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Periodic Limb Movement

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3061. Rett Syndrome

as a consequence of altered autonomic control. Secondary vascular changes in the long-term lead to abiotrophic changes in the lower limb and feet. Stage 3 - stationary or pseudostationary phase Typically aged 2-10 years. There may be an improvement in behaviour, use of the hands and communication skills. Eye contact returns and non-verbal communication may be exploited. There is persisting intellectual impairment with stereotyped hand movements. Generalised rigidity, bruxism and movements of the tongue may (...) deterioration or regression Typically age 1-4 years. May be a sudden onset of deterioration with an identifiable day when things changed; however, it may be a more subtle onset and progression in some cases. Early growth restriction may be noted in falling off of head circumference from growth curve. There are autism-like behaviours with loss of verbal and other communication, hand use and social interaction. There are abnormalities of hand movements when the patient is awake, with the hands usually held

2008 Mentor

3062. Hyaluronates and Viscosupplementation

. Reduced function and participation restriction. Signs Reduced range of joint movement. Pain on movement of the joint or at extremes of joint movement. Joint swelling/synovitis (warmth, effusion, synovial thickening). Periarticular tenderness. Crepitus. Absence of systemic features such as fever or rash. Bony swelling and deformity due to osteophytes - in the fingers this presents as swelling at the distal interphalangeal joints (Heberden's nodes) or swelling at the proximal interphalangeal joints (...) on their joints and help to improve pain. The use of local heat or cold (thermotherapy) should be considered as an adjunct to core treatments. Aids and devices: Advice on appropriate footwear (including shock-absorbing properties) as part of core treatments for people with lower-limb OA. Biomechanical joint pain or instability: should be considered for assessment for bracing/joint supports/insoles as an adjunct to their core treatments. Assistive devices (eg, walking sticks and tap turners) should

2008 Mentor

3063. Huntington's Disease

with HD it has been reported to be as common as 69%. [ ] HD then leads to progressive chorea, rigidity and dementia. It is frequently associated with seizures. Chorea is initially mild but may be severe and cause uncontrollable limb movements. As the disease progresses, chorea is gradually replaced by dystonia and Parkinsonian features. Dysarthria, dysphagia and abnormal eye movements are common. There may also be other movement disorders - eg, tics and myoclonus. HD patients can develop a wide array (...) variable. JHD (6% of all cases of HD) is defined as an age of onset of younger than 20 years. It causes Parkinsonian features, dystonia, pyramidal tract signs, dementia and epilepsy. Chorea is often mild and may be absent. Differential diagnosis Neuroacanthocytosis: a group of genetic conditions that are characterised by movement disorders and acanthocytosis (abnormally-shaped red blood cells). and other causes of . Other causes of . Investigations MRI and CT scans in moderate-to-severe HD show a loss

2008 Mentor

3064. Flying with Medical Conditions

. Trauma or surgery of the lower limbs. Family history of DVT. Age >40 years. The oral contraceptive pill. The risk of flight-related VTE is also increased in both shorter and taller individuals and in the overweight and is associated with location in a window seat [ ] . DVT prophylaxis It is wise for anyone undertaking a long-haul flight to take sensible precautions, such as to: Remain adequately hydrated. Exercise the calves. Spend periods out of their seat. Avoid excess alcohol. Avoid tight-fitting (...) below. Physiology during flight [ ] Modern aircraft are not pressurised to sea level equivalent. Cabin altitude equivalent is usually between 5,000 and 8,000 feet which means that there is a reduction in barometric pressure and a reduction in the partial pressure of alveolar oxygen (P a O 2 ). Sometimes during flight, although not usually for long periods, oxygen saturation levels can fall to around 90%. A healthy individual can usually tolerate this with no problems but it may not be the same

2008 Mentor

3065. Hand Arm Vibration Syndrome

Guidelines. You may find the article more useful, or one of our other . In this article In This Article Hand-arm Vibration Syndrome In this article Synonyms: HAVS, vibration white finger, VWF Prolonged exposure to hand-arm vibration may cause a potentially disabling chronic disorder of the upper limbs, which is called the hand-arm vibration syndrome (HAVS). As well as vascular and neurological injury, HAVS may also involve damage to bones, joints, muscles and tendons in the upper limbs. There may also (...) (little finger) in each hand at two frequencies. The thermal aesthesiometry test, which assesses the thermal receptors' threshold. Readings are again taken from the median nerve and the ulnar nerve. The Purdue Pegboard test, which is a measure of dexterity and detects loss of fine movement to both hands. The grip force measurement test, which measures the grip strength of both hands. This test is not scored but is a useful indication of vibration damage to muscles of the hand and forearm. In addition

2008 Mentor

3066. Gait Abnormalities in Children

as the leg swings forwards Typically seen with a leg length discrepancy, with a stiff/restricted joint movement as in JIA, or with unilateral spasticity as in hemiplegic . Spastic gait Stiff, foot-dragging with foot inversion. This is often seen in upper motor neurone neurological disease (eg, diplegic or quadriplegic cerebral palsy, ). Ataxic gait Instability with an alternating narrow-to-wide base. Seen in ataxic cerebral palsy affecting the cerebellum, in , and in . Trendelenberg's gait Results from (...) with absent heel contact Habitual toe walking is common in children and associates with normal tone, range of movement around the feet and normal walking on request. However, persistent toe walking is observed in spastic upper motor neurone neurological disease (eg, cerebral palsy). It can (rarely) be a presentation of mild lysosomal storage disorder. Stepping gait The entire leg is lifted at the hip to assist with ground clearance. Occurs with weak ankle dorsiflexors, compensated by increased knee

2008 Mentor

3067. Restless legs syndrome and its treatment by dopamine agonists. (Abstract)

Restless legs syndrome and its treatment by dopamine agonists. The restless legs syndrome (RLS) characteristically presents with an irresistible urge to move that is most often accompanied by creeping sensations deep in the limbs. Occasionally the upper limbs can also be affected. RLS symptoms occur at rest and are typically more intense at night and at bedtime. Some patients complain about involuntary leg movements, so-called periodic limb movements (PLM), while at rest or PLM have been

2000 Parkinsonism & related disorders Controlled trial quality: uncertain

3068. Combination Anti-Platelet and Anti-Coagulation Treatment After Lysis of Ischemic Stroke Trial (CATALIST)

is identified, that dose of eptifibatide will be investigated in a subsequent randomized placebo-controlled trial. MRI and CT are used as radiological measures of brain hemorrhage. The NIH Stroke Scale (NIHSS) is used to measure neurological worsening or recovery. The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of acute stroke on the levels of consciousness, language, neglect, visual-field loss, extra ocular movement, motor strength, ataxia, dysarthria, and sensory (...) ). The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of acute stroke on the levels of consciousness, language, neglect, visual-field loss, extra ocular movement, motor strength, ataxia, dysarthria, and sensory loss. A trained observer rates the patient's ability to answer questions and perform activities. Ratings for each of the 15 items are scored. Patients who have a score of 0 are considered to have "normal" examination. Patients with a score of 40 have the most

2003 Clinical Trials

3069. Constraint-Based Therapy to Improve Motor Function in Children With Cerebral Palsy

was derived from basic research with animal and human subjects. Randomized, controlled studies indicate that it can substantially reduce the motor deficit of adult patients with mild to moderately severe chronic strokes and can increase their independence over a period of years. CI therapy involves motor restriction of the less affected upper extremity for a period of 2 to 3 weeks while concurrently training the more affected upper limb. This gives rise to concentrated, repetitive use of the more affected (...) ). Recruitment status was: Recruiting First Posted : May 22, 2003 Last Update Posted : June 24, 2005 Sponsor: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Information provided by: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Study Details Study Description Go to Brief Summary: Pediatric Constraint-Induced (CI) Movement therapy is a rehabilitation program designed to improve motor function in children with partial paralysis

2003 Clinical Trials

3070. Safety and Efficacy of Oral Fampridine-SR for the Treatment of Spasticity Resulting From Spinal Cord Injury

impulses. As a result, subjects with an incomplete spinal cord injury may have spasticity which is muscle spasms or muscle stiffness that makes movement difficult. Fampridine-SR is an experimental drug that increases the ability of the nerve to conduct electrical impulses. This study will examine the effects of Fampridine-SR on moderate to severe lower-limb spasticity, as well as the effects on bodily functions such as bladder control, bowel function and sexual function. The study will also examine (...) (twice daily) Placebo Comparator: Placebo Other: Placebo Placebo Outcome Measures Go to Primary Outcome Measures : Double-blind Change From Baseline in Ashworth Score Evaluating Spasticity [ Time Frame: Baseline (visits 2,3) average score days 7,14 and double blind treatment period (visits 4-7) average score days 28-98 ] The Ashworth Score is the average rating (based on a scale of 1 to 5) of four lower extremity muscle groups; left and right knee flexors and extensors (hamstrings and quadriceps

2002 Clinical Trials

3071. Neurotropin to Treat Chronic Neuropathic Pain

or CRPS-II in one limb only, based on pain (1) that is post-traumatic and spread beyond the region of the injury; (2) has persisted for more than 2 weeks; and (3) is associated with swelling, altered skin color or skin temperature, altered sweating, allodynia or hyperesthesia or limitation of active movement. Atrophic changes in skin, hair loss or nail changes, or disuse atrophy of skeletal muscle may be present. Both sexes are to be studied. All ethnic and racial groups can participate. Patients must (...) Institutes of Health Clinical Center (CC) National Institute of Neurological Disorders and Stroke (NINDS) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Information provided by (Responsible Party): National Institutes of Health Clinical Center (CC) ( National Institute of Nursing Research (NINR) ) Study Details Study Description Go to Brief Summary: This study will examine the effectiveness of the drug neurotropin in treating chronic pain after injury to a limb

2000 Clinical Trials

3072. GM1 Ganglioside Effects on Parkinson's Disease

than idiopathic PD. A tremor score on the UPDRS motor scale of >5. Tremor score greater than 3 in an individual limb. High-dose vitamin E therapy (more than 1000 I.U./day) any time during the period starting 3 months prior baseline. Transient ischemic attack any time during the period starting 6 months prior baseline. Hx of 2 or more strokes. Hx of any stroke that resulted in motor deficit, movement disorder, ataxia, cognitive impairment, or a hemi-inattention syndrome. Any stroke with residua (...) for at least 3 months prior to Screening. Mini Mental State Exam score > 25. Beck Depression Inventory score < 10. Signed informed consent. Exclusion criteria: Abrupt onset of Parkinsonism. Failure of Parkinsonian symptoms to have responded to l-dopa. Motor symptoms (such as peak dose dyskinesias (UPDRS score > 3), & random on-off phenomenon, other than end-of-dose wearing-off, persistently fluctuating over a 6 month or longer period, in response to l-dopa. Hx of findings of any movement disorder other

2002 Clinical Trials

3073. Effects of Treating Obstructive Sleep Apnea in Epilepsy

, demyelination, metabolic illness, or progressive degenerative disease. Non-epileptic spells (e.g., pseudoseizures) alone or in combination with epileptic seizures. Narcolepsy or another primary sleep disorder that requires intervention with medications and which may affect results of study (e.g., severe periodic limb movement disorder). Effectively treated OSA or prior exposure to continuous positive airway pressure. History of poor compliance with antiepileptic medications. Current treatment with the vagus (...) nerve stimulator. Pregnancy. A significant history of medical or psychiatric disease which may impair participation in the trial. A history of alcohol or drug abuse during the one-year period prior to trial participation. Evidence of medical instability (e.g., congestive heart failure, cardiac arrhythmias, pulmonary disease) due to obstructive sleep apnea. Subjects who are unaware of the majority of their seizures and lack a reliable witness. Greater than ten seizures a day. Contacts and Locations

2002 Clinical Trials

3074. The Role of Dopamine in Motor Learning in Healthy Subjects and Patients With Parkinson's Disease

of a stimulus (e.g., white circle) below one of the markers by pressing the spatially corresponding key. About a second later, the next stimulus will be displayed below one of the other markers, and so on. Reaction times and accuracy will be recorded. After 3 to 10 minutes of practice (one block), there will be a rest period during which the computer will display information about the subject's accuracy of movements and reaction time. Then, a new block will start. There will be about 6 to 20 practice blocks (...) as the electrical activity during training. Indeed, patients with Parkinson's disease frequently complain of slowness and early fatigue during movements. These symptoms are believed to be related to a decrease of dopamine in the brain which may be associated with abnormalities in cerebral electrical activity. Adult patients with Parkinson's disease who are right-handed, do not have dementia, and are not depressed may be eligible for this study. Healthy volunteers who match patients in age, gender, handedness

2002 Clinical Trials

3075. Study of Repetitive Transcranial Magnetic Stimulation in Parkinson's Disease

. The stimulation may cause muscle twitching in the scalp or face and may also cause small movements of the limbs. Just before and after each rTMS session, patients will have a neurologic examination, including an evaluation of walking. Their motor function tests will be recorded on videotape to document possible improvement and to allow physicians to rate the improvement. The physicians will not know which patients are receiving actual rTMS and which are receiving sham treatment. Ratings before the first (...) patients' symptoms improved; in some they worsened temporarily, and some showed no change. Patients between 40 and 80 years of age with moderately severe Parkinson's disease, whose main problem is slowness of movement and stiffness, may be eligible for this study. Participants will be randomly assigned to one of two treatment groups: one will receive rTMS to parts of the brain involved in controlling movement; the other will receive sham, or placebo, stimulation. Nine treatments will be given over a 4

2002 Clinical Trials

3076. Effect of Ropinirole on Spinal Cord Reflexes and Restless Legs Syndrome

disturbances. Ropinirole affects chemical messengers thought to be involved in spinal cord function and in modulating RLS symptoms. Healthy normal volunteers and patients with RLS between 18 and 80 years of age may be eligible for this study. Patients must have mild to moderate RLS and periodic limb movements. All candidates will be screened with a medical history, physical and neurological evaluations, electromyogram (see below), polysomnogram (see below), electrocardiogram (ECG), and blood and urine (...) provided by: National Institutes of Health Clinical Center (CC) Study Details Study Description Go to Brief Summary: This study will examine the effects of the drug Ropinirole on spinal cord reflexes and on symptoms of restless legs syndrome (RLS). Patients with RLS have uncomfortable sensations in the legs, usually in the evening or early part of the night. Most patients also have periodic involuntary leg movements. The condition tends to worsen over time, resulting in severe discomfort and sleep

2003 Clinical Trials

3077. Improving Arm Mobility and Use After Stroke

by constraining movement in the less impaired limb for most waking hours over a 2 week period. The constraint is a taped splint in which the hand rests to prevent limb use but enable protective responses. A micro-switch within the splint will permit monitoring of contact time (wearing). Each weekday for 2 weeks, patients come to the clinic/laboratory for specific task training. Evaluations in laboratory and actual use tests are made prior to treatment, 2 weeks later, and at 4 month intervals thereafter (...) . This study examines the effectiveness of CI therapy for improving arm motion after stroke. Condition or disease Intervention/treatment Phase Cerebrovascular Accident Procedure: Constraint-induced movement therapy Phase 3 Detailed Description: Profoundly impaired motor dysfunction is a major consequence of stroke. As a result, a large number of the more than 700,000 people in America sustaining a stroke each year have limitations in motor ability and compromised quality of life. Therapeutic interventions

2003 Clinical Trials

3078. Reconstruction for chronic dysfunction of ileoanal pouches. Full Text available with Trip Pro

Reconstruction for chronic dysfunction of ileoanal pouches. A retrospective review was performed to determine the results after surgical reconstruction for chronic dysfunction of ileal pouch-anal procedures for ulcerative colitis and familial colonic polyposis at a university medical center.During the 20-year period from 1978 to 1998, 601 patients underwent colectomy and ileal pouch-anal anastomosis (IPAA) for ulcerative colitis, familial colonic polyposis, or Hirschsprung's disease. A J pouch (...) was used for 351 patients, a lateral pouch for 221, an S pouch for 6, and a straight pull-through for 23. Acute complications after pouch construction have been detailed in previous publications and are not included in this study. Chronic pouch stasis with diarrhea, frequency, urgency, and soiling gradually became more severe in 164 patients (27.3%), associated with pouch enlargement, an elongated efferent limb, and obstruction to pouch outflow, largely related to the pouch configuration used during

1999 Annals of Surgery

3079. Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Healt Full Text available with Trip Pro

according to level of evidence.A high value was placed on avoidance of cardiovascular morbidity and premature death caused by untreated hypertension.Physical activity of moderate intensity involving rhythmic movements with the lower limbs for 50-60 minutes, 3 or 4 times per week, reduces blood pressure and appears to be more effective than vigorous exercise. Harm is uncommon and is generally restricted to the musculoskeletal injuries that may occur with any repetitive activity. Injury occurs more often (...) . Because of insufficient evidence, no economic outcomes were considered.A MEDLINE search was conducted for the period 1966-1997 with the terms exercise, exertion, physical activity, hypertension and blood pressure. Both reports of trials and review articles were obtained. Other relevant evidence was obtained from the reference lists of these articles, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded

1999 CMAJ: Canadian Medical Association Journal

3080. Medications for the Treatment of Sleep Disorders: An Overview Full Text available with Trip Pro

, including amphetamines, may be used to induce daytime alertness. Parasomnias include disorders of arousal and of REM sleep. Chronic medical illnesses can become symptomatic during specific sleep stages. Many medications affect sleep stages and can thus cause sleep disorders or exacerbate the effect of chronic illnesses on sleep. Conversely, medications may be used therapeutically for specific sleep disorders. For example, restless legs syndrome and periodic limb movement disorder may be treated (...) Medications for the Treatment of Sleep Disorders: An Overview Sleep disorders can be divided into those producing insomnia, those causing daytime sleepiness, and those disrupting sleep. Transient insomnia is extremely common, afflicting up to 80% of the population. Chronic insomnia affects 15% of the population. Benzodiazepines are frequently used to treat insomnia; however, there may be a withdrawal syndrome with rapid eye movement (REM) rebound. Two newer benzodiazepine-like agents, zolpidem

2001 Primary Care Companion to the Journal of Clinical Psychiatry

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