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From the Editor This issue of the CNI REVIEW takes a look at a few of the things these very special neurologists are doing to fight disorders of movement and bring a modicum of functional ability and independence back into the lives of our patients. Take a moment to look at the words we use to describe movement disorders. We characterize these disorders using terms such as chorea, bradykinesia, dystonia, dyskinesia, tremor, dysmetria, dysdiadochokinesis, nystagmus, oscillopsia. The common denominator is kinesis—movement. These disorders change the way we move. Not only arms and legs, but fine motor control, voice, swallowing, head control, and eye motion can be affected. Like a rock in a pond, these disorders can interrupt more than just motor function in ever expanding circles. Rigidity of muscle tone, inability to initiate movement, incoordination of movement, loss of smoothness and fluidity, diminished speed of movement, loss of movement control, even violent uncontrollable movement can occur. Beyond motor function, the epiphenomenon of the underlying disease processes may induce cognitive deterioration and dementia, behavioral changes, attentional disorders, and obsessive thoughts and behaviors. These present additional challenges to our patients as they relentlessly and progressively steal independence and ability. Our contributors to this issue span a wide breadth of expertise in the neurology of movement. Pinky Agarwal, MD, and Lauren C. Seeberger, MD, describe Huntington’s disease and the current treatment options available for this dramatically disabling disease. Michael J. Frank, PhD and Randall C. O’Reilly, PhD summarize their research in computer modeling of basal ganglia, arriving at surprising and novel predictions about how this impacts a Parkinson’s patient’s cognition. Steven G. Ojemann, MD, updates us on the surgical management of Parkinsons Disease and Essential Tremor, outlining the indications, contraindications, complications and outcomes that can be expected with implantation of deep brain stimulators for these disorders. Thomas Politzer, OD, FCOVD, FAAO, describes the sometimes subtle but potentially disabling ocular effects of Parkinsons Disease, and what can be done to improve the affected Parkinson’s patient’s visual function. Josette Pressler, LPN, presents the many community resources available to patients with movement disorders with an emphasis on Parkinson’s disease. Lauren C. Seeberger, MD defines the characteristics of cerebellar tremor, outlines the etiology of this disorder, and reports on the effectiveness of new interventions for this disabling affliction. I hope you will find this issue of the CNI REVIEW enlightening and interesting. I’m sure it will give you useful information on the availability and effectiveness of new treatments for these disorders, as well as the clinical, research and community resources available to your patients with movement disorders through the CNI Movement Disorder Center and Thompson Center for Restorative Neurosurgery at the Colorado Neurologic Institute. And if you have never had the opportunity, I invite you to read Dr. Sack’s book, Awakenings, to get a vivid picture of the battle our movement disorders neurologists are waging every day. John H. McVicker, MD, FACS To view the articles: This issue of the CNI REVIEW is provided in Adobe Acrobat PDF format. You can right-click to download the PDF file to your computer, or click to open and read online. Or click on each title below to open a smaller PDF file containing only the article's pages.
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The
tarantella is an ancient southern Italian dance form, characterized by
feverish, writhing, jerking movements of the limbs, ostensibly danced
to fend off the poisonous effects of a spider bite. It bears a striking
resemblance to the dyskinesia experienced by a Parkinson’s patient with
full-blown motor fluctuations associated with their medication regimen.
But when the same patient’s medication level drops transiently between
doses, the very opposite occurs. In his compelling book Awakenings, Dr.
Oliver Sacks vividly describes patients with a post-infectious parkinson-like
syndrome, living in the rigid prison of their own unresponsive frame,
and the dramatic “awakening” of these patients given Levo-dopa. The advent
of Levo-dopa therapy was hailed as a medical miracle, and indeed it is,
freeing Parkinson’s patients from the rigidity, tremor, and difficulty
initiating movement that are the hallmarks of the disease very effectively.
But as the disease progresses and medication regimens escalate, the huge
and often sudden swings from dyskinesia to rigidity and “freezing” can
make the uncertainty of daily living a huge functional problem. Smoothing
out these motor fluctuations is just one goal of movement disorders neurologists.
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