摘要:

Cyclosporine A (CsA) neurotoxicity is an iatrogenic disease with significant morbidity and occasional mortality. We retrospectively reviewed the cases of CsA neurotoxicity among bone marrow transplant recipients at our institution, and summarized the current literature on the subject. The neurologic presentation is varied and the neurologic manifestations are reversible, even after prolonged toxicity, in most instances. Serum CsA level is useful in evaluation, as the level is high in most instances. However, in a case of suspected neurotoxicity, withdrawal of the drug is the only way of determining presence or absence of such toxicity. The electrophysiologic studies, especially electroencephalogram (EEG), is very sensitive in identifying the problem, but lacks specificity. On the other hand, the neuroimaging studies are helpful in making a diagnosis if they show characteristic findings of hyperintense lesions affecting posterior cerebral regions on T2 weighted magnetic resonance images (MRI) or white matter hypodensities on computed tomographic (CT) scan. These lesions are probably due to breakdown of blood-brain barrier resulting in leakage of fluid in interstitial space. The breakdown could be serious enough to cause microhemorrhages that may coalesce to produce macrohemorrhages.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We present the results of an open, prospective, multicentric study including 450 patients with mild to moderate Parkinson's disease (PD) converted from standard Sinemet to Sinemet CR (controlled release; Dupont Pharma, Pavia, Italy). Patients with complex fluctuations and diphasic dyskinesias were excluded and the conversion was made after some recommendations, depending on the clinical problems and the daily dosage and administration schedule of standard (STD) Sinemet. The condition of more than 60% of the patients improved after the change and 80% of them preferred the CR formulation by the end of the study. We found a moderate, but significant, improvement in most of the efficacy parameters used, such as the Unified Parkinson's Disease Rating Scale (UPDRS), the Schawb and England scale, and dyskinesias and sleep questionnaires. Forty-five patients (10%) discontinued the study due to adverse effects (mainly gastrointestinal disturbances, functional deterioration, and dyskinesias). We conclude that Sinemet CR is a useful and safe therapeutic option in patients with mild and moderate PD. Selection of the patients is the most important outcome factor.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Information on the effects of newer antiepileptic drugs (AEDs) on the electroencephalogram (EEG) is sparse and contradictory. Quantitative EEG (qEEG) provides a method of estimating the effects of drugs on the central nervous system. Twenty-three adult patients with difficult-to-control complex partial seizures, with or without secondary generalization, participated in an add-on study with one of three newer AEDs: vigabatrin (n = 10), lamotrigine (n = 6), and topiramate (n = 7). Frequency analysis and topographic mapping of awake EEGs before and during treatment with the drug were compared. Statistical analysis was performed using 2-way analysis of variance (ANOVA) with repeated measures. Vigabatrin administration was followed by a diffuse decrease in the absolute alpha (p< 0.05) and beta (p< 0.02) activities and a decrease in the absolute theta in the frontal and parieto-occipital regions (p< 0.03). Lamotrigine caused a significant diffuse increase in the faster frequencies (relative alphap< 0.04 and relative betap< 0.02), and decrease in the slower activities (relative theta in the posterior head regionsp< 0.03 and relative delta diffuselyp< 0.05). Topiramate increased the absolute beta (p< 0.05) and theta (p< 0.02) activities diffusely and decreased the relative alpha activity over the left hemisphere (p< 0.03). The different effect profiles of the newer AEDs on the electrical brain activity may reflect their different mechanisms of action.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The author recently encountered a patient with hiccups, intermittently accompanied by apparent focal rhythmic diaphragmatic myoclonus after hydrocodone administration. Review of the literature disclosed a paucity of previous reports of hiccup, but many reports of myoclonus after opiate administration. A wide variety of opiates and routes of administration have been implicated, but high doses and the presence of other agents (antipsychotics, antiemetics, nonsteroidal antiinflammatory agents, antidepressants) may pose special risks. Review of the literature suggests three types of opiate- related myoclonus. Opiate-induced myoclonus (OIM) is often generalized and is either periodic or associated with rigidity. Opiate-induced myoclonus frequently occurs in the context of underlying medical conditions, D2 antagonist coadministration, or other drugs (nonsteroidal anti-inflammatory agents, antidepressants), and usually responds to either naloxone or benzodiazepines. Intrathecal OIM has not been linked to D2 antagonist coadministration or benzodiazepine responsiveness but may be associated with nonsteroidal antiinflammatory agents. Opiate withdrawal myoclonus may be stimulus- sensitive, associated with D2 antagonist coadministration, and responsive to benzodiazepines and unresponsive to naloxone. There are several problems in interpreting the literature, and more study is needed. Opiatergic, serotonergic, dopaminergic, and other mechanisms are considered.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There are conflicting reports about estrogen modulating the activity of nigrostriatal dopaminergic neurons. Furthermore, modulation may be influenced by progesterone levels. Therefore, the clinical effects of sex steroids on parkinsonian symptoms in postmenopausal women with Parkinson's disease (PD) were analyzed in the present study. Patients (n = 12) were under the age of 80, able to perform the motor function tests, and showed no contraindications for estrogen suppletion. Motor function was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) and a patient interview on subjective changes. In a placebo-controlled, randomized, double-blind trial lasting 8 weeks, no significant dopaminergic effect of estradiol (E2) could be demonstrated, whereas in an open trial phase lasting 2 weeks, progesterone seemed to have an antidopaminergic effect. Several mechanisms are discussed that can account for the fact that we found no effect of E2on motor functioning in our patients with PD.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The aim of this retrospective study is to determine whether lipid levels rise in neuroleptic-resistant chronic schizophrenic patients during clozapine treatment and if this rise is correlated with a decrease in aggressive and suicidal behavior. Seventy neuroleptic-resistant schizophrenic patients treated with clozapine for at least 6 months were compared with 30 chronic schizophrenic patients treated with classic antipsychotic agents for the same length of time. Data on serum levels of cholesterol and triglycerides and on aggressive and suicidal behavior, as measured by the Overt Aggression Scale (OAS), were collected in both groups before treatment and 6 months later. A significant reduction in aggressive and suicidal behavior was noted in the clozapine-treated group but not in the classical antipsychotic-treated group. Clozapine treatment was associated with an elevation in serum triglyceride level, whereas classic antipsychotic treatment was associated with an increase in serum cholesterol level. We conclude that serum cholesterol level does not play a role in the clozapine-induced attenuation in aggressive and suicidal behavior in neuroleptic-resistant schizophrenic patients, though the accompanying elevation in triglycerides may be relevant to a behavioral effect.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Valproate is an antiepilcptic drug that has broad spectrum activity against several types of seizure. Little information is available about the use of valproate for acute loading of patients when a rapid increase in serum level is needed. We describe the use of intravenous valproate in 20 adults with epilepsy. In each case, a loading dose was calculated by multiplying the patient's body mass, desired change in serum level, and estimated volume of distribution. The mean dose (± SD) administered was 1420 ± 440 mg (19.4 ± 5.4 mg/kg). In four patients, the dose was infused at 20 mg/min; in all other patients, infusions were performed at 50 mg/min. The infusions were tolerated well and few clinical side effects were observed. Postinfusion levels were drawn and the apparent volume of distribution was calculated to be 0.22 ± 0.04 L/kg. The results indicate that intravenous valproate may be used to quickly and efficiently increase scrum levels in patients with epilepsy.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Based on findings that stress and anxiety may modulate immune function, we compared the production of interleukin-2 (IL-2) and interleukin-3 (IL-3) by peripheral blood mononuclear cells between 24 patients with nonmajor depressed panic disorders, 9 with agoraphobia and 15 without, and 19 healthy volunteers. No differences in the production of these cytokines was noted between the patients with panic disorders and the volunteers or between the patients with and without agoraphobia. However, in the patients, a negative correlation was found for interleukin-3 production with severity of state anxiety, but not with trait anxiety or depression. This finding indicates that interleukin-3 levels may be sensitive to the presence of anxiety and stress.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The aim of this study was to determine whether spiperone binding to lymphocytes could serve as a biological marker of susceptibility to schizophrenia and schizophrenic spectrum disorders or as a measure of response to neuroleptic treatment. Lymphocyte spiperone binding parameters (Bmax, KD) were assessed in 13 patients with schizophrenia and 4 patients with schizotypal personality disorder, all neuroleptic naive, and in 19 age- and sex-matched control subjects. A repeated determination was carried out in 11 of the schizophrenic subjects after several months of neuroleptic treatment. In addition, the binding characteristics of 12 of the schizophrenic/schizotypal patients were compared with those of 13 healthy family members and normal unrelated controls. No significant differences were detected between the schizophrenic subjects and controls before or after neuroleptic treatment or between the patients and their non-affected family members and controls.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

To objectively quantify the tremorlytic activity of budipine in Parkinson's disease (PD), we performed long-term tremor recordings in addition to the Columbia University Rating Scale (CURS) in a subset of patients (n = 14) who enrolled in a multicenter, double-blind, placebo-controlled study. Tremor occurrence improved in the budipine group (n = 7) from 24.7 ± 15.5% to 14.8 ± 14.5% (p< 0.05). Tremor intensity decreased from 9.1 ± 2.5 (signal-to-noise ratio) to 7.2 ± 1.6. The CURS sum score improved from 5.7 to 3.0 in the budipine group, whereas there was only a small improvement in the placebo group (from 7.1 to 5.5). These data suggest that budipine is an effective tremorlytic agent in PD and that it may be used as an alternative to anticholinergics.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID