Floriane Le Goff

Decline in Verbal Fluency After Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: A Microlesion Effect of the Electrode Trajectory?

BACKGROUND Decline in verbal fluency (VF) is frequently reported after chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson disease (PD). OBJECTIVE We investigated whether the trajectory of the implanted electrode correlate with the VF decline 6 months after surgery. METHODS We retrospectively analysed 59 PD patients (mean age, 61.9 ± 7; mean disease duration, 13 ± 4.6) who underwent bilateral STN-DBS. The percentage of VF decline 6 months after STN-DBS in the on-drug/on-stimulation condition was determined in respect of the preoperative on-drug condition. The patients were categorised into two groups (decline and stable) for each VF. Cortical entry angles, intersection with deep grey nuclei (caudate, thalamic or pallidum), and anatomical extent of the STN affected by the electrode pathway, were compared between groups. RESULTS A significant decline of both semantic and phonemic VF was found after surgery, respectively 14.9% ± 22.1 (P < 0.05) and 14.2% ± 30.3 (P < 0.05). Patients who declined in semantic VF (n = 44) had a left trajectory with a more anterior cortical entry point (56 ± 53 versus 60 ± 55 degree, P = 0.01) passing less frequently trough the thalamus (P = 0.03). CONCLUSIONS Microlesion of left brain regions may contribute to subtle cognitive impairment following STN-DBS in PD.

Subjective Perceived Motor Improvement after Acute Levodopa Challenge in Parkinson’s Disease

BACKGROUND Previous studies found a poor association between parkinsonian patients reported subjective improvement after commencing dopaminergic treatment and improvements in objective measures of motor impairment by clinician. OBJECTIVE To compare PD patients subjective perceived motor improvement after acute levodopa challenge test with objective motor improvement assessed by the clinician using the UPDRS part III. To analyze clinical characteristics, i.e. age, disease duration, cognitive performance or severity of axial features, that may have influenced patients perception. METHODS Fifty-seven consecutive PD patients (23 women, 34 men; mean age, 63.4±7.7 years) (Hoehn and Yahr off score, 2.5±0.7; mean disease duration, 11.4±4.1 years) completed the acute levodopa challenge. The percentage of improvement in motor disability, i.e. objective motor improvement, was determined with respect to the off-drug condition. RESULTS Bland & Altman visual analysis reveals a high degree of correlation between objective and subjective perceived motor improvement. Both the axial sub-scores in the off- and on-state (respectively, P = 0.006 and P = 0.024) and the presence of peak-dose dyskinesia (P = 0.043) significantly influence the difference between objective and subjective perceived motor improvement. CONCLUSIONS This is the first study reporting on how PD patients assessed their motor improvement after acute levodopa challenge. These findings suggest a strong correlation between objective motor improvement assessed by the clinician using the UPDRS part III and subjective perceived motor improvement reported by the patient.

Clavicle fracture mimicking dropped-head syndrome in a patient with multiple system atrophy

Dropped-head syndrome is characterized by an abnormal ante-fixed posture of the neck, usually observed in patients with neurodegenerative disorders such as multiple system atrophy (MSA) [1]. We report an unusual cause of acute antero- and latero-collis in a patient with MSA.

Recurrent Bilateral Dislocation of the Temporomandibular Joint Induced by Clonazepam in a Parkinsonian Patient.

To the Editor: D islocation of the temporomandibular joint (TMJ) is a distressing situation that may occur as a result of daily activities such as yawning, laughing, or during events that require keeping the mouth open for a long time. Generally of unknown origin, it may result from trauma, articulation disorders, or changes in the equilibrium of the masticatory muscles. Some degenerative neurological disorders, especially those occurring with spasticity as well as orofacial and oromandibular dystonia, might be related to TMJ dislocation. Drug-induced bilateral TMJ dislocations are rarely described. Herewe report the case of a parkinsonian patient who experienced recurrent dislocations of the TMJ after clonazepam treatment. A 68-year-old womanwas followed-up regularly for Parkinson disease (PD) in our center. She had no other medical history. Parkinson disease had been diagnosed 10 years earlier. Her medical treatment included the following: 600 mg per day of levodopa, 12 mg per day of ropinirole, and 200 mg per day of amantadine. Because she complained of vivid dreams and abnormal nocturnal motor behavior during the preceding 4 months, we hypothesized that she had rapid eye movement sleep behavior disorder, and 0.5 mg of clonazepam at bedtime was prescribed. The morning after the first intake, the patient was unable to close her mouth and presented excessive drooling. She had neither pain nor muscle spasms. Physical examination and x-ray confirmed the diagnosis of bilateral TMJ, which was successfully reduced by simple manual manipulationwithout need of a muscle relaxant drug. The patient no longer wished to take

Severe dizziness following rivaroxaban introduction in a parkinsonian patient: Drug-drug interaction?

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 2 octobre 2015