Clinical Trial: Single Photon Emission Computed Tomography (SPECT) to Study Paroxysmal Hyperkinetic Movement Disorders

Study Status: Completed
Recruit Status: Completed
Study Type: Observational

Official Title: The Physiology of Paroxysmal Hyperkinetic Movement Disorders: A SPECT Study

Brief Summary:

This study will use single photon emission computed tomography (SPECT) to determine what areas of the brain are responsible for paroxysmal hyperkinetic movement disorders. Patients with these disorders have sudden, brief attacks of movement, similar to epileptic seizures, but without loss of consciousness. SPECT is a nuclear medicine test that produces three-dimensional images of the brain, showing blood flow and function in different brain regions. This test, which can detect the focus of epileptic seizures, will be used in this study to scan patients while they are experiencing a hyperkinetic movement attack, while they are not having and attack, and while they are simulating an attack.

Patients 18 years of age and older who have paroxysmal movement attacks that can be easily induced by a specific trigger, such as a sudden movement or prolonged exercise, may be eligible for this study. Candidates will be screened with a medical history and review of their medical records, physical examination, videotape of attacks, and, for women, a pregnancy test.

Participants will have three SPECT scans, separated from each other by at least 48 hours. Before each scan, the subject will perform an activity that ordinarily precipitates a movement attack, such as standing up from a chair, assuming a certain posture, or doing something strenuous. Each scan will try to record one of the following conditions:

  • The subject performs the trigger activity, but does not have an attack;
  • The subject performs the trigger activity and has an involuntary attack as a result;
  • The subject performs the trigger activity and does not have an attack, but then mimics an attack voluntarily.

The purpose of this study is to determine the areas of the brain responsible for paroxysmal hyperkinetic movement disorders. Paroxysmal hyperkinetic movement disorders have been clinically recognized for a long time, although the exact neurophysiological mechanism leading to paroxysms of hyperkinetic movement attacks is not well understood. Paroxysmal hyperkinetic movement disorders are heterogenous, and the exact mechanism may differ in each subcategory. In paroxysmal dyskinesias, the idiopathic forms of paroxysmal hyperkinetic movement disorders, it is speculated that transient functional abnormality at the cellular level occurs in the basal ganglia without organic irreversible damage. Ion channel dysfunction is an attractive hypothesis to explain such transient dysfunction. Some patients with paroxysmal hyperkinetic movement disorders have a psychogenic etiology.

A promising technique to evaluate physiological changes in the brain during an attack is ictal single photon emission computed tomography (SPECT) scanning. Ictal SPECT is a reliable method to detect a seizure focus during an epileptic seizure. We will utilize ictal SPECT scanning techniques during, and between attacks, and while they are simulating such attacks. The differential activation between the attacks of hyperkinetic movements and the voluntary movements may shed light on the regions of the brain and neurophysiological mechanisms responsible for generation of paroxysmal hyperkinetic movement disorders.


Sponsor: National Institute of Neurological Disorders and Stroke (NINDS)

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Information By: National Institutes of Health Clinical Center (CC)

Dates:
Date Received: January 8, 2003
Date Started: January 2003
Date Completion: January 2005
Last Updated: March 3, 2008
Last Verified: January 2005