Nestor Galvez-Jimenez

Psychogenic movement disorders.

Psychogenic movement disorders (PMD) are challenging to diagnose and to treat. Since the nineteenth century, PMDs were recognized and described in painstaking detail. In the modern neurology clinic, PMDs may comprise 2-25% of the patient population. Recognition of the various types of PMDs, differentiation from organic illness and an approach to PMDs are described in this article.

Perioperative problems in Parkinson's disease and their management : Apomorphine with rectal domperidone

OBJECTIVE To present guidelines on the use of apomorphine in combination with rectal domperidone in Parkinsons disease (PD) patients undergoing abdominal surgery and to review the perioperative problems encountered in such patients. BACKGROUND PD patients undergoing abdominal surgery present a major therapeutic challenge. Because most antiparkinsonian medications must be withheld until the patient is able to resume oral intake, resulting rigidity and akinesia as well as alterations in gastrointestinal motility, respiratory function and swallowing mechanisms predispose these patients to numerous serious postoperative complications. We have found that parenteral apomorphine in combination with rectal domperidone markedly facilitates the care of these difficult patients. METHODS Presentation of two illustrative cases with review of the literature. RESULTS A standardized protocol using subcutaneous apomorphine and rectal domperidone was used in two PD patients who underwent abdominal surgery. Excellent control of parkinsonian symptomatology was obtained without side effects. The simplicity of the protocol was emphasized in our second patient who required urgent reoperation; the surgery nursing staff was able to restart the apomorphine immediately without having to wait for neurological follow-up assessment. CONCLUSIONS The use of parenteral apomorphine with rectal domperidone in the immediate postoperative period for patients unable to take oral antiparkinson drugs increases patient comfort, facilitates nursing care and may reduce serious postoperative complications.

Current and prospective disease-modifying therapies for amyotrophic lateral sclerosis.

Introduction: Amyotrophic lateral sclerosis (ALS) is a devastating illness of unclear etiology affecting motor neurons. It causes unremitting muscle paralysis, atrophy and death usually within 3 – 5 years from diagnosis. The human and economic costs for those affected are sobering. To date, tremendous efforts have failed to find a cure. Areas covered: An extensive literature search was undertaken using Medline and the Cochrane Systematic Review and Clinical Trial databases. Riluzole and investigational ALS drugs are discussed. Riluzole is the only approved disease-modifying therapy despite its modest effect on survival. Recent research has produced promising agents aimed at better disease control if not a cure. This review discusses agents targeting neuronal glutamate excitotoxicity, protein misfolding and accumulation, autophagy, apoptosis, mitochondrial dysfunction, free radical oxidative injury, immunomodulation, mutant mRNA counteraction, muscle physiology, neurotrophic factors and stem cell applications. The challenges in ALS drug development are highlighted. Expert opinion: Riluzole should be used for patients with definite, probable, suspected or possible ALS by World Federation of Neurology diagnostic criteria. Systematic monitoring for hepatic dysfunction, neutropenia and other serious adverse effects should be done routinely as outlined. All ALS patients should consider genetic screening and enrollment in ALS trials guided by the data reviewed.

Mutations in LRRK2 other than G2019S are rare in a north-American based sample of familial Parkinson's didease

A total of 956 individuals with Parkinsons disease (PD) from 430 multiplex PD pedigrees were screened for 12 previously reported, pathogenic LRRK2 mutations: R793M, L1114L, I1371V, R1441C, R1441G, R1441H, Y1699C, M1869T, I2012T, I2020T, G2385R, and IVS31 +3G>A. Previous screening identified the LRRK2 G2019S mutation in 5% of our families. Only 1 of the 12 newly screened mutations, R1441C, was detected in a single family in our patient cohort. These results indicate that, although the G2019S mutation remains the most common mutation identified in familial PD patients, other mutations in LRRK2 are infrequent.

Normal distribution of apolipoprotein E alleles in progressive supranuclear palsy

Apolipoprotein E (Apo E) genotype is a genetic risk factor influencing the development of Alzheimers disease (AD).Progressive supranuclear palsy (PSP), like AD, is a dementing illness with neurofibrillary tangles. We determined the frequencies of Apo E alleles in 52 PSP patients and 52 age- and gender-matched controls. The distribution of Apo E allele frequencies and genotypes showed no difference between PSP and controls. Apo E allele status does not influence the development of PSP. NEUROLOGY 1996;46: 1156-1157

A Pilot Study of Botulinum Toxin A for Headache in Cervical Dystonia

Objective.—To evaluate the prevalence of associated headache (HA) pain with craniocervical dystonia and the therapeutic effect of BoNT‐A injections on the HA component when injected for cervical dystonia.

Rasagiline induced hypersexuality in Parkinson’s disease

Impulse control disorders (ICD) are increasingly recognized in patients with Parkinsons disease (PD), particularly when treated with commonly used dopamine agonists such as pramipexole and ropinirole. Less evident is the possible association between monoamine oxidase inhibitors type B (MAO-B) and the development of ICD. Rasagiline is a second generation MAO-B I inducing moderate symptomatic and possibly disease modifying benefits with apparently good tolerability and safety profile in PD patients. Rasagiline is effective and well tolerated in PD as a monotherapy or in combination with levodopa. Here, we report a patient with PD who developed ICD when treated de novo with MAO-B inhibitors.

Where is dihydroergotamine mesylate in the changing landscape of migraine therapy

Importance of the field: Migraine affects approximately 18% of women and 6% of men, and has an immense impact on quality of life and productivity. Advancement in therapeutic options has been slow. For many patients with difficult-to-treat migraine, the appropriate use of dihydroergotamine mesylate (DHE) can result in treatment success and unprecedented patient satisfaction. Areas covered in this review: Migraine treatment guidelines regarding the role of DHE are highlighted. An overview of the market for antimigraine drugs is provided in the context of DHE, since its introduction in 1943, and the novel agents that are likely to be available in the near future. An extensive literature search was undertaken using Medline and the Cochrane Systematic Review and Clinical Trial databases. What the reader will gain: An understanding of which migraine patients are likely to benefit maximally from treatment with DHE in its various forms. Take home message: In the most difficult patient groups – including those with status migrainosus, migraine recurrence, medication-overuse headache, and chronic daily headache – DHE has therapeutic efficacy superior to other agents. The side-effect profile of DHE is more benign than is often perceived and should not be a deterrent for use in well-chosen cases.

Sirsasana (Headstand) Pose Causing Compressive Myelopathy With Myelomalacia

A 52-YEAR-OLD WOMAN presented to our institution with bilateral hand numbness. She compulsively practiced yoga for more than 30 years and performed daily headstand poses. Examination showed weak grip, right Hoffmann sign, inability to tandem, and impaired vibration and proprioception. Imaging showed severe multilevel degenerative disease, spinal stenosis, and secondary compressive myelopathy with myelomalacia worse at C5 (Figure).

RESTLESS LEGS SYNDROME

To the Editor: We read with interest the articles by Becker et al.1 and Lin et al.2 regarding the effectiveness of pramipexole in the treatment of restless legs syndrome (RLS). Prior to their report, we treated two patients with ropinirole and four patients with pramipexole for drug-resistant primary or secondary RLS. All patients fulfilled the diagnostic criteria for RLS.3 The characteristics of the patients are shown in the accompanying table. There are three men and three women with an average age of 70 years (range 64–85) and duration of illness ranging from 1 to 50 years. All patients had a trial of standard anti-RLS medications with partial or no response. The average …