RESUMEN
Camptocormia is defined as a forced posture with a forward-bent trunk which appears during standing and sitting. It was first described in 1818 by Brodie. In the last 100 years, numerous cases were observed. A psychogenic origin was presumed in most cases. We describe four patients with typical symptoms of camptocormia who present with the clinical and electromyographical criteria of a segmental dystonia. A new classification of camptocormia is proposed including (1) the primary form, a segmental dystonia of the abdominal wall muscles and (2) secondary forms. Among other conditions (psychogenic disorder, neurosis, myopathy, myositis, Parkinson's disease, multiple-system atrophy, thoracolumbar kyphosis, paraneoplastic syndrome), camptocormia is to be considered in essential tremor. A combination of dystonia of the abdominal wall muscles and essential tremor seems possible.
Asunto(s)
Músculos Abdominales/fisiopatología , Trastornos Distónicos/clasificación , Adulto , Anciano , Toxinas Botulínicas Tipo A/uso terapéutico , Diagnóstico Diferencial , Trastornos Distónicos/diagnóstico , Trastornos Distónicos/tratamiento farmacológico , Trastornos Distónicos/fisiopatología , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/uso terapéutico , Resultado del TratamientoRESUMEN
Several tests of cardiovascular and gastrointestinal function have been approved for the diagnosis of autonomic regulation dysfunction in Parkinson's disease. In the present study we compared the diagnostic value of the sympathetic skin response (SSR) with the established methods. Ninety percent of the 20 patients we examined (10 women, 10 men, 46 to 80 years) showed pathological results in the cardiovascular function test. Fifty-five percent had a prolonged colon transit, indicating a gastrointestinal dysfunction. We saw pathologically prolonged latencies of the SSR in 35% of the patients, 55% had borderline results. Three of the 20 patients had pathological results in all of the functions examined. Half of the patients had two pathological results, whereas 7 patients were pathological in only one of the three examinations. We were unable to establish any correlation between the SSR and other results, and we also found no relationship between prolonged SSR and the duration of the disease.
Asunto(s)
Nivel de Alerta/fisiología , Respuesta Galvánica de la Piel/fisiología , Enfermedad de Parkinson/fisiopatología , Piel/inervación , Sistema Nervioso Simpático/fisiopatología , Anciano , Anciano de 80 o más Años , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Presión Sanguínea/fisiología , Femenino , Tránsito Gastrointestinal/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/diagnóstico , Tiempo de Reacción/fisiología , Valores de ReferenciaRESUMEN
There are many methods to choose from in the investigation of the autonomic nervous system. The value of the individual tests to the clinician varies according to the method of investigation used. No one test can elucidate all the information needed for all functional disturbances. As a routine, measurement of blood pressure and heart rate reaction to active orthostasis and heart rate variation with deep breathing and the Valsalva manoeuvre can be useful. Spectral analysis of the heart rate is an easily performed test, only minimally disturbing for the patient, and is a valid means of investigation which may find a way into routine clinical use in the future.