Priya Jagota

Prevalence of neuroleptic-induced restless legs syndrome in patients taking neuroleptic drugs

Dopamine deficiency or dopamine dysfunction has been implicated as one of the factors involved in the pathophysiology of restless legs syndrome (RLS). Our objective is to determine the prevalence of primary RLS in patients taking neuroleptic drugs. One hundred patients taking neuroleptic drugs and 100 healthy age- and sex-matched controls were interviewed with the Cambridge-Hopkins diagnostic questionnaire for RLS. Patients with malignancy, end-stage renal disease, neuropathy, history of spinal cord diseases, pregnancy and Parkinsons disease were excluded. Only one patient had symptoms consistent with RLS (1%), similar to one patient in the control group. She was a 40 years old female with a diagnosis of depression. She started having RLS symptoms approximately four years after starting perphenazine. The symptoms persisted after the medications were discontinued but decreased in severity and frequency. Her serum ferritin level was 90.3 ng/ml. The prevalence of primary RLS is low in patients attending the out-patient clinic who are taking neuroleptic drugs. Other factors apart from dopaminergic dysfunction are likely to be involved in the pathogenesis of RLS.

Movement disorders in patients with diabetes mellitus.

Movement disorders are not infrequent in patients with diabetes mellitus. These may occur on the basis of both central and peripheral nervous system dysfunction and can be secondary to severe hyperglycemia, complications of diabetes or its treatment and less often to diseases in which both diabetes and a movement disorder are primary manifestations of the same underlying disease. We present a typical case of a severe movement disorder complicating diabetes as a springboard to review the spectrum of disorders associated with this condition.

Transplacental transfer of NMDA receptor antibodies in an infant with cortical dysplasia.

A confused and agitated 18-year-old woman presented to the emergency unit with orolingual movements, eye deviation, and a temperature of 38°C. The symptoms had begun 2 weeks prior to the admission when she developed a severe headache associated with pathologic laughing and intermittent episodes of upgaze deviation. A urine pregnancy test was positive and a transvaginal ultrasonography showed a 9-week-old fetus. An MRI of the brain was unremarkable and results of the CSF analysis were also unremarkable apart from a CSF pleocytosis (62 lymphocytes) and slightly elevated protein (55 mg/dL; normal range 0–45 mg/dL). Extensive microbiologic and serologic studies with CSF were all negative. She gradually lost consciousness, experienced respiratory failure, and was intubated. There were semirhythmic movements consisting of complex patterns of mouth opening, chewing, facial grimacing, synchronous flexion-extension, and supination-pronation limb movements, which persisted during the period of unresponsiveness. She also had generalized hyperreflexia, persistent hyperthermia, and a full bladder. Three EEGs showed diffuse slow waves with no epileptic discharges. A diagnosis of anti-NMDA receptor (NMDAR) encephalitis was made on clinical grounds and strongly positive serum NMDAR antibodies.

Identifying gaps in knowledge about Parkinson disease among medical professionals in Thailand

Although Dr. James Parkinson wrote his classic essay “The Shaking Palsy” almost 200 years ago to inform the scientific and medical communities about the disease that now bears his name, the fundamental dynamics of Parkinson disease (PD) are still not fully understood.1 Perhaps because the criteria for diagnosing PD all relate to movements, many people, including physicians, have the misconception that PD primarily is a movement disorder when, in fact, it has a great impact on many other physical and psychological functions as well. In light of the absence of a definitive understanding of the basic etiology of PD and the comprehensive scope of its impact, the medical responses to this neurodegenerative disease often are influenced by misconceptions based on myths and false assumptions.

The Arizona Sexual Experiences Scale: a validity and reliability assessment of the Thai translation (ASEX-Thai) in Parkinson's disease.

INTRODUCTION Cultural sensitivities tend to limit assessments of sexual dysfunction (SD) in Parkinsons disease (PD). OBJECTIVE To assess the validity and reliability of the Thai translation (ASEX-Thai) of the Arizona Sexual Experiences Scale (ASEX). METHOD The validity and reliability of ASEX-Thai were assessed with a random sample of 40 PD patients. Back translation and cross-cultural modifications assured content validity. Criterion validity used DSM-IV-TR criteria and receiver operating characteristics (ROC) analysis was calculated for cutoff points plus sensitivity and specificity. Internal consistency was assessed with Cronbachs alpha coefficient. Test-retest reliability was assessed by Pearsons correlation at baseline and at a 2-month follow-up. RESULT Criterion validity was conducted with a positive correlation between the clinical diagnosis of SD and DSM-IV-TR (r = 0.601; p < 0.001). The ROC analysis differentiated between SD and non-SD patients (p < 0.001). The cutoff point of ASEX-Thai at ≥16 points effectively screened for SD (sensitivity 96.2%, specificity 92.9%). Reliability was documented with the Cronbachs alpha of all items at baseline and at a 2-month follow-up with values of 0.948 and 0.962 respectively. The Pearsons correlation also showed highly significant test-retest reliability [Item 1 (r = 0.959, p < 0.001), Item 2 (r = 0.914, p < 0.001), Item 3 (r = 0.944, p < 0.001), Item 4 (r = 0.992, p < 0.001), Item 5 (r = 0.930, p < 0.001), and total ASEX-Thai score (r = 0.883, p < 0.001)]. CONCLUSION ASEX-Thai is a valid and reliable instrument for the assessment of sexual dysfunction in Thai PD patients.

Expanding spectrum of abnormal movements in MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes).

MELAS syndrome—mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes—is a distinct clinical syndrome that frequently involves skeletal muscle and/or the central nervous system. Among those, myoclonus represents the most common movement disorder of MELAS, although a variety of abnormal movements are increasingly being recognized. In this article, we report a patient with sporadic MELAS syndrome who presented with orofacial dyskinesia, parkinsonism with predominant gait freezing, and diabetes.