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   2018| March-April  | Volume 66 | Issue 7  
    Online since March 1, 2018

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Parkinson's disease: A review
Divya M Radhakrishnan, Vinay Goyal
March-April 2018, 66(7):26-35
DOI:10.4103/0028-3886.226451  PMID:29503325
Parkinson's disease is a common movement disorder seen in neurological practice, but the diagnosis and management is challenging. The diagnosis is clinical and sometimes difficult, considering a large number of motor and non-motor symptoms in PD patients. The medical management of PD patients is difficult, as choices of drugs are limited and levodopa is the mainstay of treatment. However, levodopa-induced dyskinesia (LID) is commonly seen in Parkinson's disease patients treated with levodopa. This side effect is usually encountered after a long duration of treatment, but occasionally, this may be seen even after a few days or months of treatment. Different types of surgical approaches, including unilateral pallidotomy and deep brain stimulation, have given very good results in PD patients, who cannot be managed by medications alone.
  51,691 1,340 -
Dystonia: A review
Amit Batla
March-April 2018, 66(7):48-58
DOI:10.4103/0028-3886.226439  PMID:29503327
Dystonia is a hyperkinetic movement disorder characterized by sustained or intermittent muscle contractions that cause abnormal repetitive movements, abnormal postures, or both. The new consensus classifies dystonia into two axes to characterize clinical characteristics, and etiology. This system allows correct identification of isolated and combined forms of dystonia and retains the description of generalized and focal dystonia which is very useful in planning investigations and management. The characterization of dystonia for its better identification and a brief overview of its management are discussed in this article. The treatment options for dystonia include drugs, botulinum toxin and deep brain stimulation surgery.
  16,413 645 -
Tremor syndromes: A review
Nitish Kamble, Pramod Kumar Pal
March-April 2018, 66(7):36-47
DOI:10.4103/0028-3886.226440  PMID:29503326
Among the involuntary movement disorders, tremor is a common phenomenology seen in clinical practice. The important factors that need to be determined while assessing a patient with tremor include the phenomenology of tremor, presence or absence of other neurologic signs, and the effect of medications or alcohol. Tremor can broadly be classified based on the circumstances under which it occurs, i.e., rest or action. The basal ganglia-cerebello-thalamic and dentate-olivary circuits are involved in the generation of tremor. Experimental data have suggested the olivocerebellar system as the site of the central oscillator in essential tremor. Generation of tremor in Parkinson's disease results from loss of dopaminergic neurons of the retrorubral area causing dysfunction of the globus pallidus, which finally leads to abnormal firing pattern of the ventrolateral posterior neurons of the thalamus. Involvement of the cerebello-thalamic pathways leads to orthostatic tremor. Palatal tremor is thought to be generated by the cells of the inferior olive. Holmes tremor usually results from the disruption of the dentate-rubro-thalamic circuit and also the nigro-striatal circuit. Multiple drugs can cause tremors. Demyelinating neuropathies are associated with tremors. Involvement of the deep cerebellar nuclei, cerebellar outflow tracts and the cerebrocerebellar loops has been postulated in the cerebellar tremor production. Electrophysiological methods are valuable in characterizing tremors. In addition to the pharmacological therapy including botulinum toxin therapy, surgical therapies in form of DBS or lesional surgeries are beneficial in reducing the symptoms.
  13,407 387 -
Parkinsonian syndromes: A review
Prachaya Srivanitchapoom, Yuvadee Pitakpatapee, Arpakorn Suengtaworn
March-April 2018, 66(7):15-25
DOI:10.4103/0028-3886.226459  PMID:29503324
Since James Parkinson published his remarkable clinical observations in the “An Essay On The Shaking Palsy” in 1817, the number of diseases included in the spectrum of parkinsonian syndromes (a group of diseases that have some part of their clinical features resembling those seen in Parkinson's disease), are growing. Careful history taking, comprehensive neurological examination, and utilization of proper investigations will lead the physicians to make an accurate diagnosis of the specific disease entity present. In this recent review, we cover the issue of classification of parkinsonian syndromes, and comprehensively review the characteristic features of the commonly encountered diseases that present with this syndrome. The salient aspects of the epidemiology, key clinical features, proper investigations, and possible treatment options of these diseases have also been addressed.
  12,203 353 -
Pediatric movement disorders
Rahul Badheka, Narendra Kumar Barad, Charulata Savant Sankhla
March-April 2018, 66(7):59-67
DOI:10.4103/0028-3886.226447  PMID:29503328
Pediatric movement disorders are commonly encountered clinical entities in the pediatric outpatient department. These disorders are a heterogenous group of disorders and may represent an underlying genetic disorder, a metabolic disorder or a hypoxic–ischemic insult during the perinatal period. Hyperkinetic movement disorders are more common as compared to hypokinetic disorders. This is unlike the situation in adult movement disorders where hypokinetic disorders are more often seen. A child's nervous system is more prone to hypoxic-ischemic insults due to its higher metabolic demands and the presence of an immature blood-brain barrier. The commonest movement disorders seen are tics, dystonia and chorea. Myoclonus is commonly associated with epilepsy syndromes. The aetiology of paediatric movement disorders depends on their course, their static or progressive nature, and whether an isolated symptom or an association with other neurological symptoms is present. The clue to the diagnosis is the proper recognition of the movement prevalent in the disorder.
  12,083 355 -
Neuroimaging in Parkinsonian Disorders
Madhavi Tripathi, Atin Kumar, Chandrasekhar Bal
March-April 2018, 66(7):68-78
DOI:10.4103/0028-3886.226460  PMID:29503329
Neuroimaging (NI) in Parkinson's disease (PD) includes functional techniques like positron emission tomography (PET) and single photon emission computed tomography (SPECT), and morphological imaging using magnetic resonance imaging (MRI) and transcranial sonography to probe different aspects of the neurobiology of PD. Changes in neurotransmitters in various regions of the brain and their influence on brain networks is the basis for the motor symptoms of PD which are interrogated by NI. The recent Movement Disorders Society Clinical Diagnostic Criteria for PD (MDS-PD) have included the results of a few of these neuroimaging techniques to serve as single supportive criteria or absolute exclusion criteria for the diagnosis of PD. While dopaminergic imaging is useful in the early stages of disease to differentiate the neurodegenerative versus non-degenerative causes of parkinsonism like essential tremors, it has also been used for the differential diagnosis of dementia with Lewy bodies (DLB) from Alzheimer's disease (AD), for inclusion of PD patients into clinical trials and for evaluating response to cell–replacement therapies in PD. Metabolic patterns on F-18 fluorodeoxyglucose positron emission tomography have been used effectively for the classification and differential diagnosis of the parkinsonian syndromes using visual and quantitative approaches. Disease related network-patterns have been used for a completely automated approach to differential diagnosis of parkinsonian syndromes on a single case basis. Structural MRI and advanced MR techniques have been used for the classification of PD and the atypical parkinsonian syndromes. Thus, multimodal imaging in PD may aid in an early, accurate and objective diagnostic classification by highlighting the underlying neurochemical and neuroanatomical changes that underlie this spectrum of disorders. The present challenge in PD is to develop radioligands which could bind selectively to alphasynuclein in-vivo.
  10,304 383 -
Belly dancer's dyskinesia: A rare movement disorder
Chaturbhuj Rathore, Sanjay Prakash, Dharmesh Bhalodiya
March-April 2018, 66(7):156-157
DOI:10.4103/0028-3886.226455  PMID:29503345
  9,189 81 -
Botulinum toxin in movement disorders
Priyanka Tater, Sanjay Pandey
March-April 2018, 66(7):79-89
DOI:10.4103/0028-3886.226441  PMID:29503330
Botulinum toxin has gained immense popularity since its introduction for therapeutic use. It is used in a variety of movement disorders like hemi-facial spasm, focal dystonias like blepharospasm, cervical dystonia, oromandibular dystonia, limb dystonias. It is also being used in patients with tremors, tics and for a variety of indications in Parkinson's disease as well. There are eight subtypes of toxins available, but type A and B are the ones used in movement disorder clinics. The toxin mainly acts by inhibiting the release of acetylcholine at the neuromuscular junction and causing weakness. Type B toxin has more effect over the autonomic nervous system and hence is preferred for hyper-secretory disorders. The use of electromyography and ultrasound further improve the accuracy of the procedure. It is a relatively safe therapeutic option with its effect lasting for around three months. It has very few side effects. The key is to start with the lowest possible dose and then gradually increase the dose depending upon the patient's response. Selecting the right muscles for injection is of utmost importance and is guided by the knowledge of anatomy of the muscles.
  8,673 229 -
Classification of movement disorders: The problem of terminology
Sanjay Pandey
March-April 2018, 66(7):12-14
DOI:10.4103/0028-3886.226446  PMID:29503323
  6,695 172 -
Risperidone induced rabbit syndrome
Preethi Rebello, Pavithra P Rao, Priya Nayak, Joylin Jovita Mascarenhas, P John Mathai
March-April 2018, 66(7):150-152
DOI:10.4103/0028-3886.226464  PMID:29503342
  6,598 109 -
Deep brain stimulation for movement disorders
Syam Krishnan, Krishnakumar Kesava Pisharady, KP Divya, Kuldeep Shetty, Asha Kishore
March-April 2018, 66(7):90-101
DOI:10.4103/0028-3886.226438  PMID:29503331
Deep Brain Stimulation (DBS) was introduced into clinical practice nearly four decades ago and is currently the standard of care for patients with Parkinson's disease experiencing motor complications. Apart from this, it has several other established and emerging applications in movement disorders. The exact mechanisms by which DBS provides relief in movement disorders are still unclear; disruption of pathological neuronal synchrony and abnormal information flow through the neuronal circuits involved, are the most likely underlying mechanisms. DBS has been established to be a relatively safe procedure if patients are carefully selected and followed up by experienced multidisciplinary teams. Alternatives to the traditional stereotactic frame based techniques of lead implantation are emerging, and these, along with the other recent technological advances, are likely to extend the availability of this therapy to an increasing number of patients in the future.
  5,930 253 -
Expanding indications for deep brain stimulation
Paresh K Doshi
March-April 2018, 66(7):102-112
DOI:10.4103/0028-3886.226450  PMID:29503332
It has been three decades since the first application of deep brain stimulation (DBS) for tremors was described by Benabid. Over the years, the indications for the performance of DBS have been expanding. There are now more than 1,50,000 patients around the world who have undergone DBS for various disorders. The main appeal of DBS is in its reversibility and titratability. Though the initial interest in DBS was for pain, the main indications for DBS have been movement disorders. Despite its wide appeal and “perceived” advantage, United States Food and Drug Administration, the nodal agency for approving therapies, has been cautious and guarded in providing approvals. Only two indications, i.e., Parkinson's disease and tremors, have been approved; the two other indications, i.e., dystonia and obsessive compulsive disorder (OCD), have been granted exemption under the humanitarian device usage. However, the European community has been more liberal and several of these indications have CE (Conformite Europeene) approval. Most of them will be reviewed in this article. There have been numerous indications for which DBS has been applied, which in turn has helped to change the lives of several patients. Unfortunately, due to the paucity of the number of procedures performed and the inherent difficulty in conducting “surgical” double blind randomized trials, Class 1 or Class 2 evidence for several of these indications is lacking. Hence, it is advisable that one does not embark on using each and any target for each and any indication without having the understanding or the team backup. It is cautionary that most of these therapies should be conducted in an institutional setting with an ethics and scientific committee backup and ably assisted by an experienced team.
  5,804 146 -
Movement disorders: The genesis and progression in India: Neurological perspective
Madhuri Behari
March-April 2018, 66(7):3-4
DOI:10.4103/0028-3886.226452  PMID:29503320
  5,802 126 -
Deep brain stimulation for movement disorders: Surgical nuances
Manmohan Singh, KV Shabari Girishan, Jitin Bajaj, Kanwaljeet Garg
March-April 2018, 66(7):122-130
DOI:10.4103/0028-3886.226461  PMID:29503334
Parkinson's disease (PD) and dystonia are common indications for the deep brain stimulation (DBS) procedure. It is very important to be diligent about target localization and execution of the procedure. The single most important predictor of a good postoperative outcome is proper patient selection. The various steps of performing DBS include taking a preoperative non - stereotactic MRI, stereotactic frame fixation, fusion of MRI with stereotactic CT scan images, planning of the target and trajectory, lead placement at target through the planned trajectory, implantation of pulse generator/ battery and programming of the implanted device. Utmost care and precision are required to execute the procedure, which decide the final outcome of the surgical procedure.
  5,284 211 -
Newer advances in lesional surgery for movement disorders
Milind Sankhe, Omkar Churi
March-April 2018, 66(7):113-121
DOI:10.4103/0028-3886.226463  PMID:29503333
An analysis of the existing literature on lesioning for movement disorders was undertaken to review lesion therapy and its advances. Advances in imaging technology and electrophysiological techniques used for localization of brain structures and its functions, such as microelectrode recordings and macrostimulation, have greatly improved the ability to accurately identify the target nuclei such as the ventrointermediate nucleus (Vim), globus pallidus interna (GPi) and subthalamic nucleus (STN). Many important changes are happening in the understanding of lesion making. Its application as a cheaper modality of treatment; being less cumbersome; having a wider geographical appeal; and more options to create a lesion, appeals to the clinician. The procedure is undergoing a revival.
  4,297 98 -
The rise of movement disorders
Mark Hallett
March-April 2018, 66(7):10-11
DOI:10.4103/0028-3886.226445  PMID:29503322
  3,819 70 -
Weight loss due to feeding dyskinesia: A presenting symptom of neuroacanthocytosis
Anirban Ghosal, Souren Pal
March-April 2018, 66(7):157-160
DOI:10.4103/0028-3886.226444  PMID:29503346
  3,819 66 -
ADCY5-related dyskinesia
Mahesh Kamate, Nishant Mittal
March-April 2018, 66(7):141-142
DOI:10.4103/0028-3886.226449  PMID:29503338
  3,790 71 -
Neurosurgery for movement disorders in India: Balloons to Electrodes
Srinivas Dwarakanath, Harsh Deora
March-April 2018, 66(7):5-9
DOI:10.4103/0028-3886.226458  PMID:29503321
  3,719 89 -
Expanding the phenotypic spectrum of type III GM1 gangliosidosis: Progressive dystonia with auditory startle
Sreeja H Pillai, Soumya Sundaram, Syed M Zafer, Roopa Rajan
March-April 2018, 66(7):149-150
DOI:10.4103/0028-3886.226465  PMID:29503341
  3,568 63 -
Implications of secondary unresponsiveness to dopaminergic drugs with preserved response to subthalamic nucleus stimulation in Parkinson's disease
Abhishek Lenka, Ketan R Jhunjhunwala, Albert Stezin, M Manjunath, Dwarakanath Srinivas, Ravi Yadav, Pramod K Pal
March-April 2018, 66(7):135-137
DOI:10.4103/0028-3886.226454  PMID:29503336
Improvement in motor symptoms with levodopa is one of the hallmark features of Parkinson's disease (PD). The response to levodopa may reduce during the course of the illness. Few studies have also reported reduced response to levodopa in patients with PD several years after deep brain stimulation (DBS) of the subthalamic nucleus (STN) on both the sides. In this study, we report an extreme unresponsiveness to levodopa in the presence of a good response to STN stimulation in a patient 5 years after the DBS proceudre had been carried out. The implications of this phenomenon are also discussed.
  3,558 59 -
Lateralized hyperkinetic motor behavior
Balaji Krishnaiah, Jayant Acharya, Aiesha Ahmed
March-April 2018, 66(7):131-134
DOI:10.4103/0028-3886.226448  PMID:29503335
Seizures are followed by a post-ictal period, which is characterized by usual slowing of brain activity. This case report describes a 68-year old woman who presented with right-sided rhythmic, non-voluntary, semi-purposeful motor behavior that started 2 days after an episode of generalized seizure. Her initial electroencephalogram (EEG) showed beta activity with no evidence of epileptiform discharges. Computed tomography scan showed hypodensity in the left parieto-occipital region. Magnetic resonance imaging (MRI) showed restricted diffusion/fluid-attenuated inversion recovery hyperintensities in the left precentral and post-central gyrus. Unilateral compulsive motor behavior during the post-ictal state should be considered, and not confused with partial status epilepticus to avoid unnecessary treatment. Abnormal magnetic resonance imaging (MRI) findings, which are reversible, can help with the diagnostic and therapeutic approach.
  3,525 56 -
Does cerebral infarction ameliorate essential tremor? A mini-review
Rohan Mahale, Anish Mehta, Nikith Shetty, R Srinivasa
March-April 2018, 66(7):152-154
DOI:10.4103/0028-3886.226462  PMID:29503343
  3,523 54 -
Hemimyoclonus: A rare presentation of hemimegalencephaly
Jacky Ganguly, Sandip Pal, Debasis Basu, Prasenjit Sengupta, Asutosh Pal, Chetana Chatterjee, Chiranjib Das
March-April 2018, 66(7):142-145
DOI:10.4103/0028-3886.226457  PMID:29503339
  3,431 45 -
Unusual sites of primary dystonia in adults: A series of three patients
Sahil Mehta, Aastha Takkar, Manoj Kumar Goyal, Vivek Lal
March-April 2018, 66(7):154-155
DOI:10.4103/0028-3886.226456  PMID:29503344
  3,397 54 -
Reversible “hemiparkinsonism” following surgery for a lateral ventricle liponeurocytoma in a 24-year old student
Atef Ben Nsir, Quoc-Anh Thai, Adnene Boubaker, Hafedh Jemel
March-April 2018, 66(7):145-149
DOI:10.4103/0028-3886.226443  PMID:29503340
  3,373 33 -
The cover page

March-April 2018, 66(7):1-2
DOI:10.4103/0028-3886.226453  PMID:29503319
  3,249 73 -
Interleaving pallidal deep brain stimulation improves the degree of benefit obtained in a patient with dystonia
Shizhen Zhang, Yi Wang, Peng Li, Wei Wang
March-April 2018, 66(7):138-141
DOI:10.4103/0028-3886.226442  PMID:29503337
  3,256 49 -
Online since 20th March '04
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