Yacov Balash - Academia.edu (original) (raw)

Papers by Yacov Balash

Freezing of gait (FOG) is a disabling phenomenon common in patients with advanced Parkinson’s dis... more Freezing of gait (FOG) is a disabling phenomenon common in patients with advanced Parkinson’s disease (PD). The cause of FOG is unclear. The objective of this study was to explore a novel hypothesis stating that FOG is related to asymmetric motor performance. We compared PD patients that experience FOG episodes (PDFOG) with PD patients that do not (PDFOG) and studied the relationship of FOG to asymmetry in gait and in rhythmic hand movement performance to determine whether potential FOG-related gait asymmetry is unique to walking or whether it is systemic. Subjects were tested in an “off ” (unmedicated) and again in an “on ” (medicated) state. Gait was more asymmetric in PDFOG than in PDFOG during “off ” state (p 0.005) and during “on ” (p 0.016). Rhythmicity of foot swing in one leg was correlated with the other leg in PDFOG but not in PDFOG. There was no difference in asymmetry in performance of rhythmic hand movements between the two groups. No correlation was found between asymm...

The Author(s) 2014. This article is published with open access at Springerlink.com Background Hig... more The Author(s) 2014. This article is published with open access at Springerlink.com Background Higher-level gait disorder (HLGD) in older adults is characterized by postural instability, stepping dysrhythmicity, recurrent falls and progressive immobility. Cognitive impairments are frequently associated with HLGD. Objectives The aim of this study was to compare gait and cognitive performance before and after the use of riv-astigmine in patients with HLGD, free from cognitive impairment or Parkinsonism. Methods Fifteen non-demented patients with HLGD (age

Background The use of medical cannabis (MC) is controversial. Support for its benefits is based o... more Background The use of medical cannabis (MC) is controversial. Support for its benefits is based on small clinical series. Objective The aim of this study was to report the results of a standardized interview study that retrospectively assessed the effects of MC on symptoms of Parkinson disease (PD) and its adverse effects in patients treated for at least 3 months. Methods The survey used telephone interviews using a structured questionnaire based on subjective global impressions of change for various parkinsonian symptoms and yes/no questions on adverse effects. Results Forty-seven nondemented patients with PD (40 men) participated. Their mean age was 64.2 ± 10.8 years, mean disease duration was 10.8 ± 8.3 years, median Hoehn and Yahr (H&Y) was stage III. The duration of MC use was 19.1 ± 17.0 months, and the mean daily dose was 0.9 ± 0.5 g. The delivery of MC was mainly by smoking cigarettes (38 cases, 80.9%). Effect size (r2) improvement for falls was 0.89, 0.73 for pain relief, 0...

ABSTRACT Fear of falling (FOF) is one of the key clinical features affecting older adults with a ... more ABSTRACT Fear of falling (FOF) is one of the key clinical features affecting older adults with a higher-level gait disorder (HLGD), however, its effect on gait is not clear. Twenty-one HLGD patients walked under four conditions: 1) usual walking, 2) while holding a physical therapist's hand, 3) while using a walker, and 4) while being guarded. All three interventions reduced FOF, but guarding did not significantly affect any gait parameter (p > 0.10) and the walker only increased gait speed. In contrast, handholding improved gait speed and reduced gait variability, however, an altered gait pattern persisted even with handholding. Interventions such as handholding, guarding or use of a walker apparently may reduce FOF in HLGD patients, but the impact of this reduction on gait is limited. Thus, it appears that the gait disturbances in these patients are apparently not simply the consequence of FOF.

Neurological Sciences

Bradykinesia, dysrhythmia, and decrement in hand movements (HM) are core symptoms of Parkinson’s ... more Bradykinesia, dysrhythmia, and decrement in hand movements (HM) are core symptoms of Parkinson’s disease (PD). The maximal rate of repetitive rhythm-preserving HM can be a diagnostic tool for PD bradykinesia. To improve the clinical diagnosis of bradykinesia by identifying the frequencies at which rhythmic HM become irregular in PD patients compared to healthy age-matched controls. Forty PD patients and 16 controls were asked to alternately perform left and right hand movements following the rate of a metronome with sound stimulation beginning at 85 beats per minute (BPM) and increasing in increments of 15 BPM up to 355 BPM. The rhythm of the HM for each rate was assessed visually, and the threshold frequency at which the subject could no longer rhythmically continue HM was measured by the metronome. The increasing rates of HM until reaching that threshold were compared between patients with PD and controls. The mean rates of a metronome in PD vs. healthy subjects were 173.3 ± 42.0 vs. 248.8 ± 48.5 BPM (p < 0.001) and 164.8 ± 34.2 vs. 241.2 ± 40.1 BPM (p < 0.001) for the dominant and non-dominant hands, respectively. The areas under the ROC curve were 0.929 [95%CI: (0.86–0.99)] for the dominant hand and 0.947 [95%CI: (0.88–1.0)] for the non-dominant hand. The BMP score cut-off value was 208 (sensitivity 72.7%, specificity 100%) for the dominant hand and 206 (sensitivity 87.5%, specificity 95%) for the non-dominant hand. The proposed test quantified the frequencies of rhythmic HMs in PD patients vs. controls and improved the diagnosis of bradykinesia in PD patients.

Frontiers in Neurology

Only a few case reports of stroke-like onset of Creutzfeldt-Jakob disease (CJD) have previously b... more Only a few case reports of stroke-like onset of Creutzfeldt-Jakob disease (CJD) have previously been published. We aimed to analyze the neurological, imaging, electroencephalographic (EEG), and laboratory features of patients with this very rare phenomenon. Here, we review the clinical characteristics, onset features, and clinical course variants of stroke-like CJD in 23 such patients. The median age of the patients was 71 years (range: 56–84 years); 12 were women. In 20 patients, CJD was sporadic. Thirteen patients developed apoplexy-like onset of symptoms, whereas the others had prodromal non-specific complaints. Most often the patients manifested with pyramidal signs (n = 13), ataxia (n = 9), and aphasia (n = 8). On MRI DWI sequence, all subjects had abnormal hyperintensities in various parts of the cerebral cortex, striatum, or thalamus, while EEG detected periodic triphasic waves only in 11. CSF 14-3-3 protein and total τ-protein were abnormal in 17 of 23 cases. All patients di...

Acta Neurologica Scandinavica

Clinical neuropharmacology

The use of medical cannabis (MC) is controversial. Support for its benefits is based on small cli... more The use of medical cannabis (MC) is controversial. Support for its benefits is based on small clinical series. The aim of this study was to report the results of a standardized interview study that retrospectively assessed the effects of MC on symptoms of Parkinson disease (PD) and its adverse effects in patients treated for at least 3 months. The survey used telephone interviews using a structured questionnaire based on subjective global impressions of change for various parkinsonian symptoms and yes/no questions on adverse effects. Forty-seven nondemented patients with PD (40 men) participated. Their mean age was 64.2 ± 10.8 years, mean disease duration was 10.8 ± 8.3 years, median Hoehn and Yahr (H&Y) was stage III. The duration of MC use was 19.1 ± 17.0 months, and the mean daily dose was 0.9 ± 0.5 g. The delivery of MC was mainly by smoking cigarettes (38 cases, 80.9%). Effect size (r) improvement for falls was 0.89, 0.73 for pain relief, 0.64 for depression, 0.64 for tremor, 0...

Frontiers in neurology, 2017

Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain... more Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Establis...

Movement Disorders Curricula, 2017

International Encyclopedia of Public Health, 2017

Movement Disord, 2006

In Parkinson's disease (PD), freezing suggests sudden and transient blocks of motor behavior duri... more In Parkinson's disease (PD), freezing suggests sudden and transient blocks of motor behavior during initiating or continuous repetitive movements. Its underlying pathophysiology remains unclear. The objective of this study is to compare striatal dopamine metabolism and cerebral glucose metabolism between PD patients with and without freezing of gait (FOG). A total of 10 PD patients with FOG at off and 7 PD patients without FOG underwent brain positron emission tomography with 18 [F]-6-fluoro-levodopa (FDOPA) and 18 [F]-fluordesoxyglucose (FDG). Striatum decarboxylase activity was expressed by metabolic influx constants of the striatum related to the occipital lobe (Kocc). FDG uptake in caudate and putamen was normalized to global FDG uptake. Region of interest (ROI) analysis of striatal regions was used, as well as voxel-based analysis by statistical parametric mapping (SPM). ROI analysis did not reveal differences in striatal FDOPA and FDG uptake between the groups. SPM showed lower putaminal FDOPA uptake (P ϭ 0.05 uncorrected) with increased FDG uptake (P ϭ 0.01 uncorrected) in freezing PD, whereas caudate uptake of the two tracers was reduced. Freezing-related cortical FDG decrease was found in (right) parietal regions. In conclusion, in freezing PD, caudate uptake of FDG and FDOPA was reduced, whereas putamen FDOPA decrease was associated with FDG increase. Right hemisphere circuitry seemed to be more affected in freezing patients.

Journal of Neural Transmission, Jan 21, 2010

We evaluated cognitive functions and mood in two groups of patients with multiple system atrophy ... more We evaluated cognitive functions and mood in two groups of patients with multiple system atrophy (MSA) in order to determine the influence of mood on cognitive performance. Our aim was to differentiate between parkinsonism-predominant (MSA-P) and cerebellar-predominant (MSA-C) MSA based on those parameters. Fifteen MSA-P and 10 MSA-C patients underwent neuropsychological tests that examined executive functions (working memory, response inhibition, and verbal reproduction), verbal learning and memory, verbal and visual reasoning, and processing speed. Anxiety and depression were also assessed. The findings on their cognitive performance and mood were compared to those of healthy controls and also discussed in relation to a group of Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (PD) patients. The results showed that cognitive and mood characteristics could distinguish MSA-P from MSA-C and that anxiety and depression are related to cognitive decline. Compared with healthy controls, MSA-P patients showed reduced verbal retrieval (immediate, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.019; long-term, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.018) while MSA-C patients had difficulties in learning new verbal information (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.022) and in controlling attention (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.023). These data indicate that MSA-P and MSA-C appear to have, at least in part, different cognitive and mood profiles. The neuropsychological assessments of MSA patients should test for and then take into account their level of anxiety and depression, insofar as it might have an adverse effect on their cognitive performance.

Experimental brain research, 2003

Patients with Parkinson's disease (PD) often experience freezing of gait, a debilitating phen... more Patients with Parkinson's disease (PD) often experience freezing of gait, a debilitating phenomenon during which the subject suddenly becomes unable to start walking or to continue to move forward. Little is known about the gait of those subjects with PD who experience freezing of gait or the pathophysiology of freezing. One possibility is that freezing of gait is a truly paroxysmal phenomenon and that the usual walking pattern of subjects who experience freezing of gait is not different than that of other patients with PD who do not experience these transient episodes of freezing of gait. On the other hand, a recent study noted gait changes just prior to freezing and concluded that dyscontrol of the cadence of walking contributes to freezing. To address this question, we compared the gait of PD subjects with freezing of gait to PD subjects without freezing of gait. Given the potential importance of the dyscontrol of the cadence of walking in freezing, we focused on two aspects ...

Journal of Neural Transmission. Supplementa, 2006

Gait is affected in all stages of Parkinson's disease (PD) and is one of the hallmarks fo... more Gait is affected in all stages of Parkinson's disease (PD) and is one of the hallmarks for disease progression. The fear of getting into the wheel chair is one of the first thoughts many patients ask about when the diagnosis of PD is given. At the early stages of the disease gait disturbances are present and can be measured but in most patients it does not cause significant functional disturbances. In contrast, as the disease progress, gait disturbances and postural control abnormalities are becoming major causes for lost of mobility and falls. These unfortunate consequences should be forecasted at the early stages of the disease and a preventive approach should be taken. Treatment of gait disturbances at the early stages of the disease is mainly to encourage patients to exercise and walk daily and by drugs in those with disabling symptoms. At the advanced stages, treatment should be aggressive in order to keep the patient walking safely. Drugs, physiotherapy and functional neurosurgery should be used wisely for best outcomes and least side effects. When time comes and the risk of falls is very significant, walking aids should be suggested and if no other option is left, wheel chair is a very reasonable option to maintain mobility out of home, preserving quality of life and avoiding falls with all it severe consequences.

Parkinson's Disease, 2015

Awareness of nonmotor symptoms of Parkinson’s disease is growing during the last decade. Among th... more Awareness of nonmotor symptoms of Parkinson’s disease is growing during the last decade. Among these, oral cavity disorders are, although prevalent, often neglected by the patients, their caregivers, and physicians. Some of these disorders include increased prevalence of caries and periodontal disease, sialorrhea and drooling, xerostomia, orofacial pain, bruxism, and taste impairment. Though many of these disorders are not fully understood yet and relatively few controlled trials have been published regarding their treatment, physicians should be aware of the body of evidence that does exist on these topics. This paper reviews current knowledge regarding the epidemiology, pathophysiology, and treatment options of disorders of the oral cavity in Parkinson’s disease patients.

Handbook of Clinical Neurology, 2007