Reply: Is cognition key in paradoxical kinesia?

✍ Scribed by Marco Onofrj; Laura Bonanni; Astrid Thomas

• Book ID: 102505394
• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 47 KB
• Volume: 26
• Category: Article
• ISSN: 0885-3185
• DOI: 10.1002/mds.23432

✦ Synopsis

We read with great interest the letter written by Bonanni et al. 1 describing patients with Parkinson's disease (PD)-dementia and dementia with Lewy bodies who during an earthquake had improvement in gait which lasted for months. This is different than our own observation of lack of improvement in most patients with idiopathic PD during a life-threatening war. 2 As we reported previously, during a 1-month period, 50 PD patients without dementia, under our care lived in an area where thousands of Katyusha and mortar rockets fell. They had to flee to a secure shelter within 10 to 60 seconds to save their lives. Although there was immediate danger posed to their livelihood, we observed only 1 patient with paradoxical kinesia (PK). This patient suffered from cognitive impairment (MMSE-26), like all 14 patients described by Bonanni et al. (MMSE < 24). This observation that cognitive impairment is needed for PK to occur is a unique observation. Thus, a phenomenon similar to a ''double crush'' injury involving the basal ganglia and frontotemporal region may be needed to elicit PK. The dual damage may cause a differential effect on motor-control mechanisms or it may activate alternative pathways, such as the cerebellar circuitry. It would be interesting to know if the authors observed PK in a patient with no cognitive decline.