摘要:

Gamma glutamyl transferase (GGT) and alkaline phosphatase (ALP) may not be sensitive indicators of hepatocellular damage in patients taking anticonvulsant drugs as raised levels may only reflect enzyme induction. Aspartate aminotransferase (AST) is a specific, but relatively insensitive marker of liver damage and has a poor correlation with liver histology. Serum F protein is found in high concentration in the liver and levels are not influenced by enzyme induction. We measured serum F protein levels in patients taking carbamazepine (CBZ) and phenytoin (PHT) as monotherapy and in patients receiving multiple drugs. We compared the results with patients taking sodium valproate (VPA). Serum F protein levels were elevated in 6%, 22% and 13% of patients receiving CBZ, PHT and VPA, respectively. Raised GGT levels were reported for both the CBZ (26%) and PHT (78%) groups. Raised ALP levels were observed in 16%, 25% and 4% of the CBZ, PHT and VPA groups, respectively. Raised levels of serum F protein in the VPA group and the absence of any associated increases in either GGT or AST may further support the suggestion that serum F protein is an indicator of hepatocellular dysfunction associated with anticonvulsant therapy. However, further correlation with liver histology is required.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01673.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The objective of this paper is to evaluate the accuracy of conventional diagnostic criteria for Parkinson's disease and give an overview of alternative causes to parkinsonian syndromes. We also propose a new approach to the clinical diagnosis of Parkinson's disease, which may improve the diagnostic accuracy. The available information on autopsy findings in patients clinically diagnosed as Parkinson's disease shows that 20 to 30% of these patients do not have the typical neuropathological features with Lewy bodies and cell loss in the substantia nigra. The use of selected additional clinical criteria improves the diagnostic accuracy, however, at the cost of rejecting a rather large group of patients with idiopathic disease verified by autopsy. Based on this fact and a review of the literature on parkinsonian syndromes that may be confused with idiopathic Parkinson's disease, we propose criteria for diagnostic subgroups of the disease classified at different levels of confidence. The suggested diagnostic subgroups are clinical definite, probable and possible Parkinson's disease with a decreasing level of specificity and an increasing level of sensitivity in the different patient categories. The clinical features given special importance in this classification includes presence of resting tremor, asymmetrical disease, response to dopamine agonism and presence of atypical clinical features like dementia and clinical autonomic failure at onset and pyramidal or cerebellar signs at examination. In addition, a history indicating possible etiology for another parkinsonian syndrome will exclude the diagnosis.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01674.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The spouses of a group of aged sufferers have been demonstrated to have multifarious differences relevant to parkinsonism from matched controls, which were difficult to explain by selective mating, learned or reactive behaviour. Could parkinsonism be transmissable? The frequency of inflammation and scaling on head or neck was greater (P = 0.05) in these spouses (19 available) than in controls (36), the best discriminating site of inflammation being scalp (P = 0.02). Both seborrhoeic dermatitis and overt, or pre‐clinical, parkinsonism occurred in sufferers and spouses: to presume they are not causally related is to accept multiple entities. In favour of seborrhoeic dermatitis being causal for parkinsonism, rather thanvice versa, is the involvement of a known organism,Pityrosporum ovale, in the dermatitis, and that the evidence of parkinsonism in the spouses indicated that they were only part way down the path towards the clinical conditio

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01675.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Of 261 patients with clinically diagnosed Parkinson's disease (PD), whose age at the onset was 58.2 ± 11.3, 46 patients with the onset age above 70 (the mean for the whole group + ISD) were compared to 44 patients with onset age below 47 (the mean for the whole group – ISD). Old‐onset PD patient were more susceptible to develop psychotic complications of levodopa treatment. More often had they tremor both as presenting and dominant symptom of their disease. Among young‐onset PD bradykinesia was more often the dominant clinical feature, and susceptibility to levodopa induced dyskinesia was higher. In 9 cases of young‐onset PD (20.5% of this group) paraesthesia was a presenting symptom, compared to only 1 patient (2%) in the group of old

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01676.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Tremor at rest is a classic symptom of Parkinson's disease that causes significant disability and distress for the patient and is generally only weakly responsive to conventional treatment, like anticholinergic and dopaminergic medication. This study describes the treatment with Clozapine in patients with Parkinson's disease, who despite optimal antiparkinson medical therapy still have a major disabling tremor at rest. Clozapine is an “atypical” neuroleptic agent, producing fewer extra pyramidal side effects common to conventional antipsychotic drugs. Clozapine, however, has as its most serious complication agranulocytosis, and hence all patients taking Clozapine must undergo bloodtests at least several times a month. Under these frequent blood monitoring conditions, in this study Clozapine produced a substantial alleviation of parkinsonian tremor in 17 of 23 patients (73%). The beneficial response was reached with a relative low dose of Clozapine (18 mg./day), while previous antiparkinson medication was kept unchanged. The improvement of tremor at rest was noticeable generally within 2 weeks of beginning Clozapine therapy. No tolerance to the antitremor efficacy of Clozapine was seen during study‐period of at least 6 months. Leucopenia developed in one patient, other major adverse events were hypersalivation and day‐time drowsiness. These findings confirm the substantial antitremor efficacy of Clozapine in Parkinson's

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01677.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The study was carried out in patients with MS (n‐121) and in control group (n‐519). On the basis of haemagglutination intensity and results of radioimmunoassay three phenotypes of complement receptor were classified: high HH, medium HL, and low LL. Considerable differences were observed in the distribution of these phenotypes between controls and MS in whom the low phenotype was more frequent. Family studies suggest that reduced expression of the complement receptor on the erythrocytes depends in MS on the disease process in the first place, and not on genetic fact

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01678.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

We have studied the recovery of the hypothalamic‐pituitary‐adrenal (HPA) axis from inhibition by short‐term, intravenous high‐dose, corticosteroid therapy (IVHDCT) without subsequent oral replacement therapy in 10 patients with relapsing‐remitting or progressive multiple sclerosis (MS) using the human corticotrophin‐releasing hormone (hCRH) test. There was significant HPA suppression with profoundly decreased basal and peak plasma ACTH and cortisol levels 24 h after cessation of therapy. However, at 48 h the pituitary response was greatly enhanced with peak ACTH concentrations rising by more than 100 % over baseline values in 7 of 10 patients. Basal and stimulated ACTH concentrations returned to pre‐treatment levels at 120 h. Basal and stimulated plasma cortisol levels remained subnormal in 6 patients 120 h after IVHDCT. We conclude that IVHDCT without oral replacement therapy in MS patients is endocrinol

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01679.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This investigation estimated the mechanisms of tizanidine action on spasticity using a battery of neurophysiological methods. Thirty patients with old post‐stroke spastic hemiparesis took part in the investigation. They were treated with tizanidine‐mean daily dose 15.8 ± 5.6 mg for a mean of 23.3 ± 4.8 days. A questionnaire for assessment of subjective improvement after treatment used a 5‐point scale. For standardization of the neurological examination 5‐point scales were used to assess muscle tone, muscle force and tendon reflexes. A battery of neurophysiological methods was used to analyze different mechanisms of spasticity: for alpha motoneuron excitability – the F wave parameters; for presynaptic inhibition – the ratio of H reflex amplitudes before and after vibration of the achilles tendon (Hvibr/Hmax); for common interneuron activity – the flexor reflex parameters. Our results revealed that tizanidine reduces spastically increased muscle tone, but has no influence on muscle force, tendon reflexes, Babinski sign and ankle clonus. Tizanidine is supposed to act by increasing the presynaptic inhibition and decreasing of alpha motoneuron excitability. When spasticity has decreased presynaptic inhibition and increased motoneuron excitability, it is better to treat

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01680.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Hypothesis of the circannual and circadian variation in onset of intracerebral haemorrhage (CH) was verified, by means of single cosinor method and chi‐square test for goodness of fit, in 161 consecutive patients (94 men and 67 women) admitted into the Institute of Neurosurgery of Ferrara Hospital, Italy, over 9 years. The majority of CH occurred in the morning between 06.00 AM and 12.00 noon (36.7% of cases, p<0.001); when considering the specific anatomical sites, typical supratentorial haemorrhages showed a similar pattern (37.4%, p= 0.01). A similar morning behavior was found when considering subgroups by sex (men 36.2%, women 37.3%), age ≥60 years (42.5%), no presence of hypertension (39.7%), no presence of diabetes mellitus (33.3%) and non‐smokers (30.4%). The results by cosinor analysis yielded a circadian rhythmicity both for total sample and, for the men's subgroup, with a morning peak at 11.44 and 11.25, respectively. For women, however, spectral analysis found a significant ultradian cycle, having a period of 12 h (p = 0.01). A circannual periodicity, with a prevalent peak in February, was found for total sample and males subgroups, too. The results of this study confirm that intracerebral haemorrhages present a characteristic circadian and circannual pattern in

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01681.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Seventy‐one patients with Guillain‐Barré syndrome (GBS) were retrospectively selected from within a defined area (Cantabria) in northern Spain, from 1975 to 1988. Excluding two non‐resident cases, epidemiological analysis was based on 69 cases. The annual incidence rates were stable during the 14‐year period of study with an average incidence of 0.95 (age‐adjusted, 0.86) cases per 100000 population. No significant difference was found for sex, urban or rural residence and there was no significant seasonal clustering. Antecedent event were recorded in 57% of patients, the most frequent events being upper respiratory infection and gastroenteritis. No association between use of gangliosides and the syndrome was found. Eight patients had variant syndromes including Fisher's syndrome (2 cases), and axonal (4 cases) and sensory (2 cases) GBS. Recurrences occurred in 3 cases. Excluding nine patients with incomplete follow‐up and two with Fisher's syndrome, clinical analysis was based on 60 cases. Patients were divided into three groups as a function of their peak weakness. Significant features of the severe group were a requirement for ventilation, presence of bulbar palsy or dysautonomia and a longer duration of the plateau phase. However, it was not possible at an early stage of the clinical course to predict future motor deficit. Four (6.7%) patients belonging to the severe group died during the acute phase of the disease. No specific treatment for GBS was given. Outcome was assessed by means of serial examination up to 24 months after the onset of symptoms using a functional scale. At 3, 6 and 24 months 70%, 46% and 12% of patients, respectively, had a poor outcome. Features associated with poor outcome at three months include speed of progression, duration of the plateau phase, age greater than 40 years, severe weakness at the nadir, presence of denervation and a small or absent compound muscle action potential of the

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1994.tb01682.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY