from chartreview.

Exploring the Spectrum of RHOBTB2 Variants Associated with Developmental Encephalopathy 64: A Case Series and Literature Review.

Rho-related BTB domain-containing protein 2 (RHOBTB2) is a protein that interacts with cullin-3, a crucial E3 ubiquitin ligase for mitotic cell division. RHOBTB2 has been linked to early infantile epileptic encephalopathy, autosomal dominant type 64 (OMIM618004), in 34 reported patients. We present a case series of seven patients with RHOBTB2-related disorders (RHOBTB2-RD), including a description of a novel heterozygous variant. We also reviewed previously published cases of RHOBTB2-RD. The seven patients had ages ranging from 2 years and 8 months to 26 years, and all had experienced seizures before the age of one (onset, 4-12 months, median, 4 months), including various types of seizures. All patients in this cohort also had a movement disorder (onset, 0.3-14 years, median, 1.5 years). Six of seven had a baseline movement disorder, and one of seven only had paroxysmal dystonia. Stereotypies were noted in four of six, choreodystonia in three of six, and ataxia in one case with multiple movement phenotypes at baseline. Paroxysmal movement disorders were observed in six of seven patients for whom carbamazepine or oxcarbazepine treatment was effective in controlling acute or paroxysmal movement disorders. Four patients had acute encephalopathic episodes at ages 4 (one patient) and 6 (three patients), which improved following treatment with methylprednisolone. Magnetic resonance imaging scans revealed transient fluid-attenuated inversion recovery abnormalities during these episodes, as well as myelination delay, thin corpus callosum, and brain atrophy. One patient had a novel RHOBTB2 variant (c.359G>A/p.Gly120Glu). RHOBTB2-RD is characterized by developmental delay or intellectual disability, early-onset seizures, baseline movement disorders, acute or paroxysmal motor phenomena, acquired microcephaly, and episodes of acute encephalopathy. Early onsets of focal dystonia, acute encephalopathic episodes, episodes of tongue protrusion, or peripheral vasomotor disturbances are important diagnostic clues. Treatment with carbamazepine or oxcarbazepine was found to be effective in controlling acute or paroxysmal movement disorders. Our study highlights the clinical features and treatment response of RHOBTB2-RD.

Constipation in Parkinson's Disease.

Constipation is one of the most common gastrointestinal features of Parkinson's disease (PD), occurring in over 50% of all PD patients during the course of their disease. Furthermore, constipation is now recognized as an important, prodromal symptom and may predate the onset of the classical motor symptoms by decades. Thereafter, the prevalence and severity of constipation in PD tend to parallel the course of both motor and nonmotor phenomena such as cognitive decline and depression. Difficult defecation (obstructed defecation, dyssynergia) is the primary pathophysiology underlying constipation and likely reflects involvement by the PD process of one or more of the many skeletal muscle groups that are involved in effecting defecation. Management of constipation in PD may be complicated by several patient factors including dysphagia, cognitive impairment, depression, and weak sphincter tone. While the armamentarium available to those who treat constipation, in general, has expanded considerably in recent years, the evidence supporting any therapy in the management of this symptom in PD has remained slim.

Catatonia in the Structure of Affective and Schizoaffective Disorders of the Postpartum Period

Background: аt the present stage of psychiatry, within the framework of the dimensional paradigm, catatonia is considered as a transnosological entity that manifests within the clinical space of various affective and schizoaffective disorders. In the 21st century studies, devoted to the analysis of motor disorders that appear in the clinical space of postpartum affective and schizoaffective disorders, become increasingly relevant (J.Y. Lai, T.L. Huang, 2004; A. Nahar and et al., 2017; C. Kamau, 2017; L. Csihi and et al., 2022). However, research on this issue is very limited. The objective: the analysis of catatonic phenomenon, manifesting in the postpartum period, based on the observations of three clinical cases.Patients and methods: 3 clinical cases of patients, undergoing treatment in the clinical department of the FSBSI “Mental Health Research Centre” with established diagnoses of bipolar affective disorder (ICD-10: F31.1; 1 case) and schizoaffective disorder (ICD-10: F25.2; 2 cases) with a predominance of motor disorders in the clinical picture of the disease. The main method was clinical with the use of psychological examination and data from instrumental (EEG) diagnostics.Results: movement disorders registered in the structure of apathoanesthetic depressions within the exacerbation of bipolar affective disorder are represented by the phenomena of hypokinetic catatonia and act as an amplifier of affective disorders. Catatonic symptoms within the clinical space of schizoaffective disorders, are limited by manifestations of parakinetic catatonia, do not have a direct correlation with the structure and severity of affective disorders, and indicate an increase in the progredient endogenous process.Conclusion: the analysis of clinical observations testifies in favor of the heterogeneity of affective-catatonic states not only in terms of the structure of motor phenomena, but also in terms of the psychopathological profile of affective disorders.

A Reflection on Motor Overflow, Mirror Phenomena, Synkinesia and Entrainment.

In patients with movement disorders, voluntary movements can sometimes be accompanied by unintentional muscle contractions in other body regions. In this review, we discuss clinical and pathophysiological aspects of several motor phenomena including mirror movements, dystonic overflow, synkinesia, entrainment and mirror dystonia, focusing on their similarities and differences. These phenomena share some common clinical and pathophysiological features, which often leads to confusion in their definition. However, they differ in several aspects, such as the body part showing the undesired movement, the type of this movement (identical or not to the intentional movement), the underlying neurological condition, and the role of primary motor areas, descending pathways and inhibitory circuits involved, suggesting that these are distinct phenomena. We summarize the main features of these fascinating clinical signs aiming to improve the clinical recognition and standardize the terminology in research studies. We also suggest that the term "mirror dystonia" may be not appropriate to describe this peculiar phenomenon which may be closer to dystonic overflow rather than to the classical mirror movements.

Concurrent decoding of distinct neurophysiological fingerprints of tremor and bradykinesia in Parkinson's disease.

Parkinson's disease (PD) is characterized by distinct motor phenomena that are expressed asynchronously. Understanding the neurophysiological correlates of these motor states could facilitate monitoring of disease progression and allow improved assessments of therapeutic efficacy, as well as enable optimal closed-loop neuromodulation. We examined neural activity in the basal ganglia and cortex of 31 subjects with PD during a quantitative motor task to decode tremor and bradykinesia - two cardinal motor signs of PD - and relatively asymptomatic periods of behavior. Support vector regression analysis of microelectrode and electrocorticography recordings revealed that tremor and bradykinesia had nearly opposite neural signatures, while effective motor control displayed unique, differentiating features. The neurophysiological signatures of these motor states depended on the signal type and location. Cortical decoding generally outperformed subcortical decoding. Within the subthalamic nucleus (STN), tremor and bradykinesia were better decoded from distinct subregions. These results demonstrate how to leverage neurophysiology to more precisely treat PD.