Objective
To present the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson9s disease.
Background
Although several diagnostic criteria for Parkinson9s disease have been proposed, none have been officially adopted by an official Parkinson society. Moreover, the commonest-used criteria, the UK brain bank, were created more than 25 years ago. In recognition of the lack of standard criteria, the MDS initiated a task force to design new diagnostic criteria for clinical Parkinson9s disease.
Methods/Results
The MDS-PD Criteria are intended for use in clinical research, but may also be used to guide clinical diagnosis. The benchmark is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise. Although motor abnormalities remain central, there is increasing recognition of non-motor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the MDS-PD Criteria retain motor parkinsonism as the core disease feature, defined as bradykinesia plus rest tremor and/or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies upon three categories of diagnostic features; absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of PD diagnosis). Two levels of certainty are delineated: Clinically-established PD (maximizing specificity at the expense of reduced sensitivity), and Probable PD (which balances sensitivity and specificity).
Conclusion
The MDS criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, criteria will need continuous revision to accommodate these advances. Disclosure: Dr. Postuma has received personal compensation for activities with Roche Diagnostics Corporation and Biotie Therapies. Dr. Berg has received research support from Michael J. Fox Foundation, the Bundesministerium fur Bildung und Forschung (BMBF), the German Parkinson Association and Novartis GmbH.

MDS Clinical Diagnostic Criteria for Parkinson's Disease (S19.001)

Transient global amnesia

Fragile X syndrome (FXS) is the leading inherited form of intellectual disability and autism spectrum disorder, and patients can present with severe behavioural alterations, including hyperactivity, impulsivity and anxiety, in addition to poor language development and seizures. FXS is a trinucleotide repeat disorder, in which >200 repeats of the CGG motif in FMR1 leads to silencing of the gene and the consequent loss of its product, fragile X mental retardation 1 protein (FMRP). FMRP has a central role in gene expression and regulates the translation of potentially hundreds of mRNAs, many of which are involved in the development and maintenance of neuronal synaptic connections. Indeed, disturbances in neuroplasticity is a key finding in FXS animal models, and an imbalance in inhibitory and excitatory neuronal circuits is believed to underlie many of the clinical manifestations of this disorder. Our knowledge of the proteins that are regulated by FMRP is rapidly growing, and this has led to the identification of multiple targets for therapeutic intervention, some of which have already moved into clinical trials or clinical practice.

Fragile X syndrome

This document provides guidance on the use of valproate in girls and women of childbearing age from a joint Task Force of the Commission on European Affairs of the International League Against Epilepsy (CEA-ILAE) and the European Academy of Neurology (EAN), following strengthened warnings from the Coordination Group for Mutual Recognition and Decentralised Procedures-Human (CMDh) of the European Medicines Agency (EMA), which highlight the risk of malformations and developmental problems in infants who are exposed to valproate in the womb. To produce these recommendations, the Task Force has considered teratogenic risks associated with use of valproate and treatment alternatives, the importance of seizure control and of patient and fetal risks with seizures, and the effectiveness of valproate and treatment alternatives in the treatment of different epilepsies. The Task Force's recommendations include the following: (1) Where possible, valproate should be avoided in women of childbearing potential. (2) The choice of treatment for girls and women of childbearing potential should be based on a shared decision between clinician and patient, and where appropriate, the patient's representatives. Discussions should include a careful risk-benefit assessment of reasonable treatment options for the patient's seizure or epilepsy type. (3) For seizure (or epilepsy) types where valproate is the most effective treatment, the risks and benefits of valproate and other treatment alternatives should be discussed. (4) Valproate should not be prescribed as a first-line treatment for focal epilepsy. (5) Valproate may be offered as a first-line treatment for epilepsy syndromes where it is the most effective treatment, including idiopathic (genetic) generalized syndromes associated with tonic-clonic seizures. (6) Valproate may be offered as a first-line treatment in situations where pregnancy is highly unlikely (e.g., significant intellectual or physical disability). (7) Women and girls taking valproate require regular follow-up for ongoing consideration of the most appropriate treatment regimen.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/epi.13021

Valproate in the treatment of epilepsy in girls and women of childbearing potential

Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i.e., pneumonia). In these indications, PCT levels measured on hospital admission were found to substantially reduce the initiation of antibiotic treatment in low-risk situations (i.e., bronchitis, chronic obstructive pulmonary disease exacerbation). For more severe infections (i.e., pneumonia, sepsis), antibiotic stewardship by monitoring of PCT kinetics resulted in shorter antibiotic treatment durations with early cessation of therapy. Importantly, these strategies appear to be safe without increasing the risk for mortality, recurrent infections, or treatment failures. PCT kinetics also proved to have prognostic value correlating with disease severity (i.e., pancreatitis, abdominal infection) and resolution of illness (i.e., sepsis). Although promising findings have been published in these different types of infections, there are a number of limitations regarding PCT, including suboptimal sensitivity and/or specificity, which makes a careful interpretation of PCT in the clinical context mandatory. This narrative review aims to update clinicians on the strengths and limitations of PCT for patient management, focusing on research conducted within the last 4 years.

/pdf/procalcitonin-guided-diagnosis-and-antibiotic-stewardship-pqltj0i1pv.pdf

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

무균성 수막염으로 발현한 흔하지 않은 뇌하수체졸중

Longitudinal analysis of structural connectivity in patients with newly diagnosed focal epilepsy of unknown origin

Received November 9, 2016 Revised February 20, 2017 Accepted February 20, 2017 Address for correspondence: Kyong Jin Shin, MD, PhD Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, 875 Haeun-daero, Heaundae-gu, Busan 48108, Korea Tel: +82-51-797-2080 Fax: +82-51-797-1159 E-mail: neurof1130@paik.ac.kr 신경매독은 매독균(Treponema pallidum)의 중추신경계 감염으 로 발생하며, 모든 시기의 매독에서 신경매독으로의 진행이 가능 하다. 초기의 가장 흔한 형태의 신경매독은 뇌수막염이고, 후기에 서는 뇌, 척수의 실질을 침범하는 진행마비(general paresis)이다. 수막혈관신경매독은 뇌매독의 모든 시기에 발현이 가능하고 두통, 혼동, 구역 및 구토 등 단순한 증상에서부터, 시력저하, 안면마비, 청력저하, 편마비, 언어장애, 감각이상, 보행장애 등의 다양한 임상 양상으로 나타날 수 있다. 저자들은 아급성경과의 발음장애와 언

/pdf/neurosyphilis-exhibiting-similar-mri-findings-of-multiple-3eiehc341g.pdf

Neurosyphilis Exhibiting Similar MRI Findings of Multiple Sclerosis

http://www.e-acn.org pISSN 2508-691X eISSN 2508-6960 Copyright © 2018 The Korean Society of Clinical Neurophysiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The effect of lateral wedge on postural sway in Parkinson’s disease

/pdf/the-effect-of-lateral-wedge-on-postural-sway-in-parkinson-s-3tn00ixrc3.pdf

The effect of lateral wedge on postural sway in Parkinson's disease

과거력이 없는 19세 남자가 열흘 전부터 상기도 감염증상이 있다 일주일 전부터 수평복시가 발생하여 병원에 왔다. 복시 외 의 다른 증상은 호소하지 않았고, 한 쪽 눈으로 볼 때 복시는 사라졌다. 활력징후는 혈압 110/80 mmHg, 맥박 78회/분, 호흡 20회/분, 체온 36.8°C였다. 신경학적진찰에서 환자의 의식상태 는 명료하였고 다른 고위피질기능은 정상이었다. 양안 동공의 크기나 빛반사는 정상이었으나, 양안 모두에서 외전장애를 보 였다. 얼굴신경마비나 감각저하, 근력저하, 운동실조 등 다른 신경계 증상은 없었다. 심부건반사는 양측 상하지에서 정상적 이었고, 병적과다반사는 보이지 않았다. 일반혈액검사와 일반생화학검사, 갑상선기능검사, 자가면 역항체검사, 아세틸콜린수용체항체검사를 포함한 모든 혈액 검사는 정상이었다. 뇌자기공명영상에서도 외전장애를 유발 할 만한 뇌신경 및 뇌의 구조적인 이상은 보이지 않았다. 전기

/pdf/miller-fisher-syndrome-with-blink-reflex-abnormality-3nqlopj90y.pdf

Sung Eun Kim

Papers

무균성 수막염으로 발현한 흔하지 않은 뇌하수체졸중

Longitudinal analysis of structural connectivity in patients with newly diagnosed focal epilepsy of unknown origin

Neurosyphilis Exhibiting Similar MRI Findings of Multiple Sclerosis

The effect of lateral wedge on postural sway in Parkinson's disease

Miller-Fisher Syndrome with Blink Reflex Abnormality