Micrographia in Parkinson's disease

doi:10.1016/0022-510X(72)90002-0

Journal of the Neurological Sciences

Volume 15, Issue 2, February 1972, Pages 141-152

https://doi.org/10.1016/0022-510X(72)90002-0 Get rights and content

Abstract

Micrographia has been of interest to many neurologists; the phenomenon, however, remained unexplained.

We have defined the incidence and characteristics of severe micrographia in a large population of Parkinsonian patients. It is totally separable from tremor and rigidity in these patients and has only an indefinite relationship to akinesia. In about 5% of all Parkinsonian patients, micrographia is present as a prodromal symptom before any other manifestation of the disease is noted; this is true in 30% of those patients who will later develop severe micrographia during the course of their disease. It remains essentially uninfluenced by various forms of treatment of Parkinsonism including stereotaxic thalamotomy; however, during treatment with levodopa some cases of micrographia improve. We feel that micrographia is of central origin, and evidence is offered in support of this hypothesis. A more complete understanding of the mechanism of micrographia would add much to our understanding of some subtleties of extrapyramidal motor dysfunction.

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When writing with the standard pen, peak-to-peak time was reduced in the metronome (control = 0.807 ± 0.121 seconds, metronome = 0.701 ± 0.100 seconds, p = 0.024) and activating (control = 0.807 ± 0.121 seconds, activating = 0.691 ± 0.113 seconds, p = 0.009) conditions compared to the control condition. Furthermore, the weighted pen increased the variability of distance between letter peaks (standard = 0.187 ± 0.010, weighted = 0.482 ± 0.065, p = 0.033) and the variability of time needed to complete each letter (standard = 0.176 ± 0.010, weighted = 0.187 ± 0.016, p = 0.042) compared to the standard pen. Finally, area under the curve of the extensor digitorum communis was reduced in the metronome (metronome = 66.03 ± 25.74 mV, control = 88.98 ± 30.40 mV, p = 0.034) and activating music (activating = 66.49 ± 26.02 mV, control = 88.98 ± 30.40 mV, p = 0.012) conditions compared to control when writing with the standard pen.
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Citation Excerpt :
Alternatively, increased task engagement might arise from changes in motivation or impulsivity related to alterations in forebrain neuromodulatory signaling that are reported around this time period in the DJ-1 KO rats. Impairments in manual dexterity and fine motor control are common in PD patients, and often manifest in the earliest stages of the disease [19,24], even prior to the tremor, rigidity and bradykinesia that are the defining motor symptoms of PD [21]. Forelimb reaching tasks are often used in preclinical studies to assay analogous forelimb function in rodents.
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^☆: The levodopa clinical trial was supported by U.S.P.H. grant No. 5-M01-RR-31-11 to the General Clinical Research Center, Peter Bent Brigham Hospital, Boston, Mass.

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Micrographia in Parkinson's disease☆

Abstract

Neuropsychologia

Zur Frage der Mikrographie

Mschr. Psychiat. Neurol.

Ueber einige bemerkenswerte Begleiterscheinungen der “extrapyramidalen Rigidität” (Akathisie-Mikrographie-Kinesia paradoxa)

Schweiz. med. Wschr.

Preliminary remarks on the L-dopa therapy of dystonia

Neurology (Minneap.)

Testing for akinesia

J. Neurosurg.

Über Makropsie und deren Beziehungen zur Mikrographie, sowie über eine eigentümliche Störung der Lichtempfindung

Mschr. Psychiat. Neurol.

Zur Analyse und Pathophysiologie der striären Bewegungsstörungen

Z. ges. Neurol. Psychiat.

De la micrographie dans les états Parkinsoniens postencéphalitiques et des conditions qui sont susceptibles de la modifier

Rev. neurol.

The Croonian Lectures on some disorders of motility and of muscle tone, with special reference to the corpus striatum

Lancet

In discussion to G. Challas, J. L. Chapel and R. L. Jenkins, Tourette's disease: control of symptoms and its clinical course

Int. J. Neuropsychiat.

Parkinson's disease: L-dopa treatment and handwriting area

Current ther. Res.

In discussion of B. Boshes, Voice changes in Parkinsonism

J. Neurosurg.