This study tested the hypothesis that diffusion tensor imaging (DTI) can detect alteration in microscopic integrity of white matter (WM) and basal ganglia (BG) regions known to be involved in Parkinson's disease (PD) pathology. It was also hypothesized that there is an association between the DTI abnormality and PD severity and subtype. DTI at 4 Tesla was obtained in 12 PD and 20 control subjects. The DTI measures of fractional anisotropy (FA) and mean diffusivity (MD) were evaluated using both region of interest (ROI) and voxel-based methods. Movement deficits in PD subjects were assessed using Motor Subscale (Part III) of the Unified Parkinson's Disease Rating Scale (UPDRS). Subtype determination of movement deficits was derived based upon results of subjects’ UPDRS ratings. Reduced FA (p<0.05, corrected) was found in PD subjects in a number of regions, including the precentral gyrus, substantia nigra, putamen, posterior striatum, frontal WM, and in regions related to the supplementary motor areas. Reduced FA in the substantia nigra correlated (p<0.05, corrected) with increased UPDRS motor scores. Significant spatial correlations between FA alterations in putamen and other PD-affected regions were also found in the context of PD subtypes index analysis. Our data suggest that microstructural alterations detected with DTI might serve as a potential biomarker for PD.

This study provides Class III evidence that bilateral subthalamic nucleus deep brain stimulation results in significant improvement in cervical dystonia without bradykinetic side effects.

Orthostatic myoclonus is a unique clinical and physiologic phenomenon that accompanies a slowly progressive and eventually disabling gait disorder in the elderly. This phenomenon often arises in the company of more widespread CNS disease.

Background: Respiratory stridor, sleep-disordered breathing, and respiratory insufficiency are part of the clinical spectrum of multiple-system atrophy (MSA). We have encountered cases where these were presenting symptoms, with the diagnosis of MSA being initially unrecognized. Objective: To describe cases in which breathing difficulties were the initial and primary manifestation of MSA.