FitzGerald and Jankovic(1989)' reported 10 patients with marked gait difficulty and no or only minimal upper limb involvement and coined the term 'lower body parkinsonism' (LBP). They further suggested that LBP was a homogeneous subgroup of parkinsonism, distinct from idiopathic Parkinson's disease (IPD), attributable to vascular etiology. In order to verify the validity of this clinical entity, five cases with LBP were compared with 44 cases with typical idiopathic Parkinson's disease (IPD) with respect to their clinical and neuroradiological findings. Mean age at onset was significantly older in LBP group (63.2*6.3 years) than IPD group (53.9*5.9 years). Gait disturbance was the initial motor symptom in 80% of LBP cases and 16% of IPD cases. Duration of symptoms tended to be shorter in LBP group than IPD group (3.2*2.7, 5.2*3. Lyears, respectively), although statistically not significant. Response to, L-dopa was poor in all but one case with LBP, while most cases with IPD showed good response (43 of 44 cases). On brain MRI in LBP group, four of five cases had multiple small ischernic lesions in both periventricular white matter and basal ganglia. However, one case with LBP showed normal brain MR finding and improved with L-dopa treatment, whose diagnosis proved to idiopathic Parkinson's disease. We conclude that LBP is unusual but not rare, and may be a part of clinical spectrum of either vascular parkinsonism or idiopathic Parkinson's disease. Although LBP is a heterogeneous group, most cases may be caused by multiple lacunar infarctions.
Basal Ganglia ; Brain ; Diagnosis ; Gait ; Humans ; Levodopa ; Magnetic Resonance Imaging ; Numismatics ; Parkinson Disease ; Parkinsonian Disorders* ; Stroke, Lacunar ; Upper Extremity

PURPOSE: Radionuclide cisternography may be helpful in understanding pathophysiology of postural headache and low CSF pressure in patients with spontaneous intracranial hypotension. The purpose of this study was to characterize radionuclide cisternographic findings of spontaneous intracranial hypotension. MATERIALS AND METHODS: The study population consists of 15 patients with spontaneous intracranial hypotension. Diagnosis was based on their clinical symptoms and results of lumbar puncture. All patients underwent radionuclide cisternography following injection of 111 to 222 MBq of Tc-99m DTPA into the lumbar subarachnoid space. Sequential images were obtained between 1/2 hour and 24 hour after the injection of Tc-99m DTPA. Radioactivity of the bladder, soft tissue uptake, migration of radionuclide in the subarachnoid space, and extradural leakage of radionuclide were evaluated according to the scan time. RESULTS: Radionuclide cisternogram showed delayed migration of radionuclide into the cerebral convexity (14/15), increased soft tissue uptake (11/15), and early visualization of bladder activity at 30 min (6/10) and 2 hr (13/13). Cisternography also demonstrated leakage site of CSF in 4 cases and 2 of these were depicted at 30 min. Epidural blood patch was done in 11 patients and headache was improved in all cases. CONCLUSION: The characterstic findings of spontaneous intracranial hypotension were delayed migration of radionuclide and early visualization of the soft tissue and bladder activity. These scintigraphic findings suggest that CSF leakage rather than increased CSF absorption or decreased production may be the main pathophysiology of spontaneous intracranial hypotension. Early and multiple imaging including the bladder and soft tissue is required to observe the entire dynamics of radionuclide migration.
Absorption ; Blood Patch, Epidural ; Diagnosis ; Headache ; Humans ; Intracranial Hypotension* ; Pentetic Acid ; Radioactivity ; Spinal Puncture ; Subarachnoid Space ; Urinary Bladder

BACKGROUND: The cause of idiopathic Parkinson's disease (IPD) is unknown. Recent studies suggest that IPD occurs less frequently in smokers than in non-smokers, but remains a controversial topic. We performed a case-control study to investigate the relationship between IPD and smoking in Korea. METHODS:The smoking histories of 624 IPD patients were compared with 622 age- and sex-matched control subjects at the Asan Medical Center. Detailed informa-tion on smoking behavior was identified from a questionnaire and self report. A conditional logistic regression was used to calculate the odds ratio (OR) and control for potential confounds. RESULTS: With "never-smokers" as the refer-ence category, there was an inverse association between past-smokers and IPD (OR 0.617, p=0.029), and a stronger inverse association of IPD with current-smokers (OR 0.389, p<0.001). When smokers were stratified by the interval "since quitting", there was an inverse association between those who stopped smoking more than 10 years ago and IPD (OR 0.753, p=0.31), and a greater inverse relationship with those who stopped smoking 1 to 10 years (OR 0.489, p=0.017). A significant trend of decreased risk of IPD with pack-years of smoking was detected. CONCLUSIONS: This study suggests that IPD occurs less often in smokers than in non-smokers. The inverse dose-response relationship between smoking and IPD provides indirect evidence that smoking is biologically protective.
Case-Control Studies ; Chungcheongnam-do ; Humans ; Korea ; Logistic Models ; Odds Ratio ; Parkinson Disease* ; Surveys and Questionnaires ; Self Report ; Smoke* ; Smoking*

BACKGROUND: Recently a non-Jewish German family with writer's cramp was reported to have DYT1 mutation, expanding the phenotypic spectrum of DYT1. Although functional brain surgery has been tried for generalized dystonia, surgical outcome in focal dystonia patients with DYT1 mutation has not yet been reported. We investigated the clinical features and response to thalamotomy in familial writer's cramp with DYT1 mutation. METHODS: Family members were examined and clinically affected cases were video-taped. For the detection of DYT1 mutation, PCR-RFLP(restriction fragment length polymorphism) and heteroduplex analyses were performed as screening tests. Additional DNA sequencing was performed for the proband case to confirm the GAG deletion. RESULTS: Among this clinically homogeneous non-Jewish Korean family, five members in three generations were affected. Age of onset ranged from 7 to 20 years. Writing difficulty was the initial and the main disabling problem for all the affected individuals. All had the bilateral writer's cramp in succession. Dystonia remained focal and task-specific for the entire period after onset. Unilateral thalamotomy was performed in three patients, with remarkable improvement. Surgical benefit remained unchanged during the follow-up period of 6-8 years. DYT1 mutation cosegregated with the affected members. CONCLUSIONS: This study adds another evidence that DYT1 phenotype can present with purely focal and task-specific dystonia in all the affected members of a family. Marked and sustained improvement following thalamotomy in three of our patients suggests that stereotaxic thalamotomy is beneficial in familial focal dystonia with DYT1 mutation. (J Korean Neurol Assoc 19(2):110~115, 2001)
Age of Onset ; Brain ; Dystonia ; Dystonic Disorders* ; Family Characteristics ; Follow-Up Studies ; Heteroduplex Analysis ; Humans ; Mass Screening ; Phenotype ; Sequence Analysis, DNA ; Writing

BACKGROUND: Recently a non-Jewish German family with writer's cramp was reported to have DYT1 mutation, expanding the phenotypic spectrum of DYT1. Although functional brain surgery has been tried for generalized dystonia, surgical outcome in focal dystonia patients with DYT1 mutation has not yet been reported. We investigated the clinical features and response to thalamotomy in familial writer's cramp with DYT1 mutation. METHODS: Family members were examined and clinically affected cases were video-taped. For the detection of DYT1 mutation, PCR-RFLP(restriction fragment length polymorphism) and heteroduplex analyses were performed as screening tests. Additional DNA sequencing was performed for the proband case to confirm the GAG deletion. RESULTS: Among this clinically homogeneous non-Jewish Korean family, five members in three generations were affected. Age of onset ranged from 7 to 20 years. Writing difficulty was the initial and the main disabling problem for all the affected individuals. All had the bilateral writer's cramp in succession. Dystonia remained focal and task-specific for the entire period after onset. Unilateral thalamotomy was performed in three patients, with remarkable improvement. Surgical benefit remained unchanged during the follow-up period of 6-8 years. DYT1 mutation cosegregated with the affected members. CONCLUSIONS: This study adds another evidence that DYT1 phenotype can present with purely focal and task-specific dystonia in all the affected members of a family. Marked and sustained improvement following thalamotomy in three of our patients suggests that stereotaxic thalamotomy is beneficial in familial focal dystonia with DYT1 mutation. (J Korean Neurol Assoc 19(2):110~115, 2001)
Age of Onset ; Brain ; Dystonia ; Dystonic Disorders* ; Family Characteristics ; Follow-Up Studies ; Heteroduplex Analysis ; Humans ; Mass Screening ; Phenotype ; Sequence Analysis, DNA ; Writing

BACKGROUND: Ropinirole is a non-ergoline D2 agonist which has a highly selective affinity to D2 receptor. The aim of this study was to evaluate the efficacy and safety of ropinirole in the treatment of Parkinson's disease (PD). METHODS: Seventy-six cases with PD (Hoehn and Yahr stage II to IV) were included in this trial. Each patient was randomly allocated to receive either ropinirole (n=37) or bromocriptine (n=39) over a 16-week period. All subjects were not optimally controlled on levodopa due to motor fluctuations. The response rate was defined as the percentage of patients who had at least 20% reduction of levodopa doses. The clinical status was also assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), Clinical Global Impression (CGI), and reduction of off durations. RESULTS: The end-point analysis, on an intention-to-treat basis, revealed significantly higher response rate in the ropinirole group compared with the bromocriptine group (odds ratio 2.995, 95% C.I. (1.157, 7.751)). A statistically significant improvement in CGI was also observed in the ropinirole group (p=0.046). The mean off duration was significantly reduced in the ropinirole group (p=0.0001). Other parameters using the UPDRS motor score or off duration did not show significant differences between the two groups. The overall incidence of adverse effects was not significantly different between the two groups. The most common side effects were dizziness, dyskinesia, and nausea/vomiting. No subjects were withdrawn from the study due to side effects. CONCLUSION: Ropinirole is a safe and well-tolerated drug and provides superior overall efficacy compared with bromocriptine as an adjunct to levodopa. (J Korean Neurol Assoc 19(2):102~109, 2001)
Bromocriptine ; Dizziness ; Dyskinesias ; Humans ; Incidence ; Levodopa* ; Parkinson Disease*

BACKGROUND: Ropinirole is a non-ergoline D2 agonist which has a highly selective affinity to D2 receptor. The aim of this study was to evaluate the efficacy and safety of ropinirole in the treatment of Parkinson's disease (PD). METHODS: Seventy-six cases with PD (Hoehn and Yahr stage II to IV) were included in this trial. Each patient was randomly allocated to receive either ropinirole (n=37) or bromocriptine (n=39) over a 16-week period. All subjects were not optimally controlled on levodopa due to motor fluctuations. The response rate was defined as the percentage of patients who had at least 20% reduction of levodopa doses. The clinical status was also assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), Clinical Global Impression (CGI), and reduction of off durations. RESULTS: The end-point analysis, on an intention-to-treat basis, revealed significantly higher response rate in the ropinirole group compared with the bromocriptine group (odds ratio 2.995, 95% C.I. (1.157, 7.751)). A statistically significant improvement in CGI was also observed in the ropinirole group (p=0.046). The mean off duration was significantly reduced in the ropinirole group (p=0.0001). Other parameters using the UPDRS motor score or off duration did not show significant differences between the two groups. The overall incidence of adverse effects was not significantly different between the two groups. The most common side effects were dizziness, dyskinesia, and nausea/vomiting. No subjects were withdrawn from the study due to side effects. CONCLUSION: Ropinirole is a safe and well-tolerated drug and provides superior overall efficacy compared with bromocriptine as an adjunct to levodopa. (J Korean Neurol Assoc 19(2):102~109, 2001)
Bromocriptine ; Dizziness ; Dyskinesias ; Humans ; Incidence ; Levodopa* ; Parkinson Disease*

It has recently been known that the temperature of the brain during a period of transient cerebral ischemia can critically influence neuropathologic outcome in experimental animals. Thus the severity of brain edema may be thought to be changed according to body temperature during acute stage of cerebral ischemia. We investigated the effects of hypothermia and hyperthermia on the acute brain edema during the transient global ischemia in Mongolian gerbils. During 20 miuntes of global ischemia, body temperatures were maintained at 35* in the hypothermic group (n=10). 37* in the normothermic group (n=10). 39* in the hyperthermic group (n=10). Respectively. During the period of reperfusion. Body temperatures were maintained at 37* in each group. Two hours after reperfusion. The animals were decapitated and the waler content of the brain was determined by oven dry method. The uater content were high in (1) the hyperthermic group (79.5+0.3%). (2) the normothermic group (79.2+0.2%). (3) the hypothermic group (79.0+0.2%) the control group (78.6+0.3%) in order of amount. Also there were significant differences of the water content among four groups according to the changes of intraischemic body temperature (p<0.05). At the same time we carried out another experiment for comparing the survival rates in each group. The survival rate of the hypothermic group was sillgificantly higher than that of the normothermic or the hyperthermic groups (p<0.005).
Animals ; Body Temperature* ; Brain Edema* ; Brain Ischemia ; Brain* ; Fever ; Gerbillinae* ; Hypothermia ; Ischemia* ; Ischemic Attack, Transient ; Reperfusion ; Survival Rate* ; Water

No abstract available.
Parkinson Disease*

Patients with dementia and concomitant parkinsonism are frequently encountered in the elderly population. When it comes to young adults, however, coexistence of Alzheimer's disease (AD) and Parkinson's disease (PD) is rare. We described a case of 47-year old man with presenile onset dementia associated with hemiparkinsonism involving the right extremities. Brain biopsy showed neurofibrillary tangles and neuritic plaques, compatible with Alzheimer's disease. Iodine-123 labelled N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane ([(123)I]IPT) SPECT, dopamine transporter imaging, revealed a decreased uptake in both basal ganglia, more severe on the left side, particularly the caudal putamen, which is consistent with the finding of idiopathic Parkinson's disease. This case is unique in that damage on the nigrostriatal dopaminergic system in a patient with Alzheimer's disease was demonstrated by a functional neuroimaging study and that early-onset AD and early-onset PD, two rare conditions, coexist in the same individual.
Aged ; Alzheimer Disease* ; Basal Ganglia ; Biopsy ; Brain ; Dementia ; Dopamine Plasma Membrane Transport Proteins ; Extremities ; Functional Neuroimaging ; Humans ; Middle Aged ; Neurofibrillary Tangles ; Parkinson Disease ; Parkinsonian Disorders ; Plaque, Amyloid ; Putamen ; Tomography, Emission-Computed, Single-Photon ; Young Adult