Maria Clara Scorticati

Beneficial effects of botulinum toxin type a for patients with painful tic convulsif.

Botulinum toxin is a well-known therapy for patients with diverse movement disorders. Its application has been extended to other disorders. Here, we document the case of a 70-year-old man with hemifacial spasm associated to trigeminal neuralgia secondary to an ectatic basilar artery. He was treated with botulinum toxin type A, 2.5 mouse units over five sites at the orbicularis oculi and one over the buccinator muscle. After botulinum toxin injections, relief was gained not only from twitching but also from pain. When the effects of the toxin vanished, spasms and pain recurred. Further infiltrations were given every 12 weeks following the same response pattern. This observation further validates the increasing role of botulinum toxin in pain management.

Cluster-like headache associated to a foreign body in the maxillary sinus

Cluster headache is known as one of the most painful cephalalgias to be experience by humans. They are most commonly primary, for which there are well-established diagnostic criteria; but from 3 to 5% of cluster headache cases are secondary to diverse lesions. Although its pathogenesis is uncertain, the following hypotheses have been advanced: 1) a central origin, located in the anterior hypothalamus (suprachiasmatic nucleus), as well as in the posterior hypothalamus1,2⇓; 2) a peripheral origin, with activation of the pericarotid neural plexus in the cavernous sinus3; and 3) the coexistence of a “central trigger,” located in the hypothalamus with peripheral onset of pain, and autonomic symptoms, explained by activation of the trigemino-autonomic reflex.1,2,4⇓⇓ We present a patient with symptoms consistent with cluster headache, according to the 1988 criteria of the International Headache Society,5 associated to a foreign body in the ipsilateral maxillary sinus. A 34-year-old woman sought advice for an 8-year history of right, piercing, intense orbital pain lasting from 30 to 60 …

Familial hemifacial spasm

We present a family in which hemifacial spasm involving in all cases the left side of the face occurred in five persons in three generations. Blink reflexes recorded in two cases demonstrated an unexpected R1 component on the affected side during stimulation of the contralateral side.

Movement disorders secondary to adulterated medication

Diagnosis of drug-induced movement disorders (DIMD) may prove troublesome because they can manifest after a long delay1,2 and the patient may be unable to recall his or her pharmacologic history. Also, the list of drugs capable of inducing movement disorders continues to increase.3,4 We present a series of patients, seven from Peru (who were prescribed an antibiotic) and four from Argentina with PD (treated with l-dopa–benserazide), who developed movement disorders or exhibited worsening of a pre-existing abnormal movement, without reliable information as to the true nature of the drugs taken. ### Case 4. An 83-year-old Argentinian man with a 13-year history of PD in Hoehn and Yahr stage III, currently receiving l-dopa–benserazide 700–175 mg/day plus pergolide 3 mg/day, presented with end-of-dose deterioration associated with mild peak-of-dose dyskinesias. On admission he had severe worsening of parkinsonian signs, which had occurred during the last 10 days. On examination, he was extremely bradykinetic with severely …

Myoclonus secondary to albuterol (salbutamol) instillation

Many drugs can induce myoclonus, including lithium, clozapine, penicillin, narcotics, anticonvulsants, anesthetics, calcium entry blockers, antihistamines, antineoplastic agents, levodopa, and bromocriptine.1 Here we describe three patients who, after receiving high doses of albuterol (salbutamol), developed acute multifocal myoclonic jerking. A 56-year-old man with a history of diabetes, chronic alcoholism, and bronchial asthma had a cardiorespiratory arrest 5 years ago and was admitted to the intensive care unit for a severe asthmatic crisis. Despite treatment with high doses of salbutamol, the asthmatic crises were complicated by hypoxia, subsequent transient obtundation, and muscular jerks. After an additional episode of bronchial asthma, he was prescribed buccal spray instillations of salbutamol 50 mg/day and oral dexamethasone 40 mg/day for 5 days. After he received salbutamol for 2 days, the patient’s respiratory disorder had resolved, but he developed severe, stimulus-sensitive, multifocal jerking, superimposed on voluntary actions and postures (figure, A). Results of a cerebral MRI were normal, and, without other probable causes, treatment with salbutamol was discontinued. Improvement was observed in less than 48 hours, with the …

Delayed onset limb dystonia following electric injury

It has been recognized that head trauma can induce movement disorders including tremor, dystonia, parkinsonism and tics. Likewise, lesions involving the peripheral nervous system have been held responsible for such extrapyramidal manifestations, However, involuntary movements secondary to electric injury have seldom been described. Here we report a patient who developed limb dystonia 6 years after receiving an electric discharge in the ipsilateral limb. Although imaging and laboratory studies failed to ascribe the lesion either to the central or peripheral nervous system, initial symptoms such as local bruises, edema and pain would favor peripheral damage. Botulinum toxin injections markedly improved dystonia. Analysis of cases of dystonia following electric injury reported to date suggest that: (a) dystonia may be expected to develop immediately or even years after the electric insult; (b) dystonia usually develops in or adjacent to the area initially injured; (c) dystonia remains limited to a distinct body segment; (d) severity of dystonia as well as the interval between injury and the onset of the movement disorder fails to correlate with trauma severity; (e) no evidence supports the hypothesis that previous history of movement disorders or neuroleptic exposure are predisposing factors; and (f) botulinum toxic provides symptomatic relief.

Dystonia and tremor secondary to a pediatric thalamic stroke

A previously healthy 10-year-old girl developed a right hemiparesis with sensory loss secondary to a posterolateral thalamic infarct. Despite improvement in strength, three weeks later a 4 Hz kinetic tremor appeared in the right hand accompanied by dystonia in the right upper and lower limbs. Basal ganglia vascular lesions are rare in childhood and movement disorders secondary to such lesions even more so. A thorough work-up failed to disclose the etiology. Our patient illustrates that dystonia and tremor secondary to posterolateral thalamic infarctions are also apt to occur in children and, unlike the adult picture, abnormal movements may develop very soon after the insult.

Cirugía en la enfermedad de Parkinson

Se discuten los aspectos fisiopatologicos de la enfermedad de Parkinson y la importancia de los diferentes nucleos. Se comentan las diversas tecnicas lesionales como palidotomia, o talamotomia y la estimulacion profunda cerebral.

Blefaroespasmo. Distonía oromandibular

El blefaroespasmo es una distonia focal que compromete el orbicularis oculi, que en casos severos produce una ceguera funcional. Hemos evaluado las caracteristicas clinicas y perfil neurofarmacologico en 100 casos consecutivos estudiados en los ultimos 9 anos en el Hospital Universitario de Buenos Aires, Argentina. La poblacion estuvo compuesta por 69 mujeres y 39 hombres cuyas edades oscilaron entre 29 y 78 anos. El 61 por ciento presento blefaroespasmo mientras que el resto tenia una distonia oromandibular asociada. La gran mayoria comenzo en la 5ta. decada y el comienzo fue unilateral en el 12 por ciento pero en todos los casos evoluciono a una forma bilateral. Solo el 60 por ciento habia sido previamente diagnosticado en forma correcta, mientras que en el 40 por ciento restante el diagnostico se difirio hasta varios anos el tratamiento mas efectivo fue la infiltracion del orbicular de los parpados con toxina botulinica (88 por ciento) seguido por el lisuride en dosis bajas que beneficio al 56 por ciento y el trihexifenidilo en el 54.5 por ciento de los tratados. Nuestros resultados sugieren que el cuadro puede ser manejado con exito luego de hacer un correcto diagnostico. Las infiltraciones con toxina botulinica debieran ser efectuadas por neurologos con experiencia en movimientos anormales.