Possible Functional Moving Toes Syndrome

Background: Moving toes syndrome has been classically described as an organic movement disorder, on occasion related to peripheral nerve injuries. The association between nerve trauma and movement disorders has become a controversial topic, and the functional etiology of moving toes syndrome has recently been proposed. Case Report: We describe two cases of moving toes syndrome with clinical features typically suggestive of a functional movement disorder. Discussion: The presence of entrainability and distractibility in the described patients is an indication of attentional influences on their involuntary movements. However, it is possible that if there is a subcortical origin, the toe movements could be influenced by voluntary commands

Pyridostigmine induced heart block requiring ICU admission

Myasthenia gravis is an autoimmune disorder that effects an estimated 20 people per 100,000 in the USA per year. Pyridostigmine is a common drug used in the symptomatic treatment of myasthenia gravis. While generally safe and effective, a rare set of patients treated with pyridostigmine encounter cardiac conduction disorders. Here, we report a rare presentation of an adverse drug reaction due to pyridostigmine, which is important for its implications in the acute care setting

Longitudinal assessment of falls in patients with Parkinson’s disease using inertial sensors and the Timed Up and Go test

Objective: To examine the predictive validity of a TUG test for falls risk, quantified using body-worn sensors (QTUG) in people with Parkinsons Disease (PD). We also sought to examine the inter-session reliability of QTUG sensor measures and their association with the Unified Parkinsons Disease Rating Scale (UPDRS) motor score. Approach: A six-month longitudinal study of 15 patients with Parkinsons disease. Participants were asked to complete a weekly diary recording any falls activity for six months following baseline assessment. Participants were assessed monthly, using a Timed Up and Go test, quantified using body-worn sensors, placed on each leg below the knee. Main results: The results suggest that the QTUG falls risk estimate recorded at baseline is 73.33% (44.90, 92.21)accurate in predicting falls within 90 days, while the Timed Up and Go time at baseline was 46.67% (21.27, 73.41)accurate. The Timed Up and Go time and QTUG falls risk estimate were strongly correlated with UPDRS motor score. Fifty-two of 59 inertial sensor parameters exhibited excellent inter-session reliability, five exhibited moderate reliability, while two parameters exhibited poor reliability. Significance: The results suggest that QTUG is a reliable tool for the assessment of gait and mobility in Parkinsons disease and, furthermore, that it may have utility in predicting falls in patients with Parkinsons disease.Insight Research CentreCare Innovations LL