Most studies concerning congenital mirror movements (CMMs) have been focused on the motor organization in the distal hand muscles exclusively. To the best of our knowledge, there is no data on motor organization pattern of lower extremities, and a scarcity of data on the significance of forearm and arm muscles in CMMs. Here, we describe the case of a 19-year-old boy presenting mirror movements. In these terms, a 10-year transcranial magnetic stimulation study demonstrated that the motor organization pattern of the arm muscles was different from that of distal hand and forearm muscles even in the same upper extremity, and that the lower extremities showed the same pathways as healthy children. Moreover, in this case, an ipsilateral motor evoked potentials (MEPs) for distal hand muscles increased in amplitude with age, even though the intensity of mirror movements decreased. In the arm muscles, however, it was concluded that the contralateral MEPs increased in amplitude with age.
Arm ; Child ; Evoked Potentials ; Evoked Potentials, Motor ; Follow-Up Studies ; Forearm ; Hand ; Humans ; Lower Extremity ; Male ; Muscles ; Pyramidal Tracts ; Synkinesis ; Transcranial Magnetic Stimulation ; Upper Extremity ; Young Adult

Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP.
Botulinum Toxins ; Cordotomy ; Dyspnea ; Electric Stimulation Therapy ; Genetic Therapy ; Larynx ; Paralysis* ; Recurrent Laryngeal Nerve Injuries ; Review Literature as Topic* ; Stem Cells ; Synkinesis ; Tracheostomy ; Vocal Cord Paralysis ; Vocal Cords*

The facial nerve coursing through the temporal bone provides a challenge to the otologic surgeon. Advances in surgical instrumentation and refinements of surgical strategies enable the otologist to uncover the entire course of the facial nerve safely from brainstem to its exit from temporal bone. The most common cause of facial nerve paralysis is Bell's palsy, followed by traumatic facial paralysis, herpes zoster oticus, and intratemporal tumorous lesion. The surgical approaches to the injured facial nerve depend on its causes. In consideration of selecting surgical technique of facial nerve paralysis reconstruction, clinician must find out thecause, degree and duration of paralysis for the appropriate technique. Although preventing synkinesis is more effective than treating an established one, it has been shown that when patients inevitably has facial sequelae, there is no effective intervention modalities. Numerous facial rehabilitation techniques for such facial problems after facial palsy have been developed to improve cosmesis and function. Recently botulinum toxin A chemical neurectomy has been considered as a best approach in treating facial sequelae. Botulinum toxin injection has shown remarkable results in the disappearance of facial synkinesis within a few days. This procedure helps the patients to recover from lower self-esteem and better quality of life than before.
Bell Palsy ; Botulinum Toxins ; Brain Stem ; Facial Nerve ; Facial Paralysis ; Herpes Zoster Oticus ; Humans ; Paralysis ; Quality of Life ; Regeneration ; Surgical Instruments ; Synkinesis ; Temporal Bone

PURPOSE: To evaluate clinical features of periorbital spasm and facial asymmetry in the patients who recovered poorly from Bell's palsy and facial trauma and to investigate the effect of Botulinum toxin A as a treatment for periorbital spasm and facial asymmetry. METHODS: Between November 2001 and January 2010, Botulinum toxin injection was performed in 17 patients who had blepharospasm and facial asymmetry following poor recovery from facial palsy. The past history, trauma history, clinical manifestation of blepharospasm, Botulinum toxin A injection dose, injection site, frequency of injection, and duration of effect was evaluated. Data was analyzed using the Mann-Whitney U test, SPSS 12.0. RESULTS: The mean number of injections was 2.7 +/- 2.4 times and the mean dose per injection unit was 12.2 +/- 1.2 units. The Botulinum toxin effect lasted 6.9 +/- 5.5 months in Bell's palsy patients, and 8.0 +/- 4.2 months in trauma patients. There was no significant difference between the 2 groups. Most patients reported improvement of periorbital spasm and facial asymmetry. After treatment, 1 patient complained of epiphora and 1 patient complained of ptosis; conservative treatment was performed for these patients. CONCLUSIONS: Blepharospasm can be treated and a cosmetic improvement in facial symmetry can be achieved by Botulinum toxin A injection in the patients who recover poorly from facial palsy.
Bell Palsy ; Blepharospasm ; Botulinum Toxins ; Cosmetics ; Facial Asymmetry ; Facial Nerve ; Facial Paralysis ; Humans ; Lacrimal Apparatus Diseases ; Paresis ; Spasm ; Synkinesis

synkinesis still plague even the best reconstructions. The reconstructive techniques used still represent a compromise between obtainable symmetry and motion at the expense of donor site deficits, but current techniques continue to refine and limit this morbidity. In chronically paralyzed face, direct nerve anastomosis, nerve graft, or microvascular-muscle graft is not always possible. In this case, regional muscle transposition is tried to reanimate the eyelid and lower face. Regional muscle includes maseeter muscle, temporalis muscle and anterior belly of the digastric muscle. Temporalis muscle is preferred because it is long, flat, pliable and wide-motion of excursion. In order to reanimate the upper and lower eyelid, Upper eyelid Gold weight implantion and lower eyelid shortening and tightening is mainly used recently, because this method is very simple, easy and reliable.]]>
Eyelids ; Humans ; Plague ; Rehabilitation ; Synkinesis ; Tissue Donors ; Transplants

Recovery from the laryngeal dysfunction caused by the recurrent laryngeal nerve (RLN) injury is not common. Recently, we have found that PEMS treatment improved the functional recovery rate and shortened the recovery time after RLN transection and reanastomosis in rat. In this study, we compared the morphology of RLN stumps according to their laryngeal functional status to investigate 1) the nerve morphology associated with functional recovery and 2) the possible underlying mechanism of persistent laryngeal dysfunction after RLN injury. We transected left RLN and then performed primary neurorrhaphy in Sprague-Dawley rats (n = 36). They were randomly divided into PEMS and control groups. 19 animals (10 PEMS group, 7 control group and 2 normal control animals) survived until the end of the experiment were included in the morphological analysis. Both the proximal and distal segments of reanastomosed RLN were obtained and the ultrastructural study was done using transmission electron microscope. There is no prominent morphological difference between the PEMS and control groups. In the functional recovery group, the findings suggestive of nerve regeneration were prominent both in the proximal and distal segments. Many regenerating axons were also observed in the proximal segments of RLNs in non-recovery group. But findings such as degenerating axons, infiltration of macrophage and inflammatory cells, increased collagen fibrils were frequently observed in this group. Even in the distal segments of functional non-recovery group, prominent regenerative findings were observed in 9 out of 10 (4 out of 5 PEMS and all control group animals) samples. We could not find any regenerating findings in one case of the PEMS group. Through the above results, failure of the nerve regeneration is unlikely the main cause of functional non-recovery after RLN injury in rat. Possible other causes such as synkinesis or definite but inadequate nerve regeneration should be considered and needs further investigation.
Animals ; Axons ; Collagen ; Macrophages ; Nerve Regeneration* ; Rats ; Rats, Sprague-Dawley ; Recurrent Laryngeal Nerve Injuries* ; Recurrent Laryngeal Nerve* ; Synkinesis

Botulinum toxin type A(BTA) is well known treatment agent in the treatment of paralytic strabismus in ophthalmological field for more than 15 years. Its therapeutic potential as temporary paralyzing agent was adopted to treat several neurologic, movement disorders. In recent years, BTA is considered as initial medical treatment option in such as blepharospasm, hemifacial spasm, spasmodic torticollis, spasmodic dysphonia. Authors applied BTA injection in cases with spasmosmodic torticollis, hemifacial spasm, facial synkinesis and experienced staisfactory result. So authors present our experience of BTA injection therapy and discuss techniques, advantages and disavantages.
Blepharospasm ; Botulinum Toxins* ; Botulinum Toxins, Type A ; Dysphonia ; Dystonia ; Hemifacial Spasm* ; Movement Disorders ; Strabismus ; Synkinesis* ; Torticollis*

PURPOSE: This case is the first report of unilateral ptosis associated with paradoxical movement on abduction in Korean literature and we report this case with a successful result of operations. METHODS: We examined an 18-year-old male patient who had showed drooping of right eyelid since birth. The ptosis was exaggerated on abduction. He did not have any remarkable history of illness. Corrected visual acuity was 20/20 in both eyes. Ocular motility examination revealed full range of ductions and versions in all fields of gaze. On exophthalmometric examination, no difference was found in any direction of gaze between two eyes. Under the diagnosis of unilateral ptosis associated with paradoxical movement on abduction, levator resection of right upper lid and blepharoplasty of left upper lid were performed. RESULTS: During operation, we noticed unusual finding that thickened tendon sheath was covering the lateral one third of levator aponeurosis. Paradoxical eyelid movement disappeared completely after secondary operation by removal of the previously noticed tendon sheath as much as possible.
Adolescent ; Blepharoplasty ; Blepharoptosis* ; Diagnosis ; Eyelids ; Humans ; Male ; Parturition ; Synkinesis ; Tendons ; Visual Acuity

Oculostapedial synkinesis following Bell's palsy, Ramsay Hunt syndrome and traumatic facial nerve paralysis is a rarely reported phenomenon. Oculostapedial synkinesis accompanying with hemifacial spasm also has been reported. We experienced a 51-year-old woman with persistent loud rumbling noise from her left ear related with voluntary left eye closure compatible with oculostapedial synkinesis after Bell's palsy. We objectively proved this oculostapedial synkinesis with impedance audiometry. The patient was successfully treated by transmeatal tenotomy of the left stapedius muscle tendon under local anesthesia.
Acoustic Impedance Tests ; Anesthesia, Local ; Bell Palsy* ; Ear ; Facial Nerve ; Female ; Hemifacial Spasm ; Herpes Zoster Oticus ; Humans ; Middle Aged ; Noise ; Paralysis ; Stapedius ; Synkinesis* ; Tendons ; Tenotomy

OBJECTIVE: The goal of this study was to examine association between tardive dyskinesia and soft neurological signs in schizophrenic patients. METHODS: 35 schizophrenic inpatients who met the diagnostic criteria for tardive dyskinesia developed by Schooler and Kane and 30 schizophrenic inpatients without tardive dyskinesia were enrolled in this study. Tardive dyskinesia, soft neurological signs, and cognitive function were evaluated with Abnormal Involuntary Movement Scale (AIMS), Neurological Evaluation Scale (NES), and Mini-Mental State Examination (MMSE) independently by 2 psychiatrists, respectively. Data of the two schizophrenic groups were compared and also those of 31 normal controls. RESULTS: Total schizophrenics scored higher than normal controls in total mean scores of NES (p<0.01), and its three functional area scores, sensory integration (p<0.01), motor coordination (p<0.05), and sequencing of complex motor acts (p<0.05). Patients with tardive dyskinesia showed higher prevalence rates than those without in 5 items-left graphesthesia (p<0.05), right fist-ring test (p<0.05), right fist-edge-palm test (p<0.05), right synkinesis (p<0.05), and left synkinesis (p<0.05). The total scores of NES were not significantly related to the severity of tardive dyskinesia and cognitive dysfunction. CONCLUSION: Schizophrenics had more soft neurological signs than normal subjects. Five items of NES were more impaired in the patients with tardive dyskinesia than in those without tardive dyskinesia.
Dyskinesias ; Humans ; Inpatients ; Movement Disorders* ; Prevalence ; Psychiatry ; Schizophrenia ; Synkinesis