A Family with Late-Onset and Predominant Choreic Niemann Pick Type C: A Treatable Piece in the Etiological Puzzle of Choreas

Niemman Pick type C (NPC) is a treatable neurodegenerative lysosomal disorder characterized by the widespread age of onset and clinical presentation. The adult NPC phenotype frequently includes ataxia, supranuclear gaze palsy, and cognitive and behavioral problems.1 Movement disorders are also often observed in these patients. Among them, chorea has been rarely described as a dominant sign.1, 2 On the other hand, a phenotype dominated by chorea and cognitive and behavioral manifestations is suggestive of Huntington's disease (HD).3, 4 The rare cases showing this phenotype proved to be negative for the CAG expansion in HTT and are categorized as Huntington-like disorders (HDL).5 Although the list of HDL genetic etiologies has grown considerably during the past few years, the diagnostic yield for these conditions is still limited.3, 5 Noteworthy, NPC is neither routinely considered in the differential diagnosis of chorea nor among the HDL disorders. We present 2 siblings presenting with a late onset and predominate choreic phenotype, where the final diagnosis was NPC.Fil: Rodriguez Quiroga, Sergio. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: Zavala, Lucía. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: Perez Maturo, Josefina. Universidad Austral. Facultad de Ciencias Biomédicas. Instituto de Investigaciones en Medicina Traslacional. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones en Medicina Traslacional; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: González Morón, Dolores. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: Garretto, Nelida Susana. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: Kauffman, Marcelo Andres. Universidad Austral. Facultad de Ciencias Biomédicas. Instituto de Investigaciones en Medicina Traslacional. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones en Medicina Traslacional; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; Argentin

Hemimasticatory Spasm: Report of a Case and Review of the Literature

Background:&nbsp;Hemimasticatory Spasm is a very rare disorder. Case report:&nbsp;A 62-year-old woman consulted with 30 years of unusual involuntary twitches in preauricular region and spasms that hamper jaw opening.&nbsp; During the spasms she cannot open her mouth for several seconds. At physical examination we observed hypertrophy of the masseter and temporalis&nbsp;muscles, shared features with Hemimasticatory Spasm. She was treated with botulinum toxin type A with excellent response. Discussion:&nbsp;Hemimasticatory Spasm is a rare movement disorder, but given the excellent response to botulinum toxin type A treatment, it should be considered in the spectrum of facial spasms.</p

Tonic spasms are a common clinical manifestation in patients with neuromyelitis optica Espasmos tônicos são manifestações clínicas frequentes em pacientes com neuromielite óptica

Tonic spasms have been most commonly associated with multiple sclerosis. To date, few reports of series of patients with neuromyelitis optica and tonic spasms have been published. Methods: We analyzed the characteristics and frequency of tonic spasms in 19 subjects with neuromyelitis optica. Data was collected using a semi-structured questionnaire for tonic spasms, by both retrospectively reviewing medical records and performing clinical assessment. Results: All patients except one developed this symptom. The main triggering factors were sudden movements and emotional factors. Spasms were commonly associated to sensory disturbances and worsened during the acute phases of the disease. Carbamazepine was most commonly used to treat the symptom and patients showed good response to the drug. Conclusions: Tonic spasms are a common clinical manifestation in patients with neuromyelitis optica.<br>Espasmos t&#244;nicos t&#234;m sido mais frequentemente associados com esclerose m&#250;ltipla. Foram publicados at&#233; agora poucos relatos de s&#233;rie de pacientes com neuromielite &#243;ptica e espasmos t&#244;nicos. M&#233;todos: Foram analisadas as caracter&#237;sticas e a frequ&#234;ncia de espasmos t&#244;nicos em 19 indiv&#237;duos com neuromielite &#243;ptica. Os dados foram coletados por meio de um question&#225;rio semiestruturado para espasmos t&#244;nicos, mediante a avalia&#231;&#227;o retrospectiva dos prontu&#225;rios e a an&#225;lise dos dados cl&#237;nicos Resultados: Todos os pacientes com neuromielite &#243;ptica exceto um apresentaram espasmos t&#244;nicos. Os principais fatores desencadeantes foram movimentos bruscos e fatores emocionais. Espasmos foram frequentemente associados a perturba&#231;&#245;es sensoriais e se agravaram durante a fase aguda da doen&#231;a. A carbamazepina foi utilizada frequentemente para tratar os sintomas, com boa resposta. Conclus&#245;es: Os espasmos t&#244;nicos s&#227;o manifesta&#231;&#245;es cl&#237;nicas frequentes em pacientes com neuromielite &#243;ptica

A Family with Late‐Onset and Predominant Choreic Niemann Pick Type C: A Treatable Piece in the Etiological Puzzle of Choreas

Niemman Pick type C (NPC) is a treatable neurodegenerative lysosomal disorder characterized by the widespread age of onset and clinical presentation. The adult NPC phenotype frequently includes ataxia, supranuclear gaze palsy, and cognitive and behavioral problems.1 Movement disorders are also often observed in these patients. Among them, chorea has been rarely described as a dominant sign.1, 2 On the other hand, a phenotype dominated by chorea and cognitive and behavioral manifestations is suggestive of Huntington's disease (HD).3, 4 The rare cases showing this phenotype proved to be negative for the CAG expansion in HTT and are categorized as Huntington-like disorders (HDL).5 Although the list of HDL genetic etiologies has grown considerably during the past few years, the diagnostic yield for these conditions is still limited.3, 5 Noteworthy, NPC is neither routinely considered in the differential diagnosis of chorea nor among the HDL disorders. We present 2 siblings presenting with a late onset and predominate choreic phenotype, where the final diagnosis was NPC.Fil: Rodriguez Quiroga, Sergio. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: Zavala, Lucía. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: Perez Maturo, Josefina. Universidad Austral. Facultad de Ciencias Biomédicas. Instituto de Investigaciones en Medicina Traslacional. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones en Medicina Traslacional; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: González Morón, Dolores. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: Garretto, Nelida Susana. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; ArgentinaFil: Kauffman, Marcelo Andres. Universidad Austral. Facultad de Ciencias Biomédicas. Instituto de Investigaciones en Medicina Traslacional. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones en Medicina Traslacional; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Centro Universitario de Neurología "Dr. José María Ramos Mejía".; Argentin

Tonic spasms are a common clinical manifestation in patients with neuromyelitis optica

Tonic spasms have been most commonly associated with multiple sclerosis. To date, few reports of series of patients with neuromyelitis optica and tonic spasms have been published. Methods: We analyzed the characteristics and frequency of tonic spasms in 19 subjects with neuromyelitis optica. Data was collected using a semi-structured questionnaire for tonic spasms, by both retrospectively reviewing medical records and performing clinical assessment. Results: All patients except one developed this symptom. The main triggering factors were sudden movements and emotional factors. Spasms were commonly associated to sensory disturbances and worsened during the acute phases of the disease. Carbamazepine was most commonly used to treat the symptom and patients showed good response to the drug. Conclusions: Tonic spasms are a common clinical manifestation in patients with neuromyelitis optica

Living with chronic illness scale in Parkinson's disease: longitudinal metric properties and meaningful change

Aim: To analyze the responsiveness and interpretability of the Living with Chronic Illness Scale in patients with Parkinson's disease (LW-CI-PD). Methods: Longitudinal, international study, with a convenience sample of 153 PD Spanish and Latin-American patients assessed at baseline and one year later. The LW-CI-PD and other clinical measures were applied. For responsiveness, Wilcoxon-Mann-Whitney test of differences, correlation of change between rating scales, standard error of difference, relative change, Cohen's effect size and standardized response mean of LW-CI-PD were computed. The minimally clinical important difference was calculated using anchor- (applying the Patient Global Impression of Severity) and distribution-based methods. A triangulation of interpretability indexes was performed to determine the range of the minimally clinical important difference values. Results: The LW-CI-PD scored 65.7 (11.7, range: 33–101) at baseline, and 68.6 (10.3, range: 33–102) one year later (p &lt; 0.001). Change in LW-CI-PD correlated −0.26 with change in psychosocial status, 0.18 with change in motor function and −0.15 with change in social support. Responsiveness statistics were: relative change = 4.5%; effect size = 0.25; standardized response mean = 0.46. Using PGI-S as anchor, 29 patients worsened, and the value of minimally clinical important difference for worsening in LW-CI-PD total score was 4.7. Minimally clinical important difference values using distribution-based methods were between 4.5 (1 standard error of measurement) and 10.4 (10% of total score), with a mean of 6.9. Conclusions: Our study suggest the LW-CI-PD is responsive to changes over time. The use of different methods for calculating the minimally clinical important difference allows to determine a range of the real change for the LW-CI-PD.</p

Myoclonus and angiokeratomas in adult galactosialidosis

Galactosialidosis is an autosomal recessive lysosomal storage disorder characterized by a combined deficiency of b- galactosidase and a-neuraminidase, due to a defect of another lysosomal protein, cathepsin A. The latter, forms a complex with b-galactosidase and neuraminidase, and protects them against excessive proteolytic degradation. Three clinical phe- notypes had been described: a severe early infantile form; a milder late infantile type with minor mental deterioration; and a juvenile/adult form, mainly found in Japan, which is characterized by slowly progressive neurological symptoms, skeletal and eye abnormalities, dysmorphism, angiokerato- mas, and long survival.1 Herein, we report a case of galacto- sialidosis of the juvenile-adult form in a Peruvian girl with angiokeratoma corporis diffusum (ACD) and myoclonus. A 24-year-old woman presented a 5-year history of invol- untary movements. At age 19, she developed a progressive myoclonic disorder that started in the lower limbs and caused frequent falls. The myoclonus subsequently spreads to other body regions. Five years into the disease, she was almost wheelchair bound, and other activities such as eating and speaking were considerably affected. There were, how- ever, no seizures or cognitive decline.Physical examination revealed densely peppered red mac- ules ranging from 1 to 3 mm on palms, elbows, knees, oral mucosa, lips, and on thighs and loins in a bath- ing suit distribution. Biochemical analysis showed elevated urinary sialyloligosaccharides char- 1 acteristic for galactosialidosis.Fil: Abaroa, Luz. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Garretto, Nelida S.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Arakaki, Tomoko. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Kauffman, Marcelo Andres. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: González Morón, Dolores. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Figueredo, Alex M.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Szlago, Marina. Fundación para el Estudio de las Enfermedades Neurometabólicas; ArgentinaFil: Verhagen Metman, Leo. Rush University Medical Center; Estados Unido

Everything you always wanted to know about sex and Neurology: neurological disability and sexuality

ABSTRACT Chronic neurological disorders generate disabilities affecting multiple aspects of life, including sexuality. Objective To describe the presence of sexual dysfunction and comorbidities in a population with chronic neurological disorders. To analyze the relationship between disability and sexual dysfunction. Methods A cross-sectional case-control study was carried out. Patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease (PD), and stroke of at least one year since the onset of symptoms were included, and compared with controls with no neurological disease, matched by age and sex. Results We included 71 participants: 29 controls, with a mean age of 49.4 years, and 42 patients with a mean age of 53.8 years. Sexual dysfunction was present in 22.5% of the controls and 77.5% of the patients. A statistically significant relationship between sexual dysfunction and disability was found in the logistic regression analysis (OR = 20.38, 95%CI: 2.5 –165.86). Conclusions Disability proved to be the main variable related to the presence of sexual dysfunction. Patients with ALS had the worst rates of sexual dysfunction. Patients with MS were similar to the control group. As for the PD group, no patient had normal sexuality. Finally, in stroke patients, the presence of comorbidities and their treatment may have negatively influenced sexuality. These findings showed that patients with chronic neurological diseases have sexual dysfunction and underscore the need for neurologists to know and address this problem