Post-stroke Movement Disorders Research Articles

Current opinions and practices in post-stroke movement disorders: Survey of movement disorders society members

BackgroundPost-stroke movement disorders (PSMD) encompass a wide array of presentations, which vary in mode of onset, phenomenology, response to treatment, and natural history. There are no evidence-based guidelines on the diagnosis and treatment of PSMD. ObjectivesTo survey current opinions and practices on the diagnosis and treatment of PSMD. MethodsA survey was developed by the PSMD Study Group, commissioned by the International Parkinson's and Movement Disorders Society (MDS). The survey, distributed to all members, yielded a total of 529 responses, 395 (74.7%) of which came from clinicians with experience with PSMD. ResultsParkinsonism (68%), hemiballismus/hemichorea (61%), tremor (58%), and dystonia (54%) were by far the most commonly endorsed presentation of PSMD, although this varied by region. Basal ganglia stroke (76% of responders), symptoms contralateral to stroke (75%), and a temporal relationship (59%) were considered important factors for the diagnosis of PSMD. Oral medication use depended on the phenomenology of the PSMD. Almost 50% of respondents considered deep brain stimulation and ablative surgeries as options for treatment. The lack of guidelines for the diagnosis and treatment was considered the most important gap to address. ConclusionsRegionally varying opinions and practices on PSMD highlight gaps in (and mistranslation of) epidemiologic and therapeutic knowledge. Multicenter registries and prospective community-based studies are needed for the creation of evidence-based guidelines to inform the diagnosis and treatment of patients with PSMD.

Movement disorders following mechanical thrombectomy resulting in ischemic lesions of the basal ganglia: An emerging clinical entity.

Post-stroke movement disorders (PMDs) following ischemic lesions of the basal ganglia (BG) are a known entity, but data regarding their incidence are lacking. Ischemic strokes secondary to proximal middle cerebral artery (MCA) occlusion treated with thrombectomy represent a model of selective damage to the BG. The aim of this study was to assess the prevalence and features of movement disorders after selective BG ischemia in patients with successfully reperfused acute ischemic stroke (AIS). We enrolled 64 consecutive subjects with AIS due to proximal MCA occlusion treated with thrombectomy. Patients were clinically evaluated by a movement disorders specialist for PMDs onset at baseline, and after 6 and 12 months. None of the patients showed an identifiable movement disorder in the subacute phase of the stroke. At 6 and 12 months, respectively, 7/25 (28%) and 7/13 (53.8%) evaluated patients developed PMDs. The clinical spectrum of PMDs encompassed parkinsonism, dystonia and chorea, either isolated or combined. In most patients, symptoms were contralateral to the lesion, although a subset of patients presented with bilateral involvement and prominent axial signs. Post-stroke movement disorders are not uncommon in long-term follow-up of successfully reperfused AIS. Follow-up conducted by a multidisciplinary team is strongly advisable in patients with selective lesions of the BG after AIS, even if asymptomatic at discharge.

Movement Disorders Associated with Cerebral Artery Stenosis: A Nationwide Study (P13-11.003)

<h3>Objective:</h3> We aimed to investigate the clinical characteristics of movement disorders (MD) associated with cerebral artery stenosis (CAS). <h3>Background:</h3> Studies of secondary MD caused by cerebrovascular diseases have primarily focused on post-stroke MD. However, MD can also result from CAS without clinical manifestations of stroke. <h3>Design/Methods:</h3> A nationwide multi-center retrospective analysis was performed based on the data from patients with CAS-associated MDs from MD specialized clinics in South Korea, available between January 1999 and September 2019. CAS was defined as the &gt; 50% luminal stenosis of the major cerebral arteries. The association between the MD and CAS was determined by MD specialists using predefined clinical criteria. The collected clinical information included baseline demographics, features of MD, characteristics of CAS, treatment, and outcomes of MD. Statistical analyses were performed to identify factors associated with the outcomes of MD. <h3>Results:</h3> The data from a total of 81 patients with CAS-associated MD were analyzed. The mean age of MD onset was 60.5 ± 19.7 years. Chorea was the most common MD (57%), followed by tremor/limb-shaking, myoclonus, and dystonia. Atherosclerosis was the most common etiology of CAS (78%), with the remaining cases attributed to moyamoya disease. Relative to patients with atherosclerosis, those with moyamoya disease developed MD at a younger age (p &lt; 0.001) and had a more chronic mode of onset (p = 0.001) and less acute ischemic lesion (p = 0.021). Eight patients who underwent surgical treatment for CAS showed positive outcomes. Patients with acute onset of MD had a better outcome than those with subacute-to-chronic onset of MD (p = 0.008). <h3>Conclusions:</h3> This study highlights the spectrum of CAS-associated with MD across the country. A progressive, age-dependent functional neuronal modulation in the basal ganglia due to CAS may underlie this condition. <b>Disclosure:</b> Dr. Chung has nothing to disclose. Dr. Choi has nothing to disclose. Prof. Oh has nothing to disclose. Ho-Sung Ryu has nothing to disclose. Sooyeoun You has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Park has nothing to disclose.

Deep brain stimulation for movement disorders after stroke: a systematic review of the literature.

Stroke remains the leading cause of disability in the United States. Even as acute care for strokes advances, there are limited options for improving function once the patient reaches the subacute and chronic stages. Identification of new therapeutic approaches is critical. Deep brain stimulation (DBS) holds promise for these patients. A number of case reports and small case series have reported improvement in movement disorders after strokes in patients treated with DBS. In this systematic review, the authors have summarized the patient characteristics, anatomical targets, stimulation parameters, and outcomes of patients who have undergone DBS treatment for poststroke movement disorders. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Scopus, and SpringerLink databases were searched for the keywords "DBS," "stroke," "movement," and "recovery" to identify patients treated with DBS for movement disorders after a stroke. The Joanna Briggs Institute Critical Appraisal checklists for case reports and case series were used to systematically analyze the quality of the included studies. Data collected from each study included patient demographic characteristics, stroke diagnosis, movement disorder, DBS target, stimulation parameters, complications, and outcomes. The authors included 29 studies that described 53 patients who underwent placement of 82 total electrodes. Movement disorders included tremor (n = 18), dystonia (n = 18), hemiballism (n = 6), spastic hemiparesis (n = 1), chorea (n = 1), and mixed disorders (n = 9). The most common DBS targets were the globus pallidus internus (n = 32), ventral intermediate nucleus of thalamus (n = 25), and subthalamic area/subthalamic nucleus (n = 7). Monopolar stimulation was reported in 43 leads and bipolar stimulation in 13. High-frequency stimulation was used in 57 leads and low-frequency stimulation in 6. All patients but 1 had improvement in their movement disorders. Two complications were reported: speech impairment in 1 patient and hardware infection in another. The median (interquartile range) duration between stroke and DBS treatment was 6.5 (2.1-15.8) years. This is the first systematic review of DBS for poststroke movement disorders. Overall, most studies to date have been case reports and small series reporting heterogeneous patients and surgical strategies. This review suggests that DBS for movement disorders after a stroke has the potential to be effective and safe for diverse patients, and DBS may be a feasible option to improve function even years after a stroke.

Gaps, Controversies, and Proposed Roadmap for Research in Poststroke Movement Disorders

Poststroke movement disorders (PSMDs) are a common cause of secondary movement disorders. Although prior studies have highlighted the clinical spectrum and phenomenology of PSMDs, there are many knowledge gaps worth addressing. Some of the most important include lack of clinical definitions, variable stroke symptom latencies, and lack of biomarkers for vulnerability for or resilience against developing PSMDs. Collectively, the association between stroke localization and phenomenology is less than 30%, and the long-term clinical prognosis and treatment responses are highly variable. After summarizing the accumulated evidence regarding the phenomenology, pathophysiology, neuroimaging, and treatment of PSMDs, highlighting the many gaps and controversies including diagnostic challenges, we propose a roadmap for future research to fill these gaps and resolve the related controversies. More research is warranted concerning the phenomenology, classification, diagnostic criteria, and pathophysiology of PSMDs. Further, there is an urgent need for treatment guidelines for the management of PSMDs. © 2022 International Parkinson and Movement Disorder Society.

Movement Disorders Associated With Cerebral Artery Stenosis: A Nationwide Study.

BackgroundStudies of secondary movement disorder (MD) caused by cerebrovascular diseases have primarily focused on post-stroke MD. However, MD can also result from cerebral artery stenosis (CAS) without clinical manifestations of stroke. In this study, we aimed to investigate the clinical characteristics of MD associated with CAS.Materials and MethodsA nationwide multicenter retrospective analysis was performed based on the data from patients with CAS-associated MDs from 16 MD specialized clinics in South Korea, available between January 1999 and September 2019. CAS was defined as the >50% luminal stenosis of the major cerebral arteries. The association between MD and CAS was determined by MD specialists using pre-defined clinical criteria. The collected clinical information included baseline demographics, features of MD, characteristics of CAS, treatment, and MD outcomes. Statistical analyses were performed to identify factors associated with the MD outcomes.ResultsThe data from a total of 81 patients with CAS-associated MD were analyzed. The mean age of MD onset was 60.5 ± 19.7 years. Chorea was the most common MD (57%), followed by tremor/limb-shaking, myoclonus, and dystonia. Atherosclerosis was the most common etiology of CAS (78%), with the remaining cases attributed to moyamoya disease (MMD). Relative to patients with atherosclerosis, those with MMD developed MD at a younger age (p < 0.001) and had a more chronic mode of onset (p = 0.001) and less acute ischemic lesion (p = 0.021). Eight patients who underwent surgical treatment for CAS showed positive outcomes. Patients with acute MD onset had a better outcome than those with subacute-to-chronic MD onset (p = 0.008).ConclusionsThis study highlights the spectrum of CAS-associated with MD across the country. A progressive, age-dependent functional neuronal modulation in the basal ganglia due to CAS may underlie this condition.

Post-stroke Movement Disorders: Clinical Spectrum, Pathogenesis, and Management.

Involuntary movements develop after 1-4% of strokes and they have been reported in patients with ischemic and hemorrhagic strokes affecting the basal ganglia, thalamus, and/or their connections. Hemichorea-hemiballism is the most common movement disorder following a stroke in adults while dystonia is most common in children. Tremor, myoclonus, asterixis, stereotypies, and vascular parkinsonism are other movement disorders seen following stroke. Some of them occur immediately after acute stroke, some can develop later, and others may have delayed onset progressive course. Proposed pathophysiological mechanisms include neuronal plasticity, functional diaschisis, and age-related differences in brain metabolism. There are no guidelines regarding the management of post-stroke movement disorders, mainly because of their heterogeneity.

An attempt of complex assessment of eye-movements following perinatal ischemic

Motor functions affection is frequent consequence of ischemic stroke. Spectrum of post-stroke movement disorders often includes disturbances of eye movements. Motor functions are strongly interconnected with social abilities, including social interaction (SI). Electroencephalographic (EEG) theta activity (4–6 Hz) is thought to reflect SI in infancy. This frequency band can therefore be viewed as an indirect correlate of gaze following as a factor underlying SI. This work aims to evaluate theta power and gaze following in infants with perinatal ischemic stroke. Experimental group (EG:n = 8/mean age = 6.3 months/SD = 1.4): full-term infants with perinatal ischemic stroke in the basin of the middle cerebral artery (confirmed by MRI in the acute phase, signed information consent); control group (CG:n = 22/mean age = 5.7months/SD = 0.2): full-term typically developed infants. EEG (128-channel) background were registered in infants at the age of 5 months. EEG spectral power (4.02-5.98 Hz) was calculated using fast Fourier transform algorithm (Hanning window) in several regions, which are predominantly projected into cortical areas: premotor cortex, supplementary motor area (electrodes: 6,13,28,29,112,111,117), sensorimotor cortex (electrodes: 7,30,31,35,36,37,41,55,80,87,103,104,105,106,110). Gaze following was measured using eye tracking (CG: N = 7/ma = 5.7months/SD = 0.2; EG: N = 3/ma = 6.7months/SD = 1.7). The Mann–Whitney U test revealed significant between-group differences for premotor cortex and supplementary motor area (р = 0.016), sensorimotor cortex (p = 0.004); between-group differences in gaze following (р = 0.024). Brain injury affecting gaze following, especially during infants’ early development. It can be concluded that theta power (4–6 Hz) at least in part reflects functioning of basic anatomical substrates (predominantly cortical motor areas) of gaze following.

Motor function recovery in patients after ischemic stroke

Secondary prevention of recurrent stroke and other cardiovascular diseases is of key importance for the management of a patient after ischemic stroke. Medications (antihypertensive, antiplatelet, or anticoagulant drugs and statins) are recommended for use; and a small proportion of patients should undergo surgical treatment (carotid endarterectomy); non-drug treatments (smoking cessation and alcohol abstinence, adherence to the Mediterranean diet, and increased physical activity) are of great importance. Movement disorders are seen in 80% of patients after a stroke and are the leading cause of disability. Therapeutic exercises aimed at training movements in the paretic limbs and at preventing the development of contractures are of utmost importance in post-stroke movement disorders. The use of citicoline to improve motor function recovery is discussed.

Poststroke movement disorders: One etiology many phenotypes

Poststroke movement disorders: One etiology many phenotypes

Post-stroke Movement Disorders: The Clinical, Neuroanatomic, and Demographic Portrait of 284 Published Cases

Abnormal movements are a relatively uncommon complication of strokes. Besides the known correlation between stroke location and certain movement disorders, there remain uncertainties about the collective effects of age and stroke mechanism on phenomenology, onset latency, and outcome of abnormal movements. We systematically reviewed all published cases and case series with adequate clinical-imaging correlations. A total of 284 cases were analyzed to evaluate the distribution of different movement disorders and their association with important cofactors. Posterolateral thalamus was the most common region affected (22.5%) and dystonia the most commonly reported movement disorder (23.2%). The most common disorders were parkinsonism (17.4%) and chorea (17.4%) after ischemic strokes and dystonia (45.5%) and tremor (19.7%) after hemorrhagic strokes. Strokes in the caudate and putamen were complicated by dystonia in one third of the cases; strokes in the globus pallidus were followed by parkinsonism in nearly 40%. Chorea was the earliest poststroke movement disorder, appearing within hours, whereas dystonia and tremor manifested several months after stroke. Hemorrhagic strokes were responsible for most delayed-onset movement disorders (>6 months) and were particularly overrepresented among younger individuals affected by dystonia. This evidence-mapping portrait of poststroke movement disorders will require validation or correction based on a prospective epidemiologic study. We hypothesize that selective network vulnerability and resilience may explain the differences observed in movement phenomenology and outcomes after stroke.

Movement Disorders Following Cerebrovascular Lesion in the Basal Ganglia Circuit.

Movement disorders are primarily associated with the basal ganglia and the thalamus; therefore, movement disorders are more frequently manifest after stroke compared with neurological injuries associated with other structures of the brain. Overall clinical features, such as types of movement disorder, the time of onset and prognosis, are similar with movement disorders after stroke in other structures. Dystonia and chorea are commonly occurring post-stroke movement disorders in basal ganglia circuit, and these disorders rarely present with tremor. Rarer movement disorders, including tic, restless leg syndrome, and blepharospasm, can also develop following a stroke. Although the precise mechanisms underlying the pathogenesis of these conditions have not been fully characterized, disruptions in the crosstalk between the inhibitory and excitatory circuits resulting from vascular insult are proposed to be the underlying cause. The GABA (gamma-aminobutyric acid)ergic and dopaminergic systems play key roles in post-stroke movement disorders. This review summarizes movement disorders induced by basal ganglia and thalamic stroke according to the anatomical regions in which they manifest.

Movement Disorders Following Cerebrovascular Lesions: Etiology, Treatment Options and Prognosis.

Post-stroke movement disorders are uncommon, but comprise an important part of secondary movement disorders. These exert variable and heterogeneous clinical courses according to the stroke lesion and its temporal relationships. Moreover, the predominant stroke symptoms hinder a proper diagnosis in clinical practice. This article describes the etiology, treatment options and prognosis of post-stroke movement disorders.

Arm Posturing in a Patient Following Stroke: Dystonia, Levitation, Synkinesis, or Spasticity?

BackgroundPost-stroke movement disorders occur in up to 4% of stroke patients. The movements can be complex and difficult to classify, which presents challenges when attempting to understand the clinical phenomenology and provide appropriate treatment.Case ReportWe present a 64-year-old male with an unusual movement in the arm contralateral to his ischemic stroke. The primary feature of the movement was an involuntary elevation of the arm, occurring only when he was walking.DiscussionThe differential diagnosis includes dystonia, spontaneous arm levitation, synkinesis, and spasticity. We discuss each of these diagnostic possibilities in detail.

Post stroke hemi-dystonia in children: a neglected area of research.

BackgroundChildhood arterial ischemic stroke (CAIS) is increasingly recognized as an important cause of significant long-term morbidity in the pediatric population. Post stroke movement disorders, above all hemi-dystonias, are much more common in children after stroke compared to adults. However, research in this field is largely lacking. By highlighting some important knowledge gaps, we aim to encourage future collaborative research projects in this particular field.FindingsPost stroke-dystonia seems to be much more common among children than adults. However, no reliable epidemiological data of post-stroke movement disorders in childhood are available, and differentiation between spasticity and dystonia can be challenging. Pharmacotherapy for dystonia is limited by lack of effect, especially in the long-term treatment. The pathophysiology of dystonia is complex and incompletely understood. Recent findings from functional imaging studies suggest that dystonia does not result from a single lesion but rather network dysfunctions and abnormalities in functional connectivity. However, very few patients with post stroke dystonia have been studied, and it is not clear to what extent pathophysiology of primary and post stroke ischemia shares common characteristics on network level. In general, progress in understanding the nature of childhood dystonia lags far behind adult onset CNS diseases.ConclusionsDystonia after CAIS is a common yet insufficiently understood and poorly studied clinical challenge. Studies to improve our understanding of the underlying pathophysiology and consequently the development of instruments for early prediction as well as targeted treatment of dystonia should become a high priority in collaborative childhood stroke research.

Modern aspects of organization of rehabilitation in stroke patients

Stroke is the most widely spread reason of disability. In Russian Federation the number of disabled people is higher than in Europe, that is partly due to the underdeveloped rehabilitation system. The present article discusses the medical, physical, psychological, social, professional and pedagogical issues of rehabilitation in stroke patients. The main causes of stroke in young subjects are reviewed, and the main aspects of rehabilitation in patients with movement, speech and cognitive post-stroke dysfunction are presented. The early rehabilitation is of great importance for the recovery, and should be aimed at the prevention of post-stroke complications (pneumonia, venous thrombosis etc.). It is worth noting that post-stroke cognitive impairment is associated with worse outcome and higher death rate, that is extremely important as dementia rate in patients after stroke can reach 26 %. The role of medical supply and, in particular, nicergoline (a drug with both vasoactive and neurometabolic properties) effects are discussed. Complex rehabilitation procedures lead to the cognitive improvement (proved by neuropsychological exams) and to the decrease in post-stroke movement disorder.

A patient with unilateral periodic leg movements associated with pontine infarction.

A patient with unilateral periodic leg movements associated with pontine infarction.

Extrapyramidal movement disorders in patients after stroke

Presented are the clinical spectrum and the frequency of main forms of extrapyramidal movement disorders in patients after ischemic or hemorrhagic stroke. The major cause of movement disorders in these cases are lesions within the basal ganglia and the thalamus. In the review, most important approaches to the therapy of post-stroke movement disorders, including surgery, are analyzed, and questions of long-term prognosis of poststroke movement disorders are discussed.

Neurolupus : à propos de 15 cas

Movement disorders can occur as primary (idiopathic) or genetic disease, as a manifestation of an underlying neurodegenerative disorder, or secondary to a wide range of neurological or systemic diseases. Cerebrovascular diseases represent up to 22% of secondary movement disorders, and involuntary movements develop after 1–4% of strokes. Post-stroke movement disorders can manifest in parkinsonism or a wide range of hyperkinetic movement disorders including chorea, ballism, athetosis, dystonia, tremor, myoclonus, stereotypies, and akathisia. Some of these disorders occur immediately after acute stroke, whereas others can develop later, and yet others represent delayed-onset progressive movement disorders. These movement disorders have been encountered in patients with ischaemic and haemorrhagic strokes, subarachnoid haemorrhage, cerebrovascular malformations, and dural arteriovenous fistula affecting the basal ganglia, their connections, or both.

Post-stroke Movement Disorders: Clinical Manifestations and Pharmacological Management.

Involuntary abnormal movements have been reported after ischaemic and haemorrhagic stroke. Post stroke movement disorders can appear as acute or delayed sequel. At the moment, for many of these disorders the knowledge of pharmacological treatment is still inadequate. Dopaminergic and GABAergic systems may be mainly involved in post-stroke movement disorders. This article provides a review on drugs commonly used in post-stroke movement disorders, given that some post-stroke movement disorders have shown a partial benefit with pharmacological approach.