Sensorimotor Integration and GABA-ergic Activity in Embouchure Dystonia: An Assessment with Magnetoencephalography

Background: Embouchure dystonia (ED) is a task-specific dystonia affecting musicians thought to be related to alteration in sensorimotor processing and loss of cortical inhibition. Case Report: Magnetoencephalography-coherence source imaging (MEG-CSI) was used to map connectivity between brain regions by imaging neuronal oscillations that are coherent across the brain in patient with ED at rest and while using the index finger to evoke dystonia normally triggered by playing the flute. Discussion: During rest, there was increased coherence in the bilateral frontal and parietal regions that became more focal during dystonia. Diffuse hyperexcitability and increased coherence persisted in bilateral parietal regions as well as the bilateral frontal regions

Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis

Background: There is limited information on optimization of symptomatic management of cervical dystonia (CD) after implantation of pallidal deep brain stimulation (DBS). Objectives: To describe the long-term, real-world management of CD patients after DBS implantation and the role of reintroduction of pharmacologic and botulinum toxin (BoNT) therapy. Methods: A retrospective analysis of patients with focal cervical or segmental craniocervical dystonia implanted with DBS was conducted. Results: Nine patients were identified with a mean follow-up of 41.7 ± 15.7 months. All patients continued adjuvant oral medication(s) to optimize symptom control post-operatively. Three stopped BoNT and four reduced BoNT dose by an average of 22%. All patients remained on at least one medication used to treat dystonia post-operatively. Conclusion: Optimal symptom control was achieved with DBS combined with either BoNT and/or medication. We suggest utilization of adjuvant therapies such as BoNT and/or medications if DBS monotherapy does not achieve optimal symptom control

Pimavanserin use in a movement disorders clinic: A single center experience

Objective: To assess clinical outcomes of Pimavanserin use in Parkinson disease associated psychosis (PDP). Background: Dopamine-receptor blockers (DRB) are used to treat PDP symptoms, though these may be associated with adverse effects, including worsening of Parkinsonism. There is a paucity of comparative studies with conventional neuroleptics. Pimavanserin, a selective 5-HT receptor inverse agonist, was FDA-approved in 2016 for treatment of PDP. Design/Methods: A retrospective chart review of patients prescribed pimavanserin was performed in August, 2017. Data on demographics, psychotic features, sleep, adverse effects was collected using a semi-structured telephone interview with patients and caregivers. Hallucination severity (HS) was quantified as mild (/week), moderate (1/week to \u3c1/day) or severe (daily/continuous). Results: 17 patients consented to participate in the study: 16 were diagnosed with PDP, 1 with Lewy body dementia. Mean duration of Parkinsonism was 11.8±8.0years, with 2.6±1.9 years of psychotic symptoms. At baseline, 93% reported severe hallucinations and 7%, moderate hallucinations. Three PDP patients discontinued pimavanserin by the time of interview (2 because of no benefit; 1 due to remission). 71.4% reported improvement of hallucination with pimavanserin. 6 patients received pimavanserin monotherapy: 33.3% reported no change in HS, 50% improved from severe to mild, and 16.6% improved from severe to moderate. 8 patients receiving pimavanserin and DRB: 2 reported no change in HS, 25% reported a change from severe to mild hallucinations, 37.5% reported decrease from severe to moderate hallucinations and 12.5% reported decrease from moderate to mild hallucinations. Five of 9 patients prescribed DRB (quetiapine and olanzapine) discontinued these medications with pimavanserin initiation. No major side effects were reported. One patient noted subjective improvement of sleep. Conclusions: Our survey, based on reallife experience shows that pimavanserin is well-tolerated and efficacious in treatment of PDP. It appears to be effective as both monotherapy and adjuvant treatment for moderate to severe psychosis for most patients

Pimavanserin use in a movement disorders clinic: a single-center experience

BACKGROUND: Parkinson\u27s disease psychosis (PDP) is a disabling non-motor symptom of Parkinson\u27s disease (PD) that is challenging to treat. Dopamine receptor blockers (DRB) are used to treat PDP, though these may be associated with adverse effects, including worsening of Parkinsonism. Pimavanserin, a selective 5-HT METHODS: A retrospective chart review of patients prescribed pimavanserin was performed in August, 2017. Data on demographics, psychotic features, sleep, and adverse effects was collected using a semi-structured telephone interview with patients or caregivers. Hallucination severity (HS) was quantified as mild (\u3c 1 episode/week), moderate (1/week to \u3c 1/day), or severe (daily/continuous). RESULTS: Seventeen patients consented to participate in the study; 16 were diagnosed with PDP, 1 with Lewy body dementia. Fourteen had co-morbid cognitive impairment/dementia. The mean duration of Parkinsonism was 11.8 ± 8.0 years, with 2.6 ± 1.9 years of psychosis. Eleven of the seventeen patients reported improvement of hallucinations of which 5/8 were initiated on pimavanserin monotherapy, and 6/9 reported improvement of HS with combination of DRB. Six of nine patients prescribed DRB were able to discontinue this medication after introduction of pimavanserin. Four patients discontinued medications (2, no benefit; 1, spontaneous resolution; 1, cost). No major side effects were reported, and two patients noted subjective improvement of sleep. CONCLUSION: In our series based on a small sample size, pimavanserin is well-tolerated and effective as both monotherapy and adjuvant treatment for moderate to severe. This medication can facilitate reduction or cessation of DRB medication