RESUMEN
BACKGROUND AND PURPOSE: The association of perivascular spaces in the centrum semiovale with amyloid accumulation among patients with Alzheimer disease-related cognitive impairment is unknown. We evaluated this association in patients with Alzheimer disease-related cognitive impairment and ß-amyloid deposition, assessed with [18F] florbetaben PET/CT. MATERIALS AND METHODS: MR imaging and [18F] florbetaben PET/CT images of 144 patients with Alzheimer disease-related cognitive impairment were retrospectively evaluated. MR imaging-visible perivascular spaces were rated on a 4-point visual scale: a score of ≥3 or <3 indicated a high or low degree of MR imaging-visible perivascular spaces, respectively. Amyloid deposition was evaluated using the brain ß-amyloid plaque load scoring system. RESULTS: Compared with patients negative for ß-amyloid, those positive for it were older and more likely to have lower cognitive function, a diagnosis of Alzheimer disease, white matter hyperintensity, the Apolipoprotein E ε4 allele, and a high degree of MR imaging-visible perivascular spaces in the centrum semiovale. Multivariable analysis, adjusted for age and Apolipoprotein E status, revealed that a high degree of MR imaging-visible perivascular spaces in the centrum semiovale was independently associated with ß-amyloid positivity (odds ratio, 2.307; 95% CI, 1.036-5.136; P = .041). CONCLUSIONS: A high degree of MR imaging-visible perivascular spaces in the centrum semiovale independently predicted ß-amyloid positivity in patients with Alzheimer disease-related cognitive impairment. Thus, MR imaging-visible perivascular spaces in the centrum semiovale are associated with amyloid pathology of the brain and could be an indirect imaging marker of amyloid burden in patients with Alzheimer disease-related cognitive impairment.
Asunto(s)
Enfermedad de Alzheimer , Cerebro/diagnóstico por imagen , Disfunción Cognitiva , Sistema Glinfático/diagnóstico por imagen , Placa Amiloide/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/patología , Péptidos beta-Amiloides , Cerebro/patología , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/etiología , Disfunción Cognitiva/patología , Sistema Glinfático/patología , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Placa Amiloide/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: High uric acid (UA) levels have been shown to exert a neuroprotective effect in Parkinson's disease (PD) by inhibiting oxidative stress in the nigrostriatal pathway. However, the association between striatal dopamine activity and UA level has not been clarified. METHODS: A total of 213 patients with early PD were enrolled. All patients underwent positron emission tomography using 18 F-N-(3-fluoropropyl)-2beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane and a venous blood test for quantification of serum UA. All patients were stratified into either the lower UA group or the higher UA group using the median UA level. After normalizing the positron emission tomography images, differences in the regional standardized uptake value ratios (SUVRs) were analyzed with a volume-of-interest template. All tested SUVRs were also compared after categorizing patients by gender. RESULTS: The UA affected dopamine transporter SUVRs in different ways by gender. In female patients, the higher UA level group showed a smaller reduction in dopamine transporter uptake in the posterior putamen, whereas there was no such association observed in male patients. CONCLUSIONS: Higher UA levels were correlated with higher dopamine transporter uptake in the putamen in female patients with early PD. This finding suggests that UA has a neuroprotective effect, as demonstrated by the relatively preserved striatal dopamine activity in women.
Asunto(s)
Cuerpo Estriado/metabolismo , Dopamina/metabolismo , Enfermedad de Parkinson/metabolismo , Ácido Úrico/metabolismo , Anciano , Anciano de 80 o más Años , Cuerpo Estriado/diagnóstico por imagen , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuroprotectores , Enfermedad de Parkinson/diagnóstico por imagen , Tomografía de Emisión de Positrones , Putamen/metabolismo , Caracteres Sexuales , Ácido Úrico/sangreRESUMEN
Impaired finger dexterity occurs in Parkinson's disease (PD) and has been considered a limb-kinetic apraxia associated with primary sensory cortical dysfunction. To study the role of nigrostriatal dopamine loss and elementary parkinsonian motor deficits in impaired finger dexterity of PD. Thirty-two right-handed untreated PD patients and 30 right-handed healthy controls were included. All patients underwent [18F] FP-CIT positron emission tomography studies. We examined the associations among unilateral coin rotation (CR) score, Unified Parkinson's Disease Rating Scale (UPDRS) subscores for bradykinesia and rigidity of the corresponding arm, and contralateral regional striatal dopamine transporter (DAT) uptake. We also measured the effect of oral levodopa dose on CR scores and UPDRS subscores. PD patients performed worse than controls on the CR task. Unilateral arm UPDRS bradykinesia scores were associated with DAT uptake in the contralateral putamen. The left CR score was associated with left arm bradykinesia and rigidity scores and DAT uptake in the right posterior putamen, whereas no such associations were found for the right CR score. There was a significant effect of handedness on the association of putamen DAT uptake with CR scores, but not with UPDRS subscores. An oral levodopa challenge improved CR scores and UPDRS subscores on both sides. Impaired finger dexterity in PD is related to elementary parkinsonian motor deficits and nigrostriatal dopamine loss. Impaired dominant hand dexterity associated with nigrostriatal dopamine loss seems to be compensated to some extent by the dominant cerebral cortex specialized for controlling precise finger movements.
Asunto(s)
Apraxias/etiología , Cuerpo Estriado/metabolismo , Dopamina/deficiencia , Neuronas Dopaminérgicas/patología , Dedos/fisiopatología , Hipocinesia/etiología , Enfermedad de Parkinson/fisiopatología , Sustancia Negra/metabolismo , Anciano , Antiparkinsonianos/uso terapéutico , Apraxias/metabolismo , Apraxias/fisiopatología , Brazo/fisiopatología , Cuerpo Estriado/diagnóstico por imagen , Cuerpo Estriado/fisiopatología , Dopamina/metabolismo , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Femenino , Lateralidad Funcional , Humanos , Hipocinesia/metabolismo , Hipocinesia/fisiopatología , Imagenología Tridimensional , Levodopa/uso terapéutico , Masculino , Persona de Mediana Edad , Destreza Motora , Rigidez Muscular , Enfermedad de Parkinson/diagnóstico por imagen , Enfermedad de Parkinson/tratamiento farmacológico , Tomografía de Emisión de Positrones , Índice de Severidad de la Enfermedad , Sustancia Negra/diagnóstico por imagen , Sustancia Negra/fisiopatologíaRESUMEN
INTRODUCTION: Sensory information is essential for the precise control of movement. Patients with Parkinson's disease (PD) have higher-order sensory dysfunctions including prolonged temporal discrimination threshold (TDT). However, the impact of prolonged TDT on parkinsonian motor deficits is uncertain. METHODS: This study includes 33 PD patients and 24 healthy controls. TDT values were measured in the index finger. Using coin rotation task (CRT), dexterous finger movement was assessed. Using an inertial sensor, the speed, amplitude, and frequency of finger tapping were measured. The impact of prolonged index finger TDT on two different finger movements was analyzed using the general estimating equation. RESULTS: Compared to healthy controls, TDT was prolonged in the PD patients. There was no impact of TDT on mean values or decrement for amplitude and speed, as well as mean values, decrement and variability of tapping frequency. However, prolonged TDT had a significant impact on the variability in amplitude (B = 436.905 × 10-4, Wald χ2 = 9.140, p = 0.014) and speed (B = 425.655 × 10-4, Wald χ2 = 9.876, p = 0.014) of finger tapping. There was a marginal correlation between TDT and CRT. In addition, CRT correlated with variability in amplitude and speed of finger tapping. CONCLUSION: In PD, cutaneous temporal discriminative sensory dysfunction appears to be related to increased variabilities in the speed and amplitude of fast repetitive finger movements and disturbed finger dexterity.
Asunto(s)
Discriminación en Psicología , Dedos/fisiopatología , Movimiento , Enfermedad de Parkinson/fisiopatología , Desempeño Psicomotor , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Enfermedades Desmielinizantes/complicaciones , Hierro/metabolismo , Ósmosis , Putamen/metabolismo , Putamen/patología , Anciano , Atrofia/etiología , Enfermedades Desmielinizantes/diagnóstico por imagen , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Femenino , Humanos , Imagen por Resonancia Magnética , Tomografía de Emisión de Positrones , Putamen/diagnóstico por imagenRESUMEN
BACKGROUNDS: Leukoaraiosis may present with slowly progressive parkinsonism indistinguishable from primary degenerative parkinsonism. Both leukoaraiosis and degenerative parkinsonism are an age-related disorder. Thus, comorbidity is expected to be common in elderly patients with parkinsonism. However, no systematic study has been reported on the clinical features indicating concomitant nigrostriatal dopaminergic denervation (NDD) in parkinsonian patients with leukoaraiosis. METHODS: We performed [(18)F] FP-CIT positron emission tomography studies in 42 consecutive parkinsonian patients with diffuse leukoaraiosis, but no basal ganglia vascular lesions. RESULTS: Twenty (48%) of the 42 patients had coexisting NDD. Compared to parkinsonian patients with isolated leukoaraiosis, those with coexisting NDD more frequently had asymmetric onset. They had similar degree of parkinsonian motor deficits in the legs, but greater rigidity and resting tremor in the arms. Consequently, they had less prominent lower body parkinsonism. They more frequently showed favorable response to levodopa treatment. They had similar burden of regional and total leukoaraiosis. Among a variety of clinical variables and MRI findings, only asymmetric onset and more than 30% improvement in UPDRS motor score by levodopa treatment were valuable indicators of coexisting NDD. CONCLUSIONS: We would like to recommend dopaminergic functional imaging studies for all parkinsonian patients with leukoaraiosis. Further studies are needed to confirm sensitivity and specificity of asymmetric onset and good levodopa response for the prediction of coexisting NDD in a different group of parkinsonian patients with leukoaraiosis.
Asunto(s)
Radioisótopos de Flúor , Leucoaraiosis/diagnóstico por imagen , Leucoaraiosis/epidemiología , Trastornos Parkinsonianos/diagnóstico por imagen , Trastornos Parkinsonianos/epidemiología , Tomografía de Emisión de Positrones , Anciano , Anciano de 80 o más Años , Cuerpo Estriado/diagnóstico por imagen , Femenino , Humanos , Masculino , Tomografía de Emisión de Positrones/métodos , Sustancia Negra/diagnóstico por imagenRESUMEN
Brain cannabinoid CB1 receptors contribute to alcohol-related behaviors in experimental animals, but their potential role in humans with alcohol dependence is poorly understood. We measured CB1 receptors in alcohol dependent patients in early and protracted abstinence, and in comparison with control subjects without alcohol use disorders, using positron emission tomography and [(18)F]FMPEP-d2, a radioligand for CB1 receptors. We scanned 18 male in-patients with alcohol dependence twice, within 3-7 days of admission from ongoing drinking, and after 2-4 weeks of supervised abstinence. Imaging data were compared with those from 19 age-matched healthy male control subjects. Data were also analyzed for potential influence of a common functional variation (rs2023239) in the CB1 receptor gene (CNR1) that may moderate CB1 receptor density. On the first scan, CB1 receptor binding was 20-30% lower in patients with alcohol dependence than in control subjects in all brain regions and was negatively correlated with years of alcohol abuse. After 2-4 weeks of abstinence, CB1 receptor binding remained similarly reduced in these patients. Irrespective of the diagnostic status, C allele carriers at rs2023239 had higher CB1 receptor binding compared with non-carriers. Alcohol dependence is associated with a widespread reduction of cannabinoid CB1 receptor binding in the human brain and this reduction persists at least 2-4 weeks into abstinence. The correlation of reduced binding with years of alcohol abuse suggests an involvement of CB1 receptors in alcohol dependence in humans.
Asunto(s)
Alcoholismo/metabolismo , Encéfalo/metabolismo , Receptor Cannabinoide CB1/genética , Receptor Cannabinoide CB1/metabolismo , Adulto , Alcoholismo/diagnóstico por imagen , Alelos , Encéfalo/diagnóstico por imagen , Estudios de Casos y Controles , Neuroimagen Funcional , Humanos , Masculino , CintigrafíaRESUMEN
OBJECTIVES: Patients with Parkinson's disease (PD) have higher-order discriminative sensory dysfunction including prolonged somesthetic temporal discrimination threshold (sTDT). We studied the effect of striatal dopamine loss on the prolongation of sTDT and also studied the impact of prolonged sTDT values on the various parkinsonian motor deficits. MATERIALS AND METHODS: In 30 patients with PD, the severity of parkinsonian motor deficits was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) motor scores during levodopa off and on periods. The UPDRS motor subscores were calculated, representing bradykinesia, rigidity, tremor, and axial motor deficits. During levodopa off and on periods, the sTDT value of each index finger was studied. Using [(18) F]-N-3-fluoropropyl-2-beta-carboxymethoxy-3-beta-(4-iodophenyl) nortropane (FPCIT) positron emission tomography studies, caudate and putaminal dopamine transporter uptake levels were measured. Multiple regression analysis covariated with age was used for statistical analysis. RESULTS: During the off period, the striatal FPCIT uptake levels had an impact on the sTDT values (P < 0.01). The sTDT values had an impact on the UPDRS subscores for axial motor deficits (P < 0.05), but had no impact on those for bradykinesia, rigidity, and tremor. The sTDT values as well as UPDRS total motor scores and all UPDRS subscores were improved by a single oral levodopa treatment. CONCLUSIONS: Striatal dopamine deficiency and consequent basal ganglia dysfunction may prolong sTDT, and higher-order discriminative sensory dysfunction seems to contribute in part to the development of axial motor deficits in patients with PD.
Asunto(s)
Cuerpo Estriado/diagnóstico por imagen , Dopamina/metabolismo , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/metabolismo , Trastornos de la Sensación/etiología , Adulto , Anciano , Anciano de 80 o más Años , Cuerpo Estriado/química , Cuerpo Estriado/metabolismo , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Femenino , Humanos , Levodopa/uso terapéutico , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones/métodos , Radiofármacos/uso terapéutico , Trastornos de la Sensación/metabolismo , Percepción del Tacto/fisiología , TropanosRESUMEN
BACKGROUND: No systematic study has been made to separate age-related clinical deterioration and dysfunctional brain areas from those associated with Parkinson's disease (PD). METHODS: This study included 73 de novo patients with PD and 43 age-matched controls. All subjects underwent [(18)F]-fluorodeoxy glucose (FDG) positron emission tomography studies. The severity of parkinsonian motor deficit was measured using unified PD rating scale (UPDRS) motor scores. Multiple linear regression analysis was used to identify those parkinsonian motor deficits for which severity was correlated with the age of the patients and to locate brain areas in which normalized FDG uptake values were inversely correlated with the age of the subjects. RESULTS: Patient age was positively correlated with total UPDRS motor scores and with subscores for bradykinesia and axial motor deficits, but not with subscores for tremor and rigidity. In the control group, an age-related decline in glucose uptake was found only in the cingulate cortex. However, in the patient group, an inverse correlation between age and glucose uptake was observed in the prefrontal, cingulate, orbitofrontal, perisylvian areas, caudate, and thalamus. CONCLUSIONS: In PD, widespread age-related decline in cerebral function may exaggerate the deterioration associated with bradykinesia and the axial motor deficits associated with nigral neuronal loss.
Asunto(s)
Envejecimiento/fisiología , Corteza Cerebral/metabolismo , Corteza Cerebral/fisiopatología , Glucosa/metabolismo , Enfermedad de Parkinson/metabolismo , Enfermedad de Parkinson/fisiopatología , Anciano , Anciano de 80 o más Años , Envejecimiento/metabolismo , Estudios de Casos y Controles , Corteza Cerebral/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Glucosa/fisiología , Humanos , Persona de Mediana Edad , Trastornos del Movimiento/diagnóstico por imagen , Trastornos del Movimiento/metabolismo , Trastornos del Movimiento/fisiopatología , Enfermedad de Parkinson/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodosRESUMEN
To study the effect of disease duration on the clinical, neuropsychological and [(18)F]-deoxyglucose (FDG) PET findings in patients with mixed type multiple system atrophy (MSA), this study included 16 controls and 37 mixed-type MSA patients with a shorter than a 3-year history of cerebellar or parkinsonian symptoms. We classified the patients into three groups according to the duration of parkinsonian or cerebellar symptoms (Group I = Asunto(s)
Encéfalo/metabolismo
, Glucosa/metabolismo
, Atrofia de Múltiples Sistemas/metabolismo
, Anciano
, Encéfalo/diagnóstico por imagen
, Encéfalo/patología
, Mapeo Encefálico/métodos
, Trastornos del Conocimiento/etiología
, Trastornos del Conocimiento/metabolismo
, Trastornos del Conocimiento/patología
, Femenino
, Fluorodesoxiglucosa F18
, Estudios de Seguimiento
, Humanos
, Imagen por Resonancia Magnética/métodos
, Masculino
, Persona de Mediana Edad
, Atrofia de Múltiples Sistemas/diagnóstico por imagen
, Atrofia de Múltiples Sistemas/patología
, Atrofia de Múltiples Sistemas/psicología
, Pruebas Neuropsicológicas
, Enfermedad de Parkinson Secundaria/etiología
, Enfermedad de Parkinson Secundaria/metabolismo
, Enfermedad de Parkinson Secundaria/patología
, Tomografía de Emisión de Positrones
, Radiofármacos
, Factores de Tiempo
RESUMEN
OBJECTIVE: To investigate the underlying mechanism responsible for paroxysmal kinesigenic dyskinesia (PKD). METHODS: We performed a transcranial magnetic stimulation (TMS) study in 12 drug-naïve patients with PKD and 10 healthy volunteers. TMS parameters included resting motor threshold, recruitment curve of motor evoked potential amplitudes, short intracortical inhibition and facilitation, long intracortical inhibition (LICI), and silent period. We also measured compound muscle action potential. RESULTS: LICI, representing GABA-mediated inhibition, was significantly reduced in the patients (P = 0.033), while results for all other TMS parameters tested were comparable between the two groups. CONCLUSIONS AND SIGNIFICANCE: These results suggest that a specific type of corticospinal inhibitory mechanism is impaired in patients with PKD.
Asunto(s)
Corea/fisiopatología , Inhibición Neural/fisiología , Tractos Piramidales/fisiopatología , Potenciales de Acción/fisiología , Potenciales de Acción/efectos de la radiación , Adulto , Análisis de Varianza , Electromiografía/métodos , Potenciales Evocados Motores/fisiología , Potenciales Evocados Motores/efectos de la radiación , Femenino , Humanos , Masculino , Inhibición Neural/efectos de la radiación , Tractos Piramidales/efectos de la radiación , Tiempo de Reacción/fisiología , Tiempo de Reacción/efectos de la radiación , Factores de Tiempo , Estimulación Magnética Transcraneal/métodosRESUMEN
A single nucleotide polymorphism at the nucleotide 1947 in the catechol-O-methyltransferase (COMT) gene encodes the high and low activity forms of the enzyme. We investigated COMT genotypes of 73 Korean patients with Parkinson's disease (PD), 29 with multiple system atrophy (MSA), and 49 controls, and analyzed the response to levodopa challenge in the PD patients. We found no significant difference in the distribution of the COMT genotypes among the three groups. The frequencies of the G- and A-alleles in the total population were 75 and 25%, respectively. The levodopa response was determined by a single oral levodopa challenge test with Sinemet (25/250 mg) in the patients with PD. The motor response evaluated by the time to peak response, the duration and magnitude of the response in the motor part of the Unified Parkinson's Disease Rating Scale; tapping or walking times showed no significant difference between the genotypes. Thus, pharmacokinetic or pharmacodynamic factors other than the investigated genetic variant of the COMT enzyme seem to determine the response to levodopa in PD.
Asunto(s)
Antiparkinsonianos/administración & dosificación , Catecol O-Metiltransferasa/genética , Levodopa/administración & dosificación , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/genética , Adulto , Anciano , Femenino , Genotipo , Humanos , Corea (Geográfico) , Masculino , Persona de Mediana Edad , Atrofia de Múltiples Sistemas/tratamiento farmacológico , Atrofia de Múltiples Sistemas/genética , Polimorfismo de Nucleótido SimpleRESUMEN
To define the clinical and anatomical factors associated with dyskinesias following thalamic infarction, we performed neurological examination and three-dimensional brain magnetic resonance imaging for 23 patients with thalamic infarction. We measured the total volumes and the largest diameters of the lesions on axial and coronal images. Using the atlas of human thalamus, we investigated the damaged thalamic nuclei. We compared the means of the volumes and the largest diameters of the lesions, and the frequencies of damaged thalamic nuclei between patients with and without thalamic dyskinesias. Seven (two pseudochoreoathetosis and five dystonia) of the 23 patients with thalamic infarction developed dyskinesias. No specific neurological deficits at the onset of stroke predicted the development of dyskinesias. The mean volume of the lesions of patients with dyskinesias (739 mm(3)) was significantly larger than that of those without dyskiensias (92.9 mm(3)). The means of the largest axial (11.6 mm) and coronal (10.8 mm) diameters were significantly larger in patients with dyskinesias, compared to those (axial, 7.1 mm; coronal, 6.4 mm) of patients without dyskinesias. Patients with dyskinesias had damage in the centromedian (CM) thalamic nucleus more frequently compared to those without dyskinesias. Patients with a large thalamic infarction involving the CM nucleus are more likely to develop dyskinesias.
Asunto(s)
Infarto Encefálico/patología , Infarto Encefálico/fisiopatología , Trastornos del Movimiento/patología , Trastornos del Movimiento/fisiopatología , Enfermedades Talámicas/patología , Enfermedades Talámicas/fisiopatología , Tálamo/patología , Tálamo/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Vías Nerviosas/patología , Vías Nerviosas/fisiopatologíaRESUMEN
OBJECTIVE: To describe hemidystonia and hemichoreoathetosis in an adult patient with moyamoya disease without a previous history of cerebrovascular accident. DESIGN: Case report. SETTING: Tertiary care center. PATIENT: A 22-year-old woman suddenly developed dystonic spasms in her left hand and left foot after a severe emotional stress. The dyskinesia gradually subsided over the next 4 months. Five months after the onset, she suddenly developed choreoathetoid movement in her right hand and right foot. MAIN OUTCOME AND RESULTS: The patient had both somatic and cortical sensory deficits in the right hand and right foot. Magnetic resonance imaging of the brain showed an infarction at the right putamen and lesions involving the right frontal lobe and the left frontotemporoparietal lobe. Magnetic resonance cerebral angiography showed severe stenoses of both internal carotid arteries at the supraclinoid portion and numerous collateral vessels, compatible with moyamoya disease. Single photon emission tomography of the brain showed hypoperfused areas at the right frontal and left frontotemporoparietal lobes. The choreoathetosis of the right limbs improved markedly, along with improvement of sensory deficits. CONCLUSIONS: To our knowledge, this is the first report of an adult patient presenting with hemidystonia and hemichoreoathetosis as the initial manifestations of moyamoya disease. Arch Neurol. 2000;57:1510-1512
Asunto(s)
Atetosis/diagnóstico , Corea/diagnóstico , Distonía/diagnóstico , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/diagnóstico , Adulto , Atetosis/etiología , Encéfalo/metabolismo , Encéfalo/patología , Corea/etiología , Distonía/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Índice de Severidad de la Enfermedad , Tomografía Computarizada de EmisiónAsunto(s)
Atetosis/etiología , Corea/etiología , Cuerpo Estriado/irrigación sanguínea , Dominancia Cerebral/fisiología , Infarto de la Arteria Cerebral Media/complicaciones , Lóbulo Parietal/irrigación sanguínea , Anciano , Anciano de 80 o más Años , Atetosis/diagnóstico , Atetosis/fisiopatología , Corea/diagnóstico , Corea/fisiopatología , Cuerpo Estriado/fisiopatología , Diagnóstico Diferencial , Femenino , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico , Infarto de la Arteria Cerebral Media/fisiopatología , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Lóbulo Parietal/fisiopatología , Tomografía Computarizada de Emisión de Fotón ÚnicoAsunto(s)
Infarto Cerebral/diagnóstico , Discinesias/etiología , Hombro , Anciano , Mapeo Encefálico , Niño , Cuerpo Estriado/patología , Discinesias/diagnóstico , Femenino , Humanos , Núcleos Talámicos Laterales/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Núcleos Talámicos Posteriores/patología , Enfermedades Talámicas/diagnósticoRESUMEN
We measured the changes of forearm flexor H reflexes produced by conditioning radial nerve stimulation at delays of -2, 0, 2, 4, 7.5, 10, 25 and 75 ms in 10 patients with PKD and six with generalized seizure disorder. We compared the results with 12 normal volunteers. In the patients with PKD, we compared the amounts of reciprocal inhibition between the severely and the asymptomatic or mildly affected sides of arms. Follow-up studies were done in eight PKD patients after they responded to the anticonvulsant treatment. At each delay, patients with seizure disorders showed comparable amounts of changes with controls. Patients with PKD showed paradoxical facilitation at a delay of 0 ms, enhanced facilitation between 2 to 7.5 ms delays and attenuated inhibition at a delay of 75 ms. There were no significant differences in the amount of reciprocal inhibition according to the severity of clinical symptoms. Follow-up studies showed no significant changes of reciprocal inhibition compared to the baseline data. In PKD, paradoxical facilitation and enhanced first relative facilitation period may be caused by defective spinal interneurons. In addition to the defective reciprocal inhibition, abnormalities of supraspinal inputs seem to be involved in the genesis of PKD.