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ABSTRACT: Although previous cerebral blood flow studies have suggested that the basal ganglia or thalamus are involved in the pathogenesis of paroxysmal kinesigenic dyskinesia (PKD), the precise anatomic substrate or pathophysiological networks associated with PKD remain unclear. Here, ictal and interictal single photon emission computed tomography (SPECT) in 2 patients with idiopathic PKD compared to 6 age-matched normal controls and the perfusion findings of subtraction ictal SPECT co-registered to MRI (SISCOM) in 1 patient are reported. The interictal and ictal perfusion changes were different in each of the patients and there were no consistent anatomic substrates observed. 2 patients had significant perfusion changes in the left frontal/temporal cortices compared to controls, whereas the others showed an increased uptake of 99mTc-ethyl cysteinate dimer (ECD) in the left occipital area on subtraction SPECT imaging. The results of this study suggest that the pathophysiology of PKD cannot be simply explained by lesions of the basal ganglia or thalamus, and that other associated areas of the cortex are likely involved in these movement disorders.
Neuropediatrics 11/2011; 42(6):245-8. · 0.94 Impact Factor
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ABSTRACT: Decreased visual function is one of the non-motor dysfunctions of Parkinson's disease (PD). Recent evidences suggest that essential tremor (ET) is not 'pure' motor disorder and there is growing evidence that this disease is a multiple-system disorder. In some cases, it is difficult to differentiate ET from PD. In addition, there is considerable controversy regarding the relationship between PD and ET. The objective of this study was to compare color discrimination dysfunction amongst patients with PD and ET and to investigate the clinical relevance.
Case-control comparisons of 54 patients with PD, 36 patients with ET, and 34 age-matched controls were performed. All cases underwent Farnsworth-Munsell 100 Hue test (FMT) and clinical assessments on medication. In addition, the association between color vision abnormalities and motor handicaps was investigated.
There were significant differences in the total error scores (TES) of the FMT amongst the three groups; patients with the PD had higher TES than the patients with ET and the controls after adjustments for age. In addition, the motor symptom severity in PD correlated with the FMT abnormalities, especially with regard to the axial symptoms.
The results of this study suggest that color vision abnormalities may be one of the non-motor clinical characteristics of PD-related dysfunction in contrast to ET. In addition, the severity of axial motor symptoms was closely related to visual dysfunction. Confirmation of these findings as well as the mechanisms underlying these results requires further study.
European Journal of Neurology 04/2011; 18(4):577-83. · 3.69 Impact Factor
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ABSTRACT: Background and purpose: Decreased visual function is one of the non-motor dysfunctions of Parkinson’s disease (PD). Recent evidences suggest that essential tremor (ET) is not ‘pure’ motor disorder and there is growing evidence that this disease is a multiple-system disorder. In some cases, it is difficult to differentiate ET from PD. In addition, there is considerable controversy regarding the relationship between PD and ET. The objective of this study was to compare color discrimination dysfunction amongst patients with PD and ET and to investigate the clinical relevance.Methods: Case–control comparisons of 54 patients with PD, 36 patients with ET, and 34 age-matched controls were performed. All cases underwent Farnsworth–Munsell 100 Hue test (FMT) and clinical assessments on medication. In addition, the association between color vision abnormalities and motor handicaps was investigated.Results: There were significant differences in the total error scores (TES) of the FMT amongst the three groups; patients with the PD had higher TES than the patients with ET and the controls after adjustments for age. In addition, the motor symptom severity in PD correlated with the FMT abnormalities, especially with regard to the axial symptoms.Conclusion: The results of this study suggest that color vision abnormalities may be one of the non-motor clinical characteristics of PD-related dysfunction in contrast to ET. In addition, the severity of axial motor symptoms was closely related to visual dysfunction. Confirmation of these findings as well as the mechanisms underlying these results requires further study.
European Journal of Neurology 09/2010; 18(4):577 - 583. · 3.69 Impact Factor
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ABSTRACT: The medical treatment available for patients with essential tremor (ET) is often inadequate. Furthermore, the efficacy of the medical treatments currently available for patients with ET of cranial nerve areas is less satisfactory than that of the medical treatments available for patients with ET involving the upper extremities. This pilot study was performed to evaluate whether zonisamide (ZNS) is effective in the treatment of patients with isolated head tremor.
All subjects with isolated head tremor were randomly treated with either ZNS or propranolol. After a washout period, the subjects were switched to the alternative drug.
ZNS was found to be more effective in the treatment of patients with isolated head tremor than propranolol. No severe adverse effects were reported with either ZNS or propranolol.
ZNS may be more useful than propranolol for the treatment of ET patients with head tremor.
European Journal of Neurology 09/2008; 15(11):1212-5. · 3.69 Impact Factor
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ABSTRACT: Background: The prognosis of functional disability in patients with cerebrovascular disease has not been well established. Therefore, we conducted this study to determine the prognostic significance of high-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy) levels in patients with functional disability after acute first-ever ischemic stroke. Method: A total of 309 patients with first-ever stroke were examined within 24 h after symptom onset. Hcy was measured at admission, and hs-CRP measurements were made at admission and on the seventh hospital day. The correlations between the concentration of hs-CRP or Hcy and functional disability at 1, 3, 6 and 12 months after stroke onset were analyzed. Results: The present study showed that both hs-CRP values on admission and on the seventh hospital day were significantly correlated with modified Rankin Scale (mRS) scores obtained at 4 times after the onset of stroke. These results also demonstrated that mRS scores are more closely associated with hs-CRP values on the seventh hospital day than on admission. However, there was no significant relationship between Hcy and mRS scores during the 12-month follow-up period. Conclusion: According to the present study, we cautiously suggest that hs-CRP values on the subacute phase have sufficient value as a predictor of the prognosis of functional disability after first-ever stroke.
European Neurology. 08/1970; 64(5):304-310.
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ABSTRACT: Background: High-sensitivity C-reactive protein (hs-CRP) is a sensitive systemic marker of inflammation, and increased levels of hs-CRP are associated with inflammatory reactions. Microglia-mediated neuroinflammation has been hypothesized to play an important role in the pathogenesis of idiopathic Parkinson’s disease (PD). However, the clinical value of hs-CRP in PD is poorly defined. Therefore, we conducted this study to investigate the clinical value of hs-CRP in patients with PD. Methods: We examined 212 patients with de novo PD, 253 patients with acute ischemic cerebrovascular disease and 119 healthy subjects and investigated the differences in hs-CRP among these 3 groups. The PD group was classified into 4 subgroups according to the Hoehn and Yahr stage to investigate the relationship between hs-CRP and symptom severity. Results: There was no significant difference in the hs-CRP value between the PD and the ischemic cerebrovascular disease groups, but the subjects in the 2 disease groups demonstrated higher hs-CRP levels than those in the normal control group. A post-hoc analysis of the 4 PD subgroups showed no significant differences in hs-CRP values. In addition, this study demonstrated that the odds ratio of the PD group by hs-CRP was 2.037 (95% CI 1.180–3.517; p = 0.011). Conclusion: We suggest that our results could support the hypothesis that neuroinflammation contributed to the pathogenesis of PD and cautiously assume that elevated hs-CRP might have a clinical value as a risk factor for PD.
European Neurology. 08/1970; 62(2):99-104.
