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      Movement Disorders Associated With Cerebral Artery Stenosis: A Nationwide Study

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          Abstract

          Background

          Studies of secondary movement disorder (MD) caused by cerebrovascular diseases have primarily focused on post-stroke MD. However, MD can also result from cerebral artery stenosis (CAS) without clinical manifestations of stroke. In this study, we aimed to investigate the clinical characteristics of MD associated with CAS.

          Materials and Methods

          A nationwide multicenter retrospective analysis was performed based on the data from patients with CAS-associated MDs from 16 MD specialized clinics in South Korea, available between January 1999 and September 2019. CAS was defined as the >50% luminal stenosis of the major cerebral arteries. The association between MD and CAS was determined by MD specialists using pre-defined clinical criteria. The collected clinical information included baseline demographics, features of MD, characteristics of CAS, treatment, and MD outcomes. Statistical analyses were performed to identify factors associated with the MD outcomes.

          Results

          The data from a total of 81 patients with CAS-associated MD were analyzed. The mean age of MD onset was 60.5 ± 19.7 years. Chorea was the most common MD (57%), followed by tremor/limb-shaking, myoclonus, and dystonia. Atherosclerosis was the most common etiology of CAS (78%), with the remaining cases attributed to moyamoya disease (MMD). Relative to patients with atherosclerosis, those with MMD developed MD at a younger age ( p < 0.001) and had a more chronic mode of onset ( p = 0.001) and less acute ischemic lesion ( p = 0.021). Eight patients who underwent surgical treatment for CAS showed positive outcomes. Patients with acute MD onset had a better outcome than those with subacute-to-chronic MD onset ( p = 0.008).

          Conclusions

          This study highlights the spectrum of CAS-associated with MD across the country. A progressive, age-dependent functional neuronal modulation in the basal ganglia due to CAS may underlie this condition.

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          Most cited references40

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          Moyamoya disease: current concepts and future perspectives.

          Moyamoya disease is an uncommon cerebrovascular disease that is characterised by progressive stenosis of the terminal portion of the internal carotid artery and its main branches. The disease is associated with the development of dilated, fragile collateral vessels at the base of the brain, which are termed moyamoya vessels. The incidence of moyamoya disease is high in east Asia, and familial forms account for about 15% of patients with this disease. Moyamoya disease has several unique clinical features, which include two peaks of age distribution at 5 years and at about 40 years. Most paediatric patients have ischaemic attacks, whereas adult patients can have ischaemic attacks, intracranial bleeding, or both. Extracranial-intracranial arterial bypass, including anastomosis of the superficial temporal artery to the middle cerebral artery and indirect bypass, can help prevent further ischaemic attacks, although the beneficial effect on haemorrhagic stroke is still not clear. In this Review, we summarise the epidemiology, aetiology, clinical features, diagnosis, surgical treatment, and outcomes of moyamoya disease. Recent updates and future perspectives for moyamoya disease will also be discussed.
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            Moyamoya Disease: Epidemiology, Clinical Features, and Diagnosis

            Jong Kim (2016)
            Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology remains unknown, recent genetic studies identified RNF213 in the 17q25-ter region as an important susceptibility gene of MMD among East Asian populations. Possibly because of genetic differences, MMD is relatively common in people living in East Asian countries such as Korea and Japan, compared to those in the Western Hemisphere. The prevalence of MMD appears to be slightly lower among Chinese, compared to Koreans or Japanese. There are two peaks of incidence with different clinical presentations, at around 10 years and 30-40 years. The peak appears to occur later in women than men. In children, ischemic symptoms, especially transient ischemic attacks, are predominant. Intellectual decline, seizures, and involuntary movements are also more common in this age group. In contrast, adult patients present with intracranial hemorrhage more often than pediatric patients. In patients with MMD, intracerebral hemorrhage is more often accompanied by intraventricular hemorrhage than in patients with hypertensive intracerebral hemorrhage. These different age peaks and different clinical presentations in each age group are also observed in MMD patients in the USA. Catheter angiography is the diagnostic method of choice. Magnetic resonance (MR) angiography and computed tomographic angiography are noninvasive diagnostic methods. High-resolution vessel wall MR imaging also helps diagnose MMD by revealing concentric vessel wall narrowing with basal collaterals.
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              Pathophysiology of levodopa-induced dyskinesia: potential for new therapies.

              Involuntary movements--or dyskinesias--are a debilitating complication of levodopa therapy for Parkinson's disease, and is experienced in most patients. Despite the importance of this problem, little was known about the cause of dyskinesia until recently; however, this situation has changed significantly in the past few years. Our increased understanding of levodopa-induced dyskinesia is not only valuable for improving patient care, but also in providing us with new insights into the functional organization of the basal ganglia and motor systems.
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                Author and article information

                Contributors
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                14 July 2022
                2022
                : 13
                : 939823
                Affiliations
                [1] 1Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine , Uijeongbu, South Korea
                [2] 2Department of Neurology, Heavenly Hospital , Goyang, South Korea
                [3] 3Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital , Daejeon, South Korea
                [4] 4Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul, South Korea
                [5] 5Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine , Wonju, South Korea
                [6] 6Department of Neurology, Movement Disorder Center, College of Medicine, Seoul National University Hospital , Seoul, South Korea
                [7] 7Department of Neurology, Kyung Hee University College of Medicine , Seoul, South Korea
                [8] 8Department of Neurology, Seoul National University-Seoul Metropolitan Government Boramae Medical Center and Seoul National University Medical College , Seoul, South Korea
                [9] 9Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine , Yangsan, South Korea
                [10] 10Department of Neurology, Korea University College of Medicine, Guro Hospital , Seoul, South Korea
                [11] 11Department of Neurology, Gachon University Gil Medical Center , Incheon, South Korea
                [12] 12Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
                [13] 13Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine , Ulsan, South Korea
                [14] 14Department of Neurology, Haeundae Paik Hospital, Inje University , Busan, South Korea
                [15] 15Department of Neurology, Chung-Ang University College of Medicine , Seoul, South Korea
                [16] 16Department of Neurology, Kyungpook National University Hospital , Daegu, South Korea
                [17] 17Department of Neurology, Dongsan Medical Center, Keimyung University , Daegu, South Korea
                [18] 18Department of Neurology, Chonnam National University Hospital , Gwangju, South Korea
                [19] 19Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea
                Author notes

                Edited by: Abhishek Lenka, MedStar Georgetown University Hospital, United States

                Reviewed by: Divyani Garg, Vardhman Mahavir Medical College and Safdarjung Hospital, India; Sara Schaefer, Yale University, United States

                *Correspondence: Sun Ju Chung sjchung@ 123456amc.seoul.kr

                This article was submitted to Movement Disorders, a section of the journal Frontiers in Neurology

                †These authors have contributed equally to this work

                Article
                10.3389/fneur.2022.939823
                9330487
                964f3ab0-9725-4787-9706-102801919667
                Copyright © 2022 Park, Choi, Oh, Lyoo, Baek, Kim, Yoo, Lee, Choi, Lee, Koh, Sung, Cho, Yang, Park, Shin, Ahn, Ryu, You, Choi, Kim, Lee and Chung.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 May 2022
                : 20 June 2022
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 40, Pages: 9, Words: 6383
                Funding
                Funded by: Ministry of Health and Welfare, doi 10.13039/501100003625;
                Categories
                Neurology
                Original Research

                Neurology
                movement disorders,intracranial artery stenosis,extracranial artery stenosis,moyamoya disease,cerebral artery stenosis

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