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This study aimed to compare susceptibility map-weighted imaging (SMwI) using various MRI machines (three vendors) with N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophe nyl)nortropane (We prospectively recruited 257 subjects, including 157 patients with neurodegenerative parkinsonism, 54 patients with non-neurodegenerative parkinsonism, and 46 healthy subjects from 10 hospitals between November 2019 and October 2020. All participants underwent both SMwI andThe inter-observer agreement was 0.924 and 0.942 per SN and participant, respectively. The diagnostic sensitivity of SMwI was 97.9% and 99.4% per SN and participant, respectively; its specificity was 95.9% and 95.2%, respectively, and its accuracy was 97.1% and 97.7%, respectively. There was no significant difference between the results of SMwI andThis study demonstrated that the high diagnostic performance of SMwI was maintained in a multi-centre setting with various MRI scanners, suggesting the generalisability of SMwI for determining nigrostriatal degeneration in patients with parkinsonism.• Susceptibility map-weighted imaging helps clinicians to predict nigrostriatal degeneration. • The protocol for susceptibility map-weighted imaging can be standardised across MRI vendors. • Susceptibility map-weighted imaging showed diagnostic performance comparable to that of dopamine transporter PET in a multi-centre setting with various MRI scanners.

ObjectiveTo investigate the longitudinal association among high-density lipoprotein cholesterol (HDL-C) level, HDL-C variability, and the risk of developing Parkinson disease (PD).MethodsWe conducted a nationwide, population-based cohort study. We included 382,391 patients aged ≥65 years who underwent at least 3 health examinations provided by the Korean National Health Insurance System from 2008 to 2013 and followed up until 2017. Individuals with a history of PD and missing values were excluded (n = 1,987). We assessed HDL-C variability using 3 indices, including variability independent of the mean (VIM). A multivariate-adjusted Cox proportional hazards regression analysis was performed.ResultsAmong the 380,404 participants, 2,733 individuals were newly diagnosed with PD during a median follow-up period of 5 years. The lowest quartile (Q1) group of baseline HDL-C and mean HDL-C was associated with increased PD incidence as compared with the highest quartile (Q4) group (adjusted hazard ratio [aHR], 1.20; 95% confidence interval [CI], 1.08–1.34; and aHR, 1.16; 95% CI, 1.04–1.30, respectively). The Q4 group of HDL-C variability (VIM) was associated with increased PD incidence compared to the Q1 group (aHR, 1.19; 95% CI, 1.06–1.33). The group with the Q1 of baseline HDL-C and with the Q4 of HDL-C variability had the highest risk of PD incidence (aHR, 1.6; 95% CI, 1.31–1.96).ConclusionLower HDL-C level and greater HDL-C variability were associated with a higher incidence of PD.

Background: Bee venom acupuncture (BVA) is an effective treatment method for various diseases. Bee venom, however, can cause adverse effects, even rarely including life-threatening anaphylaxis, so safety-related evidence is required. In this study, we systematically estimated the incidence rate of anaphylaxis in response to BVA. Methods: We searched eight databases (MEDLINE (Pubmed), EMBASE, Cochrane Central Register of Controlled, KISS, KMBASE, Koreamed, OASIS, and NDSL) and systematically reviewed the articles that met the inclusion/exclusion criteria. Results: Among 225 potentially relevant articles, 49 were selected for this study. The overall incidence rate of anaphylaxis in response to BVA was 0.045% (95% CI 0.028–0.062). Women (0.083%, 95% CI 0.010–0.157) showed a higher incidence rate than men (0.019%, 95% CI −0.018 to 0.055), while the incidence for patients who had a skin test conducted (0.041%, 95% CI 0.011–0.072) was not significantly different compared to that obtained for patients for which there was no information about a skin test (0.047%, 95% CI 0.026–0.067). The publication year affected the incidence rate: it was highest before 1999 (1.099%, 95% CI −1.043 to 3.241), lower between 2000 and 2009 (0.049%, 95% CI 0.025–0.073), and lowest between 2010 and 2021 (0.037% 95% CI 0.014–0.060). Conclusions: In this study, we provide reference data about risk size and factors of BVA-related anaphylaxis, which is essentially required for BVA application in clinics.

Objective: The efficacy of antidepressants in post-stroke depressive symptoms (PSD) varies. We aimed to examine whether the effect of escitalopram on PSD differs according to individual depressive symptoms and stroke lesion location. Methods: This is a post hoc analysis of EMOTION ( ClinicalTrials.gov , NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram on depression in acute stroke patients (237 with placebo, 241 with escitalopram). Depressive symptoms were evaluated with the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Changes in MADRS and individual item scores at 12 weeks were compared between the treatment groups and among the stroke lesion location groups. Stroke lesion locations were grouped according to the anatomical distribution of serotonin fibers that originate from the midbrain/pons and spread to the forebrain via subcortical structures: “Midbrain-Pons,” “Frontal-Subcortical,” and “Others.” Least-squares means were calculated to demonstrate the independent effect of lesion location. Results: Total MADRS scores decreased more significantly in the escitalopram than in the placebo group, while a significant effect of escitalopram was observed in only 3 items: apparent sadness, reported sadness, pessimistic thoughts. In the lesion location analyses, escitalopram users in the Frontal-Subcortical group showed significant improvement in total MADRS scores (placebo [n = 130] vs. escitalopram [n = 148], least-square mean [95% CI]: -2.3 [-3.5 to -0.2] vs. -4.5 [-5.5 to -3.4], p = .005), while those in the Midbrain-Pons and Others groups did not. Conclusions: The effect of escitalopram on PSD may be more prominent in patients with particular depressive symptoms and stroke lesion locations, suggesting the need for tailored treatment strategies.

BACKGROUND: It is important to quantitatively assess tremor for accurate diagnosis and evaluation of the response to interventions in patients with essential tremor (ET). OBJECTIVE: The purpose of this study was to investigate the relationship between quantitative measures of postural tremor and clinical rating scale in patients with ET. METHODS: 18 ET patients performed a postural tremor task that required them to hold their arms outstretched parallel to the floor while wearing a gyro sensor based measurement system. The time domain variables were derived from the sensor signals. Additionally, the frequency domain variables were derived from the power spectrum of the angular velocity signal. Spearman correlation analysis was employed in the relationship between the variables and clinical score. RESULTS: The RMS angular velocity of roll and yaw directions at the hand joint were strongly correlated with the clinical rating scale (r= 0.7, p< 0.01). Similarly, the peak power of roll and yaw directions at the hand joint were moderately correlated with the clinical rating scale (r= 0.61 and r= 0.67, p< 0.01). In contrast, no significant correlation coefficients were observed in the peak frequency (p> 0.05). CONCLUSION: These results indicate that hand tremor of roll and yaw directions are more associated with assessment of severity of ET compared to other joints. This study suggests that quantitative measurements of postural tremor should be considered as tremor directionality as well as attachment location.

Scans without evidence of dopaminergic deficit (SWEDD) is a radiological nomenclature which refers to patients with a normal dopamine transporter scan presumed to have parkinsonism. The motor features of SWEDD patients should be understood in order to avoid costly and inappropriate treatments. Therefore, it is important to effectively differentiate SWEDD from Parkinson's disease (PD) in the early stage of disease. As bradykinesia is a cardinal clinical feature of parkinsonism, we quantitatively investigated detailed presentations of hand movement using an angular measurement system in SWEDD and PD patients as well as normal controls.Twenty-three patients with SWEDD, 23 patients with off state early stage PD, and 23 age-matched healthy controls participated in this study. Angular velocity was measured during finger-tapping and forearm-rotation movement for the assessment of bradykinesia. RMS (root mean square) velocity and amplitude as well as movement irregularity were derived from the gyro sensor signal.SWEDD patients presented a greater average speed, a larger average amplitude, and more regular speed and amplitude only during forearm rotation than PD patients (p 0.05). SWEDD patients also exhibited a smaller average speed and average amplitude, and a more irregular speed on average during finger tapping than controls (p 0.05).Quantitative variables of forearm rotation movement showed significant differences between SWEDD and PD patients, and quantitative variables of finger tapping movement showed a significant difference between SWEDD patients and the control group. These results suggest that quantitatively-assessed variables using biomedical engineering devices could aid clinicians in the identification of potential SWEDD.

Background Evaluation of olfactory function is valuable for the detection of pre-motor state of Parkinson's disease (PD). PD patients have an increased risk of associated dementia and one-third of PD patients have mild cognitive impairment (MCI) at the time of diagnosis. However, the characteristics of olfactory dysfunction in PD-MCI patients are unclear. This study examined the relationship between olfactory dysfunction and cognitive function in drug-naive PD at the time of diagnosis with the patterns of olfactory function in PD-MCI patients using the Korean version of the Sniffin’ stick test II (KVSS II). Methods A total of 66 drug-naive PD patients were enrolled. A neuropsychiatric assessment battery and KVSS II were performed. For the statistical analyses, univariate, multivariable linear regression and Student's t-test were used to determine the relationship between the variables and olfactory function. Results Olfactory dysfunction was more prevalent in the PD-MCI group than in the PD-normal cognition (PD-CN) group. Each domains of odor threshold, discrimination, identification and total olfactory score were more impaired in the PD-MCI group than the PD-CN group. Whether cognitive impairment was single or multiple domain was not affected. Conclusion PD-MCI is more likely to be associated with severe olfactory impairment than PD-CN. There may be more extensive neurodegenerative processes affecting olfaction in PD-MCI patients. With further investigation and validation using neuropathological data, an objective olfactory function test could be used as a tool to evaluate disease progression. Further studies with prospective design investigating the prognostic value of olfactory dysfunction in PD-MCI patients are essential.

Introduction Negative myoclonus is a jerky, brief, and sudden interruption of voluntary muscle contraction. Although gabapentin and pregabalin have been reported to induce positive myoclonus in some patients with impaired renal function, there are only a few studies describing pregabalin- or gabapentin-induced negative myoclonus. This study reviewed patients who had developed pregabalin- or gabapentin-induced negative myoclonus. Methods We collected the patients with negative myoclonus who were referred to the department of neurology at a university-affiliated hospital and selected pregabalin- or gabapentin-induced negative myoclonus. Then reviewed the literature with respect to pregabalin- or gabapentin-induced negative myoclonus. Results A total of 77 patients with negative myoclonus were reviewed. Among them, 21 neuropathic pain patients who were prescribed and developed negative myoclonus induced by pregabalin (9 cases) or gabapentin (12 cases). To prove causality of the drug, probable and certain level of category according to the WHO-UMC criteria were recruited. Of the 21 patients, 3 had impaired renal function, while 18 had normal renal function. Review of the literature identified 7 further cases (6 had normal renal function) with pregabalin- or gabapentin-induced negative myoclonus. Conclusion Pregabalin- and gabapentin-induced negative myoclonus can develop even in patients with normal renal function. Physicians should keep in mind the possibility of patients developing negative myoclonus under treatment of pregabalin or gabapentin even in short period of time and with low dosage, and in the normal range of renal function. Further prospective study investigating incidence and risk factors is warranted.

Background The lack of adequate and detailed epidemiological data of Parkinson’s disease (PD), especially in Asia, is a barrier to future disease burdens and the prospect of effective public health plans. This study aimed to investigate temporal trends in the incidence and prevalence of PD in South Korea from 2010 to 2015, based on uniform diagnostic criteria. Methods This study examined all PD patients registered in a South Korean national registry database of more than 50 million individuals. We analyzed the incidence and prevalence of PD according to age, gender, and region. Results The annual incidence of PD was between 22.4–27.8 cases per 100,000 individuals. During the 6-year study period, there were 73,726 new PD patients, 42.3% of whom were men. The standardized incidence of PD increased over time in men but remained constant in women until 2013 but began to increase in 2014. The female-to-male ratio in the incidence of PD was 1.4:1 while the female-to-male ratio in the prevalence of PD was 1.6:1. The age- and gender-standardized prevalence of PD increased from 115.9 cases per 100,000 individuals in 2010 to 139.8 cases per 100,000 individuals in 2015. From 2014, the incidence and prevalence of PD peaked in individuals aged between 80 and 89 years in both men and women. Regional analysis also showed an increased prevalence of PD in all regions of Korea. Conclusions The incidence and prevalence of PD in Korea were higher in women and increased gradually from 2010 to 2015. The findings may contribute to epidemiological studies of PD in Asia, and may provide clues on risk factors for PD.

Background Previous studies have reported that patients with Parkinson's disease (PD) have a significantly lower risk of cancer. Studies reporting prevalence of skin cancers in Parkinson's disease mostly involve Caucasians. Objective A nationwide population-based study was conducted to determine the risk of skin cancer in patients diagnosed with PD in Korea. Methods Data obtained from National Health Insurance Claims records were used to retrieve information about 70 780 patients with newly diagnosed PD between January 2010 and December 2015. The control group included 353 900 sex- and age-matched patients without PD. In this nationwide population-based cohort study, we investigated the association between PD and skin cancer. Results The overall hazard ratio (HR) of skin cancers in patients with PD was 1.169 (95% CI, 1.005-1.359) compared with non-PD group. Among patients with PD, males aged above 65 had a 2.8-fold increase in the risk for melanoma development than the non-PD group (HR, 2.825; 95% CI, 1.395-5.721). In addition, female PD patients aged above 65 years showed a 1.3-fold increase in non-melanoma skin cancer risk than the non-PD group (HR, 1.305; 95% 1.073-1.589). Conclusion Compared with the general population, Korean patients diagnosed with PD had a greater risk of skin cancer. Especially, male patients aged 65 years and above, and diagnosed with PD had a significant risk of melanoma development compared with control.

Background: We aimed to examine sex differences in symptom characteristics and pharmacological responses in post-stroke depressive (PSD) symptoms. Methods: This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram for 3 months on depression in patients with acute stroke. Depressive symptoms were evaluated using the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Baseline characteristics, clinical variables, and treatment responses to escitalopram were compared between male and female patients. Treatment responses were defined as changes in MADRS (total score and its components) between baseline and 3 months and were compared between the escitalopram and placebo groups within each sex group. The least square mean was calculated to determine the independent effect of escitalopram, of which interaction was evaluated with patient sex. Results: Of the 478 patients (intention-to-treat population), 187 (39%) were female. Female patients were significantly older than male patients and demonstrated more severe depressive symptoms at baseline (male vs. female, MADRS score, mean [SD]: 9.7 ± 8.0 vs. 12.2 ± 8.4, p = 0.001), especially in apparent sadness, reported sadness, and reduced appetite items. These differences were significant after adjustment for age and the severity of neurologic deficits. The female escitalopram group showed a significant 3-month improvement in MADRS scores (placebo [n = 86] vs. escitalopram [n = 101], least square mean [95% CI] –2.7 [–4.1 to –1.2] vs. –5.0 [–6.4 to –3.6], p = 0.007), and this efficacy was prominent in apparent sadness, reported sadness, and pessimistic thoughts items. However, there was no significant effect of escitalopram on depressive symptoms in the male group. The treatment responses of escitalopram tended to be more pronounced in the female group, particularly in alleviating a subset of depressive symptoms such as apparent sadness (p for interaction = 0.009). Conclusion: PSD may differ according to sex in its symptom characteristics and treatment responses to escitalopram, and tailored treatment strategies for PSD may therefore be needed.

Background: Parkinson's disease (PD) is the second most common neurodegenerative disease in the elderly. Cerebrovascular diseases such as cerebral ischemic lesion (CIL) also commonly occur in elderly adults. However, previous studies on the relationship between PD and cerebrovascular disease have not found consistent results. Therefore, we conducted this study to evaluate whether or not PD is related to an increased prevalence of ischemic cerebrovascular lesions. Methods: This study recruited 241 patients with PD and 112 healthy controls (HCs). All subjects underwent brain magnetic resonance imaging and general neuropsychological tests. The motor severity of PD was evaluated according to the Hoehn and Yahr stage (HY stage), and the severity of CIL in all subjects was classified according to Fazekas grade. The PD patients were classified into two subgroups according to HY stage (Group 1 - HY 1, 2; Group 2 - HY 3 to 5). Results: Among all PD patients, 76% had small vessel disease, while 44% of all HCs had small vessel disease (p

Summary Background Mood and emotional disturbances are common in patients with stroke, and adversely affect the clinical outcome. We aimed to evaluate the efficacy of early administration of escitalopram to reduce moderate or severe depressive symptoms and improve emotional and neurological dysfunction in patients with stroke. Methods This was a placebo controlled, double-blind trial done at 17 centres in South Korea. Patients who had had an acute stroke within the past 21 days were randomly assigned in a 1:1 ratio to receive oral escitalopram (10 mg/day) or placebo for 3 months. Randomisation was done with permuted blocks stratified by centre, via a web-based system. The primary endpoint was the frequency of moderate or severe depressive symptoms (Montgomery-Asberg Depression Rating Scale [MADRS] ≥16). Endpoints were assessed at 3 months after randomisation in the full analysis set (patients who took study medication and underwent assessment of primary endpoint after randomisation), in all patients who were enrolled and randomly assigned (intention to treat), and in all patients who completed the trial (per-protocol analysis). This trial is registered with ClinicalTrials.gov, number NCT01278498. Findings Between Jan 27, 2011, and June 30, 2014, 478 patients were assigned to placebo (n=237) or escitalopram (n=241); 405 were included in the full analysis set (195 in the placebo group, 210 in the escitalopram group). The primary outcome did not differ by study group in the full analysis set (25 [13%] patients in the placebo group vs 27 [13%] in the escitalopram group; odds ratio [OR] 1·00, 95% CI 0·56–1·80; p>0·99) or in the intention-to-treat analysis (34 [14%] vs 35 [15%]; OR 1·01, 95% CI 0·61–1·69, p=0·96). The study medication was generally well tolerated; the most common adverse events were constipation (14 [6%] patients who received placebo vs 14 [6%] who received escitalopram), muscle pain (16 [7%] vs ten [4%]), and insomnia (12 [5%] vs 12 [5%]). Diarrhoea was more common in the escitalopram group (nine [4%] patients) than in the placebo group (two [1%] patients). Interpretation Escitalopram did not significantly reduce moderate or severe depressive symptoms in patients with acute stroke. Funding Dong-A Pharmaceutical and Ministry for Health, Welfare, and Family Affairs, South Korea.

BACKGROUND Scans without evidence of dopaminergic deficit (SWEDD), a heterogeneous disorder, refers to patients with normal dopamine transporter scan presumed to have Parkinson's disease (PD). Although clinically hard to discriminate, it is important to differentiate SWEDD from PD in the early stage of disease in practice. Olfactory dysfunction is a sensitive biomarker of neurodegeneration. A considerable number of SWEDD patients show abnormal olfaction. We investigated the olfaction and non-motor symptoms in SWEDD, PD, and healthy controls. A subgroup analysis of SWEDD by olfactory function was also conducted. METHODS This study enrolled 40 SWEDD, 28 PD, and 26 healthy controls. The Korean version of Sniffin's stick test II (KVSS II) and the Korean version of non-motor symptoms scale for PD (K-NMSS) were used to evaluate olfaction and non-motor symptoms. Patients with SWEDD were categorized into normal olfaction (SWEDD-N) and olfactory dysfunction (SWEDD-D) subgroups. RESULTS Overall KVSS II scores of SWEDD group was distinctive when compared to those of PD or controls. K-NMSS scores were increased in PD compared to those in SWEDD or controls. In subgroup analysis, KVSS II scores in SWEDD-D were similar to those in PD. K-NMSS scores in SWEDD-D were also significantly higher than those in SWEDD-N but lower than those in PD. CONCLUSIONS Olfactory dysfunction could be a biomarker to differentiate SWEDD from PD. Non-motor symptoms differed between the two SWEDD subgroups classified by olfaction. These findings suggest that the underlying pathophysiology of SWEDD with normal olfaction and olfactory dysfunction might be different.

Introduction Dopa-responsive dystonia (DRD) related to GCH1 mutation is a biochemical disorder. DRD is majorly characterized by dystonia and/or parkinsonism. Although clinical disorders show a dramatic positive response to levodopa, there are controversies over the residual signs following treatment. This study was designed to investigate the residual signs following levodopa treatment in Korean DRD patients with GCH1 mutation. Methods A structured questionnaire was prepared to obtain information about demographic factors, clinical characteristics, genetic data, neuroimaging data and residual signs following levodopa treatment of the patients, and was sent to movement specialists at tertiary hospitals. The data collected from the returned forms were analyzed using appropriate statistical methods such as Student's t-test, Mann-Whitney U test, Chi-square test or Fisher's exact test. Results Thirty-nine DRD Korean patients with GCH1 mutation were recruited. One patient was presented with only parkinsonism. Dystonia was completely resolved in 32 out of 38 patients following treatment, while parkinsonism improved without residual signs in 8 out of 9 patients. The frequency of the residual signs in Korean patients (15.8% for dystonia and 11.1% for parkinsonism) is similar to that observed in Chinese patients, but lower in Western patients. Furthermore, these signs were more frequent in those patients with a delay in their diagnosis, and those who were relatively older at the time of diagnosis. Conclusions Ethnic differences, age at diagnosis, and a temporal gap between the onset and diagnosis in Korean patients may influence the remaining neurologic abnormalities of DRD.

Background: Noncontrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is commonly used to examine intracranial arterial stenosis, although it can be difficult to identify the etiology of the stenosis. Our aim was to determine the effectiveness of 3D TOF MRA in differentiating an intracranial arterial dissection from atherosclerosis. Methods: During 2015–2017, 356 patients had confirmed intracranial arterial stenosis based on high resolution-magnetic resonance imaging. This study ultimately included 51 patients with severe focal stenosis that was caused by dissection and atherosclerosis. We compared the dissection group with the atherosclerotic narrowing group by measuring the region-of-interest (ROI) values 3 mm proximal and 3 mm distal from sites of severe focal stenosis. Results: A significant difference was observed between the median ROI difference values in the dissection group (n = 18) and the atherosclerosis group (n = 33; 35.6 [20.9–78.4] vs. 165.5 [99.8–328.5]; p < 0.001). A receiver operating characteristic curve was prepared to distinguish between dissection and atherosclerosis using the ROI difference values. The area under the curve was 0.919 (sensitivity 75.8%, specificity 94.4%). The optimal cutoff value for using ROI to distinguish between dissection and atherosclerosis was found to be 99.0 based on the Youden’s index. Conclusion: The ROI difference value from 3D TOF MRA could help distinguish between dissection and atherosclerosis. If the ROI difference value from 3D TOF MRA is small (< 99.0), detailed testing should be performed to identify dissection.

The objective of this study was to determine whether patients with carpal tunnel syndrome (CTS) manifest changes in early-stage motor function and to investigate the utility of a gyrosensor for quantitative evaluation of motor function.Angular velocity signal was measured during finger tapping in 52 patients with mild-to-moderate CTS and 45 controls. Four finger-tapping performance (FTP) values-root-mean-squared (RMS) velocity, RMS angle, peak power, and total power-were derived from the signal.All FTP values were significantly lower in patients with CTS than in controls (P = 0.001 or P 0.001). There were no significant differences between the mild and moderate CTS subgroups.FTP measurement with a gyrosensor represents a valuable tool for the evaluation of median nerve motor function in patients with CTS. It facilitates the detection of subclinical motor dysfunction in patients with early stage CTS. Muscle Nerve 59:465-469, 2019.

Essential tremor is an involuntary trembling of body limbs in people without tremor-related disease. In previous study, suppression of tremor by sensory electrical stimulation was confirmed on the index finger. This study investigates the effect of sensory stimulation on multiple segments and joints of the upper limb. It denotes the observation regarding the effect's continuity after halting the stimulation. 18 patients with essential tremor (8 men and 10 women) participated in this study. The task, "arms stretched forward", was performed and sensory electrical stimulation was applied on four muscles of the upper limb (Flexor Carpi Radialis, Extensor Carpi Radialis, Biceps Brachii, and Triceps Brachii) for 15 seconds. Three 3-D gyro sensors were used to measure the angular velocities of segments (finger, hand, and forearm) and joints (metacarpophalangeal and wrist joints) for three phases of pre-stimulation (Pre), during-stimulation (On), and 5 minute post-stimulation (P5). Three characteristic variables of root-mean-squared angular velocity, peak power, and peak power frequency were derived from the vector sum of the sensor signals. At On phase, RMS velocity was reduced from Pre in all segments and joints while peak power was reduced from Pre in all segments and joints except for forearm segment. Sensory stimulation showed no effect on peak power frequency. All variables at P5 were similar to those at On at all segments and joints. The decrease of peak power of the index finger was noted by 90% during stimulation from that of On phase, which was maintained even after 5 min. The results indicate that sensory stimulation may be an effective clinical method to treat the essential tremor.

Tinnitus is strongly associated with psychiatric symptoms, including depression and suicidality. We aimed to further investigate the association of tinnitus with depressive mood and/or suicidal ideation, and explore the shared risk factors for these within a representative sample of the adult general population. We also investigated potential mediation pathways among tinnitus, suicidal ideation, depression, shared risk factors, and perceived stress levels. We analysed data from 28,930 adults (aged ≥19 years) from the fourth and fifth Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2012 in South Korea. We investigated the presence and severity of tinnitus, depressive mood, suicidal ideation, perceived usual stress level, and socioeconomic and health-related variables. We conducted logistic regression and mediation analyses. Tinnitus and its severity were significantly associated with depressive mood and suicidal ideation. Tinnitus, depressive mood, and suicidal ideation shared common socioeconomic and health-related risk factors. Tinnitus significantly mediated the association of shared risk factors for depressive mood and suicidal ideation. Perceived usual stress level mediates the association of tinnitus with depressive mood and suicidal ideation. The correlation of perceived usual stress levels with depression and suicidal ideation was also mediated by tinnitus. Our findings implicate that tinnitus may contribute substantially to the development of depressive symptom and suicidal ideation in adults via apparent interactions with shared risk factors and stress levels.

Background Drug-induced parkinsonism (DIP) is one important cause of parkinsonism and a major cause of misleading diagnosis of Parkinson's disease (PD). DIP is caused by dopamine receptor blocking agents. Its symptoms will improve after withdrawal of offending drugs. However, parkinsonism does not regress in several individuals. It may persist or exacerbate despite drug withdrawal. Transcranial sonography (TCS) of the substantia nigra (SN) has been widely used to diagnose PD and differentiate parkinsonism types. The objective of this study was to investigate the value of early TCS findings for predicting clinical outcome of patients with newly diagnosed gastroprokinetic drug-induced parkinsonism after withdrawal of dopamine receptor blocking agents. Methods Fifty PD, 69 DIP, and 74 healthy controls were enrolled in this study. Patients with DIP were categorized into two subgroups: clinically improved after drug withdrawal (pure DIP) and clinically persistent or aggravated parkinsonism after drug withdrawal (unmasked PD). TCS was performed for all individuals to detect echogenicity in the SN. Results Transcranial sonographic SN echogenicity was significantly increased in PD while DIP and controls had similar SN echogenicity. In subgroup analysis of DIP, transcranial sonographic SN echogenicity was significantly increased in unmasked PD compared to that in pure DIP or healthy controls. Conclusions SN echogenicity on TCS could be a useful tool to differentiate PD from DIP in clinical situations. Pure DIP and unmasked PD exhibited different SN echogenicity patterns. Early SN echogenicity findings on TCS could be used a biomarker to predict clinical prognosis of DIP.

Background and purpose Headache may be a warning sign of subsequent stroke in patients with vertebral artery dissection (VAD). Even though the headache characteristics of VAD have been described predominantly in patients with extracranial VAD and neurological complications, headache semiology is not well known in patients with uncomplicated intracranial vertebral artery dissection (ICVAD). In the present study, we attempt to identify the headache semiology that characterizes ICVAD and validate the revised version of the International Classification of Headache Disorders (ICHD-3 beta) criteria for headache attributed to intracranial artery dissection. Methods Six patients with neurologically uncomplicated ICVAD presented at a participating medical center, and eight similar patients were reviewed in the literature. Combining these data, we analyzed headache characteristics of patients with uncomplicated ICVAD according to their pain onset and duration, nature, intensity, location, aggravating and relieving factors, associated symptoms, response to medication, and prognosis. Results Headache in uncomplicated ICVAD usually has an acute mode of onset (11/14) and persistent (10/14) temporal feature. Pain that has a throbbing quality (nine of 14) and severe intensity (13/14) on the ipsilesional (10/14) and occipitonuchal area (12/14) is a headache prototype in ICVAD. Additionally, headache was intensified by head flexion and rotation (three of six), and relieved by head extension and supine positioning (five of six). Headache of all patients in the present study fulfilled the ICHD-3 beta criteria. Conclusion Headache semiology of uncomplicated ICVAD is mostly homogenous in the present study. These characteristics may be helpful in the diagnosis of uncomplicated ICVAD.

A "masked face", that is, decreased facial expression is considered as one of the cardinal symptoms among individuals with Parkinson's disease (PD). Both spontaneous and voluntary mimicry toward others' emotional expressions is essential for both social communication and emotional sharing with others. Despite many studies showing impairments in facial movements in PD in general, it is still unclear whether voluntary, spontaneous, or both types of mimicry are affected and how the impairments affect the patients' quality of life. We investigated to verify whether impairments in facial movements happen for spontaneous as well as for voluntary expressions by quantitatively comparing muscle activations using surface electromyography. Dynamic facial expressions of Neutral, Anger, Joy, and Sad were presented during recordings in corrugator and zygomatic areas. In the spontaneous condition, participants were instructed to simply watch clips, whereas in the voluntary condition they were instructed to actively mimic the stimuli. We found that PD patients showed decreased mimicry in both spontaneous and voluntary conditions compared to a matched control group, although movement patterns in each emotion were similar in the two groups. Moreover, whereas the decrease in mimicry correlated with the decrease not in a health-related quality of life index (PDQ), it did so in a more subjective measurement of general quality of life index (SWB). The correlation between facial mimicry and subjective well-being index suggests that the 'masked face' symptom deteriorates patients' quality of life in a complex way affecting social and psychological aspects, which in turn may be linked to the increased depression risk among individuals with PD.

Background Magnetic resonance imaging (MRI) is a useful tool to predict the diagnosis and progression of Alzheimer's disease (AD), especially for primary physicians. However, the correlation between baseline MRI findings and AD progression has not been fully established. Objective To investigate the correlation between hippocampal atrophy (HA) and white matter hyperintensities (WMH) on initial brain MRI images and the degree of cognitive decline and functional changes over 1 year. Methods In this prospective, 12-month observational study, dementia outpatients were recruited from 29 centers across South Korea. Baseline assessments of HA and WMH on baseline brain MRI were derived as well as cognitive function, dementia severity, activities of daily living, and acetylcholinesterase inhibitor (AChEI) use. Follow-up assessments were conducted at 6 and 12 months. Results Among 899 enrolled dementia patients, 748 were diagnosed with AD of whom 654 (87%) were taking AChEIs. Baseline WMH showed significant correlations with age, current alcohol consumption, and Clinical Dementia Rating score; baseline HA was correlated with age, family history, physical exercise, and the results of cognitive assessments. Among the AChEI group, changes in the Korean version of the Instrumental Activities of Daily Living (K-IADL) were correlated with the severity of HA on baseline brain MRI, but not with the baseline severity of WMH. In the no AChEI group, changes in K-IADL were correlated with the severity of WMH and HA at baseline. Conclusion Baseline MRI findings could be a useful tool for predicting future clinical outcomes by primary physicians, especially in relation to patients' functional status.

Aims To investigate whether metabolic syndrome(MetS) can predict the new onset of carotid plaque or the progression of carotid intima-media thickness(C-IMT) and identify other associated factors in an elderly population without evidence of early carotid atherosclerosis. Methods B-mode carotid ultrasonography was used to assess the presence of carotid plaque and the C-IMT at baseline and follow-up. Participants with carotid plaque or an increased C-IMT(≥1.0mm) at baseline were excluded from the study. The new occurrence of carotid plaque, defined as early carotid atherosclerosis and the progression of C-IMT, was evaluated. Multiple regression analyses were used to determine predictors of these findings. Results A total of 370 participants over 60 years of age(median age=66 years, 34.1% men) were enrolled. After a median follow-up period of 25 months, 64 participants(17.3%) had newly developed carotid plaque. After adjusting for variables determined to be statistically significant in univariate analyses, a multivariable regression analysis showed that predictors of newly developed carotid plaque were metabolic syndrome(hazard ratio [HR]=1.916; 95% confidence interval [CI]: 1.059-3.466), white blood cell count(HR=1.313; 95% CI: 1.094-1.576) and vitamin B12(HR=1.001; 95% CI: 1.000-1.002) and total cholesterol(HR=1.009; 95% CI: 1.001-1.017) levels. A multiple linear regression analysis showed that the rate of change for C-IMT tended to be associated with the development of metabolic syndrome. Conclusions Metabolic syndrome is associated with the progression of early carotid atherosclerosis in the general population, suggesting that metabolic syndrome plays an important role in initiating the atherosclerotic process.

Patients with cerebellar lesions may show horizontal (positive)- or downward (perverted)-corrective saccades during horizontal head impulse test (HIT). However, corrective saccades in the direction of head rotation (reversed corrective saccades) have not been reported during HIT. We present two patients who showed reversed corrective saccades during horizontal HIT as an initial sign of acute cerebellitis. In contrast to the corrective saccades mostly observed in peripheral vestibular paresis, this paradoxical response indicates abnormally increased vestibulo-ocular responses due to cerebellar disinhibition over the vestibulo-ocular reflex. This paradoxical response should be considered an additional bedside cerebellar sign.

A 72-year-old woman presented with suspected parkinsonism and discolouration of the skin especially on sun-exposed areas. Thorough investigation revealed systemic zirconium intoxication due to intake of metallic colloids as a home remedy as a cause of the skin colour change. There may be an association between skin discolouration and her parkinsonism. This is unique in that various clinical manifestations developed following systemic ingestion of zirconium and this should serve as a warning on the risk of taking illicit dietary supplements.

Background Atypical Parkinsonism is less common and has more severe symptoms than Parkinson's disease (PD). Little is known about the non-motor symptom (NMS) characteristics of multiple systemic atrophy (MSA) or progressive supranuclear palsy (PSP). We report the interrelationship of NMS in MSA, PSP, and PD. Methods We studied 117 cases of PD and 57 of Atypical Parkinsonism. Out of the 57 patients, 31 had multiple systemic atrophy parkinsonian subtype (MSA-P), 14 had multiple systemic atrophy cerebellar dysfunction subtype (MSA-C), and 12 had PSP. We assessed the condition of the patients using the United Parkinson's Disease Rating Scale part III (UPDRS-III), the modified Hoehn & Yahr scale (H&Y), the non-motor symptom scale (NMSS), and the Parkinson's Disease Questionnaire (PDQ-39). Results In Atypical Parkinsonism, the NMSS scores significantly correlated with PDQ-39 scores, but not with UPDRS-III. In the MSA-P group, the mood/cognitive domain significantly correlated with both the urinary and sleep/fatigue domains. In the MSA-C group, the sleep/fatigue domain correlated with the mood/cognition and cardiovascular domains. Finally, in the PSP and PD groups, the attention/memory domain significantly correlated with the sleep/fatigue and mood/cognition domains. Discussion These results suggest that, with respect to cognitive function, dysautonomia and sleep/fatigue are detrimental factors in MSA and PSP, respectively.

Aside from the glucocerebrosidase gene, the genetic risk factors for cognitive decline in Parkinson's disease (PD) are controversial. We investigated whether the G2385R polymorphism in leucine-rich repeat kinase 2 gene (LRRK2), a risk variant for the development of PD in East Asians, is associated with cognitive dysfunction in PD. We recruited 299 PD patients, consisting of 23 carriers and 276 non-carriers of LRRK2 G2385R, from 14 centers. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). PD with cognitive dysfunction was defined as an MMSE Z score that, adjusting for age at study entry and years of education, was below -1.0 standard deviations. In multivariate analysis, PD duration, age at study entry and depression were significant risk factors for cognitive dysfunction as assessed by MMSE performance or the MoCA. In linear regression analysis of the association between MMSE Z scores and PD duration, there was no significant difference associated with the LRRK2 G2385R genotype. The interaction terms between PD duration and the LRRK2 G2385R genotype were not significant for the MMSE Z score but were significant for the MoCA. In conclusion, the LRRK2 G2385R genotype may not be associated with cognitive dysfunction in PD.

Cryolipolysis treatment is a non-invasive option for localized fat reduction without damaging the surrounding tissue. Clinical studies about cryolipolysis show various side effects, including temporary erythema, bruising, and transient numbness. But, no reports are available on motor nerve malfunction after cryolipolysis. A 24-year-old female received cryolipolysis treatment on abdomen, both arms. After 10 days, patient complained of weakness and inability to lift heavy objects. Symptoms continued for 6 months, and fully recovered without treatment. Thus, we report a case of motor neuropathy after cryolipolysis, which is a rare complication of cryolipolysis.

Objective Perverted downbeat head-shaking nystagmus (pdHSN) has been considered a sign of central pathology. Two hypotheses have been advanced as the mechanisms of pdHSN without proper validation. This study aimed to elucidate the mechanism of pdHSN. Methods Eighteen patients with pdHSN due to central lesions were subjected to analyses of their oculographic characteristics. The peak velocity, temporal features including the duration and time constant (TC), rotational axis of pdHSN were analyzed. To determine the most relevant mechanism of pdHSN, we compared the TCs of pdHSN with those of downbeat nystagmus after vertical head-shaking in four subjects, and with the TCs of horizontal head-shaking nystagmus (HSN) in three subjects who had both horizontal and downbeat nystagmus after head-shaking. Results The duration of pdHSN ranged from 14 to 25s and the estimated TC was from 3.9 to 7.8s. When the data were pooled after the intensities of the nystagmus in each patient were normalized, the TC was 5.2 (95% CI=5.0–5.4) seconds from nonlinear regression test. The rotational vectors of pdHSN ( n =8) were mostly aligned between the anterior semicircular canals. The estimated TC of downbeat nystagmus after vertical head-shaking (5.8s) was similar to that of pdHSN (6.0s) in four subjects tested. In contrast, the TC of horizontal HSN (10.9s) was significantly larger than that of pdHSN (4.9s) in three subjects. Conclusions The characteristics of TCs of HSN in our patients with central lesions suggest that pdHSN is due to enhanced activities of the central anterior canal pathway. Significance pdHSN is a sign indicative of central pathology causing cerebellar dysfunction, especially when it associated with other neuro-otological signs.

Background: Extrapyramidal signs (EPSs), which are important characteristics of Parkinson's disease (PD), occur frequently in Alzheimer's disease (AD). Although AD and PD share common clinical features such as EPSs, these diseases vary with respect to vascular risk factors. The presence of vascular risk factors increases the risk of AD; however, these factors have been known to be inversely associated with PD. We aimed to assess the effect of vascular risk factors and white matter lesions (WMLs) on EPSs in AD.Methods: We recruited 1,187 AD patients and 333 controls with neither cognitive impairment nor EPSs. All participants underwent detailed clinical evaluations which included assessments of vascular risk factors, cognitive function, and EPSs, as well as WMLs on brain MRIs. EPS subtypes were classified into tremor-dominant, postural instability gait difficulty, or indeterminate; WMLs subtypes were classified into periventricular WML (pvWML) or deep WML (dWML).Results: EPSs were present in 17.9% of subjects with AD and were significantly associated with vascular risk factors such as age, male gender, diabetes mellitus, and WMLs. Additionally, a multivariate logistic regression analysis showed that EPSs in AD were associated with pvWML (odds ratio (OR), 1.61–2.52), not with dWML. With respect to EPS subtypes, the majority (78.4%) of EPSs in AD were postural instability gait difficulty, which was also associated with WMLs (OR 1.84–2.41), pvWML (OR 2.09–3.14), and dWML (OR 1.83–3.42).Conclusions: EPSs in AD are associated with selected vascular risk factors as well as WMLs.

This study aims to develop a quantitative measure of bradykinesia which can be conveniently used during clinical finger taps test in patients with Parkinson’s disease. A miniature, light-weight gyrosensor free from gravitational artifact was used for measurement of finger taps in order to impose minimal constraint on patients. Forty Parkinson’s disease patients and 14 age-matched control subjects participated in the experiments. Subjects’ finger taps in both right and left hands were scored by two independent neurologists according to the unified Parkinson’s disease rating scale and were also measured by a gyrosensor. Four performance indices were derived from the gyrosensor signal of the index finger. All indices showed significant differences between control and patients (P

Most cardinal motor signs in Parkinson’s disease (PD) are more pronounced on one side than on the other. Unusually, one type of cardinal motor sign is found on one side while other motor signs are more pronounced on the contralateral side, the so-called dissociation of motor signs. The aims of this study were to determine the frequency of motor sign dissociation and to study the clinical characteristics of the dissociation group. To this end, clinical characteristics including the Unified Parkinson’s Disease Rating Scale, Mini-Mental State Examination, Non-Motor Symptom Questionnaire and Frontal Lobe Assessment Battery were analyzed for 411 patients during consecutive follow-up visits. Dissociation was noted in 29 (7.06%) of the 411 patients. Dissociation of tremor and rigidity-bradykinesia was the most common type of dissociation pattern (17/29). There were no significant differences in demographic factors and clinical profiles between the dissociation and control groups. We suspect that each cardinal motor sign is pathogenetically different. The presence of dissociation did not affect the natural history of PD.

Sensory tricks are clinical maneuvers that may partially relieve dystonic contractions. Any clinical maneuver that modulates afferent sensory and efferent motor pathways could be used as a sensory trick in patients with cervical dystonia. Although various sensory tricks have been described to reduce cervical dystonia, little is known about the exact mechanisms by which they operate. We report a case of cervical dystonia that was alleviated through the use of a visual-sensory trick. Our findings suggest that visual stimulation might be an effective sensory trick in cervical dystonia by compensating for a defective sensory system, or because visual pathways might be also affected by sensory interactions in cervical dystonia.

We investigated whether baseline plasma free fatty acid (FFA) concentration is associated with any (ischemic/hemorrhagic) stroke, ischemic stroke/systemic embolism (ISSE), or ischemic stroke among stroke survivors with atrial fibrillation (A-fib). Moreover, we compared the outcome predictability of FFA with previously adopted models, including the CHADS2 and CHA2 DS2 -VASc scoring systems.We analyzed data from 279 stroke patients with A-fib and investigated the association between plasma FFA concentration and outcomes using Cox regression models with competing risk analyses.Median follow-up period was 17.5 months. During the study period, any stroke, ISSE, and ischemic stroke occurred in 22, 21, and 17 patients, respectively. The cumulative risk for any stroke, ISSE, and ischemic stroke were 5.1%, 4.7%, and 4.2% at the end of the first year and 14.8%, 12.1%, and 10.8% at the end of the third year, respectively. After adjusting covariates (model 1), baseline FFA concentration was associated with recurrence of any stroke (hazard ratio [HR] = 1.774, 95% confidence interval [CI] = 1.124-2.801, per 1mEq/l increment of FFA). FFA showed a trend association with ISSE (HR = 1.569, 95% CI = 0.950-2.592) and ischemic stroke (HR = 1.630, 95% CI = 0.967-2.746). In adjusted models including CHADS2 or CHA2 DS2 -VASc score as a covariate, (models 2 and 3) FFA was still shown to be an independent predictor of any stroke and ischemic stroke. There was a significant or trend association between FFA and ISSE.FFA may be a potential biomarker that predicts outcome events in stroke with A-fib along with the CHADS2 and CHA2 DS2 -VASc scoring systems.

Alzheimer's disease (AD) is the single most common cause of primary dementia. Language-based frontotemporal dementia, another type of primary dementia, is known as primary progressive aphasia (PPA). Although the cardinal feature of AD is a progressive loss of memory, many patients with AD also present with language impairment. Moreover AD and PPA have partially shared pathophysiology. Recently, it was suggested that a history of vasectomy might be a risk factor for PPA, by immune responses to sperm or antisperm antibody (ASA), which has long been known to have antigenic property. As ASAs could develop naturally in both men and women, we studied the relation between the presence of ASAs and cognitive function in AD. A total of 86 elderly were selected (46 patient with AD, 20 with mild cognitive impairment, and 20 without cognitive dysfunction) and were assessed for the presence of ASAs with neuropsychological evaluation. However, there were no significant differences in the distribution of ASAs according to cognitive status or language function status. Thus, the current study does not support the association between the immune responses and language dysfunction in AD.

The significant association between heart rate variability (HRV) and the outcomes of stroke has led to a particular interest in alterations of HRV in stroke patients. To date, several clinical variables have been associated with alterations of HRV in stroke patients. The present study adds the new information that carotid atherosclerosis may affect HRV alterations in stroke patients.

A 54-year-old man experienced sudden onset of severe headache 3 days prior to admission. Evidence of infection or trauma was absent. Brain MRI revealed a mass-like lesion with rim enhancement and surrounding edema in the right sylvian fissure (figure, A–C). A 0.7-cm aneurysm at the right middle cerebral artery bifurcation was revealed through additional magnetic resonance angiography (figure, D) and aneurysm rupture was confirmed under microscopy during emergent surgery. Rim enhancement could be related to the presence of vasa vasorum in the aneurysm wall or neovascularization in granulation tissue within the intraluminal thrombus.1 A round lesion with rim enhancement may be an atypical imaging feature of cerebral aneurysm.

A 44-year-old man developed sudden non-fluent aphasia and right hemiplegia due to left striatocapsular infarction (Figure). Neurologic examination revealed gaze deviation to the right with eyes closed, but not with eyes open (Video). There was no spontaneous or gaze-evoked nystagmus, even after elimination of visual fixation. Leftward pursuit was impaired in a craniotopic frame of reference, and horizontal saccades were hypometric in both directions. Head impulse test was normal in the horizontal plane and there were no visual field defects. The contralesional gaze deviation with eye closure persisted for ten days.

A 29-year-old man presented with unilateral dull headache for 3 days, similar to previous headache, but with right hemiparesis; there was no antecedent infection or trauma. MRI showed left striatocapsular infarction (figure 1A), without evidence of cardioembolism or vasculitis. Digital subtraction angiography demonstrated stenosis of the left middle cerebral artery (MCA) trunk (figure 1B). Intramural hematoma suggests arterial dissection.1 The bulging intramural hematoma seen on T2* corresponded with an eccentric high signal rim on sagittal T1-weighted imaging, along the anterosuperior MCA wall at the arterial perforator origin (figure 2). The diagnosis was spontaneous MCA dissection.

Background:Postural instability is one of the most disabling features of Parkinson's disease, usually occurring in late and advanced stages. The aim of this study was to investigate the postural performance of early-stage de novo Parkinson's disease patients with no clinical postural instability using computerized dynamic posturography. We sought to understand the relationship between postural sway and disease severity and the relationship between postural instability quantitatively measured by computerized dynamic posturography and cognitive impairment in early-stage Parkinson's disease patients.Method:Thirty-one subjects with Parkinson's disease and 20 healthy controls were assessed by the computerized dynamic posturography protocol using the sensory organization test and the motor control test. A neuropsychological assessment was also administered.Results:The mean equilibrium score for sensory organization test and the vestibular input ratio were significantly correlated with Hoehn-Yahr stage. No associations between motor latency for any motor control test condition and Hoehn-Yahr stage were found. The equilibrium score for sensory organization test correlated with the mini-mental status examination scores. There was a significant correlation between motor latency for large backward translation and mini-mental status examination scores. There were significant correlations between visual perception/construction/ memory of the neuropsychological battery test and the equilibrium score for sensory organization test and between verbal word learning test, controlled word association test and motor latency for large backward translation.Conclusion:These findings showed the postural instability present in early-stage (Hoehn-Yahr stage 2-2.5) Parkinson's disease. We also found a close relationship between postural instability and cognitive function in Parkinson's disease patients.

Background: There is still debate over the utility of carotid intima-media thickness (C-IMT) or carotid plaque in predicting future cardiovascular events and death. Additionally, the importance of plasma homocysteine levels was raised as a predictor of cardiovascular events and death. Methods: 1,391 subjects were recruited from the Ansan Geriatric cohort. We used B-mode carotid ultrasonography to assess C-IMT and plaque, measuring average maximal IMT and average mean IMT through 6-8 measurements of far-wall IMT in both common carotid arteries. We evaluated the presence of plaque in carotid segments. Multivariable Cox regression analysis was used to predict both cardiovascular and all-cause mortality. Results: During a mean follow-up of 62.4 ± 12.4 months, 71 subjects (5.12%) died and 23 (1.66%) died of cardiovascular causes. Multivariable Cox regression analysis found the predictors of cardiovascular mortality to be average maximal IMT (HR = 3.709; 95% CI: 1.202-11.446) and plasma homocysteine (HR = 1.057; 95% CI: 1.012-1.103). All-cause mortality was independently associated with C-IMT (average maximal and average mean IMT) and plasma homocysteine. Conclusions: C-IMT and plasma homocysteine levels were found to predict cardiovascular and all-cause mortality independently of the presence of carotid plaque and other cardiovascular risk factors.

Impulse control and repetitive behavior disorders (ICRBs) are a group of diseases including impulse control disorder (ICD), repetitive behavior disorder (RB), and dopamine dysregulation syndrome (DDS). This study determined the prevalence and associated characteristics of ICRBs in Parkinson's disease (PD) patients. Included were 297 patients, interviewed with the questionnaire for impulsive-compulsive disorders in PD for screening of various ICRBs. Questionnaire results and clinical characteristics were analyzed. The ICRB prevalence among PD patients was 15.5 % (46 of 297), with 35 patients with ICD, 20 with RB, and 7 with DDS. Patients with ICRB were predominantly male, younger, taking higher doses of dopaminergic drugs, and had longer disease duration, worse Unified Parkinson's Disease Rating Scale (UPDRS) motor score, and worse PD quality of life questionnaire score. However, each ICRB subtype had different risk factor profiles. ICD patients were predominantly male, younger, had longer disease duration, were affected by PD from young age, were taking higher total dopaminergic drug dosages, and had more RB. RB patients had higher UPDRS part III scores, were taking higher levodopa doses, and had higher comorbid ICD. DDS patients were taking higher dopamine agonist doses, and had more frequent ICD. In multivariate logistic regression for secondary analysis, only younger age and comorbid RB or DDS showed significant association with ICD and only poor UPDRS III score and comorbid ICD were significantly associated with RB. These findings suggested that different risk factors contribute to development of each ICRB subtype. ICRB could be a combination of heterogeneous disease entities that need to be treated separately.

Joubert syndrome is a rare genetic disorder of childhood that is characterized by hypoplasia or agenesis of the cerebellar vermis in addition to brainstem malformations. Ataxia, hypotonia, developmental delay, and apnea-hyperpnea are the most prominent clinical symptoms of Joubert syndrome, but this condition can also affect multiple organs, making the clinical phenomenology of Joubert syndrome quite diverse. Seizures are the most common neurological complications of Joubert syndrome, but its neurological sequelae are poorly described because Joubert syndrome is very rare. Here we report an acute ischemic stroke in a 21-year-old woman with Joubert syndrome who had no conventional risk factors for early onset cerebrovascular disease. To date, this is the first report of an ischemic stroke in a patient with Joubert syndrome, and we believe this case may suggest an association between Joubert syndrome and extremely early onset cerebrovascular disease.