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The differential diagnosis of tremor is mainly based on clinical criteria.Nevertheless, these criteria are in some cases not sufficient to differentiate between different tremor forms. Long-term EMG has proven to be a valid and reliable method for the quantification of pathological tremors. The aim of the study was to develop a long-term EMG-based automated analysis procedure that separates parkinsonian tremor from essential tremor. Using longterm EMG tremor was recorded in 45 consecutive patients, 26 with Parkinson's disease (PD) and 19 with essential tremor (ET). Eight tremor parameters were generated automatically. By stepwise backward regression a subset of these criteria was extracted to achieve an automated classification of the tremor by a mathematical model. The obtained model was then tested on a new group of 13 patients in early stages of the disease. Significant differences between groups were found for tremor occurrence, tremor asymmetry, mean tremor frequency and standard deviation of phase of antagonistic muscles. Due to data overlap a classification of the two tremor forms was not possible based on a single tremor parameter. Using logistic regression, a linear formula based on the three parameters tremor occurrence, mean tremor frequency and standard deviation of phase was established and predicted the correct diagnosis in 93% of patients. The validation of the model on the new group of patients in early stages of the tremor disease yielded a correct diagnosis in 100% of cases. We conclude that long-term EMG recording allows a rater-independent classification of parkinsonian versus essential tremor. [ABSTRACT FROM AUTHOR]

The outcome results of home visiting programs have been mixed and modestly encouraging at best. To further understand this phenomenon it is important to understand what influences participation in home visiting programs. This study explores the relationship between housing stability and level of participation in an Early Head Start home visiting program. The housing needs of 76 Early Head Start participants were explored and compared with their participation in program home visiting services. Results indicated that housing problems were related to lower participation in home visiting services. Practice implications and recommendations are suggested. [ABSTRACT FROM AUTHOR]

Objective Drug-induced psychosis is a frequent side-effect in the treatment of advanced Parkinson's disease (PD). We sought to develop and evaluate a brief instrument for early recognition of drug-induced psychosis in PD. Methods We developed the "Parkinson Psychosis Questionnaire" (PPQ), which consists of screening questions for typical early signs and psychotic symptoms in PD and which quantifies the frequency and severity of four clinical categories - sleep disturbances, hallucinations/illusions, delusions and orientation. We performed an internal validation of the PPQ in 50 unselected patients with parkinsonism. The Brief Psychiatric Rating Scale (BPRS) and the "Structurized Clinical Interview" (SCID) for DSM IV were applied to the same patients as external references. Results Of 50 subjects, 49 suffered from idiopathic PD and one from probable MSA-P.Hoehn and Yahr stages in "on" ranged from 1.5 to 4. Sensitivity of the PPQ test for drug-induced psychosis according to SCID was 100 % (95 % CI: 73.5%, 100 %); while specificity was 92.1 % (95% CI: 78.6%, 98.3 %). The PPQ severity score was highly correlated with BPRS. We derived a linear prediction formula, which transformed PPQ into BPRS scores. Conclusion The PPQ appears to be a suitable, and easily administered instrument for early diagnosis of drug-induced psychosis in routine PD care. Whether the PPQ could also be a valuable tool for monitoring follow-up studies and therapeutic intervention trials remains to be tested. [ABSTRACT FROM AUTHOR]

Objective: To compare the tremorlytic properties of pramipexole, a non-ergoline dopamine agonist to those of placebo as add on medication in patients with Parkinson's disease.Methods: Eighty four patients with early or advanced Parkinson's disease and marked, drug resistant tremor under a stable and optimised antiparkinsonian medication were included in a double blind, randomised, placebo controlled, multicentre study and assigned to add on treatment (7 week dose titration interval, 4 week maintenance period) with either pramipexole (n=44) or placebo (n=40) as adjunct. The primary end point was the absolute change in tremor score, defined as the sum of tremor related items (16, 20, 21) of the unified Parkinson's disease rating scale (UPDRS) in "on" periods. Secondary end points included the percentage change in tremor score, the absolute and percentage changes in long term EMG tremor registration, and the change in tremor self rating scales. Safety and tolerability were assessed on the basis of adverse events, laboratory tests, ECG, and vital signs.Results: Pramipexole was significantly superior to placebo with a difference between treatment groups in the mean absolute change in tremor score of -4.4 (95% confidence interval (95% CI) -6.2 to -2.5) (p<0.0001), corresponding to a difference in the mean percentage change of -34.7% in favour of pramipexole. The secondary end points were consistent with the significant change in tremor score and provided further evidence for the benefit of pramipexole compared with placebo. Long term EMG registration as an objective measure showed a difference in mean absolute change in tremor occurrence of -15.2% (95%CI -21.4 to -9.0) (p<0.0001), and a difference in the mean percentage change of -45.7% in favour of pramipexole. The treatment effects increased during dose titration and remained stable during the 4 week maintenance dose period until the end of the study. The average daily pramipexole dose during maintenance was 4.1 (SD 0.9) mg. Safety analysis showed an increased rate of fatigue, insomnia, nausea, abdominal pain, and headache under pramipexole, comparable with previous studies.Conclusion: Pramipexole proved to be an effective agent for patients with Parkinson's disease and drug resistant tremor. [ABSTRACT FROM AUTHOR]

Using hierarchical linear modeling (HLM), we analyzed individual developmental trajectories of disruptive behavior problems between ages 3.5 to 6.0 years for 183 children of adolescent mothers. We examined how the level of problem behavior (intercept) and the rate of change over time (slope) are influenced by child's sex, mother's depression/anxiety symptoms, and mother's use of negative control for regulating child behavior. On average, disruptive behavior decreased from age 3.5 to 6.0. Child sex and maternal depression/anxiety related to the level of behavior problems but not to the rate of change. Boys and children of more depressed/anxious mothers exhibited higher levels of disruptive behavior. Maternal negative control was associated with both level of disruptive behavior and rate of change, and negative control mediated the effects of maternal depression/anxiety. Greater negative control corresponded to higher levels of behavior problems and no reduction in their display over time. Child race moderated effects of negative control. [ABSTRACT FROM AUTHOR]

Presents a study in which frontal and parietal electroencephalographic (EEG) activity was recorded from 27 infants aged 11-17 months (13 of whose mothers reported elevated depressive symptoms) during baseline and emotion-eliciting conditions. Comparisons between infants of nonsymptomatic mothers and infants of symptomatic mothers; Group differences; Methods; Results; Discussion; Conclusion.

Sixteen patients with a clinical diagnosis of probable multiple system atrophy (MSA) were examined clinically by MRI and by 123I-iodobenzamide single photon emission computed tomography (IBZM-SPECT). The clinical records of another 16 patients were also analysed retrospectively. On the basis of their clinical presentation, patients were subdivided into those with prominent parkinsonism (MSA-P, n = 11) and those with prominent cerebellar ataxia (MSA-C, n = 21). Autonomic symptoms were present in all patients and preceded the onset of motor symptoms in 63% of patients. Calculated median lifetime and the median time to become wheelchair bound after onset of disease were significantly shorter for MSA-P than for MSA-C (lifetime: 4.0 v 9.1 years; wheelchair: 3.1 vs 5.0 years) suggesting a better prognosis for cerebellar patients. A significant loss of striatal dopamine receptors (below 2 SD threshold) was detected by IBZM-SPECT in 63% of the patients (56% below 2.5 SD threshold). There was no difference between patients with MSA-C and those with MSA-P in the proportion with significant receptor loss and the extent of dopamine receptor loss. Planimetric MRI evaluation showed cerebellar and brainstem atrophy in both groups. Atrophy was more pronounced in patients with MSA-C than in those with MSA-P. Pontocerebellar hyperintensities and putaminal hypointensities on T2 weighted MRI were found in both groups. Pontocerebellar signal abnormalities were more pronounced in MSA-C than in MSA-P, whereas the rating scores for area but not for intensity of putaminal abnormalities were higher in MSA-P. MRI and IBZM-SPECT provide in vivo evidence for combined basal ganglia and pontocerebellar involvement in almost all patients in this series. [ABSTRACT FROM AUTHOR]

Describes an analysis procedure for long-term tremor recordings. Direct measure of the pathological muscle activity; Quantitative characteristics called 'tremor parameters'; Estimation of tremor severity in clinical studies; Quantification of agonist-antagonist interaction.