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Dropped head syndrome caused by various diagnoses – effect of physiotherapy (The 2nd report)
Abstracts / Journal of the Neurological Sciences 357 (2015) e255–e294
group (±). The prevalences of dysosmia were compared between the healthy controls and patients with PD. Results: Among the 83 healthy controls, 39 (47.0%; mean age, 70.6 years) were dysosmia (-), 31 (37.3%; 72.6 years) were dysosmia (±), and 13 (15.7%; 77.0 years) were dysosmia (+). Among the 60 patients with PD, 10 (16.7%; mean age, 69.0 years) were dysosmia (-), 17 (28.3%; 71.9 years) were dysosmia (±), and 33 (55.0%; 73.3 years) were dysosmia (+). Conclusion: Dysosmia including borderline dysosmia was found in 83.3% of patients with PD.
doi:10.1016/j.jns.2015.08.979
OF
928 WFN15-0390 Movement Disorders Effects of dopaminergic medication on executive function in drug-naive patients with Parkinson’s disease: using behavioral assessment of the dysexecutive syndrome
Background: Dropped head syndrome is seen in various diseases. Its pathophysiological mechanisms are unknown, but the possibility of dystonia of neck flexors or weakness of neck extensors was suggested. We reported the existence of tonic activities of extensor muscles as a common finding of surface EMG and the effect of physiotherapy to relieve their complaints in WCN 2013. Objections: We used physiotherapy for more patients to make sure its effect on dropped head syndrome. Patients and methods: Since 2010, we treated 25 cases: 18 cases of Parkinson disease and related disorders (PA), 3 cases of cervical spondylosis (CS) and 3 cases without known causes (UK) and 1 dystonia (DY). By the physiotherapy, the improvement of the alignment of the pelvis and whole vertebral column and the enhancement of activity of extensor muscles were aimed. Some of PA were received the injection of local aesthesia. We have obtained patient approval, as necessary. Results: 15 of 25 cases (60%) of which included 9 PA, 2CS, 3UK and 1DY, showed remarkable improvement. 10 cases were no improvement, which included 9 PA and 1 CS. Conclusion: We conclude that the primary reason of dropped head syndrome is unknown in PA and CS, but also that many of the patients with dropped head syndrome have secondary effects in alignment and activity of the skeletomuscular system, which could be treated with physiotherapy. The effect of local anesthesia will be discussed.
H. Murakami, Y. Owan, Y. Mori, A. Futamura, S. Tsukada, T. Sugita, T. Kuroda, S. Ishigaki, M. Honma, M. Kezuka, M. Kawamura. Department of Neurology, Showa University School of Medicine, Tokyo, Japan
RO
e280
doi:10.1016/j.jns.2015.08.981
DP
Background: There is a correlation between executive and motor functions in Parkinson’s disease (PD). However, the effect of dopaminergic medication on executive function in PD patients is uncertain, especially in drug-naive de novo PD patients. The Behavioral Assessment of the Dysexecutive Syndrome (BADS) is a sensitive executive assessment tool. Objective: We examined the effect of dopaminergic medication on executive function in drug-naive PD patients with approval by the Showa University ethics committee. Methods: Dopaminergic drugs (levodopa, dopamine agonists, selegiline) were given to 17 (9 males, 8 females) drug-naive PD patients without dementia (Mini-Mental State Examination score above 25) and increased to the optimal dose to obtain improvement in motor symptoms. Patients were tested prior to and at 4 to 7 months after drug initiation. Motor function was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS: total score and subscores of tremor, rigidity, bradykinesia and gait). Executive function was assessed using the Japanese version of the BADS. Improvements from baseline for both motor and executive assessments were compared with the levodopa equivalent dose (LED). Results: Dopaminergic drugs significantly ameliorated all motor problems. The improvement did not correlate with the LED. The mean BADS score showed no significant improvement. However, improvement in the BADS score showed a significant positive correlation with the LED. Conclusions: The effects of dopaminergic medication on executive function in drug-naïve PD patients are dose dependent.
931 WFN15-0635 Movement Disorders Opsoclonus-myoclonus syndrome in adults: a report of two cases
TE
J. Neumanna, R. Havlíčekb, P. Danišováa. aDepartment of Neurology, County Hospital Chomutov, Chomutov, Czech Republic; bDepartment of Neurology, Military University Hospital Prague, Prague, Czech Republic
UN
CO
RR
EC
Background: Opsoclonus-myoclonus syndrome (OMS) is a rare movement disorder characterized by chaotic multidirectional eye movements, myoclonus and less frequently cerebellar ataxia. OMS affects as few as 1 in 10,000,000 people per year. Case reports: We present two cases of female Caucasian patients aged 19 and 60 years respectively who developed OMS following a febrile illness. In both cases OMS starts with an acute flare-up of physical symptoms within days. The neurologic examination revealed opsoclonus, myoclonus and ataxia. Both women had normal magnetic resonance imaging of the brain. The results of routine laboratory tests were normal. In both cases, cerebrospinal fluid examinations was consistent with aseptic meningoencephalitis and showed cell-protein association (lymphocytic pleocytosis and protein elevation). The oligoclonal IgG band was negative. Cytomegalovirus, Epstein-Bar virus, Varicella-zoster virus, borrelia, coxsackie, enterovirus, streptococcal infection, syphilis, herpes simplex virus-1 and -2, human immunodeficiency virus or hepatitis were negative in the serological tests. The thyroid function tests, the tests for antinuclear and anti-neuronal antibodies were within normal limits. Malignancy was not detected on positron-emission tomography-CT. After therapies including a combination of intravenous methylprednisonolon, intravenous ceftriaxon, acyclovir and clonazepam, both patients gradually improved and had recovered. After a 12-month follow-up, both women had no neurological sequelae. We have obtained approval of both patients. Conclusion: OMS is associated with multiple etiologies. The most common etiologies are idiopathic, paraneoplastic and infectious disorders. OMS may occur in patients with aseptic brainstem encephalitis. The exact immunopathogenesis and pathophysiology of OMS are uncertain.
doi:10.1016/j.jns.2015.08.980
929 WFN15-0456 Movement Disorders Dropped head syndrome caused by various diagnoses – effect of physiotherapy (The 2nd report) M. Nagaokaa, Y. Hayashia, I. Yonezawab. aRehabilitation Medicine, Juntendo University Graduate School, Tokyo, Japan; bOrthopedic Surgery, Juntendo University Graduate School, Tokyo, Japan
doi:10.1016/j.jns.2015.08.982
group (±). The prevalences of dysosmia were compared between the healthy controls and patients with PD. Results: Among the 83 healthy controls, 39 (47.0%; mean age, 70.6 years) were dysosmia (-), 31 (37.3%; 72.6 years) were dysosmia (±), and 13 (15.7%; 77.0 years) were dysosmia (+). Among the 60 patients with PD, 10 (16.7%; mean age, 69.0 years) were dysosmia (-), 17 (28.3%; 71.9 years) were dysosmia (±), and 33 (55.0%; 73.3 years) were dysosmia (+). Conclusion: Dysosmia including borderline dysosmia was found in 83.3% of patients with PD.
doi:10.1016/j.jns.2015.08.979
OF
928 WFN15-0390 Movement Disorders Effects of dopaminergic medication on executive function in drug-naive patients with Parkinson’s disease: using behavioral assessment of the dysexecutive syndrome
Background: Dropped head syndrome is seen in various diseases. Its pathophysiological mechanisms are unknown, but the possibility of dystonia of neck flexors or weakness of neck extensors was suggested. We reported the existence of tonic activities of extensor muscles as a common finding of surface EMG and the effect of physiotherapy to relieve their complaints in WCN 2013. Objections: We used physiotherapy for more patients to make sure its effect on dropped head syndrome. Patients and methods: Since 2010, we treated 25 cases: 18 cases of Parkinson disease and related disorders (PA), 3 cases of cervical spondylosis (CS) and 3 cases without known causes (UK) and 1 dystonia (DY). By the physiotherapy, the improvement of the alignment of the pelvis and whole vertebral column and the enhancement of activity of extensor muscles were aimed. Some of PA were received the injection of local aesthesia. We have obtained patient approval, as necessary. Results: 15 of 25 cases (60%) of which included 9 PA, 2CS, 3UK and 1DY, showed remarkable improvement. 10 cases were no improvement, which included 9 PA and 1 CS. Conclusion: We conclude that the primary reason of dropped head syndrome is unknown in PA and CS, but also that many of the patients with dropped head syndrome have secondary effects in alignment and activity of the skeletomuscular system, which could be treated with physiotherapy. The effect of local anesthesia will be discussed.
H. Murakami, Y. Owan, Y. Mori, A. Futamura, S. Tsukada, T. Sugita, T. Kuroda, S. Ishigaki, M. Honma, M. Kezuka, M. Kawamura. Department of Neurology, Showa University School of Medicine, Tokyo, Japan
RO
e280
doi:10.1016/j.jns.2015.08.981
DP
Background: There is a correlation between executive and motor functions in Parkinson’s disease (PD). However, the effect of dopaminergic medication on executive function in PD patients is uncertain, especially in drug-naive de novo PD patients. The Behavioral Assessment of the Dysexecutive Syndrome (BADS) is a sensitive executive assessment tool. Objective: We examined the effect of dopaminergic medication on executive function in drug-naive PD patients with approval by the Showa University ethics committee. Methods: Dopaminergic drugs (levodopa, dopamine agonists, selegiline) were given to 17 (9 males, 8 females) drug-naive PD patients without dementia (Mini-Mental State Examination score above 25) and increased to the optimal dose to obtain improvement in motor symptoms. Patients were tested prior to and at 4 to 7 months after drug initiation. Motor function was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS: total score and subscores of tremor, rigidity, bradykinesia and gait). Executive function was assessed using the Japanese version of the BADS. Improvements from baseline for both motor and executive assessments were compared with the levodopa equivalent dose (LED). Results: Dopaminergic drugs significantly ameliorated all motor problems. The improvement did not correlate with the LED. The mean BADS score showed no significant improvement. However, improvement in the BADS score showed a significant positive correlation with the LED. Conclusions: The effects of dopaminergic medication on executive function in drug-naïve PD patients are dose dependent.
931 WFN15-0635 Movement Disorders Opsoclonus-myoclonus syndrome in adults: a report of two cases
TE
J. Neumanna, R. Havlíčekb, P. Danišováa. aDepartment of Neurology, County Hospital Chomutov, Chomutov, Czech Republic; bDepartment of Neurology, Military University Hospital Prague, Prague, Czech Republic
UN
CO
RR
EC
Background: Opsoclonus-myoclonus syndrome (OMS) is a rare movement disorder characterized by chaotic multidirectional eye movements, myoclonus and less frequently cerebellar ataxia. OMS affects as few as 1 in 10,000,000 people per year. Case reports: We present two cases of female Caucasian patients aged 19 and 60 years respectively who developed OMS following a febrile illness. In both cases OMS starts with an acute flare-up of physical symptoms within days. The neurologic examination revealed opsoclonus, myoclonus and ataxia. Both women had normal magnetic resonance imaging of the brain. The results of routine laboratory tests were normal. In both cases, cerebrospinal fluid examinations was consistent with aseptic meningoencephalitis and showed cell-protein association (lymphocytic pleocytosis and protein elevation). The oligoclonal IgG band was negative. Cytomegalovirus, Epstein-Bar virus, Varicella-zoster virus, borrelia, coxsackie, enterovirus, streptococcal infection, syphilis, herpes simplex virus-1 and -2, human immunodeficiency virus or hepatitis were negative in the serological tests. The thyroid function tests, the tests for antinuclear and anti-neuronal antibodies were within normal limits. Malignancy was not detected on positron-emission tomography-CT. After therapies including a combination of intravenous methylprednisonolon, intravenous ceftriaxon, acyclovir and clonazepam, both patients gradually improved and had recovered. After a 12-month follow-up, both women had no neurological sequelae. We have obtained approval of both patients. Conclusion: OMS is associated with multiple etiologies. The most common etiologies are idiopathic, paraneoplastic and infectious disorders. OMS may occur in patients with aseptic brainstem encephalitis. The exact immunopathogenesis and pathophysiology of OMS are uncertain.
doi:10.1016/j.jns.2015.08.980
929 WFN15-0456 Movement Disorders Dropped head syndrome caused by various diagnoses – effect of physiotherapy (The 2nd report) M. Nagaokaa, Y. Hayashia, I. Yonezawab. aRehabilitation Medicine, Juntendo University Graduate School, Tokyo, Japan; bOrthopedic Surgery, Juntendo University Graduate School, Tokyo, Japan
doi:10.1016/j.jns.2015.08.982