Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From 1986 to 1999, 2460 HIV-positive inpatients were seen in our Hospital. Neurological abnormalities were detected in 1053 (42.8%) patients. In this group, 28 (2.7%) had involuntary movements, 14 (50%) with secondary parkinsonism, six (21.4%) with hemichorea/hemiballismus, four (14.2%) with myoclonus, two (7.2%) with painful legs and moving toes, one (3.6%) with hemidystonia and one (3.6%) with Holmes' tremor. The HIV itself (12 patients), toxoplasmosis of the midbrain (1) and metoclopramide-related symptoms (1) were the most probable causes for the parkinsonism. All patients with hemichorea/hemiballismus were men and in all of them toxoplasmosis of the basal ganglia, mostly on the right side, was the cause of the involuntary movements. Generalized myoclonus was seen in two patients and they were due to toxoplasmosis and HIV-encephalopathy respectively; two others presented with spinal myoclonus. The two patients with painful legs and moving toes had an axonal neuropathy. The patient with hemidystonia suffered from toxoplasmosis in the basal ganglia and the patient with Holmes' tremor had co-infection with tuberculosis and toxoplasmosis affecting the midbrain and cerebellum. We conclude that HIV-infected patients can present almost any movement disorder. They can be related to opportunistic infections, medications, mass lesions and possibly to a direct or indirect effect of the HIV itself.
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PMID:Movement disorders in 28 HIV-infected patients. 1224 84

Clinically relevant movement disorders are identified in 3% of patients with HIV infection seen at tertiary referral centres. In the same setting, prospective follow-up shows that 50% of patients with AIDS develop tremor, parkinsonism or other extrapyramidal features. Hemiballism-hemichorea and tremor are the most common hyperkinesias seen in patients who are HIV positive, but other movement disorders diagnosed in these patients include dystonia, chorea, myoclonus, tics, paroxysmal dyskinesias and parkinsonism. Patients with movement disorders usually present with other clinical features such as peripheral neuropathy, seizures, myelopathy and dementia. In the vast majority of patients, hyperkinesias result from lesions caused by opportunistic infections, particularly toxoplasmosis, which damage the basal ganglia connections. On the other hand, parkinsonism and tremor can result from dopaminergic dysfunction resulting from HIV itself or the use of antidopaminergic drugs. The management of patients who are HIV positive who present with movement disorders involves recognition and treatment of opportunistic infections, symptomatic treatment of the movement disorder and the use of highly active antiretroviral therapy (HAART). The most effective treatment of cerebral toxoplasmosis in patients with HIV infection is the combination of sulfadiazine and pyrimethamine. Symptomatic treatment of the movement disorder is often disappointing: hemiballism improves with antipsychotics, but tremor, parkinsonism and other phenomena usually fail to respond to available therapies. Preliminary data suggest that HAART may be helpful in the symptomatic control as well as prevention of movement disorders in patients who are HIV positive.
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PMID:HIV-related movement disorders: epidemiology, pathogenesis and management. 1226 60

This training exercise helps health workers to understand what it might feel like to be at risk for HIV infections and/or to be infected with the virus. Participants stand in a circle with their eyes closed, and the facilitator walks around them and taps one of them on the shoulder. This person is, thus, anonymously designated as being HIV-positive. All the participants then mill around and decide whether to shake hands with each other or not. Shaking hands is symbolic of having unprotected intercourse. Depending on the size of the group, they can shake hands with 3 or 4 people. If the person whose hand they shake scratches their palm, then they were exposed to HIV, and they must then scratch the palm of any other hands they shake. With the "HIV exposed" people sitting in an inner circle and the "HIV unexposed" in an outer circle, discussion can then center on how it feels to be exposed and what factors would influence the decision to have counseling and/or testing. Then the inner circle people are instructed to have the test and are randomly assigned cards which read "negative" or "positive." Those with negative cards move to the outer circle and the discussion centers on how they feel and how those with positive cards feel and how this would change their behavior. At the end, all participants must be reminded that this was simply a training exercise.
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PMID:Understanding HIV. Training exercise for health workers. 1228 24

The Australian Family Planning Association developed a practice exercise to help health workers understand HIV risks. The exercise has 10-25 participants and lasts about 1.5 hours. Participants sit in a circle. Each participant receives a card marked either HIV positive or HIV negative. No participant has to inform others of his/her HIV status. The facilitator encourages participants to say what they think and feel. Participants are reminded that exposure to HIV does not always mean that they will become infected with HIV, but that there is a strong chance that exposure will lead to HIV infection. The facilitator asks all participants to close their eyes and he/she will go around the circle and touch someone on the shoulder, indicating that that person is now HIV infected. After asking participants to open their eyes, the facilitator asks whether they can tell who is HIV infected. He/she asks how they felt when he/she was moving around the circle. Participants can move around the circle and talk among themselves and, if they want, they can shake the hands of 3-4 persons. HIV-infected persons must scratch the palm of all participants shaking their hand. The latter must scratch the palm of each hand thereafter. Any participant whose palm was not scratched sits in a circle outside of the inner circle of those infected with HIV. The facilitator asks if anyone does not want to shake hands. Participants discuss whether or not they were infected and why or why not. They later discuss whether or not it is important to undergo pre-test counseling and to have an HIV test. Persons in the inner circle discuss how they feel while they were waiting for HIV test results. They discuss what they need to do to reduce their HIV risk and how they are going to do it. HIV-positive persons in the inner circle are also asked how they feel. After the exercise, the participants may be emotional. It is important to remind them that it is only an exercise. They should say what they think of the exercise. The facilitator should ask them where they can go to get HIV information.
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PMID:[Understanding HIV. Training: practice exercises for health workers]. 1229 26

According to the Wenhui Daily newspaper, the number of people infected with HIV in Shanghai, China, is growing rapidly and could surpass 16,000 next year, dramatically up from the current level of 183 confirmed cases. Many Shanghai residents lack basic information about HIV/AIDS and how to protect themselves against becoming infected. For example, more than one-third of people surveyed in the city were unaware that condom use during sexual intercourse reduces the risk of HIV transmission, and 20-50% of people believed that HIV can be spread by swimming, shaking hands, or touching objects handled by HIV-infected individuals. Wenhui Daily cited unspecified health officials as the source of its information. Nationwide, China has reported less than 8000 confirmed cases of HIV infection, although more than 300,000 people are thought to be infected. 1.2 million people are projected to be infected with HIV in China by 2000. The youngest person known to be infected with HIV in Shanghai is a 21-month old infant whose mother transmitted the virus during pregnancy. China's leaders have only recently begun to take steps to check the spread of HIV and to teach the public how to protect itself.
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PMID:Increasing number of people infected by HIV in Shanghai, China. 1232 60

Uganda has one of the worst AIDS epidemics in the world, and the number of cases is doubling every 4-6 months; yet it has done much to halt the spread of the disease. Uganda has had a vigorous AIDS education campaign since 1986. It is the only country in the world to carry out a national serosurvey to determine the prevalence of the virus. HIV-positive individuals run a counseling service. The Protestant and Catholic churches have launched anti-AIDS drives, stressing sexual fidelity for the healthy, compassion and care for the sick. President Yoweri Museveni had instructed the Ministry of Health to mobilize the educational and awareness campaign to correct the misconceptions of the people regarding AIDS. The campaigns have used leaflets, posters, radio, schools, political cadres, the army, and local civic action groups to spread the word in Uganda's many vernaculars. All have stressed that that untested blood transfusions and dirty needles can pass the virus, as can mothers to newborns. They have emphasized that AIDS cannot be caught from shaking hands, sharing cups or bedding or from mosquitoes. The AIDS Support Organization, a volunteer group of HIV/AIDS infected persons, has been established to respond to the needs of those who are infected or looking for accurate information. Although the campaign was constrained by limited financial resources, the government never saw this as an obstacle in their goal and it is now being used as a model in other African countries.
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PMID:An open approach to AIDS. Uganda. 1232 4

The spectrum of movement disorders in the tropics is different from that seen in the industrialized nations of the west. This is not surprising given the unique combination of environmental and population characteristics in the tropics. Infections seldom encountered in the west such as tuberculous meningitis, typhoid fever, Japanese encephalitis, malaria, trypanosomiasis or cysticercosis are often seen in the tropics and with global patterns of travel and immigration these conditions are becoming more common worldwide. Movement disorders associated with these infections, HIV, slow virus and prion disease are discussed. Taking into account the diverse etiologies of movement disorders in the tropics, movement disorders with a nutritional basis such as the infantile tremor syndrome, seasonal ataxia and tropical ataxic neuropathy, and manganese neurotoxicity are also reviewed. Finally, certain special characteristics of ubiquitous disorders such as Parkinson's disease, and disorders with a genetic basis such as Wilson's disease and spinocerebellar degeneration are described.
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PMID:Movement disorders in the tropics. 1247 95

The major psychoactive constituent of Cannabis sativa, delta(9)-tetrahydrocannabinol (delta(9)-THC), and endogenous cannabinoid ligands, such as anandamide, signal through G-protein-coupled cannabinoid receptors localised to regions of the brain associated with important neurological processes. Signalling is mostly inhibitory and suggests a role for cannabinoids as therapeutic agents in CNS disease where inhibition of neurotransmitter release would be beneficial. Anecdotal evidence suggests that patients with disorders such as multiple sclerosis smoke cannabis to relieve disease-related symptoms. Cannabinoids can alleviate tremor and spasticity in animal models of multiple sclerosis, and clinical trials of the use of these compounds for these symptoms are in progress. The cannabinoid nabilone is currently licensed for use as an antiemetic agent in chemotherapy-induced emesis. Evidence suggests that cannabinoids may prove useful in Parkinson's disease by inhibiting the excitotoxic neurotransmitter glutamate and counteracting oxidative damage to dopaminergic neurons. The inhibitory effect of cannabinoids on reactive oxygen species, glutamate and tumour necrosis factor suggests that they may be potent neuroprotective agents. Dexanabinol (HU-211), a synthetic cannabinoid, is currently being assessed in clinical trials for traumatic brain injury and stroke. Animal models of mechanical, thermal and noxious pain suggest that cannabinoids may be effective analgesics. Indeed, in clinical trials of postoperative and cancer pain and pain associated with spinal cord injury, cannabinoids have proven more effective than placebo but may be less effective than existing therapies. Dronabinol, a commercially available form of delta(9)-THC, has been used successfully for increasing appetite in patients with HIV wasting disease, and cannabinoid receptor antagonists may reduce obesity. Acute adverse effects following cannabis usage include sedation and anxiety. These effects are usually transient and may be less severe than those that occur with existing therapeutic agents. The use of nonpsychoactive cannabinoids such as cannabidiol and dexanabinol may allow the dissociation of unwanted psychoactive effects from potential therapeutic benefits. The existence of other cannabinoid receptors may provide novel therapeutic targets that are independent of CB(1) receptors (at which most currently available cannabinoids act) and the development of compounds that are not associated with CB(1) receptor-mediated adverse effects. Further understanding of the most appropriate route of delivery and the pharmacokinetics of agents that act via the endocannabinoid system may also reduce adverse effects and increase the efficacy of cannabinoid treatment. This review highlights recent advances in understanding of the endocannabinoid system and indicates CNS disorders that may benefit from the therapeutic effects of cannabinoid treatment. Where applicable, reference is made to ongoing clinical trials of cannabinoids to alleviate symptoms of these disorders.
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PMID:Therapeutic potential of cannabinoids in CNS disease. 1261 97

The human immunodeficiency virus type 1 (HIV-1) Tat protein is a key pathogenic factor in a variety of acquired immune deficiency syndrome (AIDS)-associated disorders. A number of studies have documented the neurotoxic property of Tat protein, and Tat has therefore been proposed to contribute to AIDS-associated neurological diseases. Nevertheless, the bulk of these studies are performed in in vitro neuronal cultures without taking into account the intricate cell-cell interaction in the brain, or by injection of recombinant Tat protein into the brain, which may cause secondary stress or damage to the brain. To gain a better understanding of the roles of Tat protein in HIV-1 neuropathogenesis, we attempted to establish a transgenic mouse model in which Tat expression was regulated by both the astrocyte-specific glial fibrillary acidic protein promoter and a doxycycline (Dox)-inducible promoter. In the present study, we characterized the phenotypic and neuropathogenic features of these mice. Both in vitro and in vivo assays confirmed that Tat expression occurred exclusively in astrocytes and was Dox-dependent. Tat expression in the brain caused failure to thrive, hunched gesture, tremor, ataxia, and slow cognitive and motor movement, seizures, and premature death. Neuropathologies of these mice were characterized by breakdown of cerebellum and cortex, brain edema, astrocytosis, degeneration of neuronal dendrites, neuronal apoptosis, and increased infiltration of activated monocytes and T lymphocytes. These results together demonstrate that Tat expression in the absence of HIV-1 infection is sufficient to cause neuropathologies similar to most of those noted in the brain of AIDS patients, and provide the first evidence in the context of a whole organism to support a critical role of Tat protein in HIV-1 neuropathogenesis. More importantly, our data suggest that the Dox inducible, brain-targeted Tat transgenic mice offer an in vivo model for delineating the molecular mechanisms of Tat neurotoxicity and for developing therapeutic strategies for treating HIV-associated neurological disorders.
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PMID:Neuropathologies in transgenic mice expressing human immunodeficiency virus type 1 Tat protein under the regulation of the astrocyte-specific glial fibrillary acidic protein promoter and doxycycline. 1270 54

Parkinsonism has been associated with HIV/AIDS and cerebral cryptococcal disease, but to date there has been no report of histological cryptococcal lesions in the substantia nigra (SN) in a patient with parkinsonism. We report on a case of a 63-year-old man who presented with tremor, gait disturbance, and mask-like facies, and showed cryptococcal meningoencephalitis with cryptococcal abscesses in the SN at autopsy, without Lewy bodies or significant degeneration of the SN neurons. Parkinsonism also represented the first manifestation of AIDS in this previously undiagnosed patient. This case highlights the importance of considering infectious etiologies in patients presenting with parkinsonism, and underscores the need for autopsy in evaluation of patients with new or unexplained movement disorders. Movement disorders in association with AIDS and mesencephalic mass lesions are discussed.
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PMID:Mesencephalic cryptococcal abscesses presenting with parkinsonism as an initial manifestation of AIDS. 1463 81


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