ABSTRACT Introduction: Parkinson’s disease (PD) is increasing in prevalence due to a growing elderly population. Although there is no cure, there are exercise therapies and medications for mild to moderate disease. For more advanced disease, infusion or surgical interventions including deep brain stimulation surgery, levodopa carbidopa intestinal gel, and subcutaneous apomorphine infusion are considered. As these interventions become increasingly available, it is imperative for a neurologist involved in the care of advanced PD to be aware of the indications and …
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In this short post we’ll look at the various clinical uses of Botulinum Toxin injections or Botox®. Blepharospasm It’s a condition which causes excessive blinking an eye closure with difficulty opening the eyes made worse by bright light and can be very disabling causing problems with eating, conversation and even driving. Cervical dystonia abnormal head posturing or pulling with the tightness of neck muscles commonly associated with neck pain. This can result in twisting and turning of the head in …
What is Botulinum Toxin anyway? What is Botox given for? How was it discovered? What does it look like? How does it work? How long does it last? Have you ever wondered about these questions? Let’s have a look. Botulinum Toxin was discovered due to sausage poisoning from under cooked food in the time of Napoleonic wars from food shortage. Later on, we discovered the Botulinum toxin bacterium that makes this toxin, purified toxin and found its various serotypes and …
Patient Beliefs, Culture and Experiences from a Developing country Danish Bhatti MD University of Nebraska Medical Center (UNMC) Movement Disorder team partnered with several institutions in Pakistan to conduct an exploratory prospective multi center, study on characteristics of Parkinson’s disease (PD) in Pakistan with focus on experiences cultures beliefs and risk factors from a developing country. These institutions included University College of Pharmacy at University of Punjab, Neurology departments of Hamdard University Hospital, Liaqat University Medical and Health Sciences, Shifa …
Using Nebraska state registry for research in Parkinson’s disease. Danish Bhatti MD Nebraska was the first State and still one of the only three states in U.S. which have a state mandated registry for Parkinson’s disease (PD). This registry was established 20 years ago with work and efforts by the faculty of Public Health and movement disorders Neurologist in Nebraska. This has accumulated a large amount of data over the last years of patients with PD through various sources. This …
One of the hallmark feature of Parkinson’s disease (PD) is a tremor that is present at rest and usually start on one side, typically in the arm but can be seen also as a starting in the leg. This PD tremor is very characteristic and can be separated from other tremors, the most common being essential tremor or benign familial tremor. It is a common mistake by most physicians especially primary care physicians to diagnose patients with the new onset …
Most common evaluations of Parkinson’s disease (PD) in the clinic consist of motor assessments using some form of repetitive task. One such tool is use of a Unified Parkinson’s Disease Rating Scale or UPDRS which involves multiple different activities such as repetitive finger tapping with first finger and thumb as fast as possible. The clinician observes for any slowing or decreasing amplitude or any irregularity with freezing of the movement. Since the original description of Parkinson’s disease, the assessment of …
Phenomenology of abnormal ocular and eyelid movements may appear complex and difficult to describe at first but recognition of an overall pattern is helpful in characterization: Ocular flutter comprises bursts of saccades in one plane, typically horizontal, during forward fixation. There are no intervals between saccades. Opsoclonus is a continuous succession of multidirectional conjugate saccadic eye movements with no inter-saccadic interval, sometimes aptly called ‘saccadomania’. Patients can manifest ocular flutter when developing or recovering from opsoclonus, and both disorders probably …
In general, surgical referral for all types of dystonia can be considered in patients who have failed trials with anticholinergic drugs, benzodiazepines, and levodopa in generalized/segmental dystonia, or had no benefit or failure with botulinum toxin injections in cranial and cervical dystonia. There is currently no widely accepted consensus about which type of medication, which dose, or how many trials are needed before surgery. In general, it is not mandatory to have tried all available medications. Symptoms should be disabling …
Structure: BTX is synthesized as a single-chain peptide with a molecular mass of 150 kilodaltons. This form has relatively little potency as a neuromuscular blocking agent, and activation requires a 2-step modification in the tertiary structure of the protein. This process converts the single-chain neurotoxin to a di-chain neurotoxin comprising a 100,000-dalton heavy chain (HC) linked by a disulfide bond to a 50,000-dalton light chain (LC). BTX acts at the neuromuscular junction where it exerts its effect by inhibiting the …
