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fects (more so in children than in adults) with the anticholinergic agents trihexyphenidyl (Artane) and ethopropazine (Parsidol) given in massive doses which are achieved by increasing the dosage very gradually The drug-induced tardive dyskinesias require specialized treatment, as described in Chaps 6 and 42 Reinstitution of the offending drug or anticholinergic agents is often tried Tetrabenazine, a centrally active monoamine-depleting agent, is effective but not easily available The acute dystonic drug reactions are treated as noted above In the focal dystonias, the most effective treatment has proved to be the periodic injection of botulinum toxin into the affected muscles Stereotactic surgery on the pallidum and ventrolateral thalamus has given rather unpredictable results, but in recent years there has been a renewed interest in this form of treatment (see page 91) Paroxysmal Choreoathetosis and Dystonia Under the names paroxysmal kinesigenic dyskinesia, familial paroxysmal choreoathetosis, and periodic dystonia, among others, there has been described an uncommon sporadic or familial disorder characterized by paroxysmal attacks of choreoathetotic movements or dystonic spasms of the limbs and trunk Both children and young adults are affected There are three main forms of familial paroxysmal choreoathetosis One, which has an autosomal dominant (less often recessive) pattern of inheritance and a tendency to affect males, has an onset in adolescence or earlier It is characterized by numerous brief (less than minutes) attacks of choreoathetosis provoked by startle, sudden movement, or hyperventilation hence the title paroxysmal kinesigenic choreoathetosis There may be many dozens of attacks per day or occasional ones This disorder responds well to anticonvulsant medication, particularly to phenytoin and carbamazepine In other families, such as those originally described by Mount and Reback and subsequently by Lance and by Plant et al, the attacks take the form of persistent (5 min to 4 h) dystonic spasms and have reportedly been precipitated by the ingestion of alcohol or coffee or by fatigue but not by movement per se (nonkinesigenic type) The attacks may be predominantly one-sided or bilateral This form of the disease is inherited as an autosomal dominant trait; a few families have displayed diplopia and spasticity and others have shown a familial tendency to infantile convulsions (each of these types has a different gene locus) Attacks may occur every several days or be separated by years A favorable response to benzodiazepines (clonazepam) has been reported, even when the drug is given on alternate days (Kurlan and Shoulson) A third type, formerly thought to be a variant of the MountReback type mentioned above, is precipitated by prolonged exercise and has a separate gene locus In addition to a response to benzodiazepines, it has the unique characteristic of improving with acetazolamide Because of their paroxysmal nature and the response (of the kinesigenic type) to anticonvulsant drugs, these familial disorders had been thought to represent seizures originating in the basal ganglia Whether the conventional notions of synchronous neuronal activity generating a seizure are even applicable to the basal ganglia seems doubtful to us Consciousness is not lost and the electroencephalogram is normal, even when recorded during an attack of choreoathetosis, arguing against an epileptic discharge in any case More common than these familial dyskinesias are sporadic cases and those secondary to focal brain lesions, such as the ones reported by Demirkirian and Jankovic They classify the paroxys-. c# mvc website pdf file in stored in byte array display in browser Display (Show) PDF file embedded in View in ASP.Net MVC Razor
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As well as I want to restrict the context menu in Pdf Viewer . ... There is a need for the application to display PDF file for user preview, which I did ... mal dyskinesias according to the duration of each attack and the event or activity that precipitates the abnormal movements (kinesigenic, nonkinesigenic, exertional, or hypnagogic) As with the familial cases, the acquired kinesigenically induced movements improve with anticonvulsants; others respond better to clonazepam Some cases are an expression of a serious neurologic or metabolic disease, or they may follow injuries such as stroke, trauma, encephalitis, perinatal anoxia, multiple sclerosis, hypoparathyroidism, or thyrotoxicosis The most severe instances in our experience have been of the kinesigenic variety due to multiple sclerosis and, in a few recent cases, to HIV, as a result of toxoplasmosis, lymphoma, or a presumed encephalitis due to the retrovirus itself These patients were relatively unresponsive to medications Also, it should be recalled that oculogyric crises and other nonepileptic spasms have occurred episodically in patients with postencephalitic parkinsonism; these phenomena are now seen with acute and chronic phenothiazine intoxication and with Niemann-Pick disease (type C) The Identity of Chorea, Athetosis, and Dystonia It must be evident from the foregoing descriptions that the distinctions between chorea and athetosis are probably not fundamental Even their most prominent differences the discreteness and rapidity of choreic movements and the slowness and con uence of athetotic ones may be more apparent than real As pointed out by Kinnier Wilson, involuntary movements may follow one another in such rapid succession that they become con uent and therefore appear to be slow In practice, one nds that the patient with relatively slow, con uent movements also shows discrete, rapid ones, and vice versa, and that many patients with chorea and athetosis also exhibit the persistent disorder of movement and posture that is generally designated as dystonia In a similar vein, no meaningful distinction except one of degree can be made between choreoathetosis and ballismus Particularly forceful movements of large amplitude (ballismus) are observed in certain patients with Sydenham and Huntington chorea who, according to traditional teaching, exemplify pure forms of chorea and athetosis, respectively The close relationship between these involuntary movements is illustrated by the patient with hemiballismus who, at the onset of the illness, exhibits wild inging movements of the arm and, after a period of partial recovery, shows only choreoathetotic exion-extension movements that are limited to the ngers and hand For this reason, the terms hemiballismus and hemichorea have sometimes been used interchangeably It should be pointed out that all disorders of movement due to lesions of the extrapyramidal system have certain other attributes in common The abnormalities of movement are superimposed on relatively intact praxic and voluntary movements, implying integrity of the cerebral control of the corticospinal systems The persistence of the abnormal movements indicates that they are veritable release phenomena; they are abolished by sleep and enhanced by anxiety and excitement; they are caused by a variety of diseases, some of which evoke one type of movement disorder more than another; and they can be altered by certain pharmacologic agents and by stereotactic lesions in certain parts of the motor systems To the clinician, the most dif cult examples are those in which all types of involuntary movement and tremors are combined a gestalt of dyskinesias Finally, while lesions in these parts of the cerebrum are most certainly manifest as disorders of movement, it would be incorrect to assume that other parts of the brain are not as involved; regions. mvc open pdf file in new window [Solved] How Can I Display A Pdf From Byte Array In Mvc ? - CodeProject
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