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)

Eighteen patients with medically intractable Parkinson's disease that was characterized by bradykinesia, rigidity, and marked "on-off" fluctuations underwent stereotactic ventral pallidotomy under local anesthesia. Targeting was aided by anatomic coordinates derived from the MRI, intraoperative cell recordings, and electrical stimulation prior to lesioning. A nonsurgically treated group of seven similarly affected individuals was also followed. Assessment of motor function was made at baseline and at 3-month intervals for 1 year. Following the lesioning, patients improved in bradykinesia, rigidity, resting tremor, and balance with resolution of medication-induced contralateral dyskinesia. When compared with preoperative baseline, all quantifiable test scores after surgery improved significantly with the patients off medications for 12 hours: UPDRS by 65%, and CAPIT subtest scores on the contralateral limb by 38.2% and the ipsilateral limb by 24.2%. Walk scores improved by 45%. Medication requirements were unchanged, but the patients who had had surgery were able to tolerate larger doses because of reduced dyskinesia. Ventral pallidotomy produces statistically significant reduction in parkinsonism and contralateral "on" dyskinesia without morbidity or mortality and with a short hospitalization in Parkinson's disease patients for whom medical therapy has failed.
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PMID:Stereotactic ventral pallidotomy for Parkinson's disease. 772 66

A 21-year-old patient with right basal ganglial AVM was scheduled twice for cranioplasty under general anesthesia (nitrous oxide oxygen isoflurane anesthesia and modified neurolept anesthesia), after a surgery for removal of hematoma from the AVM three months previously. After this operation and before anesthesia for cranioplasties, he showed tremor-like seizure around the left arm and leg about once a day. During anesthesia for cranioplasties, he developed the similar and enhanced seizure frequently in response to intravenous injections of thiopental and midazolam, needle injections into the skin, intratracheal as well as oral suctions and other stimuli. The reason of decreased cerebral perfusion is probably due to the previous operation and administrations of thiopental and midazolam. Because of decreased perfusion around this cerebral lesion, concentrations of the anesthetics might have remained low around the lesion under general anesthesia. Therefore, the resulting hypoxia and prolonged light anesthesia in the basal ganglia, might have enhanced the seizure.
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PMID:[Preexisting seizure was enhanced under general anesthesia in a AVM patient]. 783 12

We report two patients presenting for thalamotomy in whom tremor was abolished for 8 h after propofol anaesthesia. Propofol has two contrasting actions. It may have an anti-Parkinsonion effect, abolishing abnormal limb movements. On other occasions, propofol is known to induce spontaneous abnormal limb movements, as well as epileptiform activity. Propofol is probably best avoided for stereotactic procedures. It is difficult to reconcile these two opposing actions.
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PMID:Propofol--contrasting effects in movement disorders. 794 34

Postanesthesia shaking is a frequent complication developing for unknown reasons during emergence from general anesthesia. The sources of primary knowledge concerning how patients describe their postanesthesia shaking experiences are sparse. This study presents data to expand the body of PACU nursing knowledge through patients offering information about the shaking phenomenon. In an attempt to categorize ways patients talk about their shaking experience, the research question guiding this study was this: How do patients talk about the postanesthesia shaking phenomenon? This descriptive research used an interview design. Telephone interviews were conducted with 103 subjects. Tape recorded interviews with the 43 subjects who remembered their shaking experience are included in the presentation of data. These data show that when patients were asked to talk about their shaking experience, they not only had memory of the postanesthesia shaking phenomenon, but they talked about their shaking experience in various ways. Further research is needed to promote a greater understanding of patient responses to this postanesthesia complication.
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PMID:Patients talk about their postanesthesia shaking experiences. 806 26

Stereotactic thalamotomy of the VIM (ventral intermediate) nucleus is considered as the best neurosurgical treatment for Parkinsonian and essential tremors. However, this surgery, especially when bilateral, still presents a risk of recurrence and neurological complications. We observed that acute VIM stimulation at frequencies higher than 60 Hz during the mapping phase of the target suppressed the tremor of Parkinson's disease (PD) and essential tremor (ET). This effect was immediately reversible at the end of the stimulation. This was initially proposed as an additional treatment for patients already thalamotomized on the contralateral side, and then extended as a regular procedure for extra-pyramidal dyskinesias. Since January 1987, we implanted 126 thalami in 87 patients (61 PD, 13 ET, 13 dyskinesias of various origins). Deep brain stimulation electrodes were stereotactically implanted under local anaesthesia, using stimulation and micro-recording to delineate the best site of stimulation. Electrodes were subsequently connected to implantable programmable stimulators. The optimal frequency was around 130 to 185 Hz. The results (evaluated by a neurologist from 0 = no effect to 4 = perfect relief) are related to the type of tremor. Altogether, 71% of the 80 patients benefited from the procedure with grade 3 and 4 results. In 88% of the PD cases, the results were good (grade 3) or excellent (grade 4) and stable with time. Rigidity was moderately for a long improved but akinesia was not. The same level of improvement was observed in 68% of the ET patients and only in 18% of the other types of dyskinesias.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias. 810 99

Midazolam is a short-acting, water-soluble benzodiazepine used for induction and maintenance of general anesthesia and as an adjunct to regional anesthesia. This substance produces several types of untoward reactions, including agitated excitement, mental confusion, and uncooperativeness, as well as dystonic extrapyramidal reactions, such as tonic clonic movements, muscle tremor, and athetoid movements. We describe two patients who developed akinesthesia with athetoid movements of the lower extremities after receiving midazolam as a premedication and as an adjunct to epidural anesthesia. These movements occurred with a sensory level of T4 as assessed by pinprick, even though the patients were unable to move their lower extremities.
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PMID:Midazolam-induced athetoid movements of the lower extremities during epidural anesthesia reversed by physostigmine. 812 77

Excitatory movements have been observed during induction of anesthesia with etomidate, thiopental, methohexital, and propofol. We studied the frequency of these excitatory effects and correlated movements with electroencephalographic (EEG) findings in 67 unpremedicated patients (mean age 66.1 yr, range 45-82 yr). Excitatory effects, including myoclonus, tremor, and dystonic posturing, occurred in 86.6% of patients receiving etomidate; 69.2% of the patient responses were myoclonic. Multiple spikes appeared on the EEG in 22.2% of the etomidate patients. The frequency of excitatory effects was 16.6% after thiopental, 12.5% after methohexital, and 5.5% after propofol. None of the patients receiving thiopental, methohexital, or propofol developed myoclonic or seizure activity. In most patients, the excitatory movements were coincident with the early slow phase of the EEG which corresponds to the beginning of deep anesthesia. We conclude that perhaps caution should be exercised when administering etomidate to patients with a history of seizures as the myoclonic activity is associated with seizure activity. The incidence of excitatory movements after administration of propofol is very low.
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PMID:Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol. 821 99

Postanesthesia shaking is a common complication occurring after general anesthesia. Although the cause is unknown, some nurses believe that shaking is useful and beneficial for patients because it increases body temperature and that shaking stops when patients are no longer hypothermic. The primary purpose of this study was to examine changes in body temperature among patients who developed and who did not develop shaking. Secondary purposes were to examine changes in body temperature among patients who received or who did not receive intravenous narcotic-analgesic medication treatment to stop shaking and among those who either stopped shaking or who continued to shake until spontaneous cessation occurred minutes to hours later. The convenience sample consisted of 36 shaking patients and 56 nonshaking patients who were extubated, were over 18 years of age, had an intact intravenous line, and received isoflurane anesthesia. Shaking was established when patients reached and sustained grade 2 or 3 shaking on a 0-to-3 visual scale for 3 minutes (no shaking to forceful shaking). Shaking was determined as having stopped when patients achieved grade 2 on a 0-to-2 visual scale (continues shaking to stopped shaking). Axillary temperature was measured on PACU admission and again after 60 minutes. The six hypotheses were supported. Patients who developed shaking (mean = .67 degrees C [1.2 degrees F]) changed body temperature at the same rate as those who did not develop shaking (mean = .72 degrees C [1.3 degrees F]). Administration of intravenous narcotic-analgesic medication to stop shaking did not alter the rate of body temperature change in patients who received or who did not receive treatment for shaking and those who did or who did not stop shaking. Findings suggest that postanesthesia shaking does not increase body temperature. This finding does not support the long-held belief that shaking is useful and beneficial for patients because it increases body temperature. Findings also indicated that the administration of intravenous narcotic-analgesic medications to stop shaking does not alter the rate of body temperature change. Suggestions for further research focus on systematically examining nursing interventions currently implemented to stop shaking. Research findings will provide evidence that either supports or fails to support the implementation of therapeutic interventions that effectively stop shaking within 5 minutes.
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PMID:Patients who develop postanesthesia shaking increase body temperature at the same rate as those who do not develop shaking. 837 31

In microscopic sections of the rodent brain the dorsal fascia dentata frequently shows perineuronal swelling and neuronal swelling and shrinkage. Factors influencing the occurrence of such changes, which may mimic excitotoxic effects, have been examined using various schedules of anaesthesia and perfusion fixation. Laboratory mice anaesthetized with a low dose of sodium pentobarbital manifested prolonged excitation in comparison to those anaesthetized with a high dose: the occurrence of tremor and convulsions, however, was not related to the morphological changes in the fascia dentata. The changes were diminished by increasing the perfusion pressure (from 80 to 120 mmHg), by reducing the duration of the wash-out period with buffer (from 45 to 15 seconds) and by prolonging the perfusion time (from 7 to 15 minutes). They were abolished when 5% solution of glutaraldehyde was used instead of a 2.5%. The results show that the quality of brain fixation may be best assessed according to the morphology of the dorsal fascia dentata, and that the occurrence of acute swelling and shrinkage in this area should not be mistaken for pathological changes.
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PMID:The dorsal fascia dentata as a probe of fixation quality in the rodent brain. 859 47

To clarify the role of heredity and of some environment risk factors in the etiology of idiopathic Parkinson's disease, we performed a case-control study in two regions of southern Italy, Campania and Molise. We selected two controls for each parkinsonian patient, the patient's spouse and a sex- and age-matched neurological control. One hundred sixteen consecutive outpatients with Parkinson's disease (77 men, 39 women; mean age +/- SD = 62.5 +/- 9.9) and the same number of spouses and neurological controls were interviewed about five environmental risk factors (cigarette smoking, well-water drinking, head trauma with loss of consciousness, strict diets, general anesthesia) and two genetic risk factors (family history of Parkinson's disease or of essential tremor). Well-water drinking and family history of Parkinson's disease or essential tremor showed a positive association with Parkinson's disease; smoking showed a negative association. The most relevant risk factor was history of familial Parkinson's disease (odds ratio = 14.6; 95% confidence interval = 7.2 - 29.6); 33% of our patients had at least one affected relative. We also showed a unilateral distribution of ancestral secondary cases on the paternal or on the maternal side, which suggests a dominant inheritance. Clinical and epidemiologic features of cases with familial Parkinson's disease showed no peculiarity. The study suggests a strong role of the genetic factors in the etiology of Parkinson's disease.
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PMID:Environmental and genetic risk factors in Parkinson's disease: a case-control study in southern Italy. 877 Oct 62


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