Progress and Prospects in Parkinson's Research/Symptoms/Motor
Motor symptoms of Parkinson's disease
The symptoms that usually lead a clinician to suspect Parkinson's are the ones that affect movement.
Bradykinesia
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Slowness of movement. The following references are relevant:- Morris et al (2010) Striding Out With Parkinson Disease: Evidence-Based Physical Therapy for Gait Disorders [1] Schenkman et al (2011) Profile of Functional Limitations and Task Performance Among People With Early- and Middle-Stage Parkinson Disease [2] Heldman et al (2011) The Modified Bradykinesia Rating Scale for Parkinson’s Disease: Reliability and Comparison with Kinematic Measures [3] Further Researchedit
See Also:-editIntroduction to Parkinson's Science/Q Page 2 Symptomatic Relief for PD/Bradykinesia Referencesedit
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Rigidity
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Reduced force, impetus or speed of movement The following refences are relevant:- Ackermann et al (1989) Palilalia as a symptom of levodopa induced hyperkinesia in Parkinson's disease.[1] Heldman et al (2011) The Modified Bradykinesia Rating Scale for Parkinson’s Disease: Reliability and Comparison with Kinematic Measures[2] # Espay et al (2011) Differential Response of Speed, Amplitude, and Rhythm to Dopaminergic Medications in Parkinson’s Disease [3] Further Researchedit
References
Referenceedit |
Tremor
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Involuntary shaking, trembling or quivering movements of the muscles The following references are relevant:- Sanchez-Ramos et al (2011) Quantitative Analysis of Tremors in Welders[1] Mure et al (2011) Parkinson’s Disease Tremor-Related Metabolic Network: Characterization, Progression, and Treatment Effects [2] Helmich et al (2012) Cerebral causes and consequences of parkinsonian resting tremor: a tale of two circuits?[3] Further Researchedit
Referencesedit
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Here is a list of other motor symptoms of Parkinson's. Some are less prominent than those above, at least initially and some may occur only rarely. Many are not unique to Parkinson's:
Akathesia
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Redirected to Restless Legs Syndrome: ( To subpage for editing >> ) Uncontrollable, involuntary movement of the legs and feet The following references are relevant:- Gao et al (2010) Restless Legs Syndrome and Erectile Dysfunction[1] Gao et al (2010) Restless legs syndrome and Parkinson’s disease in men[2] Pourcher et al (2010) Compulsive habits in restless legs syndrome patients under dopaminergic treatment [3] Peeraully and Tan (2012) Linking restless legs syndrome with Parkinson's disease: clinical, imaging and genetic evidence [4] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2802250/ Further Researchedit
Referencesedit
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Akinesia
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Also see Freezing Put further text about the symptom here Further Researchedit
Referencesedit |
Amimia
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Fixed and vacant expression (masking) Very little research has been carried out on this common PD symptom but the following are relevant :- Allen (1931) The Dissociation of voluntary and emotional movements of the face with special reference to emotional paresis as a physical sign [2] Hemmesch et al (2009)The Influence of Facial Masking and Sex on Older Adults’ Impressions of Individuals with Parkinson’s Disease. [3] Clark et al (2011) Visual Exploration of Emotional Facial Expressions in Parkinson's Disease [4] Tickle-Degnen et al (2011) Culture, Gender and Health Care Stigma: Practitioners’ Response to Facial Masking Experienced by People with Parkinson’s Disease < [5] Further Researchedit
Referencesedit
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Aphagia
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Inability to swallow Swallowing problems are frequently reported by PD patients but the symptom awaits detailed scientific research. The following references are relevant:- eHealthMe (1977)Could Parkinson's disease cause Aphagia? A study of 26 patients [1] eHealthMe (1977) Could Azilect cause Aphagia? [2] Russell et al (2010) Targeted exercise therapy for voice and swallow in persons with Parkinson’s disease [3] Further Researchedit
Referencesedit
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Aphonia
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Aphonia: Inability to make sounds. ( To subpage for editing >> ) Inability to make sounds The following references are relevant:- Critchley (1981) Speech disorders of Parkinsonism: a review [1] Russell et al (2010) Targeted exercise therapy for voice and swallow in persons with Parkinson’s disease [2] Hallett (2011) Psychogenic Parkinsonism [3]
Referencesedit
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Athetosis
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Involuntary movements of the face, tongue and extremities. A number of projects have concentrated on this symptom:- Neilson (1974) Measurement of involuntary arm movement in athetotic patients [1] Hallett and Alvarez (1983) Attempted rapid elbow movements in patients with athetosis [2] Further Researchedit
Referencesedit
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Automatism
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Forced obedience to external stimuli or commands. Some potentially relevant references are:- Allain et al (1995) Explicit and procedural memory in Parkinson's disease. [1] Allain et al (1995) Procedural memory and Parkinson's disease. [2] Perez-Velazquez (2012) The biophysical bases of will-less behaviours [3] Further Researchedit
Referencesedit
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Balance
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Susceptibility to falls Alternative termseditPostural instability---Falls
King et al (2012) Do clinical scales of balance reflect turning abnormalities in people with Parkinson's disease? [1] Duncan and Earhart (2012) Should One Measure Balance or Gait to Best Predict Falls among People with Parkinson Disease? [2] Boonsinsukh et al (2012) A Cane Improves Postural Recovery From an Unpracticed Slip During Walking in People With Parkinson Disease [3] Further Researchedit
Referencesedit
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Blepharospasm
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Spasm of the eyelid The following references are relevant:- Elston (1992) A new variant of blepharospasm [1] Hallett et al (2008) ..Update on blepharospasm: Report from the BEBRF International Workshop[2] Armstrong (2011) Visual symptoms in Parkinson's Disease [3] Further Researchedit
Referencesedit
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Bruxism
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Grinding of teeth These references are relevant:- Magee (1970) Bruxisma related to levadopa therapy [1] Durham et al (1993) Management of orofacial manifestations of Parkinson's disease with splint therapy: a case report.[2] Stivastaya et al (2002) Bruxism as presenting feature of Parkinson's disease. [3] Further Researchedit
Referencesedit
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Catalepsy
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Tireless, timeless , effortless maintenance of postures. The following references are relevant:- Azam et al (2010) Design, synthesis and anti-Parkinsonian evaluation of 3-alkyl/aryl-8-(furan-2-yl)thiazolo[5,4-e][1,2,4]triazolo[1,5-c]pyrimidine-2(3H)-thiones against neuroleptic-induced catalepsy and oxidative stress in mice.[1] Nayebi et al (2010) Buspirone improves 6-hydroxydopamine-induced catalepsy through stimulation of nigral 5-HT(1A) receptors in rats. [2] Mahmoudi et al (2011) Buspirone improves the anti-cataleptic effect of levodopa in 6-hydroxydopamine-lesioned rats. [3] Further Researchedit
Referencesedit
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Catatonia
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Catatonia Holding of statuesque postures The following references are relevant:- Northoff et al (1997) Glutamatergic dysfunction in catatonia? Successful treatment of three acute akinetic catatonic patients with the NMDA antagonist amantadine. [1] Bhati et al(2007) Clinical Manifestations, Diagnosis, and Empirical Treatments for Catatonia [2] Carroll et al(2007) Katatonia - A New Conceptual Understanding of Catatonia and a New Rating Scale [3] Further Researchedit
Referencesedit
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Chorea
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Involuntary, desultory flickering movement. The following references are relevant:- Barbeau et al (1965) Fingerprint Patterns in Huntington's Chorea and Parkinson's Disease [1] Reuter et al (2000) Late onset levodopa responsive Huntington's disease with minimal chorea masquerading as Parkinson plus syndrome [2] Ciammola et al (2011) Atypical Parkinsonism Revealing a Late Onset, Rigid and Akinetic Form of Huntington's Disease [3] Further Researchedit
Referencesedit
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Choreoathetosis
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Involuntary jerky snake-like movements usually of the arms. The following references are relevant:- Teräväinen and Calne (1980) Action tremor in Parkinson’s disease [1] Bhidayasiri and Truong,(2004) Chorea and related disorders [2] Perkovic et al (2010) Sildenafil induced choreoathetosis in men with Parkinson's disease.[3] Further Researchedit
Referencesedit
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Clonus
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Vibrato-like reaction to forced muscle stretching. The following references are relevant:- Hofmann (1962) Observations on peripheral servo mechanisms in Parkinsonian rigidity [1] Burke et al (1972) Tonic vibration reflex in spasticity, Parkinson's disease, and normal subjects [2] Findley et al (1981) Tremor, the cogwheel phenomenon and clonus in Parkinson's disease [3] Further Researchedit
Referencesedit
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Cogwheel rigidity
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Cogwheel rigidityeditStiffness in the muscles, with a jerky quality when arms and legs are repeatedly moved. The following references are relevant:- Lance et al(1963) Action tremor and the cogwheel phenomenon in Parkinson’s disease[1] Findley et al (1981) Tremor, the cogwheel phenomenon and clonus in Parkinson’s disease [2] Ghiglione et al(2005) Cogwheel Rigidity [3] Further Researchedit
Referencesedit
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Contractures
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Permanent contraction at joints. The following references are relevant:- Ebin (1951) Surgical Treatment of Parkinsonism: Indications and Results[1] Kyriakides and Hewer (1988) Hand contractures in Parkinson's disease. [2] Shah et al (2005) Flexion contracture after total knee arthroplasty in a patient with Parkinson's disease: successful treatment with botulinum toxin type A. [3] Further Researchedit
Referencesedit
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Disequilibrium
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Redirected to Balance. ( To subpage for editing >> ) Susceptibility to falls Alternative termseditPostural instability---Falls
King et al (2012) Do clinical scales of balance reflect turning abnormalities in people with Parkinson's disease? [1] Duncan and Earhart (2012) Should One Measure Balance or Gait to Best Predict Falls among People with Parkinson Disease? [2] Boonsinsukh et al (2012) A Cane Improves Postural Recovery From an Unpracticed Slip During Walking in People With Parkinson Disease [3] Further Researchedit
Referencesedit
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Drop Foot
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Redirected to Foot_Drop ( To subpage for editing >> ) Foot Drop or (Drop Foot)editLocomotion defect whereby the heel of a foot is raised from the ground while walking The following references are relevant:- Belfiore and Campanella (1994) A clinical sign of Parkinson's disease: the absence of lateral foot drop [1] Rogers et al (2011) Perturbations of ground support alter posture and locomotion coupling during step initiation in Parkinson's disease [2] The following references are relevant:- Further Researchedit
Referencesedit
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Dyskinesia
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Abnormality of muscle tone or movement. The following references are relevant:- Chung et al(2010) Objective Measurement of Dyskinesia in Parkinson Disease using a Force Plate [1] Timbasco et al (2012) Clinical Aspects and Management of Levodopa-Induced Dyskinesia [2] Espay et al (2012) “On” state freezing of gait in Parkinson disease -A paradoxical levodopa-induced complication [3] Further Researchedit
Referencesedit
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Dystonia
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Sustained muscle contractions causing twisting and repetitive movements or abnormal postures. Further Researchedit
Referencesedit |
Exotropia
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Redirected to Strabismus (To subpage for editing >> ) Divergent squint of the eyes (See also Exotropia = Outward divergence and Esotropia = Inward Divergence. Also Tic)
Rascol et al (1991) Square wave jerks in parkinsonian syndromes[1] Scoditti, et al (1993) Peroneal muscular atrophy with parkinsonism, ptosis, and congenital strabismus. [2] Almer et al (2011) Ocular Motor and Sensory Function in Parkinson Disease [3] Further Researchedit
Referencesedit
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Facial Masking
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Redirected to Amimia ( To subpage for editing >> ) Fixed and vacant expression (masking) Very little research has been carried out on this common PD symptom but the following are relevant :- Allen (1931) The Dissociation of voluntary and emotional movements of the face with special reference to emotional paresis as a physical sign [2] Hemmesch et al (2009)The Influence of Facial Masking and Sex on Older Adults’ Impressions of Individuals with Parkinson’s Disease. [3] Clark et al (2011) Visual Exploration of Emotional Facial Expressions in Parkinson's Disease [4] Tickle-Degnen et al (2011) Culture, Gender and Health Care Stigma: Practitioners’ Response to Facial Masking Experienced by People with Parkinson’s Disease < [5] Further Researchedit
Referencesedit
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Falls
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Redirected to Balance ( To subpage for editing >> ) Susceptibility to falls Alternative termseditPostural instability---Falls
King et al (2012) Do clinical scales of balance reflect turning abnormalities in people with Parkinson's disease? [1] Duncan and Earhart (2012) Should One Measure Balance or Gait to Best Predict Falls among People with Parkinson Disease? [2] Boonsinsukh et al (2012) A Cane Improves Postural Recovery From an Unpracticed Slip During Walking in People With Parkinson Disease [3] Further Researchedit
Referencesedit
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Festination
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Forced hurrying of walking, talking or thought. The following references are relevant:- Devos et al (2007) Improvement of gait by chronic, high doses of methylphenidate in patients with advanced Parkinson's disease [1] Hausdorff (2009) Gait dynamics in Parkinson’s disease: Common and distinct behavior among stride length, gait variability, and fractal-like scaling [2] Hove et al (2012) Interactive Rhythmic Auditory Stimulation Reinstates Natural 1/f Timing in Gait of Parkinson's Patients [3] Further Researchedit
Referencesedit
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Flexion
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Bent or curved posture The following references are relevant:- Hong and Earhart (2010) Effects of Medication on Turning Deficits in Individuals with Parkinson's Disease [1] Mak et al (2011) Limb Collapse, Rather Than Instability, Causes Failure in Sit-to-Stand Performance Among Patients With Parkinson Disease [2] Xia et al (2011) Differentiation between the contributions of shortening reaction and stretch-induced inhibition to rigidity in Parkinson’s disease [3] Further Researchedit
Referencesedit
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Foot Drop
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Foot Drop or (Drop Foot)editLocomotion defect whereby the heel of a foot is raised from the ground while walking The following references are relevant:- Belfiore and Campanella (1994) A clinical sign of Parkinson's disease: the absence of lateral foot drop [1] Rogers et al (2011) Perturbations of ground support alter posture and locomotion coupling during step initiation in Parkinson's disease [2] The following references are relevant:- Further Researchedit
Referencesedit
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Freezing of Gait
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Inability to initiate locomotion The following references are relevant:- Morris et al (2010) Striding Out With Parkinson Disease: Evidence-Based Physical Therapy for Gait Disorders [1] Maidan et al (2010) Heart rate changes during freezing of gait in patients with Parkinson's disease [2] Espay et al(2012) “On” state freezing of gait in Parkinson disease - A paradoxical levodopa-induced complication [3] Further Researchedit
References
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Hyperkinesia
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Increased force, speed, violence, speed of movement. The following references are relevant:- Ackermann et al (1989) Palilalia as a symptom of levodopa induced hyperkinesia in Parkinson's disease.[1] Inzelberg et al (1995) Kinematic properties of upper limb trajectories in idiopathic torsion dystonia[2] Thomsen et al (2011) Psychomotor stimulation by dopamine D1-like but not D2-like agonists in most mouse strains [3] Further Researchedit
References
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Hypertonia
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Excessive muscle tone The followng references are relevant:- Wright et al (2007) Axial hypertonicity in Parkinson’s disease: Direct measurements of trunk and hip torque [1] Goldenberg(2008) Medical Management of Parkinson’s Disease [2] Xia et al (2011) Differentiation between the contributions of shortening reaction and stretch-induced inhibition to rigidity in Parkinson’s disease[3] Further Researchedit
References
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Hypokinesia
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Reduced force, impetus or speed of movement The following refences are relevant:- Ackermann et al (1989) Palilalia as a symptom of levodopa induced hyperkinesia in Parkinson's disease.[1] Heldman et al (2011) The Modified Bradykinesia Rating Scale for Parkinson’s Disease: Reliability and Comparison with Kinematic Measures[2] # Espay et al (2011) Differential Response of Speed, Amplitude, and Rhythm to Dopaminergic Medications in Parkinson’s Disease [3] Further Researchedit
References
Referenceedit |
Kinesia paradoxa
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Redirected to ( To subpage for editing >> ) Paradoxical kinesiaeditSometimes referred to as 'Kinesia paradoxa' Unexpected reversal of motor symptoms
Faith 'Cures'editThe earliest reference to this phenomenon is to be found in Chapter 2 of the Gospel of St. Mark, where Jesus is at Capernaum and is faced with a bedridden man who is "sick of the palsy".
This account begs the questions as to whether the palsy as described equates with PD and whether the observable benefits were permanent or temporary. In modern times the most documented "miracle" cure is that of Sister Marie Simon-Pierre, who attested that she had been cured of Parkinson's Disease after praying to the late Pope John Paul II.[who himself manifested advanced symptoms of PD]
It is not possible to evaluate these events without a sight of the report of the panel of medical experts set up by the Vatican to evaluate claims of cures. More Observationsedit(1921)editSouques [1] observed the phenomenon and coined the term 'Paradoxical kinesia' to describe it. (1976)editMarshall et al Activation-induced restoration of sensorimotor functions in rats with dopamine-depleting brain lesions [2] succeeded in reproducing Kinesia Paradoxica by exposing Parkinsonian rats to potentially life-threatening situations.
(1989)editKeefe et al Dopamine ReleaseStudies in an Animal Model [3] found that by inducing PK they could switch Parkinson symptoms on and off in rats. Rats were given brain lesions to inhibit their dopamine production capacity by 98% and they became Parkinsonian. They were placed in deep water and managed to swim effectively. They also escaped from shallow ice baths.
(2007)editSchlesinger et al [4] interviewed 50 PD patients, who had been exposed to life-threatening situations in war. Two had experiened PK. (2009)editRobottom et al < [5]noted that symptoms varied when PD patients were placed under emotional or physical stress. The Abruzzi earthquakeedit(2009)editAt 03.32 Central European Summer Time on the night of 6th April 2009 the city of L'Aquila, which is the capital of the Abruzzo region in Italy, was devastated by a sudden earthquake with a strength of 5.8 on the Richter Scale. There was considerable damage to property, 308 people lost their lives and some 1,500 were injured.However there is a long history of earth tremors in the region and the majority of citizens evacuated their properties forthwith and survived. It so happened that 70km. away was a Movement Disorder clinic, operated by the University G.D. Annunzio Chieti-Pescari, which had neen monitoring the symptoms of 14 patients in the city with parkinsonism and dementia. The movemnt disorders of all of them were at Hoehn and Yahr stages 3 to 5. Measurements taken 3 months after the earthquake showed an unaccountable significant improvement in their UPDRS motor rating. There was also considerable anecdotal evidence of their performmance at the moment when the earthquake struck:- "He ran like hell out of the two storey building pushing his two children (17 and 15 years old) and his wife" relates to a 59 year old retired chemical engineer in his tenth year since being diagnosed with PD. "During the earthquake hit he ran from his house." describes a 58 year old retired truck driver five years after PD diagnosis. "During the night time earthquake, she rose from her bed and hurried out of her apartment at the third floor. When she was examined, 15 days after the earthquake, she walked to the office assisted by her daughter (in the previous visit she had been carried on a wheelchair)." Describes a 90 year old woman with both PD and dementia. "During the night time earthquake hit he ran away from his second floor apartment." relates to a 77 year od retired public employee. "During the earthquake, he jumped out of bed and ran through three flights of stairs, carrying and pushing his 72 year old wife (she reported he practically lifted her up through the collapsing apartment and floors)." Part of an acount of a 77 year old retired engineer who had experienced PD symptoms for three year. After 5 months the patients had regressed to their pre-earthquake state. A full account was published by Bonanni et al(2010) Protracted benefit from paradoxical kinesia in typical and atypical parkinsonisms[6] Oliver SackseditPK can occur without the need for divine intervention or geological catastrophes. “Awakenings”, by Oliver Sacks, is one of the most lucid and closely observed accounts of PD symptoms. It is based on the case notes of a series of encounters that he had with patients as a result of the PD pandemic called Encephalitis Lethargica. In the 1920’s. This form of the disease is characterised by its rapid onset and progression and its pronounced symptoms. For example bradykinesia progresses to the point where the patient becomes catatonic. Sacks noted a number of occurrences of Pardoxical kinesia:-In the 1950s there was a PD patient at the Highlands Hospital, London, who:-
At the same hospital were two PD patients who shared a room for 20 years. Both were motionless and mute, but one evening:-
Another patient at Mount Carmel Hospital would sit completely motionless unless she was suddenly thrown three (or more) oranges.
Another Mount Carmel patient seemed totally incapable of movement until one day when:-
Hypotheses for PKedit(1989)editMorris et al [7] evaluated the factors influencing gait in PD patients.
(1991)editGlickstein and Stein [8]
(2009)editSchlesimger et al (Ibid) advanced three possible hypotheses to explain PK. Basal Ganglia Reserves This assumes that reserves of dopamine are held in the basal ganglia and are released in emergencies. Compensatory cerebellar circuitry This assumes that dormant alternative cerebellar circuitry can be activated by reward-seeking behaviour. Noradrenic augmentation This assumes that a primitive, latent system of movement can be stimulated into use by the secretion of the neurotransmitter noradrenaline acting upon the sympathetic nervous system. This is also known as the "fight-or-flight response" Visual CueingeditVisual cueing is a form of PK which can be activated, and controlled by an indvidual as an alternative form of locomotion. Morris et al [9]evaluated cadence control for slow to medium walking speeds in PD patients and showed that an increase in step frequency was a compensation for reduced stride length. They concluded:-
Further Readingedit
Related PageseditReferencesedit
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Masking
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Redirected to ( To subpage for editing >> ) Fixed and vacant expression (masking) Very little research has been carried out on this common PD symptom but the following are relevant :- Allen (1931) The Dissociation of voluntary and emotional movements of the face with special reference to emotional paresis as a physical sign [2] Hemmesch et al (2009)The Influence of Facial Masking and Sex on Older Adults’ Impressions of Individuals with Parkinson’s Disease. [3] Clark et al (2011) Visual Exploration of Emotional Facial Expressions in Parkinson's Disease [4] Tickle-Degnen et al (2011) Culture, Gender and Health Care Stigma: Practitioners’ Response to Facial Masking Experienced by People with Parkinson’s Disease < [5] Further Researchedit
Referencesedit
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Micrographia
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Microscopic handwriting The following references are relevant:- Oliveira et al (1997) Micrographia in Parkinson's disease: the effect of providing external cues [1] Dounskaia et al (2009) Biased Wrist and Finger Coordination in Parkinsonian Patients during Performance of Graphical Tasks [2] Shukla et al (2012) Micrographia and related deficits in Parkinson's disease: a cross-sectional study [3] Further Researchedit
Referencesedit
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Motor fluctuations
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Motor fluctuations 'On-off' periods, wearing off, dose failures, and freezing associated with long-term levodopa use The following references are relevant:- Bordelon et al (2011) Medication Responsiveness of Motor Symptoms in a Population-Based Study of Parkinson Disease [1]/ Bohnen et al (2011) Leucoaraiosis, nigrostriatal denervation and motor symptoms in Parkinson’s disease [2] Mera et al (2012) Feasibility of home-based automated Parkinson’s disease motor assessment [3] Further Researchedit
Referencesedit
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Myoclonus
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Sudden violent jerks. The following references are relevant:- Mera et al (2011) Feasibility of home-based automated Parkinson’s disease motor assessment [1] Lanska (2010) Chapter 33: the history of movement disorders [2] Kojovic et al (2011) Myoclonic disorders: a practical approach for diagnosis and treatment [3] Further Researchedit
Referencesedit
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Oculogyric crises
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Attacks of forced deviation of gaze; The following references are relevant:- Clough et al (1983) Oculogyric crises and parkinsonism. A case of recent onset [1] Furumoto et al (1989) Oculogyric crisis as an initial symptom of juvenile parkinsonism-like disease [2] Wilkaniec et al (2013) Toxicity of extracellular secreted alpha-synuclein: Its role in nitrosative stress and neurodegeneration. [3] Further Researchedit
Referencesedit
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'On-off'
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Redirected to ( To subpage for editing >> ) Motor fluctuations 'On-off' periods, wearing off, dose failures, and freezing associated with long-term levodopa use The following references are relevant:- Bordelon et al (2011) Medication Responsiveness of Motor Symptoms in a Population-Based Study of Parkinson Disease [1]/ Bohnen et al (2011) Leucoaraiosis, nigrostriatal denervation and motor symptoms in Parkinson’s disease [2] Mera et al (2012) Feasibility of home-based automated Parkinson’s disease motor assessment [3] Further Researchedit
Referencesedit
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Palipraxia
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Forced repetitive movement. The following references are relevant:- Ghika (----) Mood and behaviour in disorders of the basal ganglia.[1] Critchley (1970) Aphasioloy and other aspects of language[2] Naremore (1981) Language science : recent advances[3] Further Researchedit
Referencesedit
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Paradoxical kinesia
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Paradoxical kinesiaeditSometimes referred to as 'Kinesia paradoxa' Unexpected reversal of motor symptoms
Faith 'Cures'editThe earliest reference to this phenomenon is to be found in Chapter 2 of the Gospel of St. Mark, where Jesus is at Capernaum and is faced with a bedridden man who is "sick of the palsy".
This account begs the questions as to whether the palsy as described equates with PD and whether the observable benefits were permanent or temporary. In modern times the most documented "miracle" cure is that of Sister Marie Simon-Pierre, who attested that she had been cured of Parkinson's Disease after praying to the late Pope John Paul II.[who himself manifested advanced symptoms of PD]
It is not possible to evaluate these events without a sight of the report of the panel of medical experts set up by the Vatican to evaluate claims of cures. More Observationsedit(1921)editSouques [1] observed the phenomenon and coined the term 'Paradoxical kinesia' to describe it. (1976)editMarshall et al Activation-induced restoration of sensorimotor functions in rats with dopamine-depleting brain lesions [2] succeeded in reproducing Kinesia Paradoxica by exposing Parkinsonian rats to potentially life-threatening situations.
(1989)editKeefe et al Dopamine ReleaseStudies in an Animal Model [3] found that by inducing PK they could switch Parkinson symptoms on and off in rats. Rats were given brain lesions to inhibit their dopamine production capacity by 98% and they became Parkinsonian. They were placed in deep water and managed to swim effectively. They also escaped from shallow ice baths.
(2007)editSchlesinger et al [4] interviewed 50 PD patients, who had been exposed to life-threatening situations in war. Two had experiened PK. (2009)editRobottom et al < [5]noted that symptoms varied when PD patients were placed under emotional or physical stress. The Abruzzi earthquakeedit(2009)editAt 03.32 Central European Summer Time on the night of 6th April 2009 the city of L'Aquila, which is the capital of the Abruzzo region in Italy, was devastated by a sudden earthquake with a strength of 5.8 on the Richter Scale. There was considerable damage to property, 308 people lost their lives and some 1,500 were injured.However there is a long history of earth tremors in the region and the majority of citizens evacuated their properties forthwith and survived. It so happened that 70km. away was a Movement Disorder clinic, operated by the University G.D. Annunzio Chieti-Pescari, which had neen monitoring the symptoms of 14 patients in the city with parkinsonism and dementia. The movemnt disorders of all of them were at Hoehn and Yahr stages 3 to 5. Measurements taken 3 months after the earthquake showed an unaccountable significant improvement in their UPDRS motor rating. There was also considerable anecdotal evidence of their performmance at the moment when the earthquake struck:- "He ran like hell out of the two storey building pushing his two children (17 and 15 years old) and his wife" relates to a 59 year old retired chemical engineer in his tenth year since being diagnosed with PD. "During the earthquake hit he ran from his house." describes a 58 year old retired truck driver five years after PD diagnosis. "During the night time earthquake, she rose from her bed and hurried out of her apartment at the third floor. When she was examined, 15 days after the earthquake, she walked to the office assisted by her daughter (in the previous visit she had been carried on a wheelchair)." Describes a 90 year old woman with both PD and dementia. "During the night time earthquake hit he ran away from his second floor apartment." relates to a 77 year od retired public employee. "During the earthquake, he jumped out of bed and ran through three flights of stairs, carrying and pushing his 72 year old wife (she reported he practically lifted her up through the collapsing apartment and floors)." Part of an acount of a 77 year old retired engineer who had experienced PD symptoms for three year. After 5 months the patients had regressed to their pre-earthquake state. A full account was published by Bonanni et al(2010) Protracted benefit from paradoxical kinesia in typical and atypical parkinsonisms[6] Oliver SackseditPK can occur without the need for divine intervention or geological catastrophes. “Awakenings”, by Oliver Sacks, is one of the most lucid and closely observed accounts of PD symptoms. It is based on the case notes of a series of encounters that he had with patients as a result of the PD pandemic called Encephalitis Lethargica. In the 1920’s. This form of the disease is characterised by its rapid onset and progression and its pronounced symptoms. For example bradykinesia progresses to the point where the patient becomes catatonic. Sacks noted a number of occurrences of Pardoxical kinesia:-In the 1950s there was a PD patient at the Highlands Hospital, London, who:-
At the same hospital were two PD patients who shared a room for 20 years. Both were motionless and mute, but one evening:-
Another patient at Mount Carmel Hospital would sit completely motionless unless she was suddenly thrown three (or more) oranges.
Another Mount Carmel patient seemed totally incapable of movement until one day when:-
Hypotheses for PKedit(1989)editMorris et al [7] evaluated the factors influencing gait in PD patients.
(1991)editGlickstein and Stein [8]
(2009)editSchlesimger et al (Ibid) advanced three possible hypotheses to explain PK. Basal Ganglia Reserves This assumes that reserves of dopamine are held in the basal ganglia and are released in emergencies. Compensatory cerebellar circuitry This assumes that dormant alternative cerebellar circuitry can be activated by reward-seeking behaviour. Noradrenic augmentation This assumes that a primitive, latent system of movement can be stimulated into use by the secretion of the neurotransmitter noradrenaline acting upon the sympathetic nervous system. This is also known as the "fight-or-flight response" Visual CueingeditVisual cueing is a form of PK which can be activated, and controlled by an indvidual as an alternative form of locomotion. Morris et al [9]evaluated cadence control for slow to medium walking speeds in PD patients and showed that an increase in step frequency was a compensation for reduced stride length. They concluded:-
Further Readingedit
Related PageseditReferencesedit
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Paratonia
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Redirected to ( To subpage for editing >> ) Involuntary variable resistance during passive movement The following references are relevant:- Bahram et al (2009) Exercise therapy, quality of life, and activities of daily living in patients with Parkinson disease: a small scale quasi-randomised trial [1] Franzen et al (2009) Reduced Performance in Balance, Walking and Turning Tasks is Associated with Increased Neck Tone in Parkinson's Disease [2] Xia et al (2011) Differentiation between the contributions of shortening reaction and stretch-induced inhibition to rigidity in Parkinson’s disease [3] Further Researchedit
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Paresis
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Partial paralysis. The following references are relevant:- Chao et al (2007) Surgical Management of Parkinson's Disease: Update and Review [1] Halett(2011) Psychogenic Parkinsonism [2] Armstrong et al(2011) Visual Symptoms in Parkinson's Disease [3] Further Researchedit
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Postural instability
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Redirected to ( To subpage for editing >> ) Susceptibility to falls Alternative termseditPostural instability---Falls
King et al (2012) Do clinical scales of balance reflect turning abnormalities in people with Parkinson's disease? [1] Duncan and Earhart (2012) Should One Measure Balance or Gait to Best Predict Falls among People with Parkinson Disease? [2] Boonsinsukh et al (2012) A Cane Improves Postural Recovery From an Unpracticed Slip During Walking in People With Parkinson Disease [3] Further Researchedit
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Propulsive gait
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When walking, steps become faster and faster with progressively shorter steps that passes from a walking to a running pace Further Researchedit
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Resting Tremor
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Redirected to Tremor ( To subpage for editing >> ) Involuntary shaking, trembling or quivering movements of the muscles The following references are relevant:- Sanchez-Ramos et al (2011) Quantitative Analysis of Tremors in Welders[1] Mure et al (2011) Parkinson’s Disease Tremor-Related Metabolic Network: Characterization, Progression, and Treatment Effects [2] Helmich et al (2012) Cerebral causes and consequences of parkinsonian resting tremor: a tale of two circuits?[3] Further Researchedit
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Restless Legs Syndrome
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Uncontrollable, involuntary movement of the legs and feet The following references are relevant:- Gao et al (2010) Restless Legs Syndrome and Erectile Dysfunction[1] Gao et al (2010) Restless legs syndrome and Parkinson’s disease in men[2] Pourcher et al (2010) Compulsive habits in restless legs syndrome patients under dopaminergic treatment [3] Peeraully and Tan (2012) Linking restless legs syndrome with Parkinson's disease: clinical, imaging and genetic evidence [4] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2802250/ Further Researchedit
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Shaking Palsy
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An early name for Parkinson's Disease. |
Tachykinesia
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Tachykinesia Rapid Movement The following references are relevant:- Ellis et al (2011) Which Measures of Physical Function and Motor Impairment Best Predict Quality of Life in Parkinson’s Disease? [1] Ellis et al (2011) Factors Associated With Exercise Behavior in People With Parkinson Disease [2] Espay et al(2012) “On” state freezing of gait in Parkinson disease - A paradoxical levodopa-induced complication [3] Further Researchedit
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Tic
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Redirected to Blepharospasm ( To subpage for editing >> ) Spasm of the eyelid The following references are relevant:- Elston (1992) A new variant of blepharospasm [1] Hallett et al (2008) ..Update on blepharospasm: Report from the BEBRF International Workshop[2] Armstrong (2011) Visual symptoms in Parkinson's Disease [3] Further Researchedit
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Torticolls
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Asymmetric spasm of the neck muscles The following references are relevant:- Bronstein and Rudge (1986) Vestibular involvement in spasmodic torticollis[1] Jahanshah (2000) Factors that ameliorate or aggravate spasmodic torticollis [2] Thompson et al (2011) Convergent mechanisms in etiologically-diverse dystonias [3] Further Researchedit
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