Kinesia paradoxa

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Kinesia paradoxa (sometimes also K. paradoxica ) is a phenomenon in neurology that can be observed in patients suffering from forms of akinesia or bradykinesia , especially those with Parkinson's disease. Triggered by specific stimuli, such patients can suddenly perform complex motor processes, which are normally difficult and slow for them, fluently and at almost normal speed. The best-known example of this is the normal gait, which is usually severely impaired in Parkinson's patients.

Historical

The term was coined for the first time in 1921 by the French neurologist Alexandre-Achille Souques , who contributed significantly to the research of Parkinsonism. He used it to describe a sudden and brief period of mobility that appeared to be triggered by emotional or physical stress.

In 1967, after years of recurring reports of such cases of Kinesia paradoxia, James Purdon Martin published one of the first studies of the phenomenon and the use of visual stimuli to induce it.

Classification

A categorization can be made on the basis of the triggering mechanisms.

Life threatening situations

As already observed by Alexandre-Achille Souques, kinesia paradoxa can be triggered in brady- or akinetic patients by very strong emotional or physical stress, i.e. in potentially life-threatening situations. Here are some case studies:

  • A fire broke out in a hospital that also treats Parkinson's patients. The patients were housed on the third floor and could normally only be moved using a wheelchair. The nurses wanted to explain this to the fire department, but then noticed that the patients had already left the building. They evidently escaped using the stairs.
  • In the 2009 L'Aquila earthquake , a 90-year-old woman who had been bedridden for a year managed to get out of bed and run from the third floor, where her apartment was located, into the street. Even after that, she was still able to walk with support, whereas she had to be moved in a wheelchair beforehand. She and 13 other patients with Parkinson's disease and dementia were able to escape the accident, and in 5 patients the improvement in motor skills could still be observed 2 to 5 months after the event.
  • A 2007 study described the occurrence of Kinesia paradoxa in two Parkinson's patients in Haifa during the Lebanon War . In both cases, the warning sirens were not sufficient as an auditory stimulus; additional visual stimuli were required. So it was possible for one of the two, who had suffered from freezing of gait (briefly "frozen" movement in the late stages of the disease) for almost ten years , to run out of the danger zone.
  • An akinetic Parkinson's patient took care of his grandson and he went outside to play. When the grandfather suddenly heard a bang like a car accident, he was so worried that his grandson might have been run over that he ran out into the street. (Nothing happened to the boy.)

External stimuli

Visually

In his 1976 study, James Purdon Martin examined the effect of visual stimuli in the form of objects or lines of various configurations on the mobility of Parkinson's patients for the first time. Stripes, sheets of paper, contrasting floor tiles or obstacles such as bricks or pieces of wood can trigger Kinesia paradoxa and thus improve the gait pattern dramatically. The best effect could be achieved with transverse, broad lines that contrast strongly with the ground and with three-dimensional objects that were placed in the way as obstacles.

In his book Awakenings , Oliver Sacks described the case of a patient who used small white paper balls as visual stimuli.

"She would carry in one hand a supply of minute paper balls of which she would now let one drop to the ground: its tiny whiteness immediately 'incited' or 'commanded' her to take a step, and thus allowed her to break loose from the freeze and resume her normal walking pattern ... "

“In one hand she carried a supply of tiny paper balls, one of which she occasionally dropped to the floor: this tiny white point animated, yes, almost commanded her to take a step forward and thus allowed her to get out of her frozen position To free the state and continue their normal locomotion pattern ... "

- Oliver Sacks : Awakenings

Auditory

Auditory stimuli such as music or rhythms are also able to significantly improve motor processes. In a study, for example, the occurrence of freezing of gait - the sudden freezing of the gait in Parkinson's patients - was significantly reduced by auditory rhythmic stimulation. At the same time, the speed and the step rhythm were increased and the turning around at the end of the path, which was required during the experiment, was also faster. Here, a “click” - a 50 ms long 4.625 Hz tone - was played through headphones, the frequency of which was adjusted to the test subjects.

Oliver Sacks also observed the power of music to act as a new inner clock in his patients and described this together with an insight into the patient's point of view in his book Awakenings . In the case of a former music teacher who, ever since she had Parkinson's disease, found her movements to be wooden and robotic, and who often seemed frozen like a still life, the mere introduction of songs to which she used to enjoy dancing helped.

"With this sudden imagining of music, this coming of spontaneous inner music, the power of motion, action, would suddenly return, and the sense of substance and restored personality and reality; now, as she put it, she could 'dance out of the frame', the flat frozen visualness in which she was trapped, and move freely and gracefully: 'It was like suddenly remembering myself, my own living tune.' But then, just as suddenly, the inner music would cease, and with this all motion and actuality would vanish, and she would fall instantly, once again, into a Parkinsonian abyss. "

“With this sudden idea of ​​music, the emergence of a spontaneous inner melody, the power of movement and action came back, just like the feeling of being, of rediscovered personality and reality; for her it was as if she could “dance out of the frame”, leave the flat, still visuality in which she felt trapped and move freely and gracefully: “It was like a sudden memory of your own being, of her own melody of life. "But just as suddenly as this inner music came, it also disappeared again and with it all movement and reality disappeared and let them fall back into a Parkinsonian abyss."

- Oliver Sacks : Awakenings

medication

Treatment of Parkinson's disease with L-dopa increased the incidence of kinesia paradoxa in such patients. Previously, the phenomenon had mainly been observed in patients suffering from lethargic encephalitis and post- encephalitic Parkinson's disease. Oliver Sacks first treated these post-encephalitic Parkinson's patients with L-Dopa and described their disease and the effects of drug therapy in his book Awakenings . The drug seems to be a mandatory prerequisite for other Parkinson's patients in order to enable kinesia paradoxa.

Mechanism of action

How Kinesia paradoxa works is not yet clear. However, there are several theories based on three basic concepts.

literature

  • Oliver Sacks: Awakenings . Picador, 1973, ISBN 0-375-70405-1 .
  • Eirini Banou: Kinesia Paradoxa: A Challenging Parkinson's Phenomenon for Simulation . In: GeNeDis 2014 . Springer International Publishing, 2015, ISBN 978-3-319-08926-3 , pp. 165-177 .
  • Pablo Arias, Javier Cudeiro: Effect of Rhythmic Auditory Stimulation on Gait in Parkinsonian Patients with and without Freezing of Gait . In: PLoS One . tape 5 , no. 3 , March 22, 2010, doi : 10.1371 / journal.pone.0009675 .

Movie

Web links

Individual evidence

  1. ↑ Alexandre-Achille Souques: Kinésie paradoxale . In: Revue Neurologique . No. 37 . Paris 1921, p. 559-660 .
  2. ^ The Basal ganglia and posture. By James Purdon Martin, MA, MD, FRCP (Lond.), Consulting Physician to the National Hospital for Nervous Diseases, Queen Square, London. 9¾ × 7½ in. Pp. 152+ xiv. Illustrated. 1967. London: Pitman Memcal Publishing Co. Ltd. 80s . In: British Journal of Surgery . tape 55 , no. 1 , 1968, ISSN  1365-2168 , pp. 83-83 , doi : 10.1002 / bjs.1800550126 ( wiley.com [accessed April 26, 2016]).
  3. ↑ Eirini Banou: Kinesia Paradoxa: A Challenging Parkinson's Phenomenon for Simulation . In: GeNeDis 2014 (=  Advances in Experimental Medicine and Biology ). No. 822 . Springer International Publishing, 2015, ISBN 978-3-319-08926-3 , pp. 165–177 , doi : 10.1007 / 978-3-319-08927-0_18 ( springer.com [accessed April 26, 2016]).
  4. ^ Hammond TC: New Developements: Falls, Drooling & Exercise in Parkinson's Disease. In: The Parkinson's Source . No. 40 . American Parkinson Disease Association, 2010.
  5. ^ L. Bonanni, A. Thomas, F. Anzellotti, D. Monaco, F. Ciccocioppo: Protracted benefit from paradoxical kinesia in typical and atypical parkinsonisms . In: Neurological Sciences . tape 31 , no. 6 , 2010, ISSN  1590-1874 , p. 751-756 , doi : 10.1007 / s10072-010-0403-5 ( springer.com [accessed April 26, 2016]).
  6. ↑ Ilana Schlesinger, Ilana Erikh, David Yarnitsky: Paradoxical kinesia at war . In: Movement Disorders: Official Journal of the Movement Disorder Society . tape 22 , no. 16 , 2007, ISSN  0885-3185 , p. 2394-2397 , doi : 10.1002 / mds.21739 , PMID 17914720 .
  7. ↑ Robert B. Daroff: Paradoxical Kinesia . In: Movement Disorders . tape 23 , no. 8 , 2008, ISSN  1531-8257 , p. 1193–1193 , doi : 10.1002 / mds.22060 ( wiley.com [accessed April 28, 2016]).
  8. ^ The Basal ganglia and posture. By James Purdon Martin, MA, MD, FRCP (Lond.), Consulting Physician to the National Hospital for Nervous Diseases, Queen Square, London. 9¾ × 7½ in. Pp. 152+ xiv. Illustrated. 1967. London: Pitman Memcal Publishing Co. Ltd. 80s . In: British Journal of Surgery . tape 55 , no. 1 , 1968, ISSN  1365-2168 , pp. 83-83 , doi : 10.1002 / bjs.1800550126 ( wiley.com [accessed May 12, 2016]).
  9. ↑ Pablo Arias, Javier Cudeiro: Effect of Rhythmic Auditory Stimulation on Gait in Parkinsonian Patients with and without freezing of gait . In: PLoS ONE . tape 5 , no. 3 , March 22, 2010, doi : 10.1371 / journal.pone.0009675 , PMID 20339591 , PMC 2842293 (free full text).
  10. ↑ Hardie RJ: Parkinson's disease . Chapman and Hall Medical, London 1990, ISBN 0-412-26220-7 , pp. 559-596 .
  11. ↑ Eirini Banou: Kinesia paradoxa: a challenging Parkinson's phenomenon for simulation . In: Advances in Experimental Medicine and Biology . tape 822 , January 1, 2015, ISSN  0065-2598 , p. 165-177 , doi : 10.1007 / 978-3-319-08927-0_18 , PMID 25416986 .