ISSN:0885-3185    

DOI:10.1002/mds.870110302

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractChronic electrical subthalamic nucleus (STN) stimulation is under investigation for alleviating parkinsonian symptoms. STN alterations may carry the risk of provoking abnormal involuntary movements (AIMs). We took advantage of the reversibility of the stimulation technique to assess the possibility of inducing AIMs, using different electrical variables with or without concomitant levodopa intake. Above a given threshold voltage, stimulation could induce contralateral distal mobile AIMs or hemiballism in the off‐drug condition in two patients. AIMs occurred after a latency that varied from a few minutes up to several hours after switching on the stinulator. Hemiballism immediately disappeared upon switching off the stimulator. In these patients, levodopa had never provoked that type of AIMs before surgery. Levodopa‐induced AIMs were not modified by electrical stimulation, but off‐phase dystonia disappeared in one patient. Stimulation of the STN induced AIMs that resembled both those observed following spontaneous lesions of the STN and levodopa‐induced diphasic AIMs in parkinsonian patients. As electrical stimulation provoked AIMs and antiparkinsonian benefit occurred with different electical variables and different timing, the mechanisms responsible for these two effects could be d

ISSN:0885-3185    

DOI:10.1002/mds.870110303

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractWe determined the variables associated with the progression and duration of illness of patients with Parkinson's disease (PD) and investigated the cause of death. In 474 patients with parkinsonism, who visited the Academic Hospital between January 1, 1960 and August 31, 1993, we did a survival analysis with the following covariates: age at onset, intial symptom (tremor or rigidity/hypokinesia), age at reaching Hoehn and Yahr stage III, dementia‐free period, and levodopa treatment. A total of 345 patients with parkinsonism fulfilled the criteria of idiopathic PD; 258 of them were still alive on the closing date of this study. There were significantly more men than women (1.43:1). Medical advice was sought in an earlier stage by men and by patients with tremor as presenting symptom. For patients with rigidity/hypokinesia as first symptom, the duration of illness until reaching Hoehn and Yahr stage III was shorter than for patients starting with tremor alone. If the initial symptom is tremor, patients develop dementia less frequently and later after onset than when tremor is not involved. Reaching Hoehn and Yahr stage III and developing dementia both, limit the patient's survival time. The mortality risk for a patient was found to be increased form the moment levodopa treatment was started as compared to those patients who had not yet started with the treatment. The effect of levodopa on survival could not be disentangled from effects of other factors related to the start of levodopa treatmen

ISSN:0885-3185    

DOI:10.1002/mds.870110304

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractThe possibility of using magnetic resonance (MR) to evaluate the severity of the pathological changes of Parkinson's disease (PD) is suggested by the known accumulation of iron in the basal ganglia in PD and the reduced signal evident from this area with conventional reduced signal evident from this area with conventional T2‐weighted MR imaging. To improve the specificity of MR for the measurement of tissue iron content, we have developed a method that quantifies the effects of paramagnetic centers sequestered inside cellular membranes, based on the echo time dependence of the decay of transverse magnetization caused by the local field inhomogeneities which are due to intracellular iron. This method enables an index of local tissue iron content to be calculated for structures of the basal ganglia. We report here the application of this method to a series of patients with PD (n = 12) and of normal, age‐matched controls (n = 13). Our objective was to determine whether this measurement of basal ganglia iron concentration correlates with the presence and severity of PD. We observed a significant increase in iron content in both the putamen and pallidum in PD as well as a correlation with the severity of clinical symptomatology. More severely affected patients had a higher iron content in both of these structures. Our results suggest that this MR measurement may provide a noninvasive method of measuring the severity of the pathological changes underlying

ISSN:0885-3185    

DOI:10.1002/mds.870110305

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractTwenty‐five patients with hand tremor of 2 + (moderate) to 4 + (severe) on the tremor severity rating scale were randomized to receive either 50 U of botulinum toxin (BTX) type A (Allergan, Irvine, CA) or placebo injections into the wrist flexors and extensors of the dominant limb. If patients failed to respond to the initial injection, they were eligible to receive another injection of 100 U 4 weeks later. Rest, postural, and kinetic tremors were evaluated at 2‐ to 4‐week intervals over a 16‐week study period using tremor severity rating scales, accelerometry, and assessments of improvement and disability. A signigicant improvment (p<0.05) was observed on the tremor severity rating scale 4 weeks after injection in patients treated with BTX as compared with placebo, and this effect was maintained for the duration of the study. Four weeks after injection, 75% of BTX‐treated patients vs. 27% of placebo‐treated patients (p<0.05). reported mild to moderate improvement (peak effect rating ≥2). There were no significant improvements in functional rating scales, although trends were observed for some items. Postural accelerometry measurements showed a ≥30% reduction in amplitude in nine of 12 BTX‐treated subjects and in one of nine placebo‐treated subjects (p<0. 05). Although all patients treated with BTX reported some degree of finger weakness, no severe, irreversible, or unexpected adverse events occurred. Chemodenervation with BTX may significantly ameliorate essential hand tremor in patients who fail to improve with conventional ph

ISSN:0885-3185    

DOI:10.1002/mds.870110306

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractThe ergoline derivative FCE 23884 acts as a dopamine D1agonist in untreated parkinsonian animals and as a D2antagonist in animals whose dopamine system is intact or levodopa treated. To evaluate whether this dual action might benefit patients with Parkinson's disease (PD) who have developed levodopa‐induced dyskinesias, the motor effects of FCE 23884 were examined in seven such individuals using a double‐blind, placebo‐controlled design. At doses up to the maximum tolerated dose (3.5 ± 0.5 mg), FCE 23884 monotherapy did not affect parkinsonian severity. On the other hand, coadministration of FCE 23884 with a mildly dyskinetic dose of levodopa, infused intravenously under steady‐state conditions, reduced the antiparkinson response by 54 ± 19% and tended to diminish dyskinesia severity. The results thus fail to suggest any useful role for FCE 23884 in the symptomatic treatment of PD. Although D2receptor blockade provided by FCE 23884 antgonizes both the antiparkinson and dyskinesigenic responses to levodopa, the degree of D1receptor stimulation appears insufficient to ameliorate parkinsonian sympt

ISSN:0885-3185    

DOI:10.1002/mds.870110307

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractWe studied nitrogen radical nitric oxide (.NO) release and reactive oxygen species (ROS) production by isolated neurophils after phorbol myristate acetate (PMA) stimulation in 12 newly diagnosed and nine treated Parkinson's disease (PD) patients and 10 age‐matched healthy controls. Neutrophils of both groups of PD patients had an elecated PMA‐activated release of ·NO [61 and 57%, respectively, higher than that of controls (p<0.05)]. In contrast, H2O2release was only significantly increased by 56% in chronically treated patients. In agreement, the maximum rate of luminoldependent chmiluminescence, which partly represents O2‐H2O2‐.NO interactions, was increased only in the treated group. When other blood markers of oxidative stress were compared, only erythrocyte catalase activity was decreased in both PD patient series by 33 and 39%, respectively (p<0.05), whereas plasma antioxidant capacity and erythrocyte superoxide dismutase activity levels were decreased only in treated PD patients. This study suggests that neurophils express a primary alteration of ·NO release in PD patients, whereas H2O2and oxidativestress parameters are more probably related to the evolution of PD or to effects of treatment wi

ISSN:0885-3185    

DOI:10.1002/mds.870110308

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractWe compared autonomic function in patients with multiple system atrophy (MSA) or with idiopathic Parkinson's disease (IPD) by measuring sympathetic skin response (SSR) and R‐R interval variability (RRIV). SSR was investigated in 26 patients (13 with MSA and 13 patients with IPD). RRIV during deep breathing, Valsalva maneuver, and on standing was investigated in 20 patients (nine with MSA and 11 with IPD). MSA and IPD patients had similar age, illness duration, and therapy. Abnormal SSR was more frequent in MSA (69%) than in IPD (7.7%; X2, 10.4; p<0.002). RRIV during deep breathing and the Valsalva maneuver was lower in MSA than in IPD (p<0.02). RRIV during standing up was not significantly different in IPD and MSA, These differences between MSA and IPD may be due to more severe and widespread autonomic disturbance in MSA, related to more severe neuropathologic involvement of the autonomic nervous system. SSR and RRIV may aid in the differntial diagnosis of parkinsonism and help to exclude from clinical trials MSA patients clinically misdiagnosed as having IP

ISSN:0885-3185    

DOI:10.1002/mds.870110309

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractWe conducted a randomized, double‐blind, placebo‐controlled tolerability study of a N‐methyl‐D‐aspartate (NMDA) glutamate receptor ion‐channel blocker, remacemide hydrochloride, in 31 independently ambulatory patients (18 men, 13 women) with Huntington's disease (HD). Subjects were randomized to receive either placebo or active remacemide at dosages of 200 mg/day or 600 mg/day. The primary outcome measure was the proportion of subjects able to compleate the study with the assigned treatment. Remacemide was generally well tolerated, and no significant differences between the treatment arms were found in the primary outcome measure. A trend toward impovement in chorea was observed among subjects administered remacemide 200 mg/day. Based on the tolerability and safety demonstrated during this short‐trem trial, remacemide warrants more extended controlled investigation in pat

ISSN:0885-3185    

DOI:10.1002/mds.870110310

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY

摘要:

AbstractWe observed abnormal involuntary movements, involving principally the facial and neck muscles, in 23 patients with stuttering. These movements were similar to involuntary movements seen in distinct dystinic syndromes. There was a history of stuttering in the first degree relatives of six patients. The association of stuttering with degenerative neurologic disorders and focal brain lesions, cerebral blood flow changes in patients with developmental stuttering, its occurrence as a side effect of centrally acting drugs, induction and alleviation of stuttering by mechanical perturbation, or by electrical stimulation of the thalamus, a strong genetic predisposition with male preponderance, and the statistically significant occurrence of stuttering in the family history of patients with idiopathic torsion dystonia suggest an organic basis for developmental stuttering. These findings and the reported similarities between the involuntary movements associated with stuttering and dystonic involuntary movements support the hypothesis that stuttering is a form of segmental or focal action dystonia.

ISSN:0885-3185    

DOI:10.1002/mds.870110311

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1996

数据来源: WILEY