Persistent Movement Disorders Research Articles

The Effect of Melatonin on Sleep Disorders in Children with Cerebral Palsy A Randomized Clinical Trial.

Cerebral palsy (CP) is one of the most common causes of serious physical disability in childhood and is a persistent movement disorder before the age of three. This disorder can negatively affect both the child and their family. In recent years, the use of melatonin as a safe, effective, and cheap drug has been expanding in improving the sleep disorders of these children. Therefore, this study aimed to investigate melatonin's effect on sleep disorders in children with CP. This double-blind clinical trial was conducted on children aged 2 to 12 years with CP who were referred to the pediatric neurology clinic for sleep problems. The participants were included in the study by convenience sampling. After obtaining informed consent from parents, patients were divided randomly into two intervention (melatonin) and control (placebo) groups. In the intervention group, patients received oral melatonin tablets, and in the control group, patients received a placebo (3 mg oral lactose) 30 minutes before going to sleep. The results of this study showed no significant relationship between age and gender with sleep disorders in children with CP (P>0.05). A significant effect of melatonin on sleep disorders was found in children with CP. The greatest effect of melatonin is the time required to start falling asleep. Melatonin was associated with decreased time needed to fall asleep and increased sleep duration. The results of the study demonstrated that sleep disorders are prevalent among children with CP. Therefore, proper and timely treatment of these children is crucial. According to the present study's findings, melatonin effectively improves the time of falling asleep and these children's sleep duration.

Hyperbaric oxygenation therapy in treatment of traumatic spinal cord injury: a pilot study

Spinal cord traumatic injury as resulting persistent movement and sensory disorders is one of the most disabling consequences of traumatic factor impact on the human body. Despite a large number of experimental and clinical studies aimed at developing methods for restoring lost functions, there is no acceptable solution to the problem. One of the promising areas in the treatment and rehabilitation of this category of patients is the use of hyperbaric oxygenation (HBO). Experimental models have shown that HBO has a neuroprotective effect in spinal cord injury, but the results of clinical application of the method are still controversial. Objective: to determine the effectiveness of HBO in the complex therapy of victims with traumatic spinal cord injury and the feasibility of further study of this area. Materials and Methods: Study design is a pilot observational retrospective “case – control”. The database of patients with spinal cord injury who were hospitalized at Romodanov Neurosurgery Institute in the period from 2010 to 2020 were used for the analysis. When selecting a control for each clinical case, the following factors were considered: gender, age, circumstances of injury, type of damage to the osteoligamentous apparatus, level of neurological deficit, degree of damage and compression of the spinal cord, time elapsed from the moment of injury to surgery. 28 "case ‒ control" pairs were analyzed. The main criterion for therapy effectiveness was the change in the functional class according to the ASIA scale. Results. Positive dynamics was registered in 57% of victims, including in the group of patients receiving HBO therapy - in 71%, in the control group - in 43%. HBO therapy in the postoperative period significantly affects the dynamics of regression of neurological disorders (p=0.0295). The odds ratio is 3.333 (95% confidence interval - 1.098‒10.116, p=0.0335). The calculation of the odds ratio, adjusted for additional analyzed factors, showed a more pronounced efficiency - 4.519 (95% confidence interval - 1.279‒15.962, p=0.0192). Conclusions. The obtained results indicate that usage of HBO as a method of complex therapy for traumatic spinal cord injury is promising for further study in order to determine the effectiveness of the method, the optimal timing of treatment initiation in the postoperative period and its duration.

A New Mixed Clustering-based Method to Analyze the Gait of Children with Cerebral Palsy

Cerebral palsy is a group of persistent central movement and postural developmental disorders, and restricted activity syndromes. This syndrome is caused by non-progressive brain damage to the developing fetus or infants. Cer... | Find, read and cite all the research you need on Tech Science Press

Management of Tardive Syndrome: Medications and Surgical Treatments.

Tardive syndrome (TS) is an iatrogenic, often persistent movement disorder caused by drugs that block dopamine receptors. It has a broad phenotype including movement (orobuccolingual stereotypy, dystonia, tics, and others) and nonmotor features (akathisia and pain). TS has garnered increased attention of late because of the Food and Drug Administration approval of the first therapeutic agents developed specifically for this purpose. This paper will begin with a discussion on pathogenesis, clinical features, and epidemiology. However, the main focus will be treatment options currently available for TS including a suggested algorithm based on current evidence. Recently, there have been significant advances in TS therapy, particularly with the development of 2 new vesicular monoamine transporter type 2 inhibitors for TS and with new data on the efficacy of deep brain stimulation. The discussion will start with switching antipsychotics and the use of clozapine monotherapy which, despite the lack of higher-level evidence, should be considered for the treatment of psychosis and TS. Anti-dyskinetic drugs are separated into 3 tiers: 1) vesicular monoamine transporter type 2 inhibitors, which have level A evidence, are approved for use in TS and are recommended first-choice agents; 2) drugs with lower level of evidence for efficacy including clonazepam, Ginkgo biloba, and amantadine; and 3) drugs that have the potential to be beneficial, but currently have insufficient evidence including levetiracetam, piracetam, vitamin B6, melatonin, baclofen, propranolol, zolpidem, and zonisamide. Finally, the roles of botulinum toxin and surgical therapy will be examined. Current therapies, though improved, are symptomatic. Next steps should focus on the prevention and reversal of the pathogenic process.

Persistent complex movement disorders in NMDA encehalitis: A case report in a child

A wide variety of movement disorders, often in combination, can be observed in children with anti-NMDAR encephalitis. A case of a 8 year old boy presenting as movement disorder, faciobrachial movements and seizures was diagnosed as NMDA encephalitis 3 years ago. CSF and serum NMDA antibodies were positive early in the course and early diagnosis could be made. The child deteriorated in spite of IVIGand methylprednisolone, needing ICU care and recovered gradually in 3-4 weeks after addition of Azathioprine. Prednisolone tapering doses and Azathioprine were continued as maintenance therapy and is still ongoing after three years There was gradual speech deterioration with loss of speech and the child developed a complex movement disorder, having multiple movement types, difficult to classify into the standard classification of movement disorders. The movements wax and wane with therapy but have not completely responded to maintenance Azathiprine and low dose steroids even after 3 years of therapy suggesting long term affection and disability due to complex movement disorders in NMDA encephalitis.

RE-KINECT, A REAL-WORLD, PROSPECTIVE TARDIVE DYSKINESIA SCREENING STUDY: AN EVALUATION OF BASELINE CHARACTERISTICS IN OLDER PATIENTS

Introduction Older age is a risk factor for developing tardive dyskinesia (TD), a persistent movement disorder associated with prolonged exposure to antipsychotics. In older patients, TD symptoms may appear after shorter antipsychotic treatment. RE-KINECT (NCT03062033), a real-world study of outpatients prescribed antipsychotics, was designed to identify the presence of drug-induced involuntary movements consistent with TD (i.e., “possible TD”) and to characterize the impact of these movements on health-related quality of life. Baseline data from RE-KINECT were analyzed to explore the patient experience of possible TD and how it affects functioning in older adults (≥55 years). Methods Adults with ≥3 months of lifetime exposure to antipsychotics and ≥1 psychiatric disorder were recruited. The presence of possible TD was based on clinicians’ observation and assessment of involuntary movements in 4 body regions (head/face, trunk/neck, upper extremities, and lower extremities). Patients were categorized into Cohort 1 (without visible movements or possible TD) or Cohort 2 (with visible movements and confirmed by clinician as consistent with possible TD). Baseline outcomes for all patients included demographics, clinical history, patient-reported health status (score range, 0 [“no health problems”] to 10 [“health as bad as you can imagine”]), and the patient-reported EuroQoL 5-Dimensional 5-Level questionnaire (EQ-5D-5L; domain score range, 1 [no problems or symptoms] to 5 [extreme problems or symptoms]). Clinicians also assessed the location and severity (ratings, “none”, “some”, or “a lot”) of abnormal movements in Cohort 2 patients. Exploratory statistical testing was conducted between older adults (≥55 years) in Cohorts 1 and 2. Results Of the 738 patients enrolled in the study, the results of those ≥55 years (N=300, 41%) are presented here. Within this subgroup, 114 (38%) had clinician-confirmed possible TD (Cohort 2) and 186 (62%) had no visible movements or had movements that were inconsistent with TD (Cohort 1). In Cohort 2 patients, the highest frequencies of severe abnormal movements (severity rating: “a lot”) were observed in the head/face (25%) and upper extremities (14%). Cohort 2 patients were less likely to be married, more likely to live in care homes, and were more likely to have longer lifetime exposure to antipsychotics than Cohort 1 patients (Table). More patients in Cohort 2 had schizophrenia or schizoaffective disorder, while those in Cohort 1 were more likely to have a mood disorder. Patients in Cohort 2 also had slightly higher mean EQ-5D-5L scores at baseline in four EQ-5D-5L domains, suggesting a somewhat greater impact on health-related quality of life, particularly in the domain of self-care. Conclusions Results from this real-world sample of older psychiatric outpatients suggest that the greater risk and severity of TD in this population may be associated with more limited support systems and reduced quality of life, which are separate from the effects of age itself. This research was funded by This research was fully funded by Neurocrine Biosciences, Inc.

ОЦЕНКА ЭФФЕКТИВНОСТИ МЕТОДИКИ ФИЗИЧЕСКОЙ РЕАБИЛИТАЦИИ С ИСПОЛЬЗОВАНИЕМ СОВРЕМЕННОГО ВЕРТИКАЛИЗАТОРА "IRIGO" ДЛЯ МУЖЧИН 55-60 ЛЕТ ПОСЛЕ ПЕРЕНЕСЕННОГО ИНСУЛЬТА

Rehabilitation treatment after stroke is an important link in the rehabilitation of patients and aims to: increase overall body tone; the production of active movements by means of an inhibition; prevention of pathological conditions: persistent movement disorders, contractures and ankylosis; the struggle with increased muscle tone and synkinesis; prevention of complications in connection with the forced lack of exercise; identification, restoration and compensation of motor skills. The study of the manifestation of motor disorders in patients with hemorrhagic stroke, leads to the conclusion that the early verticalization and exercises on the standing frame “Irigo” allow: activate the cardiovascular system; set an intense afferent relationship, which stimulates the ability of nerve cells to “retrain” and to a certain extent to take on the duties of the dead, compensate for their inaction; reduce the risk of secondary complications. On the basis of theoretical analysis of literature sources and results obtained after diagnostic tests, the authors developed a method of physical rehabilitation with the use of innovative tools and methods for men from 55 to 60 years after suffering a hemorrhagic stroke at the outpatient treatment stage. To assess the effectiveness of the developed technique for the rehabilitation of men after suffering a hemorrhagic stroke, the authors felt it appropriate to use the following tests of functional and musculoskeletal status: timed inspiratory capacity (the Stange test), a orthostatic test, a simplified Romberg test, goniometry of elbow joint, the test “the distance traveled in 1 minute”, test “the board with figures”.

Resting Tremor after Mild Head Injury: Case Report

AbstractOver the past few decades, it has been recognized that traumatic brain injury (TBI) may result in various movement disorders. However, moderate or mild TBI only rarely causes persistent post-traumatic movement disorders. In the present report, we describe a case of secondary tremor due to a mild head injury with a transitory loss of consciousness. A 26-year-old man developed an isolated rest tremor of the hands and legs without other neurologic signs. The interval between the head trauma and the onset of the symptoms was 4 months. Neuroimaging studies reveled gliosis in the lentiform nucleus. Haloperidol administration resulted in tremor reduction. A rest tremor, similar to essential tremor, can be a rare complication of head trauma. Haloperidol may be an effective and safe treatment modality for post-traumatic tremor. Further studies are needed to clarify the optimal drug for the treatment of post-traumatic tremor.

Chapter 30 - Movement disorders secondary to craniocerebral trauma

Over the past few decades it has been recognized that traumatic brain injury may result in various movement disorders. In survivors of severe head injury, post-traumatic movement disorders were reported in about 20%, and they persisted in about 10% of patients. The most frequent persisting movement disorder in this population is kinetic cerebellar outflow tremor in about 9%, followed by dystonia in about 4%. While tremor is associated most frequently with cerebellar or mesencephalic lesions, patients with dystonia frequently have basal ganglia or thalamic lesions. Moderate or mild traumatic brain injury only rarely causes persistent post-traumatic movement disorders. It appears that the frequency of post-traumatic movement disorders overall has been declining which most likely is secondary to improved treatment of brain injury. In patients with disabling post-traumatic movement disorders which are refractory to medical treatment, stereotactic neurosurgery can provide long-lasting benefit. While in the past the primary option for severe kinetic tremor was thalamotomy and for dystonia thalamotomy or pallidotomy, today deep brain stimulation has become the preferred treatment. Parkinsonism is a rare consequence of single head injury, but repeated head injury such as seen in boxing can result in chronic encephalopathy with parkinsonian features. While there is still controversy whether or not head injury is a risk factor for the development of Parkinson's disease, recent studies indicate that genetic susceptibility might be relevant.

Bilateral Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus for Posttraumatic Midbrain Tremor

Posttraumatic movement disorders are common sequelae of brain injury, occurring in as many as 66% of people suffering traumatic brain injury. Approximately 5% of patients with severe traumatic brain injury have persistent movement disorders, most commonly tremor ( 1. Krauss JK Jankovic J. Head injury and posttraumatic movement disorders. Neurosurgery. 2002; 50: 927-940 PubMed Google Scholar ). Posttraumatic midbrain tremor (also known as Holmes or rubral tremor) is particularly disabling because it typically affects the upper extremities and its combination of rest, action, and postural components results in severe functional impairment ( 1. Krauss JK Jankovic J. Head injury and posttraumatic movement disorders. Neurosurgery. 2002; 50: 927-940 PubMed Google Scholar , 2. Deuschl G Bain P. Deep brain stimulation for trauma: patient selection and evaluation. Mov Disord. 2002; 17: S102-S111 Crossref PubMed Scopus (75) Google Scholar ).

Long-stay psychiatric patients: a prospective study revealing persistent antipsychotic-induced movement disorder.

ObjectiveThe purpose of this study was to assess the frequency of persistent drug-induced movement disorders namely, tardive dyskinesia (TD), parkinsonism, akathisia and tardive dystonia in a representative sample of long-stay patients with chronic severe mental illness.MethodNaturalistic study of 209, mainly white, antipsychotic-treated patients, mostly diagnosed with psychotic disorder. Of this group, the same rater examined 194 patients at least two times over a 4-year period, with a mean follow-up time of 1.1 years, with validated scales for TD, parkinsonism, akathisia, and tardive dystonia.ResultsThe frequencies of persistent movement disorders in the sample were 28.4% for TD, 56.2% for parkinsonism, 4.6% for akathisia and 5.7% for tardive dystonia. Two-thirds of the participants displayed at least one type of persistent movement disorder.ConclusionsPersistent movement disorder continues to be the norm for long-stay patients with chronic mental illness and long-term antipsychotic treatment. Measures are required to remedy this situation.

A case of vascular hemichorea responding to topiramate.

Although vascular chorea often comes into remission spontaneously, a few patients may remain with persistent movement disorder. Most movements respond well to neuroleptics as well as other antidopaminergic drugs, but some patients show poor responses to those neuroleptics. Topiramate is a widely used of broad-spectrum anticonvulsant possessing a complex mechanism of action. It has been proven to enhance gamma-aminobutyrate acid activity and to be effective in the control of other movement disorders. We describe a 63-year-old woman with intractable vascular hemichorea which was controlled with anti-convulsant, topiramate.

Reduction in Neuroleptic-Induced Movement Disorders After a Switch to Quetiapine in Patients With Schizophrenia

Persistent neuroleptic-induced movement disorders limit effective pharmacological management of psychotic disorders. Although antipsychotic switching is a common strategy for managing extrapyramidal side effects (EPSs), there is insufficient empirical support to guide the clinician. We designed the present study to examine whether patients with preexisting EPS switched to quetiapine would show greater reduction in EPS compared with control patients. Twenty-two patients with schizophrenia meeting clinical criteria for tardive dyskinesia or coexisting parkinsonism were randomized either to switch from their current antipsychotic to quetiapine (n = 13) or to remain on their current treatment (n = 9). A battery of standard clinical assessments for EPS along with electromechanical instrumental measures was administered before randomization and again 1 and 3 months postrandomization. We observed significant reduction in parkinsonism (P < 0.001) and akathisia (P = 0.02) based on clinical assessments and dyskinesia (P < 0.05) based on instrumental assessment for the quetiapine group. Subjects remaining on current treatment exhibited an increase in rigidity (P < 0.05) based on instrumental measures. These findings support the switching to quetiapine in the management of preexisting neuroleptic-induced extrapyramidal side effects.

The Long-Term Outcomes of Human West Nile Virus Infection

Since its introduction to North America in 1999, human infection with West Nile virus (WNV) has resulted in considerable acute morbidity and mortality. Although the ongoing epidemic has resulted in a great increase in our understanding of the acute clinical features of human illness and helped to define associated clinical syndromes, far less is known about potential long-term clinical and functional sequelae. Several recent assessments, however, suggest that patients--even those with apparently mild cases of acute disease--frequently have subjective, somatic complaints following WNV infection. Persistent movement disorders, cognitive complaints, and functional disability may occur after West Nile neuroinvasive disease. West Nile poliomyelitis may result in limb weakness and ongoing morbidity that is likely to be long term. Although further assessment is needed, the long-term neurological and functional sequelae of WNV infection are likely to represent a considerable source of morbidity in patients long after their recovery from acute illness.

Long-Term Neurological Complications after Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy accompanying cardiac arrest is a common cause of long-term neurological dysfunction. With the improvement in prehospital emergency systems, larger numbers of people are resuscitated from cardiac arrests, although with the increased prospect of neurological sequelae. Neurological impairment after cardiac arrest is dependent on the degree of brain damage suffered during the arrest. Although the duration and severity of brain ischemia is often difficult to determine, clinicians are often faced with difficult issues related to predicting outcome related to awakening and long-term neurological deficits after the arrest. Neurological impairments range from mild cognitive deficits to severe motor and cognitive deficits that preclude independence in many activities of daily living. Several neurological syndromes have been described in patients who awaken from hypoxic-ischemic coma with lasting motor and cognitive deficits. This review will address many of the common syndromes after hypoxic-ischemic encephalopathy, including persistent vegetative states, seizures, myoclonus, movement disorders, cognitive dysfunction, and other neurological abnormalities.

Mouvements anormaux d’origine médicamenteuse : les syndromes tardifs

Persistent drug-induced movement disorders (tardive syndromes) remain an important clinical problem and consist of a variety of involuntary movements appearing in a patient exposed to a dopamine-blocking agent. The current state of knowledge on this topic is summarised in this article. Clinical aspects (tardive dyskinesia, tardive dystonia and other forms), prevalence, risk factors, prevention and management are discussed.

Persistent movement disorders following Japanese encephalitis.

The authors report on movement disorders that persist for a long duration following Japanese encephalitis (JE). Fifteen patients with diagnosed JE were followed up after an interval of 3 to 5 years. Of the four patients with a movement disorder, two were children with severe generalized dystonia in whom MRI revealed bilateral thalamic lesions. The two adult patients had parkinsonism. MRI in both adult patients showed lesions confined to the substantia nigra. Viral antibody and antigen were absent in the CSF of all patients.

Glutaric aciduria and suspected child abuse.

Subdural and retinal haemorrhages in young children without an appropriate history of trauma strongly suggest non-accidental injury. Similar features are occasionally found in patients with glutaric aciduria type 1 (GA1), a rare inborn error of metabolism, and have led to the misdiagnosis of non-accidental injury.1-3 When and how should this condition be sought in cases of suspected child abuse? GA1 is an autosomal recessive disorder caused by deficiency of the enzyme glutaryl-CoA dehydrogenase. Commonly it presents before age 18 months with a sudden onset of encephalopathy, following which the child has a severe and persistent movement disorder. Before this there may have been episodes of irritability or mild encephalopathy with no sequelae. Clinical examination at this stage often shows macrocephaly, and cerebral imaging may show bilateral frontotemporal atrophy or widening of the Sylvian fissure, with or without subdural effusions (fig 1). Following the catastrophic encephalopathic …

Adverse neurobiological effects of long-term use of neuroleptics: human and animal studies

Neuroleptics have revolutionized the treatment of schizophrenia and other psychoses since the early 1950s. Several adverse neurobiological effects are, however, associated with the long-term use of these agents. This article will review human and animal studies of these adverse effects, and also present some new data. Tardive dyskinesia (TD) is the most widely studied potentially persistent movement disorder resulting from long-term neuroleptic treatment, and several risk factors for TD development have been identified. Although drug-induced parkinsonism (DIP) usually disappears after the offending agent is withdrawn, a small portion of patients may have persistent parkinsonism. It is however, unclear if this is an aging-related effect. Persistent cognitive impairment associated with long-term use of typical neuroleptics has not been well documented. Atypical antipsychotics may produce improvement in cognitive performance in patients with chronic schizophrenia. MRI changes that are secondary to neuroleptics are possible, but have not yet been studied adequately. There is one unconfirmed report of neurofibrillary tangles associated with long-term neuroleptic use. A number of investigators have reported vacuous chewing movements, and neuropathologic changes following prolonged administration of neuroleptics in animals. We discuss the implications of the various reported adverse effects of long-term use of neuroleptics.

Post-traumatic movement disorders in survivors of severe head injury.

The present study investigates the occurrence of post-traumatic movement disorders in survivors of severe head injury. We studied a series of 398 consecutive patients who were admitted to the hospital with a Glasgow Coma Score of 8 or less after they sustained a head trauma. One hundred thirty-four out of 398 patients (34%) died after they were admitted to the hospital or in the further course. A recent follow-up was obtained in 221 of the 264 remaining patients (84%). Follow-up consisted of a three-level assessment, including questionnaires, telephone interviews, and personal examinations. Fifty out of 221 patients (22.6%) had developed movement disorders secondary to the head trauma, which were transient in 23 patients (10.4%) and persistent in 27 patients (12.2%). Forty-two patients (19%) had tremors, nine (4.1%) had dystonia, and seven (3.2%) had other movement disorders. Twelve patients (5.4%) had disabling low-frequency kinetic tremors (2.5 to 4 Hz) or dystonia, or both. Low-frequency kinetic tremors developed with a latency from 2 weeks to 6 months after trauma, and dystonia with a latency from 2 months to 2 years. When compared with patients without movement disorders, this subgroup was characterized by a different distribution profile of Glasgow Coma Scores with a higher proportion of lower scores on admission (p < 0.05). When we compared the initial CT findings, there were highly significant associations between generalized brain edema and the occurrence of any movement disorders, between generalized brain edema and the occurrence of persistent movement disorders, and between generalized brain edema and the occurrence of kinetic tremors and dystonia. We detected similar associations for focal cerebral lesions, but not for subdural and epidural hematomas. In conclusion, transient or persistent movement disorders are common sequelae in survivors of severe head injury. Disabling movement disorders such as kinetic tremors and dystonia, however, occur only in a small group of patients.