Showing papers by "Mark Hallett published in 2004"

Levodopa in the treatment of Parkinson's disease: current controversies.

Abstract: Levodopa is the most effective symptomatic agent in the treatment of Parkinson's disease (PD) and the "gold standard" against which new agents must be compared. However, there remain two areas of controversy: (1) whether levodopa is toxic, and (2) whether levodopa directly causes motor complications. Levodopa is toxic to cultured dopamine neurons, and this may be a problem in PD where there is evidence of oxidative stress in the nigra. However, there is little firm evidence to suggest that levodopa is toxic in vivo or in PD. Clinical trials have not clarified this situation. Levodopa is also associated with motor complications. Increasing evidence suggests that they are related, at least in part, to the short half-life of the drug (and its potential to induce pulsatile stimulation of dopamine receptors) rather than to specific properties of the molecule. Treatment strategies that provide more continuous stimulation of dopamine receptors provide reduced motor complications in MPTP monkeys and PD patients. These studies raise the possibility that more continuous and physiological delivery of levodopa might reduce the risk of motor complications. Clinical trials to test this hypothesis are underway. We review current evidence relating to these areas of controversy.

Clinical evaluation of idiopathic paroxysmal kinesigenic dyskinesia New diagnostic criteria

Abstract: Background: Paroxysmal kinesigenic dyskinesia (PKD) is a rare disorder characterized by short episodes of involuntary movement attacks triggered by sudden voluntary movements. Although a genetic basis is suspected in idiopathic cases, the gene has not been discovered. Establishing strict diagnostic criteria will help genetic studies. Methods: The authors reviewed the clinical features of 121 affected individuals, who were referred for genetic study with a presumptive diagnosis of idiopathic PKD. Results: The majority (79%) of affected subjects had a distinctive homogeneous phenotype. The authors propose the following diagnostic criteria for idiopathic PKD based on this phenotype: identified trigger for the attacks (sudden movements), short duration of attacks ( Conclusions: The diagnosis of idiopathic paroxysmal kinesigenic dyskinesia (PKD) can be made based on historical features. The correct diagnosis has implications for treatment and prognosis, and the diagnostic scheme may allow better focus in the search for the PKD gene(s).

How self-initiated memorized movements become automatic: a functional MRI study.

Abstract: We used functional magnetic resonance imaging (fMRI) and dual tasks to investigate the physiology of how movements become automatic. Normal subjects were asked to practice some self-initiated, self-paced, memorized sequential finger movements with different complexity until they could perform the tasks automatically. Automaticity was evaluated by having subjects perform a secondary task simultaneously with the sequential movements. Our secondary task was a letter-counting task where subjects were asked to identify the number of times a target letter from the letter sequences was seen. Only the performances that achieved high accuracy in both single and dual tasks were considered automatic. The fMRI results before and after automaticity was achieved were compared. Our data showed that for both conditions, sequential movements activated similar brain regions. No additional activity was observed in the automatic condition. There was less activity in bilateral cerebellum, presupplementary motor area, cingulate cortex, left caudate nucleus, premotor cortex, parietal cortex, and prefrontal cortex during the automatic stage. These findings suggest that most of the motor network participates in executing automatic movements and that it becomes more efficient as movements become more automatic. Our results do not provide evidence for any area to become more activated for automatic movements.

Clinical evaluation of idiopathic paroxysmal kinesigenic dyskinesia

Abstract: Background: Paroxysmal kinesigenic dyskinesia (PKD) is a rare disorder characterized by short episodes of involuntary movement attacks triggered by sudden voluntary movements. Although a genetic basis is suspected in idiopathic cases, the gene has not been discovered. Establishing strict diagnostic criteria will help genetic studies. Methods: The authors reviewed the clinical features of 121 affected individuals, who were referred for genetic study with a presumptive diagnosis of idiopathic PKD. Results: The majority (79%) of affected subjects had a distinctive homogeneous phenotype. The authors propose the following diagnostic criteria for idiopathic PKD based on this phenotype: identified trigger for the attacks (sudden movements), short duration of attacks (<1 minute), lack of loss of consciousness or pain during attacks, antiepileptic drug responsiveness, exclusion of other organic diseases, and age at onset between 1 and 20 years if there is no family history (age at onset may be applied less stringently in those with family history). In comparing familial and sporadic cases, sporadic cases were more frequently male, and infantile convulsions were more common in the familial kindreds. Females had a higher remission rate than males. An infantile-onset group with a different set of characteristics was identified. A clear kinesigenic trigger was not elicited in all cases, antiepileptic response was not universal, and some infants had attacks while asleep. Conclusions: The diagnosis of idiopathic paroxysmal kinesigenic dyskinesia (PKD) can be made based on historical features. The correct diagnosis has implications for treatment and prognosis, and the diagnostic scheme may allow better focus in the search for the PKD gene(s).

Disturbed surround inhibition in focal hand dystonia.

Abstract: Disturbances in surround inhibition could account for various movement disorders. Here we test the functional operation of surround inhibition in focal hand dystonia. Transcranial magnetic stimulation was set to be triggered by self-initiated voluntary flexion of the index finger. During this movement, motor-evoked potential amplitudes from the little finger muscle were significantly suppressed in healthy subjects but enhanced in dystonia patients. This result supports the idea that disturbed surround inhibition is a principal pathophysiological mechanism of dystonia.

Surround inhibition in human motor system.

Abstract: In sensory systems, a neural mechanism called surround inhibition (SI) sharpens sensation by creating an inhibitory zone around the central core of activation. In the motor system, the functional operation of SI remains to be demonstrated, although it has been hypothesized to contribute to the selection of voluntary movements. Here we test this hypothesis by using transcranial magnetic stimulation of the human motor cortex. The motor evoked potential of the little finger muscle is suppressed or unchanged during self-paced, voluntary movements of the index finger, mouth or leg, despite an increase in spinal excitability. This result indicates that motor excitability related to little finger movement is suppressed at the supraspinal level during these movements, and supports the idea that SI is an organizational principle of the motor system.

Changes in brain anatomy in focal hand dystonia.

Abstract: No consistent cerebral anatomical abnormality has ever been reported in primary focal hand dystonia (FHD). The present voxel-based morphometry study showed a significant bilateral increase in gray matter in the hand representation area of primary somatosensory and, to a lesser extent, primary motor cortices in 36 patients with unilateral FHD compared with 36 controls. The presence of anatomical changes in the perirolandic cortex for the unaffected hand as well as that for the affected hand suggests that these disturbances may be, at least in part, primary.

Pilot trial of 1-octanol in essential tremor

Abstract: 1-Octanol (an 8-C alcohol currently used as a food-flavoring agent) is known to inhibit tremor in essential tremor (ET) animal models at a much lower dose than ethyl alcohol. The authors conducted a randomized, placebo-controlled pilot trial of a single oral dose of 1 mg/kg of 1-octanol in 12 patients with ET. No significant side effects or signs of intoxication were observed. 1-Octanol significantly decreased tremor amplitude for up to 90 minutes. The results suggest 1-octanol as a well-tolerated and safe potential treatment for ET. Further trials are warranted.

Open-label dose-escalation study of oral 1-octanol in patients with essential tremor.

Abstract: Twenty-one single oral doses of 1-octanol were given to patients with essential tremor (ET) in an open-label dose-escalation study. The drug was well tolerated up to 64 mg/kg. The main side effect was an unusual taste. No overt intoxication was seen. There was evidence for efficacy, with a significant reduction in tremor amplitude as measured by accelerometry and handwriting that was maximal at 2 hours. Higher doses may produce more sustained benefit.

Small de novo duplication in the repeat region of the TATA-box-binding protein gene manifest with a phenotype similar to variant Creutzfeldt-Jakob disease.

Abstract: A 20-year-old North American patient developed rapidly progressive cognitive decline and pronounced ataxia, a phenotype compatible with prion disease. No structural changes were found in the PRNP gene, which excludes genetic prion disease, but the patient's PRNP codon 129 Met/Met genotype is known to predispose to variant Creutzfeldt-Jakob disease (vCJD). Further studies identified an expanded allele with 55 CAG/CAA repeats in the TBP gene. The increase of trinucleotide repeat number in the coding region of the TBP gene has previously been associated with spinocerebellar ataxia type 17 (SCA17). The patient's unaffected parents and siblings show normal-size TBP alleles with 37-38 repeats. Haplotype and nucleotide sequence analyses clearly indicate that the mutation has occurred de novo on a paternal chromosome by insertion/ duplication of a (CAA)(CAG)(CAA)(CAG) 15 sequence. This report presents a second fully investigated sporadic case of SCA 17 occurring as a result of a DNA rearrangement within the polymorphic TBP trinucleotide repeat region. Our findings suggest that patients suspected of vCJD should undergo testing for SCA17, Huntington's disease and other neurodegenerative disorders having phenotypic similarities with vCJD.

Exercise-induced dystonia as a preceding symptom of familial Parkinson's disease

Abstract: Paroxysmal exercise-induced dystonia can occur with Parkinson's disease (PD), and in rare cases, this can also be the presenting symptom. We report on 2 second cousins (no known consanguinity) who presented with paroxysmal exercise-induced dystonia who later developed clinical features of PD. Although autosomal recessive inheritance was suggested, and the dystonic features further suggest parkin as a possible cause, sequencing for parkin mutations was negative and this family may represent a genetic variant of PD. Further genotype-phenotype studies in this and similar families may give clues to pre-symptomatic symptoms in PD and may reflect a particular phenotype of interest for genetics studies in the future.

Localizing brain interactions from rhythmic EEG/MEG data

Abstract: The interpretation of MEG/EEG data in terms of brain connectivity is largely obscured by artefacts of volume conduction, i.e. by the fact that a single source is observable in many channels. Here, we analyze a measure which is insensitive to spurious connectivity arising from volume conducted "self-interaction". For rhythmic data such a measure can be given by the imaginary part of the cross-spectrum between EEG/MEG channels. For the derivation we essentially exploit that a signal is not time-lagged to itself. To localize the sources of this observed interaction we fit a model cross-spectrum consisting of N interacting dipoles to the sample cross-spectrum. The relation to the maximum likelihood estimator will be discussed in detail. The method is illustrated for MEG data of human alpha rhythm in eyes closed condition. The eigenvalues of the imaginary cross-spectrum clearly indicate the presence of at least 4 necessarily interacting sources. Fits of 2 to 6 dipoles in a realistic volume conductor all resulted in locations scattered in the mesial part of the occipital lobe.

Facial action myoclonus in patients with olivopontocerebellar atrophy

Abstract: We studied four patients with familial olivopontocerebellar atrophy (OPCA) who had abnormal twitching of the cheeks and perioral muscles induced by facial movements. With the muscles at rest, electromyographic (EMG) recordings of the orbicularis oris and risorius muscles revealed myokymic discharges in the absence of visible movements. With voluntary contraction, the EMG showed synchronous discharges in the orbicularis oris and risorius muscles ipsilaterally associated with visible twitching. The duration of the EMG bursts was 10 to 75 ms with a frequency of 8 to 25 Hz, which suggested that the abnormal twitching was most consistent with a myoclonic disorder. Because it was induced by activation of the facial muscles, this movement disorder represents a form of action myoclonus.

Motor Program Memory Storage in Parkinson's Disease Patients Tested with a Delayed Response Task

Abstract: We used a delayed response paradigm to test the hypothesis that the prolonged reaction time in patients with Parkinson's disease (PD) is related to a deficiency in their ability to store a motor program in memory while waiting to move. PD patients, both on and off medication, were compared with age-matched normal subjects during arm movements directed toward a target light. The target light was displayed either during a 3- to 9-s delay or for only 1 s followed by a 2- to 8-s delay before the go signal. At the end of the delay, subjects were required to begin movement rapidly. The reaction time of PD patients was longer than normal and increased slightly when the patients were off medication. The patients had no excessive increase in reaction time with delay in either task compared with the control subjects. We conclude that patients with PD can hold a motor program in memory storage for at least 8 s.

Amodal imagery in rostral premotor areas

Abstract: Inspired by Rick Grush's emulation theory, we reinterpreted a series of our neuroimaging experiments which were intended to examine the representations of complex movement, modality-specific imagery, and supramodal imagery The emulation theory can explain motor and cognitive activities observed in cortical motor areas, through the speculation that caudal areas relate to motor-specific imagery and rostral areas embrace an emulator for amodal imagery

Visualization of spatiotemporal patterns of EEG rhythms during voluntary movements

Abstract: The power change of electroencephalographs (EEG) rhythms is an indicator to investigate neuronal activation underlying EEG electrodes. We developed a software routine for analysis and visualization of spatiotemporal patterns of EEG oscillations: event-related desynchronization (ERD) and event-related synchronization (ERS). Further, the spatiotemporal representation of task-related coherence (TRC) was also proposed for investigation of interregional neuronal connectivity. As concurrent artifacts and volume conduction effect may result incorrect or spatially blurred estimation of EEG features, we have embedded data preprocessing functions to reduce these effects including: correcting eye movement-related artifact, changing reference methods and spatial filtering undesirable neuronal activity. These functions were subsequently applied to study EEG time-frequency patterns during self-paced movements in normal volunteers.