摘要:

AbstractHyperactivity in the subthalamic nucleus (STN) projections to the globus pallidus medialis (GPM) has been established as a crucial feature of parkinsonism in animal models of Parkinson's disease (PD). Recent experiments blocking the STN glutamatergic output to GPM or lesioning the STN support this concept by showing a dramatic reversal of parkinsonism. We review the role of stereotaxic surgery in the past and the possible future application of subthalamotomy for PD.

ISSN:0885-3185    

DOI:10.1002/mds.870080402

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

年代:1993

数据来源: WILEY

摘要:

AbstractWe recorded cortical frontal, central, and parietal somatosensory evoked potentials (SEPs) in 9 patients with hemiparkinsonism and in a group of 25 healthy volunteers. No differences were observed in the SEPs recorded after stimulation of the asymptomatic and symptomatic sides in the patients. Likewise, comparison with the healthy controls did not reveal significant group differences or abnormal waveforms in the patients. Even frontal N30 deflection, which has been reported to be diminished in Parkinson's disease (PD), was normal and symmetric in the patients. Therefore, no evidence was found for altered sensory input to the motor or premotor and supplementary motor cortices in PD.

ISSN:0885-3185    

DOI:10.1002/mds.870080403

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

年代:1993

数据来源: WILEY

摘要:

AbstractPositron emission tomography and18F‐fluorodeoxyglucose were used to measure the regional cerebral glucose consumption in a 15‐year‐old choreatic girl with classical Sydenham's chorea shortly after the onset of hyperkinetic movements and 5 months later after chorea had resolved and in a 74‐year‐old hemichoreatic woman with long‐standing hyperkinesia as a residuum of Sydenham's chorea in adolescence. Whereas cerebellar, thalamic, and cortical glucose consumption was within normal limits in both patients, lentiform and caudate glucose consumption was significantly increased in both hemispheres of the 15‐year‐old patient and in the hemisphere contralateral to the chorea in the 74‐year‐old patient. In the younger patient, striatal glucose consumption returned to normal after her hyperkinesia had disappeared with antibiotic therapy. The observation of an increase in striatal glucose consumption in Sydenham's chorea, in contrast to the decrease of this variable encountered in the vast majority of other choreatic disorders, leads to questioning the pathophysiology of chorea in humans and suggests the use of emission tomographic measurement of variables related to cerebral energy metabolism for differential diagnosis in

ISSN:0885-3185    

DOI:10.1002/mds.870080404

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

年代:1993

数据来源: WILEY

摘要:

AbstractThe effects of both opiate agonists and the opiate antagonist naloxone were examined in a rodent model of tardive dyskinesia (TD). Chronic (˜20 weeks) administration of fluphenazine resulted in the emergence of vacuous chewing mouth movements (VCMs), a response which may be a useful model for this disorder. Fluphenazine‐induced VCMs were not affected by a variety of selective opiate agonists administered intracerebroventricularly, but were potently suppressed by subcutaneous administration of the opiate antagonist naloxone. These findings suggest that increased opiate transmission may contribute to the pathogenesis of TD. Further investigation of the role of opiate antagonists in treating this disorder are warrant

ISSN:0885-3185    

DOI:10.1002/mds.870080405

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

年代:1993

数据来源: WILEY

摘要:

AbstractThe knowledge of functional capacities of postsynaptic dopaminergic receptors in parkinsonian syndromes is important for differential diagnosis and for planning therapeutic approaches. Subcutaneous apomorphine challenges serve as a pharmacological tool in testing dopaminergic responsiveness, but discrepancies between results of the apomorphine test and long‐term levodopa treatment remain.123I IBZM (I‐123 labeled iodobenzamide) as a dopaminergic receptor ligand allows depiction of D2‐receptors by means of SPECT methods. The correlation between dopaminergic responsiveness and D2‐receptor status as demonstrated by123I IBZM‐SPECT imaging was assessed by applying an apomorphine test to 41 patients with parkinsonian syndromes. All subsequently underwent an123I IBZM‐SPECT. Apomorphine responders showed a significantly higher binding of123I IBZM than nonresponders, and patients with idiopathic Parkinson's disease (IPD) had higher D2‐receptor density as visualized by SPECT than patients with other parkinsonian syndromes. The marked overlap between the groups allowed a reliable prediction only in patients with an abnormally low basal ganglia/frontal cortex ratio of123I

ISSN:0885-3185    

DOI:10.1002/mds.870080406

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

年代:1993

数据来源: WILEY

摘要:

AbstractThe cerebral metabolic rate of glucose was measured in 14 Parkinson's disease patients with severe on‐off fluctuations. Two positron emission tomography (PET) scans with [18F]fluorodeoxyglucose were performed, one after a challenge of subcutaneous apomorphine at a dose able to relieve akinesia within 15 min and the other with the vehicle. Apomorphine reduced glucose utilization by 4‐6% in the lenticular nuclei and the occipital cortex and by 6‐9% in the thalamic nuclei, but this effect was not statistically significant. Thus, central stimulation of dopamine receptors by apomorphine in advanced Parkinson's disease is not associated with cerebral methabolic changes as assessed by PET. Despite a dramatic improvement of the motor state, the global neuronal activity in the striatum and its downstream projections remains stable, suggesting an equilibrium between excitatory and inhibitory dopaminergic activ

ISSN:0885-3185    

DOI:10.1002/mds.870080407

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

年代:1993

数据来源: WILEY

摘要:

AbstractTerguride (TER), a semisynthetic derivative of lisuride, has been found to display dopamine (DA) agonist and DA antagonist effects in animals, depending on the experimental model used. TER (2 mg/day) was compared to placebo in 41 fluctuating Parkinson's disease patients to test its effect on akinesia and dyskinesia. Mean hours “off” decreased at weeks 6 and 12 (p<0.05) in the TER group but the overall difference from the placebo group was not significant. Only the TER group displayed a decrease over time in mean Columbia University Rating Scale total score “on” and “off” (p = 0.001 and p = 0.03, respectively). Duration of involuntary movements and resulting disability were not significantly different between patients on TER and those on placebo administration. In the overall evaluation, patients preferred TER (p = 0.01). Tolerance of TER was very good in all but one patient whose wearing‐off increased; no one dropped out because of side effects. This 3‐month doubleblind study showed that TER, added to stable doses ofL‐dopa, may have slight antipark

ISSN:0885-3185    

DOI:10.1002/mds.870080408

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

年代:1993

数据来源: WILEY

摘要:

AbstractInter‐ and intrarater reliability in scoring the signs of Parkinson's disease using the original Columbia scale and a modified version of this, the Sydney scale, were assessed in five neurologists participating in a long‐term study of Parkinson's disease. Scoring was done on video recordings of 41 patients whose disability ranged from mild to severe. Although all the neurologists were familiar with the scales and had received training designed to produce uniformity of scoring, interrater reliability was poor. The mean score for the Columbia scale varied from 18.6 to 30 and for the Sydney scale from 15.2 to 23.2. By contrast, intrarater reliability was good. This study highlights the limitations of clinical rating scales in Parkinson's disease when more than one rater is used. In designing clinical trials, every effort should be made to ensure that the same patient is always assessed by the same ra

ISSN:0885-3185    

DOI:10.1002/mds.870080409

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

年代:1993

数据来源: WILEY

摘要:

AbstractTo gain insight into the antiparkinsonian effects of selective D1 and D2 dopamine receptor stimulation, we examined the ability of D1 (SKF 38393) and D2 (quinpirole) agonists to reverse catalepsy induced by the combined administration of reserpine and α‐methyl‐p‐tyrosine (AMPT) in rats. Catalepsy, the failure to correct an externally imposed posture, is a measure of akinesia and was assessed using the bar test. Rats injected with reserpine alone (2.5 mg/ kg i.p.) developed akinesia and ptosis within 60‐90 min. The D1 agonist SKF 38393 (30 mg/ kg i.v.) rapidly reversed ptosis and restored near‐normal mobility when administered 24 h after reserpine and AMPT; catalepsy was reversed for 90 min, after which the drug effect wore off. Quinpirole (1 mg/ kg i.v.) reversed catalepsy for the duration of the test period (4 h) but did not consistently reverse ptosis or promote normal mobility; the rats continued to exhibit kyphotic postures with little spontaneous locomotion. These results indicate that selective D1 stimulation is sufficient to reverse reserpine‐induced akinesia and highlight the need for the development of potent selective D1 agonists for clincal traial in Parkinson's disease. In serve dopamine depletion, D2 stimulation alone appears to be insufficient to restore normal movement. Quinpirole, but not SKF 38393, elicited paroxysmal limb/ body jerking in reserpine‐AMPT‐treated rats, providing further evidence that atypical jerking can be elicited by D2 stimulation in the complete absence of D1 stimulation. This laboratory observation suggests that some jerking dyskinesias seen in treated parkinsonian patients may be mediated by an imbalance in D1‐D2 re

ISSN:0885-3185    

DOI:10.1002/mds.870080410

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

年代:1993

数据来源: WILEY

摘要:

AbstractFifteen patients with torticollis who had been treated with repeated injections of botulinum toxin type A (botox A) developed antibodies to the toxin. This resulted in loss of benefit in the 13 patients who had improved with botox A injections and failure to develop muscle atrophy after injection in all 15 patients. Patients were then injected with botulinum toxin type F (botox F) in the same muscles that had been injected with botox A. Ten of the 15 improved after botox F injections, including 9 of the 12 patients who had improved with type A toxin. Six of 9 patients with pain had improvement in pain after botox F injections. Patients reported similar improvement with type F and type A toxins, but duration of benefit was ˜3 months with type A and ˜1 month with type F. Botox F is an effective treatment for torticollis in patients who are immune to botox A. The usefulness of type F toxin, however, is limited by short duration of benefi

ISSN:0885-3185    

DOI:10.1002/mds.870080411

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

年代:1993

数据来源: WILEY