Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013421 (dystonia)
 8,418 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report two cases of cranial dystonia (blepharospasm) associated with olivopontocerebellar atrophy (OPCA). The pathophysiology of blepharospasm appears to involve an increased excitability of the interneurons of the blink and corneal reflexes. It is hypothesized that blepharospasm associated with OPCA might be due to rostral brainstem lesions disrupting central dopaminergic and cholinergic pathways, resulting in disinhibition of brainstem reflexes or denervation supersensitivity of the facial nuclear complex.
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PMID:Blepharospasm associated with olivopontocerebellar atrophy. 253 Nov 69

The movement disorder investigated in these studies has some features in common with human idiopathic dystonia, and information obtained in these studies may be of potential clinical benefit. The present experimental results indicated that peptidergic stimulation of the LC resulted in a NE-mediated inhibition of cerebellar Purkinje cells located at terminals of the ceruleo-cerebellar pathway. However, it is not certain as to the following: (a) what receptors were stimulated by the ACTH N-terminal fragments at the LC that resulted in this disorder; (b) whether NE, released onto Purkinje cell synapses located at terminals of the ceruleo-cerebellar pathway, did indeed cause the long-term depression at Purkinje cell synapses (previously described by others) that resulted in the long duration of the movement disorder; (c) whether the inhibition of inhibitory Purkinje cells resulted in disinhibition or increased excitability of the unilateral cerebellar fastigial or interpositus nuclei, the output targets of the Purkinje cell axons, that may have been an important contributing factor to this disorder. These questions are currently being investigated.
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PMID:A dystonia-like syndrome after neuropeptide (MSH/ACTH) stimulation of the rat locus ceruleus. 284 Aug 7

Sixty-four patients treated with cisplatin-containing regimens were entered into a randomized, double-blinded study examining the antiemetic efficacy of metoclopramide with and without lorazepam for control of cisplatin-induced emesis. Metoclopramide was administered to all patients at 2 mg/kg, intravenously, 30 minutes before chemotherapy and 1.5, 3.5, and 5.5 hours posttreatment. Patients randomized to receive combined antiemetic therapy were administered lorazepam at 2 mg/m2 (maximum, 4 mg dose) intravenously, 30 minutes before chemotherapy. Those patients not receiving lorazepam were given normal saline placebo. Degree of nausea and number of vomiting episodes were recorded on a data flow sheet with a visual analogue scale. Drug toxicities were evaluated before each administered dose. Patients receiving both metoclopramide and lorazepam experienced significantly less vomiting episodes (P less than 0.05) and nausea (P less than 0.01) when compared to patients given metoclopramide alone. Forty-four percent of those receiving the combined therapy reported no nausea or vomiting episodes compared to only 22% receiving metoclopramide alone. Sedation was significantly more common in patients receiving lorazepam (88%) as opposed to patients receiving only metoclopramide (43%), P less than 0.01. Amnesia was seen in 25% receiving lorazepam. No significant difference in diarrhea, dystonia, or disinhibition was observed between the two arms. The authors conclude that the combination of lorazepam and metoclopramide was superior to metoclopramide alone in the prevention of cisplatin-induced nausea and vomiting, with sedation and amnesia more commonly observed in the combined regimen.
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PMID:Metoclopramide versus metoclopramide and lorazepam. Superiority of combined therapy in the control of cisplatin-induced emesis. 291 33

Regional cerebral blood flow (rCBF) was measured with H2(15)O positron emission tomography in 5 patients with acquired hemidystonia (AHD) due to structural lesions of the basal ganglia or posterior thalamus contralateral to the dystonic limb. Patients were scanned at rest and when performing paced joystick movements in freely chosen directions with the dystonic and then the unaffected arm. Findings were compared with those of 5 age-matched controls performing joystick movements with the right arm. At rest, there was decreased activity in ventroanterior thalamus, posterior thalamus, angular gyrus ipsilateral to the lesion, and bilateral frontoorbital cortex. At a similar level of significance, increased resting activity was found in lentiform nucleus, hippocampus, and anterior insula contralateral to the lesion. Using the affected arm, AHD cases showed significant overactivity of contralateral prefrontal, lateral premotor cortex, rostral supplementary motor area, anterior cingulate area 32, bilateral sensorimotor cortex (SMC) and insula, mesial parietal cortex, and ipsilateral cerebellum. There was similar frontal overactivity when the unaffected arm performed the joystick movements, though SMC and insula overactivity was contralateral rather than bilateral. The associated frontal overactivity on movement is consistent with acquired dystonia being a syndrome of thalamofrontal disinhibition due to structural disruption of basal ganglia inhibitory control. Our findings also suggest that cortical activation during movement of the unaffected limb is abnormal in acquired hemidystonia.
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PMID:Motor reorganization in acquired hemidystonia. 777 48

The behavioural and movement disorders reported in 240 patients described in the literature with lesions affecting the caudate nucleus, putamen and the globus pallidus (lentiform nucleus) have been analysed. Reports were classified into two groups: small or isolated lesions involving the said nuclei alone; and large lesions with additional involvement of the adjacent internal capsule and/or periventricular white matter. Amongst the 240 cases, dystonia was the most frequent movement disorder recorded (36%); chorea (8%) and parkinsonism (6%) or dystonia-parkinsonism (3%) were uncommon. The commonest behavioural disturbance was the syndrome of abulia (apathy with loss of initiative and of spontaneous thought and emotional responses) (13%); disinhibition was rare (4%). Confusion usually was associated with intracerebral haemorrhage and depression was a relatively non-specific finding. Aphasia was extremely rare with lesions confined to these basal ganglia structures. Lesions of the caudate nucleus rarely caused motor disorders but were more likely to cause behavioural problems. Chorea has been described in only 6% of those with caudate lesions, and dystonia in only 9%. The most significant behavioural disturbance described in 28% of those with caudate lesions was the syndrome of abulia, sometimes alternating with disinhibition (11%). Lesions of the lentiform nuclei rarely caused abulia (10%) and did not produce disinhibition, but they commonly caused dystonia (49%), particularly when the putamen was involved (63%). Bilateral lesions of the lentiform nuclei, either of the globus pallidus or of the putamen, caused parkinsonism (19%) or dystonia-parkinsonism (6%) infrequently. The prominence of the behavioural disturbance of abulia with caudate lesions emphasizes the more complex cognitive role of this basal ganglia structure. The frequent occurrence of dystonia and less commonly of parkinsonism with lentiform lesions emphasize the motor roles of putamen and globus pallidus.
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PMID:The behavioural and motor consequences of focal lesions of the basal ganglia in man. 792 71

Cortical myoclonus (CM) and focal dystonia (FD) are commonly characterized by co-contraction of agonist and antagonist muscles, enhancement by intentional movement, strong influence by sensory input, and spread to adjacent muscles. On the other hand, they are different in the nature of movements, speed of muscle contraction, speed of spread, and drug effects. There are abundant data indicating that CM is due to pathological hyperexcitability of the sensorimotor cortex (S1-M1), while, in FD, no definitive evidence to suggest cortical hyperexcitability has been found. Changes in regional cerebral blood flow (rCBF) studied by positron emission tomography (PET) during movements in patients with dystonia were inconsistent with regard to S1-M1, but the frontal cortex including the rostral SMA was shown to be overactivated, suggesting the thalamocortical disinhibition based on the basal ganglia disorders.
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PMID:[Pathophysiology of involuntary movements--dystonia and myoclonus from viewpoint of brain activities]. 875 5

We have done a few physiological studies on six patients with cortical reflex myoclonus and three patients with unilateral focal dystonia caused by a discrete cerebrovascular lesion in the basal ganglia. The silent period after magnetic cortical stimulation was normal or slightly prolonged in all the patients with cortical myoclonus. In contrast, in patients with focal dystonia, it was shortened in the muscles on the contralateral side to the lesion, whereas normal in duration on the ipsilateral side. Excessive inputs from the disinhibited supplementary motor cortex to the primary motor cortex due to a lesion of the basal ganglia must cause this shortening in the dystonic hand muscles. Excitability recovery of the motor cortex after hypersynchronous activation by magnetic stimulation should be prolonged in the myoclonic patients. Cortico-cortical inhibition of the motor cortex studied with paired magnetic stimulation technique was disturbed in both the patients with myoclonus and those with dystonia. This result suggested that the disinhibition of the motor cortex is present in both disorders. Based on these results, we conclude that the motor cortex is similarly disinhibited in both disorders, but recovery function from hypersynchronous activation is different between these two groups.
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PMID:[Electromyographic analysis of cortical myoclonus and focal dystonia]. 875 6

Rapidly progressive autosomal dominant parkinsonism and dementia with pallido-ponto-nigral degeneration (PPND) is a neurodegenerative disorder which begins later in life (> 30 years of age) and is characterized by rapidly progressive parkinsonism, dystonia, dementia, perservative vocalizations and pyramidal tract dysfunction. The disease is observed in a large American family that includes almost 300 members in nine generations with 34 affected individuals. In this kindred evidence for linkage to chromosome 17q21 was obtained with a maximum lod score of 9.08 for the D17S958 locus. Multilocus analysis positions the disease gene in an approximately 10 cM region between D17S250 and D17S943. Notably, the disease locus for a clinically distinct familial neurodegenerative disease named 'disinhibition-dementia-parkinsonism-amyotrophy complex' (DDPAC) was recently mapped to the same region of chromosome 17, suggesting that PPND and DDPAC may possibly originate from mutations in the same gene.
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PMID:Localization of the gene for rapidly progressive autosomal dominant parkinsonism and dementia with pallido-ponto-nigral degeneration to chromosome 17q21. 878 53

Spasticity is partly caused by disinhibition of spinal stretch reflex activity and blocking of the group Ia afferents may improve its clinical symptoms. Since muscle afferent block has been successfully used for treating dystonia, this method may become useful for treating spasticity as well. We injected diluted lidocaine (0.5%, 50 ml/session) and ethanol (5 ml) into thigh adductors (for leg crossing), medial hamstrings (for medial rotation of the leg), quadriceps femoris (for hyperextension of the knee), tibialis posterior and triceps surae muscles (pes equinovarus deformity), biceps brachii and forearm flexors (for flexion deformities of the upper extremity) in 12 patients with spasticity. Although the duration of action was short (< 1 day) at first, it was gradually prolonged to several weeks by repeating the injection every 3-4 days. The final outcome was comparable to that obtained by botulinum toxin injection in the same group of patients. This method may prove its promise as a means of treating spasticity.
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PMID:[Treatment of spasticity with botulinum toxin and muscle afferent block]. 912 98

We examined age-dependent changes in voluntary eye movements in normal subjects (age : 5-76) using a visually guided saccade (V-saccade) task and a memory guided saccade (M-saccade) task. Changes were more evident in M-saccades. The latencies were long in children (< 12 y.o.) and elderly people (> 50 y.o.). Both young children and elderly people tended to break fixation by making a saccade to the cue stimulus that indicated the future target position. On the other hand, both young children and elderly people tended to be slow in making M-saccade promptly after the central fixation point went off. Thus, they had difficulties both in suppressing unnecessary saccades and in initiating saccades based on memory. Interestingly, similar difficulties were observed, in exaggerated forms, in patients in basal ganglia disorders, such as Parkinson's disease, juvenile parkinsonism, dopa-responsive dystonia, and hereditary progressive dystonia with marked diurnal fluctuation. These findings were consistent with the known functions of the basal ganglia which have been revealed by physiological studies using trained monkeys. The substantia nigra pars reticulata exerts tonic inhibitory influences over the superior colliculus, thereby preventing excitatory inputs from triggering unnecessary saccades. The tonic inhibition, however, is removed by a phasic inhibition largely originating in the caudate nucleus. Thus, inhibition and disinhibition are key mechanisms of the basal ganglia. In fact, experimental manipulations of these serial inhibitory pathway in the basal ganglia led either to the difficulty in initiation of saccades, especially M-saccades, or to the difficulty in suppressing unnecessary saccades. These comparisons suggest that the functions of the basal ganglia are immature in young children while they become deteriorated in elderly people.
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PMID:[Changes and disorders in voluntary saccades during development and aging]. 914 26


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