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The symptoms and signs of Sandifer's syndrome are described, especially the abnormal movements, which can wrongly be diagnosed as some form of dystonia. They affect head, neck and chest, and are often accompanied by abnormal postures. The syndrome, may or may not, be associated with hiatus hernia, and gastro-intestinal symptoms are common. Neurologically impaired children are especially at risk, and can present particular difficulties in diagnosis. Barium swallow can confirm the diagnosis, and also help to establish the cause. The possible reasons for the syndrome are considered, relief of abdominal discomfort being most plausible. Treatment can result in dramatic improvement, although sometimes surgery is needed.

Sleep disorders are a prevalent group of diseases. In addition to the sleep-related symptoms that appear in many other diseases, proper sleep-disorders are frequent and often relevant. The International Classification of 2014, ICSD-3, distinguishes Insomnia, Hypersomnia, Parasomnias, Circadian Rhythm Disorders, abnormal movements during the sleep, respiratory disorders and a group of other disorders.

Dystonia is characterized by sustained or intermittent muscle contractions leading to abnormal movements and impairment in daily activities. Stereotactic dentatotomy has been a treatment option in cases of spasticity or dystonia, especially in patients with cerebral palsy, but the long-term effect of dentatotomy in dystonia is still unknown. Here we describe a dystonic patient who underwent dentatotomy for symptomatic treatment of refractory dystonia and whose 20-year follow-up showed improvement in symptoms.

Background: Lafora disease is a rare progressive myoclonus epilepsy with an autosomal recessive inheritance characterized by seizures, myoclonus and progressive cognitive decline. Case characteristics: An 11 year old boy presented with complaints of aggressive behavior, abnormal movements and declining intellectual function and was earlier treated as a case of attention deficit hyperactivity disorder. The child was subjected to Axillary skin biopsy as a part of evaluation and diagnosed as a case of Lafora body disease. parental counselling done and the child was discharged on symptomatic treatment. Message: Lafora body disease should be kept in mind while evaluating a child with neuropsychiatric manifestations.

Background Diaphragmatic myoclonus is a rare disorder of repetitive diaphragmatic contractions, acknowledged to be a spectrum that includes psychogenic features. Electromyography has been the diagnostic tool most commonly used in the literature. Methods To test whether we could perform a noninvasive technique to delineate the diaphragm as the source of abnormal movements and demonstrate distractibility and entrainability, we used B-mode ultrasound in a patient with diaphragmatic myoclonus. Results Ultrasound imaging clearly delineated the diaphragm as the source of her abdominal movements. We were able to demonstrate entrainability of the diaphragm to hand tapping to a prescribed rhythm set by the examiner. Conclusions We recommend the use of ultrasound as a noninvasive, convenient diagnostic tool for further studies of diaphragmatic myoclonus. We agree with previous findings that diaphragmatic myoclonus may be a functional movement disorder, as evidenced by distractibility and entrainability demonstrated on real-time video with ultrasonography.

Focal hand dystonia (FHD) in musicians is a movement disorder causing abnormal movements and irregularities in playing. Since weak electrical currents applied to the brain induce persistent excitability changes in humans, cathodal tDCS was proposed as a possible non-invasive approach for modulating cortical excitability in patients with FHD. However, the optimal targets and modalities have still to be determined. In this pilot study, we delivered cathodal (2 mA), anodal (2 mA) and sham tDCS over the motor areas bilaterally for 20 min daily for five consecutive days in two musicians with FHD. After cathodal tDCS, both patients reported a sensation of general wellness and improved symptoms of FHD. In conclusion, our pilot results suggest that cathodal tDCS delivered bilaterally over motor-premotor (M-PM) cortex for 5 consecutive days may be effective in improving symptoms in FHD.

A theory of action control (General Tau Theory) is applied to analyzing normal and abnormal movements in PD; and to designing and testing the efficacy of a sonic aid for PD. A central aspect of the theory, which is supported by experimental evidence across a variety of actions and species, is that the trajectories of competent skilled actions follow a particular temporal pattern, which is described by the mathematical function, tauG. Since tauG-control of actions can be largely deficient in PD, we designed a device that generates whoop-like sounds, where the fundamental frequency of the sound follows the tauG pattern. Our hypothesis was that by listening to these sounds the nervous system of someone with PD might be helped subsequently to self-generate tauG patterns in their nervous system, which might facilitate movement control in different situations. Five adults with PD, and five age-matched controls, took part in the study. They each listened to the sounds under two conditions: (a) experimental - turning a handle for 5 minutes while the sounds were played (b) control - turning the handle without the sounds. Before and after each condition, the tauG-control of lateral body sway while standing was measured (without the sounds playing), using force-plates, on two tasks: (i) keeping the feet down, (ii) lifting the trailing foot. The number of participants out of five, who showed greater ratio improvement following practice with whoop sounds compared to without sounds, was, on each task, high for the PDs compared with the age-matched controls (4 vs 2 or 3). Thus, for the PDs, listening to the tauG whoop-like sounds while performing one action (handle turning) improved subsequent tauG-control on a different task (body-swaying).

Dystonia is a movement disorder that is characterized by involuntary muscle contractions, abnormal movements and postures, as well as by non-motor symptoms, and is due to abnormalities in different brain areas. In this article, we focus on the growing number of experimental studies aimed at explaining the pathophysiological role of the cerebellum in dystonia. Lastly, we highlight gaps in current knowledge and issues that future research studies should focus on as well as some of the potential applications of this research avenue. Clarifying the pathophysiological role of cerebellum in dystonia is an important concern given the increasing availability of invasive and non-invasive stimulation techniques and their potential therapeutic role in this condition.

A 22-year-old man came to our clinic with abnormal movements. Five years earlier, he was admitted to the intensive care unit in a coma due to methanol intoxication after drinking significant amount of home-made liquor. He was discharged 4 months later with binocular blindness, slowing of movements and abnormal limb postures. Treatment …

DYT1 is a debilitating movement disorder caused by loss-of-function mutations in torsinA. How these mutations cause dystonia remains unknown. Mouse models which have embryonically targeted torsinA have failed to recapitulate the dystonia seen in patients, possibly due to differential developmental compensation between rodents and humans. To address this issue, torsinA was acutely knocked down in select brain regions of adult mice using shRNAs. TorsinA knockdown in the cerebellum, but not in the basal ganglia, was sufficient to induce dystonia. In agreement with a potential developmental compensation for loss of torsinA in rodents, torsinA knockdown in the immature cerebellum failed to produce dystonia. Abnormal motor symptoms in knockdown animals were associated with irregular cerebellar output caused by changes in the intrinsic activity of both Purkinje cells and neurons of the deep cerebellar nuclei. These data identify the cerebellum as the main site of dysfunction in DYT1, and offer new therapeutic targets. DOI: http://dx.doi.org/10.7554/eLife.22775.001, eLife digest Dystonia is the third most common type of movement disorder after Parkinson’s disease and tremor. Patients with dystonia experience prolonged involuntary contractions of their muscles, often causing uncontrollable postures or repetitive movements. Almost thirty years ago, genetic studies revealed that a mutation in the gene that encodes a protein called torsinA causes the most common type of dystonia, called DYT1. Exactly how mutations that affect the torsinA protein give rise to DYT1 remains unclear, and there are still no effective treatments for the disorder. Part of the problem is that we do not fully understand how torsinA works, or which of its many proposed functions is relevant to dystonia. Moreover, attempts to study DYT1 using genetically modified mice have proved largely unsuccessful. This is because mice that simply express the same genetic mutations that cause dystonia in humans do not show the overt symptoms of dystonia. Fremont, Tewari et al. have now generated a mouse ‘model’ that does show symptoms of dystonia, and used these model mice to investigate the role of torsinA in the disorder. Acutely reducing the amount of torsinA protein in a region of the brain called the cerebellum induced the symptoms of dystonia in the mice. Conversely, reducing the amount of torsinA in a different brain area known as the basal ganglia had no such effect, even though both the cerebellum and the basal ganglia contribute to movement. Furthermore, neither manipulation had any effect in juvenile mice, which suggests that, in contrast to humans, young mice can compensate for the loss of torsinA. Fremont, Tewari et al. also found that the loss of torsinA causes the cerebellum to generate incorrect output signals, which in turn trigger the abnormal movements seen in dystonia. In the future, further studies of the model mice could identify the exact changes that occur in neurons following the loss of torsinA from the cerebellum. Understanding these changes could potentially pave the way for developing effective treatments for DYT1 and other dystonias. DOI: http://dx.doi.org/10.7554/eLife.22775.002

The role of autoimmune etiologies in the genesis of epilepsy and encephalitis has been recently discovered. Historically, infectious and to a lesser degree metabolic etiologies have also been implicated in convulsive and nonconvulsive seizures (NCS) and status epilepticus (SE). With the recent advances in and recommendations for continuous EEG (cEEG) monitoring, NCS and nonconvulsive SE (NCSE) are being increasingly detected in these conditions. It is imperative to diagnose abnormal movements that are associated with such disease states and to differentiate between epileptic and nonepileptic events. Hence, cEEG monitoring serves a vital role in spell characterization and identification of seizures and SE.

This dissertation describes an 18-year study of patients with severe mental illnesses (SMI) conducted in Curacao. Medicine use is common among this group, and the prevalence of movement disorders, for example tremor (trembling), slowness and abnormal movements of the face, is 80%. These disorders are associated with shame and non-compliance with medication regimens. The study results show that switching from one antipsychotic drug to another does not reduce the prevalence of movement disorders, and that tremor responds well to treatment. Based on these results, the guideline for schizophrenia should be adjusted. Patients with SMI differ from less severely ill patients in various ways. Researchers advocate a separate guideline for patients with SMI in order to improve their quality of life.

This chapter provides an efficient method for office-based assessment of some of the most commonly encountered neurological disorders in the elderly, including memory difficulties, neck and back pain, sensory changes, motor weakness, headache, abnormal movements and gait impairment. Clinical strategies while collecting a history and performing a neurological exam as an additional important tool in narrowing the differential diagnosis with localization of the potential etiology are addressed in this chapter. Finally, a clinically-guided supplementary testing approach related to the neurological chief complaint with a cost effective and confirmatory diagnostic purpose is also discussed.

Case “A” was referred to our clinic and was seen by two authors (RR and MMR) first at the age of 6 years. His parents, Mr and Mrs X, described a history of abnormal movements since the age of 3 years; these included blinking and strange head movements.

Huntington’s disease (HD) is an autosomal dominant, hyperkinetic movement disorder, and progressive neurodegenerative disorder characterized by choreiform abnormal movements, cognitive deficits, psychiatric manifestations, emotional disturbances, and dementia associated with progressive striatal atrophy. The disorder was first described in 1872 by Dr. George Huntington in his article titled “On Chorea.” Dr. Huntington entitled the disease “Hereditary Chorea,” whereas observations of some cases which do not present with chorea later led to the acceptance of the “Huntington’s Disease” label. The HD gene (IT15) is sited on the short arm of chromosome 4, and the normal number of CAG (glutamine) repeats is expanded (generally >40). Genetic mutation in HD gene results in an expanded polyglutamine stretch in the NH2 terminus of huntingtin protein (HTT).

The cause and treatment of functional movement disorders and nonepileptic spells in children is poorly understood, and an association with migraine has not previously been reported. We retrospectively reviewed children diagnosed with chronic or episodic migraine at our institution from 2006 to 2013 to determine the proportion with nonorganic movement disorders, their phenomenology, provoking factors, and natural history. Thirty-two patients were identified, representing 4.3% of patients with chronic migraine and 0.9% of patients with episodic migraine. Twenty-four of the 32 (75%) had chronic migraine, whereas 8 (25%) had episodic migraine. Nonepileptic spells was the most common phenomenon in both cohorts, followed by tremor and functional gait disorders. Severe migraine attacks preceded these movements in the majority of patients. With appropriate migraine therapy, significant reduction or resolution of these movements was reported. We conclude that nonorganic movement disorders are observed in pediatric migraine, are more prevalent among chronic migraineurs, and can resolve with improved pain control.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis was first described in young women with ovarian teratoma. Typical presentations include subacute onset of neuropsychiatric symptoms, seizures, altered awareness, movement disorders, and autonomic dysfunction. Growing evidence indicates that anti-NMDAR encephalitis is one of the most common causes of encephalitis in children and young adults. We present a case of a 2 year-old boy with anti-NMDAR encephalitis to illustrate and discuss the differences in neurological presentation, frequency of symptoms, and association with underlying tumor between children and adults.

Objective: To evaluate the effect of wireless biofeedback therapy on bruxism. Methods: Fifteen bruxiers participated to be treated by this therapy. The abnormal movements of teeth during sleep were monitored by a maxillary splint with an electric resistance strain gauge. Meanwhile, the receiver device recorded these details and analyzed the data, including the value of the biting force, occurring time and duration. If the value of biting force or duration exceeds the threshold, a vibrating device like a watch style will alert the patient to relax the masticatory muscles and nervous system to stop the abnormal grinding or clenching. Data were recorded during 8 hours’ sleep and analyzed after the 12 weeks’ treatment and 24 weeks’ treatment. Results: The average episodes of bruxism have declined from (10.60 ± 1.23) to (6.60 ± 0.75) after 12 weeks’ treatment (p p treatment, and the average duration of bruxism events was reduced to (3.37 ± 0.34) s (p

Introduction Local field potential (LFP) recordings from implanted deep brain stimulator (DBS) leads can provide insight into the pathogenesis of the Parkinson’s disease (PD) specifically by looking at some of the local network properties at the location of the electrode. We recorded LFP activity from DBE leads implanted in the subthalamic nucleus (STN) and performed subsequent data analysis on PD patients undergoing DBS surgery in the off state both at rest and during continuous movement of the contralateral hand in order to identify any reproducible pathophysiological signatures of the disease. Methods LFPs were recorded in 8 patients with PD who underwent bilateral DBS lead implantation within the STN. Following DBS lead placement, bipolar (0–1, 1–2, 2–3) recordings were performed for 2 min at rest and another 2 min with contralateral repetitive hand grasp movements. All recordings were performed in the off state with at least 12 h of since their last medication and prior to macrostimulation testing in the nucleus. The raw LFP recordings were transformed to the frequency domain via the fast fourier transform and then a power spectral was generated from that data with a frequency resolution of 1.3 Hz. Beta-band spectral peaks were located and compared between the two testing states. Results In all patients, predominance of both low and high beta band frequencies (13–20 and 20–35 Hz respectively) were observed both at rest and during movement at the DBS contact where stimulation was deemed to be most therapeutic. Paradoxically, stronger beta peak energy was noted during movement as opposed to the rest state in all patients. Conclusion In patients with PD, excess beta band coupling that paradoxically synchronizes with movement may be a signature of the off state. This excess beta band activity appears to also correlate with the most active DBS lead contact. This increase in energy, or synchronization, during the movement phase is in contrast to what happens in the cortex during similar EEG analysis. This increase in the abnormal beta energy, in PD patients, may help explain the abnormal movements, such as rigidity and bradykinesia, seen in these patients. Further investigations may to help to identify and provide stimulation in situations where excess beta band activity is prevalent at the active contact.

Opsoclonus myoclonus ataxia syndrome (OMAS) is a rare neurological disorder predominantly affecting young children and causing severe neurological disability. Its early identification and treatment is advocated. Here we report a two year old child presenting with abnormal movements and subsequently developed features of OMAS and responding favourably to Adrenocorticotropic hormone (ACTH).J Nepal Paediatr Soc 2015;35(1):70-72

Abnormal movements including tremor and myoclonus have been described in patients with vitamin B12 deficiency before or upon initiation of treatment with vitamin B12. We report here a case of vitamin B12 deficiency in an infant who presented first with chaotic rotatory eye movements (myoclonus) followed by the appearance of tremors in the tongue, palate, upper and lower limbs. All the abnormal movements disappeared spontaneously within a period of six weeks. To our knowledge, this is the first report of vitamin B12 deficiency presenting with myoclonus in the eyes.

Anti-N-methyl-D-aspartate (NMDA) receptor antibody encephalitis is an autoimmune antibody encephalitis with psychiatric symptoms, memory disturbances, seizures and abnormal movements. It is more common in young women. We report a young man diagnosed as anti-NMDA receptor antibody encephalitis and presenting with confusion due to non-convulsive status epilepticus involving unilateral hemisphere.

Gilles de la Tourette's syndrome is an uncommon illness associated with repetitive un-voluntary abnormal movements and utterance. It is often associated with other psychiatric morbidities. Management requires awareness of this uncommon illness, keen observation, relevant evaluation, and combination of pharmacology and psychotherapy for an optimal outcome. This case is brought out here for florid presentation and nuances of management.

Introduction A sudden loss of consciousness followed by abnormal movements can be ictal or syncopal in origin. Transient response by the brain to sudden decrease of blood flow may cause sudden loss of consciousness followed by abnormal movements that mimic seizure. Dysrhythmia is one of the important and critical reasons of such events that should be differentiated from seizure. Case Presentation In this case report we describe a 55 year-old woman admitted to our emergency department first with the impression of seizure. Eventually, it was realized that she had suffered from brain hypo-perfusion secondary to hypokalemia induced arrhythmia. Her arrhythmia was managed by unsynchronized biphasic shock in acute phase and also potassium replacement. She was then admitted to the CCU (Coronary Care Unit) where she received further care for medical management and drug dose adjustment and was discharged 4 days later. Conclusions Syncope from arrhythmia most commonly results from ventricular tachycardia, which accounts for 11% of all cases of syncope. Torsades de point is a unique type of ventricular tachycardia, characterized by QRS complexes of changing amplitude proceeded by prolonged QT intervals and almost often followed by loss of consciousness and also seizure like movements. Prolonged QT interval which is an important provocative factor for torsades de point commonly results from interactions between drug therapy, myocardial ischemia, and electrolyte disturbances such as hypokalemia or hypomagnesaemia. Changes in the extracellular potassium level have predominant and profound influences on the function of the cardiovascular system that may provoke fatal demonstrations such as QT prolongation, ventricular arrhythmia and even cardiac arrest. Electrolyte assessment is particularly important in certain patient populations, such as the elderly in whom a variety of pathological states or conditions like dehydration or renal failure are more common. Early identification and correction of these disturbances are necessary to control either seizures or seizure-like movements and prevent permanent brain damage, as anticonvulsants alone are generally ineffective.

BackgroundLittle is known about conversion disorder in childhood.AimsTo document clinical incidence, features, management and 12-month outcome of non-transient conversion disorder in under 16-year-olds in the UK and Ireland.MethodSurveillance through the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System.ResultsIn total, 204 cases (age range 7-15 years) were reported, giving a 12-month incidence of 1.30/100 000 (95% CI 1.11-1.52). The most common symptoms were motor weakness and abnormal movements. Presentation with multiple symptoms was the norm. Antecedent stressors were reported for 80.8%, most commonly bullying in school. Most children required in-patient admission with frequent medical investigations. Follow-up at 12 months was available for 147 children, when all conversion disorder symptoms were reported as improved. Most families (91%) accepted a nonmedical explanation of the symptoms either fully or partially.ConclusionsChildhood conversion disorder represents an infrequent but significant clinical burden in the UK and Ireland.

Resume Les dyskinesies tardives (DT) sont des effets indesirables qui ont ete decrits initialement avec les neuroleptiques classiques. Ce travail a pour objectif d’etudier les caracteristiques des DT sous neuroleptiques classiques en Tunisie. Ce champ de recherche est actuellement peu etudie depuis l’innovation des antipsychotiques de seconde generation, cependant il demeure pertinent d’autant plus que l’on a decrit de plus en plus des DT sous antipsychotiques atypiques et que les neuroleptiques classiques sont encore souvent prescrits dans certains pays tels que la Tunisie. En effet, il semble que le risque de survenue de ces phenomenes serait similaire, independamment de la generation therapeutique incriminee [21] , [24] . Nous avons examine, en ambulatoire, un groupe de 157 sujets atteints de schizophrenie stabilises sur le plan psychiatrique, diagnostiquees selon les criteres du DSM-IV-R, traites par des neuroleptiques classiques, dans les services de psychiatrie generale de l’hopital militaire de Tunis et de l’hopital psychiatrique Razi de la Manouba, entre aout 2009 et fevrier 2010. La recherche de DT a ete effectuee selon les criteres du DSM-IV-R. L’âge moyen de l’echantillon etait de 37 ± 6 ans. Parmi les patients, 64,3 % etaient sous forme retard ; il s’agissait du fluphenazine decanoate dans 90 % des cas et de l’haloperidol decanoate dans 10 %. La duree moyenne de neuroleptisation etait de 7 ± 3 ans. La dose quotidienne moyenne en NLP etait de 572,9 ± 145,3 mg equivalent dose chlorpromazine. Au total, 74,5 % des patients etaient sous anti-cholinergiques, de type biperidene dans 96 % des cas. La prevalence des DT a ete estimee a 35 %. Le score Abnormal Involuntary Movement Scale (AIMS) moyen a ete estime a 17 ± 9. La repartition des patients en fonction de la gravite, du type et de l’etendue des DT a montre une predominance des DT moderees (52,7 %), choreiformes (78,4 %) et mixtes (58,7 %). La duree moyenne d’evolution des DT etait de 18 ± 6 mois. Nos resultats concordent avec des resultats epidemiologiques obtenus anterieurement en Tunisie et dans le monde. Cette etude pourrait constituer une base de donnees dans le domaine de recherche sur les DT sous antipsychotiques. L’amelioration du depistage de ces phenomenes moteurs ainsi que de leur traitement favoriserait la prise en charge globale du patient.

We report a case of Reactive Arthritis with Neuropsychiatric Syndrome in an adult associated with Group A beta haemolytic streptococcal infection 1 . "PANS" (Paediatric Acute Onset Neuropsychiatric Syndrome) is an immune mediated neuropsychiatric syndrome secondary to Group A beta haemolytic streptococcal infection which includes usually abrupt onset of obsessive-compulsive disorder, often pre-pubertal in onset, separation anxiety & abnormal movements during attack 2 . PANS is very common in children especially pre-pubertal age group. However the existence of neuropsychiatric syndrome as a post-streptococcal manifestation in adults is rare & long debated. There has been only one case report in the literature of post- streptococcal neuropsychiatric syndromes in adults 3,19 . We discuss the aspects of immune mediated post

Hyperkinetic movements, such as tremor, myoclonus, chorea, and dystonia, occur in many neurologic and medical conditions. Accurate clinical evaluation is the important first step for the proper diagnosis and treatment of patients with abnormal movements.

Vit B12 plays important role in different organ in our body, most importantly haematological system and central as well as peripheral nervous system. So its deficiency in children can cause poor weight gain, developmental regression, mental changes, abnormal movements, encephalopathy or may leads to longterm neurological sequelae. Early diagnosis and prompt treatment can alter the disease process. Here we present a case of severe vit B12 deficiency, who admitted with encephalopathy and successfully treated with a good neurological outcome almost towards normal.

Cerebral function monitoring is widely used in neonatal intensive care, but its potential role in assessment of older infants is scarcely reported. We reviewed the use of cerebral function monitoring on a general paediatric ward in a series of young infants admitted with abnormal movements. Review of the amplitude-integrated EEG obtained by cerebral function monitoring revealed electrographic seizures in four of seven infants monitored. We also surveyed general paediatric wards in hospitals in our region of the UK to ask about current use of cerebral function monitoring and local availability of formal electroencephalography services. Cerebral function monitoring was not being used in the 16 other paediatric departments surveyed, and there was very limited provision for obtaining a full-array electroencephalogram out-of-hours.With adequate training and education, it is feasible to undertake cerebral function monitoring on a general paediatric ward. Continuous cerebral function monitoring is a tool that has potential use for detecting clinical seizures and augmenting clinical neuro-observations of young children admitted to a general paediatric ward.• In intensive care settings, cerebral function monitoring (CFM) has long been used for the continuous bedside monitoring of brain function in critically ill neonates, children and adults. • Very few studies have looked at the use of CFM outside of the intensive care setting, and it is presently unclear if CFM is used in the general paediatric ward. What is new: • CFM is presently not widely used in the general paediatric setting. • With appropriate training and support, CFM can be successfully introduced to the general paediatric ward with the potential to enhance the clinical monitoring of young infants admitted with abnormal movements.

Primary torsion dystonia is a movement disorder characterised by sustained or intermittent involuntary muscle contractions causing abnormal movements, postures or both. In this study, 3 brothers affected by inherited primary dystonia 16 (DYT16) began an oral therapy with high-dose thiamine from November to December 2015. After 3 months, an important improvement of the motor symptoms was observed. Our results support the hypothesis that pathogenesis of the symptoms might be related to a dysfunction in mitochondrial oxidative phosphorylation due to a focal impairment of thiamine-dependent processes. Our results support some authors9 hypothesis that dystonia might have a mitochondrial aetiology.

Functional movement disorders (FMDs) encompass a broad range of abnormal movements (e.g., tremor, dystonia, myoclonus, and parkinsonism) that are clinically inconsistent with known neurologic diseases. Although they account for 16% of new referrals to neurology clinics,1 the pathophysiology of FMDs is poorly understood. In addition, FMDs represent a serious challenge for clinicians in terms of diagnosis and management. One of the key clinical features of FMDs is that the abnormal movements can be eliminated by distraction maneuvers.2 Susceptibility to distraction is typical of voluntary movements, and yet patients with FMDs report that the movements are not under their control. This discrepancy between behavioral findings and patient reports may indicate that the symptoms are feigned or that there is a disruption in the brain processes related to self-agency, the subjective sense of controlling one's actions. A behavioral analogue of self-agency may be alexithymia (impaired ability to read one's own emotional state), which is also found among those with FMDs.3

Unusual weather conditions, such as low level wind shear, downdraft and clear-air turbulence, are potential hazards for aviation operations. The current aviation unusual weather detection systems used around airports utilize several ground-based meteorological monitoring stations to observe the weather information. However, these systems, such as of the low level wind shear alert system (LLWAS), can only detect the unusual weather near the ground surface level. It is thus necessary to improve current aviation unusual weather detection systems. In this paper we propose using aircraft ADS-B Mode-S ES data to develop a vertical weather profile to augment the current aviation unusual weather detection system, and by doing so all aircrafts with ADS-B systems can serve as our weather sensors in the air, and thus a three-dimensional aviation unusual weather detection system can be established. As a result, the objective of this work is the evaluation of the correlation between the decoded ADS-B data and the unusual weather conditions. This paper first conducts the necessary transformations of the decoded ADS-B data to the weather parameters. After these transformations and adjustments of the parameters derived from ADS-B Mode-S ES data, their feasibilities for use with the unusual weather detection algorithms are analyzed. In addition, the abnormal movements of the aircraft observed from the decoded ADS-B data might be interpreted as possible turbulence. Therefore, the observed abnormal movements of aircraft are validated using the turbulence alert messages from pilot reports. Finally, the results of using a three-dimensional aviation unusual weather detection system prototype based on the ADS-B data are presented in this paper.

Spastic gait is classically link to a corticospinal syndrome related o upper motor neuron involvement from various causes (stroke, ultiple sclerosis, cerebral tumor, motor neuron disorders. . .). ocal dystonia is another cause of limb stiffness. Several condiions resulting in abnormal movements, postures, or spasm that ay resemble spastic gait or focal dystonia have been recognized including disorders of the central and peripheral nervous systems s well as non-neurological conditions). Here we report a case of Stiff Leg Syndrome (SLS) in which rigidty involved the right side, predominantly the lower extremity. nitial presentation mimicked spastic gait and this case illustrate he challenge in diagnosing isolated limb stiffness.

Objectives: Cerebral Palsy (CP) is a condition where non progressive disorders of posture caused by abnormal development of, or damage to, motor control centers of brain resulting in abnormal movements. Improving gross motor function in children with cerebral palsy has been a major aim of physical therapist. The purpose of this study is to find out the Effect of Cage Therapy using Advanced Spider Suit Compared to Traditional Physical Therapy on Gross Motor Function in Children with Cerebral Palsy. Materials and Methods: A comparative study was conducted to find out the effect of Cage Therapy using Advanced Spider Suit Compared to Traditional Physical Therapy on Gross Motor Function in Children with Cerebral Palsy. 10 children with cerebral palsy were selected for this intervention. Age group between 4-8 years With GMFCS level III-IV were selected for this study. In 10 children we have 2 Hypotonic, 2 hemiplegic and 6 Spastic diplegic kids. These subjects were equally distributed in each group. Intervention: Therapy lasted for 8 weeks (5 days a week and 2hrs/day). Group A - 5 subjects were subjected to Cage therapy using advanced spider suit. Group B – 5 subjects were subjected to traditional physical therapy. Gross Motor Function Measure was used to assess gross motor abilities of the subjects before and after intervention. Results: The result showed significant improvement with Cage therapy using advanced spider suit therapy than traditional physical therapy on Gross Motor Function Measure. Conclusions: The Cage Therapy using Advanced Spider Suit is more effective and beneficial therapy than Traditional Physical Therapy in improving Gross Motor Function in Children with Cerebral Palsy.

Animal-borne data loggers allow movement, associated behaviours, and energy expenditure in fish to be quantified without direct observations. As with any tagging, tags that are attached externally may adversely affect fish behaviour, swimming efficiency and survival. We report on free-swimming wild Atlantic cod (Gadus morhua) held in a large mesocosm that exhibited distinctly aberrant rotational swimming (scouring) when externally tagged with accelerometer data loggers. To quantify the phenomenon, the cod were tagged with two sizes of loggers (18 g and 6 g

Epilepsy most often begins in childhood and is therefore an important paediatric disorder. Seizures, which are abnormal movements or behaviour which result from abnormal electrical activity in the brain, are a symptom of epilepsy. Not all patients who appear to have seizures have epilepsy. Epilepsy is the group of disorders which are characterised by a tendency for recurrent seizures and are alternatively known as ‘seizure disorders’.

Involuntary abnormal movements have been reported after ischaemic and haemorrhagic stroke. Post stroke movement disorders can appear as acute or delayed sequel. At the moment, for many of these disorders the knowledge of pharmacological treatment is still inadequate. Dopaminergic and GABAergic systems may be mainly involved in post-stroke movement disorders. This article provides a review on drugs commonly used in post-stroke movement disorders, given that some post-stroke movement disorders have shown a partial benefit with pharmacological approach.

Psychogenic Movement Disorders (PMDs) are a subtype of conversion disorder, classified under somatoform disorders in the DSM. Diagnosis and treatment of PMDs are challenging for both neurologists and psychiatrists. Typical clinical characteristics of these disorders are acute onset, fast progression, movement patterns incongruent with organic movement disorders, distractibility, variability and simultaneous occurrence of various abnormal movements and dysfunctions. The diagnosis of PMDs should not be regarded as a diagnosis of exclusion and electrophysiology is not always helpful. The cause of PMDs is unknown and the underlying brain mechanisms remain uncertain. However, recent functional magnetic resonance imaging studies have demonstrated altered blood flow in conversion disorders that may reflect changes in synaptic activity. Involvement of allied health professionals and psychotherapy continue to be the mainstay of treatment.

Abnormal movements are infrequent presentations in acute stroke.1 However, 3 main presentations have been described as being specific to an acute stroke: limb-shaking, hemichorea-hemiballism, and unilateral asterixis.1 We report an abnormal movement that reminds us of a spontaneous limb withdrawal in 3 patients with hyperacute stroke and stroke worsening.

Sixty-five years ago, Richard Asher1 was the first to describe, in The Lancet , a pattern of self-harm characterized by fabricated histories, symptoms, and signs of illness. Asher named this condition Munchausen syndrome after the famous Baron Munchhausen, a literary character loosely based on the German nobleman Hieronymus Karl Friedrich Freiherr von Munchhausen, a model of a shameless but cunning liar toying with reality and exaggeration. Munchausen syndrome frequently involves movement disorders2 difficult to distinguish from organic disease. Here, we describe the novel constellation of a factitious disorder presenting as a supposedly genetically confirmed hereditary disease manifesting with abnormal movements. As genetic testing plays a rapidly increasing role in diagnostics in all areas of medicine including rare and unusual conditions3,4 and is typically considered gold standard without further scrutiny, it is important to alert physicians to the possibility of manipulation of genetic testing reports by the patient in the context of somatoform disorders.

Within many clinical settings, healthcare assistants (HCAs) and assistant practitioners (APs) encounter patients who present with movement patterns that may deviate from what are considered to be normal fluid movements. Abnormal movements may occur at rest, during an activity, or be present all the time. This article describes how movement is controlled, why abnormal movement patterns emerge and how HCAs and APs can help patients.

異常運動（abnormal movement：AM）が頻発するものの、背景脳波活動が著しく抑制され、てんかん性脳波異常を認めない重症心身障害児（重症児）の1例を対象に24時間ビデオ脈拍数（pulse rate：PR）記録を行った。頻脈とPR較差から求めたPR増加区間のビデオを観察し、AMの内容や頻度を分析した。3回のビデオPR記録を分析して、抗てんかん剤（antiepileptic drugs；AED）（（ゾニサミド（ZNS）クロバザム（CLB））の効果判定を行った。ZNSとCLBの投与により、上肢伸展や泣きなどが減少もしくは消失したことから、これらのAMがてんかんであると診断した。てんかん性脳波異常を認めない重症児のAMでは、抗てんかん剤による治療的診断の適応となることも少なくない。適切なAMの評価が必要であり、ビデオPR記録は有用と考える。