BOTULINUM TOXIN: RESEARCH ISSUES ARISING FROM PRACTICE
|
|
- Samson Carter
- 6 years ago
- Views:
Transcription
1 % of baseline CMAP Botulinum toxin: mechanism of action BOTULINUM TOXIN: RESEARCH ISSUES ARISING FROM PRACTICE Clinical benefits of botulinum toxin (BT) injections depend primarily on the toxin's peripheral action General assumption is that effects of BT remain localized to the injection site Degree of muscle paralysis depends on BT dosage Maja Kojović The time course of the effects of intramuscular BT-serial EMG CMAP amplitude The amplitude CMAP in the injected EDB starts to decline 48 hours after the injection This decline peaks between days 7 and 21. Recovery in 90 or more days Greater the dosage of BT greater the paralysis of the muscle However observations from clinical practice BT peripheral action depends also on the state of the injected muscle-bt is preferentially uptaken by the most active muscle fibers( autofocusing ) Remote effects in the non-injected muscles Clinical benefit may be out of proportion of BT induced weakness No or loss of clinical benefit despite Long-term effect of BT CENTRAL ACTION OF BT? Hamjian and Walker, 1994 Possible mechanisms for central action of BT 1. Reduction of Ia afferent input Changes in reciprocal inhibition Changes in excitability and sensorimotor integration at cortical level 2. Retrograde transport to the spinal cord and transcytosis to other neurons 3.Changes in gene expression in α motoneuron 4. Hematogeneous spread (unlikely) From Caleo M. et al state of the injected muscle Animal experiments suggest that the toxin is preferentially taken up by the most active muscle fibers- autofocusing (Hughes and Whaler, 1962) In hemifacial spasm, injections of BT to OO muscle: moderate muscle paralysis, but complete loss of ephatic response ( Glocker, 1995 ) preferential uptake of BT by hyperactive synapses involved in ephaptic transmission Injection of BT in both EDB : the effect of the induced neuromuscular blockade was greater on the side that received peripheral nerve stimulation (Eleopra, 1997) 1
2 active inactive state of the injected muscle-dystonia state of the injected muscle-spasticity Nerve stimulation improve BT effect in spastic paraparesis ( Frasson, 2005) However Electrical activation of OO does not improve effectiveness of BT in blepharospasm ( Conte, 2010)- celling effect? Increased efficacy of BT after active and passive muscle activity in animal experiments (Minamoto, 2007) Remote effects in the non-injected muscles When BT was injected to one side in patients with blepharospasm ( Girlada, 1996) Clinical benefit was bilateral CMAP and SFEMG changes were present on both sides Clinical benefit out of proportion of weakness- central effect of BT Tonic vibration reflex All patients Patients with prolonged clinical benefit In adductor spasmodic dysphonia with unilateral thyroarytenoid muscle injections of BT-A ( Bielamowicz and Ludlow,2000) EMG bursts were reduced bilaterally (thus also in the non-injected muscles) Improvement in speech symptoms as a result of changes in a central pathophysiological mechanism? Trompetto,2006 Central effect of BT- effect on inhibition Loss of inhibition at different CNS levels: SPINAL CORD: Loss of Reciprocal inhibition (Nakashima, 1989) BRAINSTEM: Enhanced blink reflex recovery cycle (Berardelli, 1985) MOTOR CORTEX: Reduced intracortical inhibition (Ridding, 1995) Loss of inhibition at different CNS levels: SPINAL CORD: Loss of Reciprocal inhibition (Nakashima, 1989)- reversed by s ( Priori, 1995) BRAINSTEM: Enhanced blink reflex recovery cycle (Berardelli, 1985)- not affected by BT inj MOTOR CORTEX: Reduced intracortical inhibition (Ridding, 1995)- reversed by ( Gilio, 2000) Possible clinical manifestation of deficient inhibition: Co-contraction of antagonist muscles Non-selective activation of muscles Overflow of dystonia Mirror dystonia 2
3 APB MEP amplitude (mv) Central effect of BT- effect on intracortical inhibition ABNORMAL ( ENHANCED) CORTICAL PLASTICITY Healthy controls Dystonia before BT Dystonia 1 month after BT Dystonia 3 months after BT Patients with primary dystonia have enhanced response to different experimental plasticity protocols (Quartarone, 2003; Quartarone, 2008). Focal limb dystonia is typically triggered by a period of intensive training of a particular movement- a clinical feature that may link the role of maladaptive plasticity to development of dystonic symptoms In monkey, overtraining in specific hand movements trigger the symptoms that resemble human dystonia (Byl, 1996). The idea is that overtraining itself triggers functional changes in sensory and motor cortices, leading to abnormal sensorimotor integration that somehow results in dystonic symptoms. Adapted from Gilio, 2000 Central effect of BT- effect on cortical plasticity as assesed by motor mapping studies with TMS The corticomotor representation of upper limb muscles in writer s cramp are distorted and displaced, but this can be temporarly reveresed following botulinum toxin injection (Byrnes, 1998) Reversible reorganisation of corticomotor representation of the hand in cervical dystonia (Thickbroom, 2003) Sensorimotor cortical plasticity as assesed by PAS protocol single pulse TMS Paired Associative Stimulation PAS TMS on the M1 APB ADM APB single pulse TMS ADM 1mV MEP sensory-nerve electrical stimulation on contralateral median nerve > 1mV MEP (Stefan, 2000) Sensorimotor cortical plasticity in dystonia, as assessed by PAS protocol Central effect of BT- effect on sensorimotor cortical plasticity in dystonia s reduce response to PAS in parallel with clinical improvementcontribution to clinical benefit? before 1 month after 3 months after In susceptible individuals an excessive tendency to form association between sensory input and motor output may lead to dystonia ( musician s dystonia, writer s cramp) before PAS 0 min 30 min 60 min before PAS 0 min 30 min 60 min before PAS 0 min 30 min 60 min ( Quartarone, 2003; Weise, 2006; Edwards 2006) Kojović,
4 weeks Central effect of BT- effect on sensorimotor cortical plasticity in dystonia Central effect of BT- effect on SSEPs in dystonia and spasticity The longer was the time elapsed since the last injections the more pronounced was the rpas response R 2 =0 p<0.01 Metodological implications when enrolling dystonia patients in future studies Cervical dystonia: reduction in the amplitude of P22/N30 precentral component after treatment with BT- in parallel with clinical improvement ( Kanowsky, 1998) changes in cortical excitability secondary to BT induced modulation of spindle afferent input But in writer s cramp : no changes in cortical SSEPs before and after BT treatment (Contarino, 2007) Spasticity: An improvement of cortical SEPs associated with reduction of spasticity in cerebral palsy (Park, 2002; Frascarelli, 2011) normalized rpas 200 response at 30 min 400 Kojović, 2011 Some patient with CD report return of symptoms at the time when injected muscles are still paralysed (Gelb, 1989) In some patients there is no clinical improvement despite EMG detected changes in muscle activity pattern after BT injections ( Gelb, 1991) Loss of clinical benefit in patients who were initially good responders Dystonia is an abnormality of central motor programs When the most active muscles are denervated by BT, mechanisms of abnormal central programming may engage previously inactive muscle into dystonic vicious cycle - motor (mal)adaptation This may explain the failure of surgery for torticollis ( rhizotomy, peripheral nerve section, muscle section) - abnormal head position eventually recurs ABNORMAL NECK POSTURE PRODUCED BY ACTIVITY OF DIFFERENT MUSCLES?? ADVANTAGE OF BT TREATMENT could be in preventing central motor adaptation due to its temporary paralysing effect Relevance of changing pattern of injection on repeated treatment sessions? Combination of s with repeated session of rtms? Long-term effect of BT in dystonia Long-term remission of idiopathic cervical dystonia after BT treatment in 6/30 patients (Giladi, 2000) The possibility that BT might have induced early remission in those patients who would otherwise develop spontaneous remission ( 10-20%). Gamma motor neuron paralysis induced by BT may change afferent input from injected muscles and act as continuous sensory trick reorganization in the BG and/ or sensorimotor cortex correction of the basic pathophysiological process which causes cervical dystonia The role of combining s with repeated session of rtms? 4
5 Long-term effect of BT in spasticity CONCLUSIONS Early treatment of spasticity may (theoretically) brake a cycle of spasticity muscle shortening fibrosis contractures Cosgrove et al. (1994) : s in gastrocnemius muscle of hereditary spastic infant rats before they developed spasticity prevented shortening of muscle in adult rats Window of opportunity in children, but studies are lacking Effect on BT on recurrent ( Renshaw) inhibition (Marchand-Pauvert, 2014) possibility of long term effect by modulating maladaptive spinal cord plasticity in stroke patients? Clinical benefits of s depend mainly on the toxin's peripheral action However, this seems not to be the whole story Central action of BT may account for remote effects of BT may contribute to clinical improvement after injections May underlie long-term effects of treatment Research issues arising from practice and possible clinical relevance of feedback information BT research issues: relevance for understanding the pathophysiology of dystonia How to improve the response to BT? How to obtain clinical effect with a lower BT dose? Insight into pathophysiology of disease Dystonia is an abnormality of sensory-motor network Change of afferent input caused by s result in upstream changes that may affect different nodes of network Abnormalities in inhibition and plasticity in dystonia are not predetermined fixed aberrations, but reflect dynamic functional reorganisation influenced by inputs from another nodes in the network THANK YOU FOR YOUR ATTENTION 5
Reflexes. Dr. Baizer
Reflexes Dr. Baizer 1 Learning objectives: reflexes Students will be able to describe: 1. The clinical importance of testing reflexes. 2. The essential components of spinal reflexes. 3.The stretch reflex.
More informationTHE CLINICAL USE OF BOTULINUM TOXIN IN THE TREATMENT OF MOVEMENT DISORDERS, SPASTICITY, AND SOFT TISSUE PAIN
THE CLINICAL USE OF BOTULINUM TOXIN IN THE TREATMENT OF MOVEMENT DISORDERS, SPASTICITY, AND SOFT TISSUE PAIN Spasmodic torticollis (cervical dystonia), blepharospasm, and writer s cramp are specific types
More informationNon-therapeutic and investigational uses of non-invasive brain stimulation
Non-therapeutic and investigational uses of non-invasive brain stimulation Robert Chen, MA, MBBChir, MSc, FRCPC Catherine Manson Chair in Movement Disorders Professor of Medicine (Neurology), University
More informationMotor systems.... the only thing mankind can do is to move things... whether whispering or felling a forest. C. Sherrington
Motor systems... the only thing mankind can do is to move things... whether whispering or felling a forest. C. Sherrington 1 Descending pathways: CS corticospinal; TS tectospinal; RS reticulospinal; VS
More informationDystonia: Title. A real pain in the neck. in All the Wrong Places
Focus on CME at the University of Western Ontario Dystonia: Title in All the Wrong Places A real pain in the neck By Mandar Jog, MD, FRCPC and; Mary Jenkins, MD, FRCPC What is dystonia? Dystonia is a neurologic
More informationClare Gaduzo BSc RMN Registered Aesthetics Practitioner (qualified with Medics Direct)
Clare Gaduzo BSc RMN Registered Aesthetics Practitioner (qualified with Medics Direct) 07935567067 cjg.aesthetics@yahoo.co.uk www.cjgaesthetics.co.uk http://www.facebook.com/cjgaesthetics @CJGAesthetics
More informationWater immersion modulates sensory and motor cortical excitability
Water immersion modulates sensory and motor cortical excitability Daisuke Sato, PhD Department of Health and Sports Niigata University of Health and Welfare Topics Neurophysiological changes during water
More informationThe Physiology of the Senses Chapter 8 - Muscle Sense
The Physiology of the Senses Chapter 8 - Muscle Sense www.tutis.ca/senses/ Contents Objectives... 1 Introduction... 2 Muscle Spindles and Golgi Tendon Organs... 3 Gamma Drive... 5 Three Spinal Reflexes...
More informationBotox. Botox (onabotulinum toxin A) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.75.01 Subject: Botox Page: 1 of 8 Last Review Date: September 15, 2017 Botox Description Botox (onabotulinum
More informationThe role of sensorimotor cortical plasticity in the pathophysiology of Parkinson's disease and dystonia
The role of sensorimotor cortical plasticity in the pathophysiology of Parkinson's disease and dystonia Thesis submitted for the degree of PhD Maja Kojovic Institute of Neurology University College London
More informationHubert H. Fernandez, MD
Hubert H. Fernandez, MD Associate Professor Co-Director, Movement Disorders Center Director, Clinical Trials for Movement Disorders Program Director, Neurology Residency and Movement Disorders Fellowship
More informationThe Nervous System S P I N A L R E F L E X E S
The Nervous System S P I N A L R E F L E X E S Reflexes Rapid, involuntary, predictable motor response to a stimulus Spinal Reflexes Spinal somatic reflexes Integration center is in the spinal cord Effectors
More informationMedication Prior Authorization Form
(OnabotulinumtoxinA) Dysport (abobotulinumtoxina) Myobloc (rimabotulinumtoxinb) Xeomin (incobotulinumtoxina) Policy Number: 1042 Policy History Approve Date: 12/11/2015 Revise Dates: 7/7/2016 Next Review:
More informationChapter 13. The Nature of Muscle Spindles, Somatic Reflexes, and Posture
Chapter 13 The Nature of Muscle Spindles, Somatic Reflexes, and Posture Nature of Reflexes A reflex is an involuntary responses initiated by a sensory input resulting in a change in the effecter tissue
More informationCOGNITIVE SCIENCE 107A. Motor Systems: Basal Ganglia. Jaime A. Pineda, Ph.D.
COGNITIVE SCIENCE 107A Motor Systems: Basal Ganglia Jaime A. Pineda, Ph.D. Two major descending s Pyramidal vs. extrapyramidal Motor cortex Pyramidal system Pathway for voluntary movement Most fibers originate
More informationLateral view of human brain! Cortical processing of touch!
Lateral view of human brain! Cortical processing of touch! How do we perceive objects held in the hand?! Touch receptors deconstruct objects to detect local features! Information is transmitted in parallel
More informationProfessor Tim Anderson
Professor Tim Anderson Neurologist University of Otago Christchurch 11:00-11:55 WS #91: Shakes Jerks and Spasms - Recognition and Differential Diagnosis 12:05-13:00 WS #102: Shakes Jerks and Spasms - Recognition
More informationIntroduction to TMS Transcranial Magnetic Stimulation
Introduction to TMS Transcranial Magnetic Stimulation Lisa Koski, PhD, Clin Psy TMS Neurorehabilitation Lab Royal Victoria Hospital 2009-12-14 BIC Seminar, MNI Overview History, basic principles, instrumentation
More informationORIGINAL CONTRIBUTION. Sensory Modulation of the Blink Reflex in Patients With Blepharospasm. exhibit an abnormal excitability of the blink reflex
ORIGINAL CONTRIBUTION Sensory Modulation of the Blink Reflex in Patients With Blepharospasm Evelia Gómez-Wong, MD; Maria J. Martí, MD; Eduardo Tolosa, MD; Josep Valls-Solé, MD Objective: To measure the
More informationImaging Studies in Focal Dystonias: A Systems Level Approach to Studying a Systems Level Disorder
Imaging Studies in Focal Dystonias: A Systems Level Approach to Studying a Systems Level Disorder The Harvard community has made this article openly available. Please share how this access benefits you.
More informationDystonias. How are the dystonias classified? One way of classifying the dystonias is according to the parts of the body they affect:
Dystonias What are the dystonias? The dystonias are movement disorders in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The movements, which are involuntary
More informationBOTOX. Description. Section: Prescription Drugs Effective Date: January 1, 2013 Subsection: CNS Original Policy Date: December 7, 2011
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.12.01 Subject: Botox Page: 1 of 6 Last Review Status/Date: December 6, 2012 BOTOX Description Botox (onabotulinum
More informationTrans-spinal direct current stimulation: a novel tool to promote plasticity in humans
Trans-spinal direct current stimulation: a novel tool to promote plasticity in humans Jean-Charles Lamy, PhD Brain and Spine Institute, Paris 1 Background Grecco et al., J Neuroresto, 2015 2 Background:
More informationHemifacial spasm. Parkinson's Disease Center and Movement Disorders Clinic
Parkinson's Disease Center and Movement Disorders Clinic 7200 Cambridge Street, 9th Floor, Suite 9A Houston, Texas 77030 713-798-2273 phone www.jankovic.org Hemifacial spasm Diagnosis Hemifacial spasm
More informationScottish Medicines Consortium
Scottish Medicines Consortium clostridium botulinum neurotoxin type A, 100 unit powder for solution for injection (Xeomin ) No. (464/08) Merz Pharma UK Ltd 09 May 2008 The Scottish Medicines Consortium
More informationHEAD AND NECK PART 2
HEAD AND NECK PART 2 INTEGRATED CURRICULUM = Integrate Basic Science and Clinical Training 1- ENT PATIENT EXAM IN ICS COURSE - Today and next week - Review/Preview Anatomy underlying ENT exam 2- NEUROANATOMY/NEUROLOGY
More informationDisorders of language and speech. Samuel Komoly MD PhD DHAS Professor and Chairman Department of Neurology
Disorders of language and speech Samuel Komoly MD PhD DHAS Professor and Chairman Department of Neurology http://neurology.pote.hu major categories disorders of language and speech cortical types aphasias
More informationStretch reflex and Golgi Tendon Reflex. Prof. Faten zakareia Physiology Department, College of Medicine, King Saud University 2016
Stretch reflex and Golgi Tendon Reflex Prof. Faten zakareia Physiology Department, College of Medicine, King Saud University 2016 Objectives: Upon completion of this lecture, students should be able to
More informationEnhanced Long-Term Potentiation-Like Plasticity of the Trigeminal Blink Reflex Circuit in Blepharospasm
716 The Journal of Neuroscience, January 11, 2006 26(2):716 721 Neurobiology of Disease Enhanced Long-Term Potentiation-Like Plasticity of the Trigeminal Blink Reflex Circuit in Blepharospasm Angelo Quartarone,
More informationMotor tracts Both pyramidal tracts and extrapyramidal both starts from cortex: Area 4 Area 6 Area 312 Pyramidal: mainly from area 4 Extrapyramidal:
Motor tracts Both pyramidal tracts and extrapyramidal both starts from cortex: Area 4 Area 6 Area 312 Pyramidal: mainly from area 4 Extrapyramidal: mainly from area 6 area 6 Premotorarea: uses external
More informationPaired-Pulse TMS to one Brain Region. Joyce Gomes-Osman Research Fellow Berenson-Allen Center for Non-Invasive Stimulation LEASE DO NOT COPY
Paired-Pulse TMS to one Brain Region Joyce Gomes-Osman Research Fellow Berenson-Allen Center for Non-Invasive Stimulation Paired-Pulse Paradigms Sequential pulses applied to the same cortical region Variable
More informationDendrites Receive impulse from the axon of other neurons through synaptic connection. Conduct impulse towards the cell body Axon
Dendrites Receive impulse from the axon of other neurons through synaptic connection. Conduct impulse towards the cell body Axon Page 22 of 237 Conduct impulses away from cell body Impulses arise from
More informationMaking Things Happen: Simple Motor Control
Making Things Happen: Simple Motor Control How Your Brain Works - Week 10 Prof. Jan Schnupp wschnupp@cityu.edu.hk HowYourBrainWorks.net The Story So Far In the first few lectures we introduced you to some
More informationUnderstanding Dystonia
Understanding Dystonia Sand Sharks Anthony Richardsen, Lindsey Rathbun, Evan Harrington, Chris Erzen The Essentials What, Why, How What is Dystonia? Dystonias are movement disorders often characterized
More informationCortical Control of Movement
Strick Lecture 2 March 24, 2006 Page 1 Cortical Control of Movement Four parts of this lecture: I) Anatomical Framework, II) Physiological Framework, III) Primary Motor Cortex Function and IV) Premotor
More informationNeural Basis of Motor Control
Neural Basis of Motor Control Central Nervous System Skeletal muscles are controlled by the CNS which consists of the brain and spinal cord. Determines which muscles will contract When How fast To what
More informationVL VA BASAL GANGLIA. FUNCTIONAl COMPONENTS. Function Component Deficits Start/initiation Basal Ganglia Spontan movements
BASAL GANGLIA Chris Cohan, Ph.D. Dept. of Pathology/Anat Sci University at Buffalo I) Overview How do Basal Ganglia affect movement Basal ganglia enhance cortical motor activity and facilitate movement.
More informationM0BCore Safety Profile
M0BCore Safety Profile Active substance: Clostridium botulinum neurotoxin type A haemagglutinin complex Pharmaceutical form(s)/strength: powder for solution for injection, 300 unit and 500 unit P-RMS:
More informationNervous System: Spinal Cord and Spinal Nerves (Chapter 13)
Nervous System: Spinal Cord and Spinal Nerves (Chapter 13) Lecture Materials for Amy Warenda Czura, Ph.D. Suffolk County Community College Eastern Campus Primary Sources for figures and content: Marieb,
More informationProfessor Tim Anderson
Professor Tim Anderson Neurologist University of Otago Christchurch 11:00-11:55 WS #91: Shakes Jerks and Spasms - Recognition and Differential Diagnosis 12:05-13:00 WS #102: Shakes Jerks and Spasms - Recognition
More informationIntroduction to Neurobiology
Biology 240 General Zoology Introduction to Neurobiology Nervous System functions: communication of information via nerve signals integration and processing of information control of physiological and
More informationUsing Transcranial magnetic stimulation to improve our understanding of Transverse Myelitis
Using Transcranial magnetic stimulation to improve our understanding of Transverse Myelitis Kathy Zackowski, PhD, OTR Kennedy Krieger Institute Johns Hopkins University School of Medicine TMS (transcranial
More informationAbnormal motor unit synchronization of antagonist muscles underlies pathological co-contraction in upper limb dystonia
Brain (1998), 121, 801 814 Abnormal motor unit synchronization of antagonist muscles underlies pathological co-contraction in upper limb dystonia S. F. Farmer, 1,2 G. L. Sheean, 1,2 M. J. Mayston, 3 J.
More informationBotulinum toxin in upper limb spasticity: study of reciprocal inhibition between forearm muscles
Neurophysiology, Basic and Clinical NeuroReport 8, 3039 3044 (997) TO establish whether botulinum A toxin (BTX-A) acts on modifying reciprocal inhibition between forearm muscles in spasticity, 20 patients
More informationMuscle Weakness Or Paralysis With Compromise Of Peripheral Nerve
Muscle Weakness Or Paralysis With Compromise Of Peripheral Nerve Muscle weakness or complete paralysis may be secondary to an interruption in the communication between the brain and nerve cells in the
More informationNeuroPsychiatry Block
NeuroPsychiatry Block Stretch reflex and Golgi Tendon Reflex By Prof. Faten zakareia Physiology Department, College of Medicine, King Saud University 2017 Email: Faten@ksu.edu.sa Ext:52736 NeuroPsychiatryBlock
More informationPhysiology. D. Gordon E. Robertson, PhD, FCSB. Biomechanics Laboratory, School of Human Kinetics, University of Ottawa, Ottawa, Canada
Electromyography: Physiology D. Gordon E. Robertson, PhD, FCSB Biomechanics Laboratory, School of Human Kinetics, University of Ottawa, Ottawa, Canada Nervous System Central Nervous System (cerebellum,
More informationThe Three Pearls DOSE FUNCTION MOTIVATION
The Three Pearls DOSE FUNCTION MOTIVATION Barriers to Evidence-Based Neurorehabilitation No placebo pill for training therapy Blinded studies often impossible Outcome measures for movement, language, and
More informationBotox. Botox (onabotulinum toxin A) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.75.01 Subject: Botox Page: 1 of 10 Last Review Date: November 30, 2018 Botox Description Botox (onabotulinum
More informationTask-specific dystonias: a review
Washington University School of Medicine Digital Commons@Becker ICTS Faculty Publications Institute of Clinical and Translational Sciences 2008 Task-specific dystonias: a review Diego D. Torres-Russotto
More informationNeurophysiology of systems
Neurophysiology of systems Motor cortex (voluntary movements) Dana Cohen, Room 410, tel: 7138 danacoh@gmail.com Voluntary movements vs. reflexes Same stimulus yields a different movement depending on context
More informationSource: *Dystonia facts medically edited by: Charles Patrick Davis, MD, PhD
Source: http://www.medicinenet.com/script/main/art.asp?articlekey=349 Dystonia facts* *Dystonia facts medically edited by: Charles Patrick Davis, MD, PhD Dystonia is a disorder of muscle control; it can
More informationClinical features of dystonia: a pathophysiological revisitation Angelo Quartarone, Vincenzo Rizzo and Francesca Morgante
Clinical features of dystonia: a pathophysiological revisitation Angelo Quartarone, Vincenzo Rizzo and Francesca Morgante Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, Università
More informationSensory Trick in Task Specific Upper Limb Dystonia (ULD)
UNIVERSITÀ DEGLI STUDI DI CAGLIARI Dipartimento di Scienze Mediche e Sanità Pubblica Scuola di Specializzazione in Neurologia Direttore: Prof. Giovanni Defazio Sensory Trick in Task Specific Upper Limb
More informationNervous System C H A P T E R 2
Nervous System C H A P T E R 2 Input Output Neuron 3 Nerve cell Allows information to travel throughout the body to various destinations Receptive Segment Cell Body Dendrites: receive message Myelin sheath
More informationArterial Blood Supply
Arterial Blood Supply Brain is supplied by pairs of internal carotid artery and vertebral artery. The four arteries lie within the subarachnoid space Their branches anastomose on the inferior surface of
More informationBiological Bases of Behavior. 8: Control of Movement
Biological Bases of Behavior 8: Control of Movement m d Skeletal Muscle Movements of our body are accomplished by contraction of the skeletal muscles Flexion: contraction of a flexor muscle draws in a
More informationTable of Contents. Preface... xi. Part I: Introduction to Movement Disorders
Table of Contents Visit www.healthreferenceseries.com to view A Contents Guide to the Health Reference Series, a listing of more than 14,000 topics and the volumes in which they are covered. Preface...
More informationCortical Map Plasticity. Gerald Finnerty Dept Basic and Clinical Neuroscience
Cortical Map Plasticity Gerald Finnerty Dept Basic and Clinical Neuroscience Learning Objectives Be able to: 1. Describe the characteristics of a cortical map 2. Appreciate that the term plasticity is
More informationTable of Contents. 1.0 Description of the Procedure, Product, or Service Safety and Provider Compliance... 1
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Safety and Provider Compliance... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific...
More informationDepartment of Neurology/Division of Anatomical Sciences
Spinal Cord I Lecture Outline and Objectives CNS/Head and Neck Sequence TOPIC: FACULTY: THE SPINAL CORD AND SPINAL NERVES, Part I Department of Neurology/Division of Anatomical Sciences LECTURE: Monday,
More informationMovement Disorders Will Garrett, M.D Assistant Professor of Neurology
Movement Disorders Will Garrett, M.D Assistant Professor of Neurology I. The Basal Ganglia The basal ganglia are composed of several structures including the caudate and putamen (collectively called the
More informationBotulinum toxins: abobotulinumtoxina (Dysport ), incobotulinumtoxina (Xeomin ), onabotulinumtoxina (Botox ), & rimabotulinumtoxinb (Myobloc )
Botulinum toxins: abobotulinumtoxina (Dysport ), incobotulinumtoxina (Xeomin ), onabotulinumtoxina (Botox ), & rimabotulinumtoxinb (Myobloc ) These services may or may not be covered by your HealthPartners
More informationV1-ophthalmic. V2-maxillary. V3-mandibular. motor
4. Trigeminal Nerve I. Objectives:. Understand the types of sensory information transmitted by the trigeminal system.. Describe the major peripheral divisions of the trigeminal nerve and how they innervate
More informationChapter 9. Nervous System
Chapter 9 Nervous System Central Nervous System (CNS) vs. Peripheral Nervous System(PNS) CNS Brain Spinal cord PNS Peripheral nerves connecting CNS to the body Cranial nerves Spinal nerves Neurons transmit
More informationUSE OF BOTOX IN THE CHILD WITH CEREBRAL PALSY. Andrew Redfern Senior Registrar, Paed Neurodevelopment Red Cross Children s Hospital
USE OF BOTOX IN THE CHILD WITH CEREBRAL PALSY Andrew Redfern Senior Registrar, Paed Neurodevelopment Red Cross Children s Hospital WHAT IS BOTOX? BOTOX is a purified form of Botulinum toxin Neurotoxin
More informationLecture VIII. The Spinal Cord, Reflexes and Brain Pathways!
Reflexes and Brain Bio 3411! Monday!! 1! Readings! NEUROSCIENCE 5 th ed: Review Chapter 1 pp. 11-21;!!Read Chapter 9 pp. 189-194, 198! THE BRAIN ATLAS 3 rd ed:! Read pp. 4-17 on class web site! Look at
More informationNeurophysiological Basis of TMS Workshop
Neurophysiological Basis of TMS Workshop Programme 31st March - 3rd April 2017 Sobell Department Institute of Neurology University College London 33 Queen Square London WC1N 3BG Brought to you by 31 March
More informationHUMAN MOTOR CONTROL. Emmanuel Guigon
HUMAN MOTOR CONTROL Emmanuel Guigon Institut des Systèmes Intelligents et de Robotique Université Pierre et Marie Curie CNRS / UMR 7222 Paris, France emmanuel.guigon@upmc.fr e.guigon.free.fr/teaching.html
More informationFunctional Distinctions
Functional Distinctions FUNCTION COMPONENT DEFICITS Start Basal Ganglia Spontaneous Movements Move UMN/LMN Cerebral Cortex Brainstem, Spinal cord Roots/peripheral nerves Plan Cerebellum Ataxia Adjust Cerebellum
More informationLAY LANGUAGE PROTOCOL SUMMARY
Kinsman Conference Workshop A-3 - Responsible research: IRBs, consent and conflicts of interest Elizabeth Steiner MD, Associate Professor of Family Medicine, Co-Chair, Institutional Review Board, OHSU
More informationDr Barry Snow. Neurologist Auckland District Health Board
Dr Barry Snow Neurologist Auckland District Health Board Dystonia and Parkinson s disease Barry Snow Gowers 1888: Tetanoid chorea Dystonia a movement disorder characterized by sustained or intermittent
More informationPAIN MANAGEMENT in the CANINE PATIENT
PAIN MANAGEMENT in the CANINE PATIENT Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physio), CAFCI, CCRT Part 1: Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physio), CAFCI, CCRT 1 Pain is the most common reason
More informationMovement Disorders. Psychology 372 Physiological Psychology. Background. Myasthenia Gravis. Many Types
Background Movement Disorders Psychology 372 Physiological Psychology Steven E. Meier, Ph.D. Listen to the audio lecture while viewing these slides Early Studies Found some patients with progressive weakness
More informationManagement of Spasticity
Management of Spasticity Stephen P. Moran, M.D. Department of Physical Medicine and Rehabilitation Ochsner Medical Center Outline Review pathophysiology of spasticity Discuss epidemiology of spasticity
More informationUpper and Lower Motoneurons for the Head Objectives
Upper and Lower Motoneurons for the Head Objectives Know the locations of cranial nerve motor nuclei Describe the effects of motor cranial nerve lesions Describe how the corticobulbar tract innervates
More informationPLASTIC CHANGES IN SPINAL SYNAPTIC TRANSMISSION FOLLOWING BOTULINUM TOXIN A IN PATIENTS WITH POST-STROKE SPASTICITY
J Rehabil Med 2015; 47: 910 916 ORIGINAL REPORT PLASTIC CHANGES IN SPINAL SYNAPTIC TRANSMISSION FOLLOWING BOTULINUM TOXIN A IN PATIENTS WITH POST-STROKE SPASTICITY Marjorie Kerzoncuf, MD 1, Laurent Bensoussan,
More informationPathophysiology of Dystonia
Continuing Medical Education 84 Pathophysiology of Dystonia Rou-Shyan Chen Abstract- Dystonia is a diverse movement disorder characterized by involuntary muscle co-contraction of the agonist and antagonist,
More informationMedication Prior Authorization Form
(OnabotulinumtoxinA) Dysport (abobotulinumtoxina) Myobloc (rimabotulinumtoxinb) Xeomin (incobotulinumtoxina) Policy Number: 1042 Policy History Approve Date: 12/11/2015 Revise Dates: 07/07/2017 Next Review:
More informationExternal shock waves therapy in dystonia: preliminary results
European Journal of Neurology 2009, 16: 517 521 doi:10.1111/j.1468-1331.2008.02525.x External shock waves therapy in dystonia: preliminary results C. Trompetto a,b, L. Avanzino a,c, M. Bove b,c, L. Marinelli
More informationNeurosoft TMS. Transcranial Magnetic Stimulator DIAGNOSTICS REHABILITATION TREATMENT STIMULATION. of motor disorders after the stroke
Neurosoft TMS Transcranial Magnetic Stimulator DIAGNOSTICS REHABILITATION TREATMENT of corticospinal pathways pathology of motor disorders after the stroke of depression and Parkinson s disease STIMULATION
More informationChapter 12 Nervous Tissue. Copyright 2009 John Wiley & Sons, Inc. 1
Chapter 12 Nervous Tissue Copyright 2009 John Wiley & Sons, Inc. 1 Terms to Know CNS PNS Afferent division Efferent division Somatic nervous system Autonomic nervous system Sympathetic nervous system Parasympathetic
More informationNeurons Chapter 7 2/19/2016. Learning Objectives. Cells of the Nervous System. Cells of the Nervous System. Cells of the Nervous System
Learning Objectives Neurons Chapter 7 Identify and describe the functions of the two main divisions of the nervous system. Differentiate between a neuron and neuroglial cells in terms of structure and
More informationFES courses from Salisbury District Hospital
FES courses from Salisbury District Hospital The purpose of the course is to give an introduction to practical clinical FES as practised in the clinical service at Salisbury District Hospital. The techniques
More informationModule 1: Chapter 1 - The Human Organism
Module 1: Chapter 1 - The Human Organism How are the terms CGW & S: begin organ system *Communication; ability to anatomy & physiology and worksheet critically read text, & think their subcategories defined
More informationDisorders of Movement M A R T I N H A R L E Y N E U R O L O G Y
Disorders of Movement M A R T I N H A R L E Y N E U R O L O G Y Educational Objectives Improved history taking in patients with movement disorders. Develop a systematic approach to observing and describing
More informationExcitation-Contraction Coupling & Reflexes, Proprioception and Movement. PSK 4U Unit 4, Day 4
Excitation-Contraction Coupling & Reflexes, Proprioception and Movement PSK 4U Unit 4, Day 4 Excitation-Contraction Coupling Muscles work by converting electrical and chemical energy into mechanical energy!
More informationDiagnosis and treatment of dystonia
Diagnosis and treatment of dystonia Professor Tom Warner, Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology National Hospital for Neurology and Neurosurgery Queen Square What
More informationBrain Plasticity. Brain Plasticity. Recovery from Deprivation 1/2/11. Dogma. Modern neuroscience. Deprivation can lower IQ. Deprivation reversed
Brain Plasticity Brain Plasticity Dogma Adult brain is stable, unchanging Lose neurons Do not grow/repair neurons Modern neuroscience Brain changes throughout life plasticity Extra capacity Face life s
More informationOriginal. and Shinsuke IIJIMA. Nobuyuki KAWATE 1, 2, Miyuki MATSUMOTO 1 1, 2
Showa Univ J Med Sci 29 2, 193 200, June 2017 Original Comparison of Plantar Pressure and Plantar Contact Area before and after Botulinum Toxin Type A BoNT-A Therapy in Stroke Patients with Lower Limb
More informationChanges in intracortical excitability induced by stimulation of wrist afferents in man
12359 Journal of Physiology (2001), 534.3, pp.891 902 891 Changes in intracortical excitability induced by stimulation of wrist afferents in man Jean-Marc Aimonetti and Jens Bo Nielsen * Laboratoire Développement
More informationSteps in EMG analysis
Steps in EMG analysis at rest - spontaneous activity fibs, psw, myotonia, complex rep discharges fasciculations, myokymia at slight voluntary contraction - MUP shape parameters, stability (jiggle), behaviour
More informationNeuroscience with Pharmacology 2 Functions and Mechanisms of Reflexes. Prof Richard Ribchester
Neuroscience with Pharmacology 2 Functions and Mechanisms of Reflexes Prof Richard Ribchester René Descartes Cogito, ergo sum The 21st century still holds many challenges to Neuroscience and Pharmacology
More informationDiagnosis and treatment of dystonia
Diagnosis and treatment of dystonia Professor Tom Warner, Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology National Hospital for Neurology and Neurosurgery Queen Square What
More informationVoluntary Movement. Ch. 14: Supplemental Images
Voluntary Movement Ch. 14: Supplemental Images Skeletal Motor Unit: The basics Upper motor neuron: Neurons that supply input to lower motor neurons. Lower motor neuron: neuron that innervates muscles,
More informationVibramoov NEUROREHABILITATION OF THE LOCOMOTOR SYSTEM THROUGH FUNCTIONAL PROPRIOCEPTIVE STIMULATION
Vibramoov NEUROREHABILITATION OF THE LOCOMOTOR SYSTEM THROUGH FUNCTIONAL PROPRIOCEPTIVE STIMULATION Principe of action BRAIN ACTIVATION VIBRAMOOV REVOLUTIONIZES FUNCTIONAL MOVEMENT THERAPY One of the main
More informationCephalization. Nervous Systems Chapter 49 11/10/2013. Nervous systems consist of circuits of neurons and supporting cells
Nervous Systems Chapter 49 Cephalization Nervous systems consist of circuits of neurons and supporting cells Nervous system organization usually correlates with lifestyle Organization of the vertebrate
More informationAuditory System Feedback
Feedback Auditory System Feedback Using all or a portion of the information from the output of a system to regulate or control the processes or inputs in order to modify the output. Central control of
More informationDifferential modulation of intracortical inhibition in human motor cortex during selective activation of an intrinsic hand muscle
J Physiol (2003), 550.3, pp. 933 946 DOI: 10.1113/jphysiol.2003.042606 The Physiological Society 2003 www.jphysiol.org Differential modulation of intracortical inhibition in human motor cortex during selective
More informationMotor Systems I Cortex. Reading: BCP Chapter 14
Motor Systems I Cortex Reading: BCP Chapter 14 Principles of Sensorimotor Function Hierarchical Organization association cortex at the highest level, muscles at the lowest signals flow between levels over
More information