Exposure to agricultural insecticides, together with yet incompletely understood predisposing genotype/phenotype elements, notably increase the risk of Parkinson's disease. Here, we report findings attributing the increased risk in an insecticide-exposed rural area in Israel to interacting debilitating polymorphisms in the ACHE/PON1 locus and corresponding expression variations. Polymorphisms that debilitate PON1 activity and cause impaired AChE overproduction under anticholinesterase exposure were strongly overrepresented in patients from agriculturally exposed areas, indicating that they confer risk of Parkinson's disease. Supporting this notion, serum AChE and PON1 activities were both selectively and significantly lower in patients than in healthy individuals and in carriers of the risky polymorphisms as compared with other Parkinsonian patients. Our findings suggest that inherited interactive weakness of AChE and PON1 expression increases the insecticide-induced occurrence of Parkinson's disease.

Hemiballismus/hemichorea constitute a neurological syndrome characterized by violent proximal involuntary movements on one side of the body, involving mainly the upper extremity. They are usually associated with small infarcts or hemorrhages in the vicinity of the subthalamic nucleus. Tumors, granulomas and surgical lesions were also reported as causative pathologies. Lesions in different sites of the striatum e.g. the subthalamic fasciculus and the head of the caudate nucleus 1 were reported to cause hemiballismus as well.In the last two decades, several patients 2-10 suffering from hemichorea or hemiballismus, associated with hyperglycemia ABSTRACT: Objective: To describe three patients suffering from transient hemichorea/hemiballismus associated with hyperglycemia, review previous reports and propose a possible pathophysiological explanation for this phenomenon. Results: Our original cases and previously reported ones reveal a uniform syndrome: mostly female patients (F/M ratio of 11/2), 50-80 years old, usually with no previous history of diabetes mellitus (9/13), develop choreic or ballistic movements on one side of the body over a period of hours. Serum glucose levels are elevated. In most of the patients, a lowering of the blood sugar level reverses the movement disorder within 24-48 hours. Conclusions: We believe that the combination of a recent or old striatal lesion (causing increased inhibition of the subthalamic nucleus) and hyperglycemia (causing decreased GABAergic inhibition of the thalamus) may be responsible for the appearance of this unilateral hyperkinetic movement disorder. Undiagnosed diabetes mellitus should always be suspected in patients who develop hemiballistic or hemichoreic movements. When hyperglycemia is detected and corrected, the movement disorder usually resolves within two days and may not require symptomatic therapy with dopamine receptor antagonists. RÉSUMÉ: Hémichorée transitoire/hémiballisme associé à une hyperglycémie d'apparition récente. Objectif:Le but de cet article est de décrire trois patients ayant présenté une hémichorée/hémiballisme transitoire en association à une hyperglycémie, de revoir les cas rapportés dans la littérature et de proposer une explication physiopathologique de ce phénomène. Résultats: Nos cas et ceux qui ont été rapportés dans la littérature présentaient un syndrome uniforme: une majorité de femmes (proportion F/H de 11/2), dont l'âge variait de 50 à 80 ans, habituellement sans histoire antérieure de diabète (9/13), qui développent des mouvements choréiques ou ballistiques d'un côté du corps en quelques heures. La glycémie est élevée. Chez la plupart des patients, une baisse de la glycémie fait régresser le désordre du mouvement en 24 à 48 heures. Conclusions: Nous croyons que la combinaison d'une lésion striatale récente ou ancienne (causant une augmentation de l'inhibition du noyau sousthalamique) et d'une hyperglycémie (causant une diminution de l'inhibition GABAergique du thalamus) pourraient être responsables de l'apparition de ce désordre d...

ABSTRACT:Background:In recent years, an increased prevalence of Parkinson's disease (PD) in southern Israel was observed. The aim of this study was to determine which exposures are associated with PD in the urban population of this region.Methods:Ninety-three PD patients living in towns were compared to 93 age and sex matched controls. A previously validated questionnaire, including demographic data, education, data on exposures, previous diseases, family history and habits, was administered.Results:In multivariate logistic regression analysis, it was found that history of work in construction sites was the strongest predictor of PD risk, followed by exposure to pesticides. In contrast, there was a negative association with smoking and history of mechanical factory employment. When the same statistical analysis was limited to association of PD with smoking, pesticides and construction work, the latter was found to be the strongest risk factor.Conclusion:The risk factors for PD in this population are work on a construction site and exposure to pesticides.

Murine typhus is a febrile systemic illness, presenting with headache and undulating fever. Neurological involvement is considered a rare complication. During 1994 and 1995, 34 patients admitted to our hospital were diagnosed as having murine typhus. Five of these patients presented with a syndrome of subacute "aseptic" meningitis or meningoencephalitis. Three had bilateral papilloedema and 2 had focal neurological signs. None had a rash or other systemic findings suggestive of rickettsial disease. The diagnosis was based on serum and cerebrospinal fluid serology and on prompt response to doxycycline therapy. These cases suggest that neurological involvement in murine typhus is more common than previously suspected and that murine typhus should be included in the differential diagnosis of subacute meningitis in endemic areas.