Letters to the Editor

Valuable Tool for Patients withOrthostatic Tremor

Orthostatic tremor is an uncommon disabling condition. One ofthe most troublesome symptoms is inability to stand in a queue.Patients can no longer go out shopping, wait at a bus stop, oridle to admire the view. One of my patients has found a veryeffective practical solution to this problem, which has trans-formed her life. She has purchased a rucksack with a stoolattached (Fig.1). It is light on the back, has two pockets, and iseasy to take off and put on again.

She wrote: “It takes the vulnerable feeling away. I can takea bus and walk back enjoying the freedom and independence—knowing that I can sit down whenever I want. I used it in thebank yesterday—as there was a long wait and many people.Previously I would have given up. I can go to exhibitionsagain—and joined a group looking at trees in a garden, led byan expert who talked at length about them. It truly has madesuch a difference I thought I should share it with others. Mostof all, I can wait at bus stops now.”

In the United Kingdom, the rucksack stool can be purchasedby means of Littlewoods catalogue (see the 2002 catalogue,page 205, product number 115118). This catalogue is alsoavailable online (www.littlewoods-index.com).

I write so that other physicians may advise their patients ofthis dramatic simple solution to a difficult problem. I hope itwill be useful.

David Bateman, MDNeurology DepartmentRoyal United Hospital

Combe Park, Bath, United Kingdom

Re: Klintenberg et al., Tardive DyskinesiaModel in the Common Marmoset

In an otherwise excellent article on an animal model of tardivedyskinesia, Klintenberg and colleagues1 state that “extrapyra-midal side effects are still the major limiting factors in the useof antipsychotics.” This is incorrect and underestimates themagnitude of the problems that are still present in the treatmentof schizophrenia, in particular, as well as other psychotic dis-orders. Neither clozapine nor quetiapine have been reported tocause the various extrapyramidal side effects, but they do causesedation and orthostatic hypotension as well as a panoply of

FIG. 1. A: The ready-to-wear rucksack. B: The rucksack positioned for sitting.

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other side effects. Clozapine, the most effective of the anti-psychotics, causes massive weight gain, drooling, and possiblydiabetes and myocarditis. More importantly, however, thesedrugs are useful primarily for improving the “positive” symp-toms of schizophrenia and reducing the relapse rate. They arenot very effective in improving the “negative” symptoms suchas anhedonia, blunted affect, and apathy, and are minimally ifat all effective in treating the cognitive deficits that are part ofthe schizophrenia picture.2 The introductory paragraph in theTD article suggests that if the motor side effects were lessproblematic, then there would be a dramatic breakthrough intreating psychosis. Unfortunately, this is not the case.

Joseph H. Friedman, MDDepartment of Clinical NeurosciencesBrown University School of Medicine

Providence, Rhode Island, USA

References

1. Klintenberg R, Gunne L, Ndren PE. Tardive dyskinesia model in thecommon marmoset. Mov Disord 2002;17:360–265.

2. Buchanan RW, Carpenter WT Jr. Schizophrenia: introduction andoverview. In: Sadock BJ, Sadock VA, editors. Comprehensive text-book of psychiatry. Seventh edition. Philadelphia: Lippincott Wil-liams and Wilkins; 2000. p 1108.

Review of the iMovie Video-Editing System

Editing videotapes is comparable to editing manuscripts.1 Withthe introduction of a computer-based digital video-editing pro-grams, neurologists can now produce crisp and instructivedigital videotapes or “movies” using their personal desktop orlaptop computer. In this journal, Jog and Grantier2 have dis-cussed recently the advantages of digital video recording sys-tems over traditional analogue video systems, such as VHS andHi8. For neurologists who expect to present videos, of theseveral digital video-editing options, iMovie merits specialconsideration.

iMovie is a computer application program that is preinstalledin the Apple OSX operating system. To realize its full potential,the program requires the new G4 Apple computer, such as theiMac, but it can be used with recent G3 Apple computers andoperating systems OS 9.0.4. However, iMovie is incompatiblewith the common PC platforms that use the Windows operatingsystem, such as Dell and Gateway computers.

iMovie imports (transfers) video and audio recordings fromdigital video cameras. With the addition of an analogue-to-digital converter, iMovie can import VHS and Hi8 videos andcombine them seamlessly into digital videos. It can also importaudio from a microphone, compact disk (CD), or other sourceinto its two audio channels.

Once media are imported, segments (clips) are displayed forindividual editing. Each clip can be easily trimmed (cut), rear-ranged (pasted), deleted, copied, and otherwise altered and then

combined in any sequence. iMovie can also add other digitalimages, such as ones from cameras, scanners, and Adobe Pho-toshop. An iMovie subprogram can insert title segments, innumerous fonts and colors, on a black background or superim-posed on a clip. It can also create transitions between clips.

Once the movie has been edited, it can be projected at thestandard video rate of 30 frames per second at full screen size.The movie can be stored, with no loss of image quality, inseveral different media. For example, the edited video can beexported back to digital videotape. It can also be converted toanalogue format and downloaded to VHS tape for use in acommon VHS player. If the movie requires less than 700 MB,which is equivalent to 2.5 to 3 minutes, it can be exported to aCD. iMovies of approximately 4 GB (15–18 minutes) can beexported to a digital video disk (DVD). Because iMac comput-ers include a built-in CD or DVD burner, depending on themodel, no further hardware is required for editing or storage.

iMovies can also be exported to QuickTime or DVD-Rformats, which both include video compression. The compres-sion for DVD-R is so substantial that it allows the same 4 GBof space to hold 90 minutes of video. An Apple DVD-R can beplayed or projected directly from most DVD players withoutrequiring a computer.3

In addition, exporting iMovies to QuickTime format allowsthem to be inserted into a Microsoft PowerPoint presentation.This required circuitous route—iMovie to QuickTime to Pow-erPoint—is a drawback. Nevertheless, it allows movies to beshown on PC platforms. Short, highly compressed digital mov-ies can be posted on the internet. High-quality QuickTimemovies can be exported, but they usually require as muchmemory as the original.

Although it can be separately purchased for $30 (costs areapproximate “street prices” in New York City, 2002), iMovie isa component of the OSX operating system. The major cost isreally the required iMac or comparable G4 computer. An iMacwith a DVD burner costs $1,500. An analogue-to-digital con-verter for conversion of VHS to digital tapes (and back again)costs $150 to $400. For individuals who require advancedediting options, which would be far beyond those required byneurologists, Apple offers a more complex and expensive pro-gram: Final Cut Pro ($1,000).

The prospective digital video editor must also invest time(4–8 hours) in learning the iMovie program. Fortunately, theseamless integration of software and hardware eliminates manyof the usual problems and frustrations. Another advantage isthat much of the iMovie program is intuitive. In addition togood documentation and online help, independent instructivebooks, such as Pogue’s iMovie2,4 are available. Overall, by thecommon technical yardstick of an application’s ratio of “powerto ease of use,” it is quite favorable.

For those individuals wedded to PCs, several digital-editingprograms based on the Windows operating system are avail-able.5 Depending on the particular PC and its configuration,additional hardware (e.g., digital video capture-board) might berequired. Assuming that the computer will support them, com-mon programs are Adobe Premiere v. 6.0 ($550) and Ulead’sVideoStudio 6 ($99).

In summary, iMovie provides a simple but effective andpowerful digital video editing program that, aside from the costof a Mac computer, is economical in its financial cost and time

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required learning it. iMovie is particularly suitable for neurol-ogists who wish to edit, store, project, and publish digital video.

David Myland Kaufman, MDChristopher Cimino, MD

Departments of NeurologyMontefiore Medical Center

Albert Einstein College of MedicineBronx, New York, USA

References

1. Kaufman DM. Videotape quality. Mov Disord 1995;10:803–804.2. Jog MS, Grantier N. Methods for digital video recording, storage,

and communication of movement disorders. Mov Disord 2001;16:1196–1200.

3. LaBarge R. DVD compatibility test. DV. July, 2002, p 20–29.4. Pogue D. iMovie2: the missing manual. Cambridge: Pogue Press/

O’Reilly; 2001.5. Nulph RG. Editing software: buyer’s guide. Videomaker, June,

2002, p 34–39.

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