摘要:

A 67 year-old retired mechanical engineer is brought to the physician by his wife for evaluation of cognitive decline. She states that in the 2 years since retirement her husband has suffered progressive memory impairment and an inability to complete his usual tasks around the house. At a recent family gathering, he was unable to name several close relatives. His medical history includes hypertension for 5 years, controlled with enalapril. There is no history of alcohol abuse. Physical examination is unremarkable except for a Mini Mental State Exam (MMSE) score of 24. Psychometric testing reveals a moderate short-term memory impairment. Attention and orientation are mildly impaired; language, praxis, and visual perception are in normal range. Mood is not suggestive of depression. A work-up for reversible causes of dementia, including thyroid stimulating hormone and vitamin B–12, is normal. A fluorescent treponemal antibody absorption test is done to rule out syphilis, which is negative. A magnetic resonance image (MRI) of the brain reveals mild cortical atrophy.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Tiagabine (TGB), a recently approved anticpileptic drug (AED), has a specific mechanism of action that is unique among AEDs. A potent AED with linear, predictable pharmacokinetics, it inhibits -γ-aminobutyric acid (GABA) reuptake into neurons and glia. Tiagabine does not have any clinically relevant effects on hepatic metabolism or on serum concentrations of other AEDs, nor does it interact with commonly used non-AEDs. The most common side effects of TGB in controlled studies are dizziness, asthenia, somnolence, accidental injury, infection, headache, nausea, and nervousness. These events are usually mild to moderate in severity and generally do not require medical intervention. At dosages of 30–56 mg daily, TGB is an effective add-on treatment for partial seizures. Although patients who have medically refractory epilepsy can be converted to TGB monotherapy, more controlled studies are necessary to confirm the efficacy of TGB as monotherapy and to determine the effective dosage range.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Female sex hormones, and more specifically estrogen, can have biochemical and behavioral effects on the dopaminergic system. The effects of estrogen on the dopaminergic system can be classified as either neuroprotectivc or symptomatic. The neuroprotective effects refer to the ability of estrogen to prevent or modulate insults to the dopaminergic system and therefore to alter the natural history of disease processes affecting the dopaminergic circuitry in the brain. With regard to the symptomatic effects, support for suppressi ve and enhancing effects has been documented in humans and laboratory animals. The preclinical literature for neuroprotective and symptomatic effects of estrogen on the mesostriatal dopaminergic system forms the basis for studies on the influence of estrogen on the prevalence, disease progression, clinical signs, and medication effects of movement disorders, including Parkinson's disease, chorea, dystonia, tics, and myoclonus. Understanding the role of estrogen in modulating the dopaminergic system will allow clinicians to tailor therapies for women with movement disorders and optimize therapies for mcnstrually related symptom fluctuations. Such clarifications may also guide recommendations on the use of postmenopausal hormonal replacement therapy in women with movement disorders or those genetically at risk.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The number of drugs used to treat affective disorders such as depression is rapidly increasing. Citalopram (CIT), an antideprcssant, is a selective serotonin (5-hydroxytryptamine; 5-HT) reuptakc inhibitor (SSRI). In the present study, rats were treated with 10 mg/kg/d racemic CIT for two weeks with use of osmotic pumps, and the following were monitored: open-field behavior, racemic and enantiosclective concentrations of CIT and metabolites in blood, brain parenchyma, and extracellular space, and the brain extracellular monoaminc levels. The racemic CIT concentration in scrum was estimated about tenfold lower than in brain parenchyma but much higher than in brain extracellular fluid. The major CIT metabolites, demethylcitalopram (DC1T) and didemethylcitalopram (DDCIT) were 20% and 30%, respectively, of the amounts of CIT in scrum and even lower in the brain parenchyma. The S-cnantiomer/R-enantiomer ratios for CIT and DCIT were about 1.01 and 0.31, respectively, in blood and brain. There was a clear correlation between the different drug components within and between blood and brain compartments. Citalopram had no measured effect on open-field behavior, but it elevated extracellular 5-HT and decreased 5-HIAA levels. No correlations between any of the drug components and the brain monoamincs were found. In summary, the drug components after chronic dosing correlated well between the periphery and the brain, but not with the brain monoaminc concentrations. Further studies investigating the combined pharmacokinctic/dynamic effects could take advantage of blood drug monitoring for the commonly used novel antidcpressant drugs.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We investigated the efficacy and safety of botulinum toxin A (BTX) manufactured from a new bulk strain for the treatment of cervical dystonia. This was a single-blinded retrospective comparison of length of benefit, subjective improvement, and complications of treatment in 50 patients treated with the old form of toxin designated 79–11 and the new toxin strain BCB2024. The mean duration of benefit of the 79–11 strain and the BCB2024 strain were the same. Subjective efficacy, measured on a −4 to +4 scale, demonstrated no difference between the two strains. Dysphagia occurred in 12% of patients injected with the 79–11 strain and 14% of subjects injected with the BCB2024 strain. We also used a clinician's global assessment that incorporated the duration of benefit, subjective efficacy, and complications as a secondary analysis. There was no significant difference between the two forms of botulinum toxin A according to this scale. We conclude that the 79–11 strain and the BCB2024 strain offer similar peak efficacy, duration of benefit, and adverse events.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

To evaluate whether lazabemide has proarrhythmic or hypotensivc potency in Parkinson's disease (PD), we conducted an 8-week, double-blind, placebo-controlled, parallel group study with use of 24-hour ambulatory elcctrocardiographic (ECG) monitoring. Fifty-one patients with PD who did not have clinically apparent heart disease were randomized in a double-blind fashion to receive either lazabemide (n = 25) or placebo (n = 26) treatments. Lazabemide therapy did not induce clinically significant arrhythmias. A paroxysmal atriovcntricular (AV) block, which progressed from first-degree AV block, was found in one patient in the lazabemide group. This was determined not to be a new AV block. However, the causality of lazabemide in prolongation of the pause was not ruled out completely. In addition, the asymptomatic fall in systolic blood pressure seen 3 minutes after standing up was observed to be more pronounced in the lazabemide group than in the placebo group. The mean decrease of systolic blood pressure was 10 mmHg greater in the lazabemide group than in the placebo group. In conclusion, lazabemide did not induce any clinically significant arrhythmias in patients without clinically apparent heart disease. However, it may increase the asymptomatic, orthostatic drop in systolic blood pressure.

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 if the serotonin antagonist mianserin improves antidepressant-induced sexual dysfunction in women. The work was prompted by an earlier study of men by our team of researchers. The study population included 16 women aged 20–65 years undergoing treatment at a psychiatric outpatient clinic, who presented with sexual dysfunction subsequent to intake of a serotonin reuptake inhibitor (SRI) for depression. Sexual function (four domains) was evaluated by semistructured interviews before and after the administration of mianserin 15 mg/d for 3 weeks. The most prominent sexual dysfunction was anorgasmia. Clinically significant improvement was noted in all domains in two thirds of the patients, in most cases in the first or second week of treatment. None of the patients with panic disorder (PD) responded to mianserin, in contrast to those with affective disorder or obsessive compulsive disorder (OCD), indicating a possible relevance of the psychiatric diagnosis to mianserin effectiveness. There were no major adverse effects and no changes in the patients' stabilized psychiatric status. We conclude that mianserin is beneficial in reversing sexual function caused by SRI intake. Further large-scale, placebo-controlled studies are needed to confirm these findings.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We compared the kinetic-dynamic profile of a postprandial dose of levo-dopu-benserazide dispersible formulution to that of the standard form in eight patients with parkinsonism presenting delayed or irregular patterns of after-meal levodopa dose effects. Patients were studied on two occasions, one week apart, according to an intrasubject randomized cross-over design. Thirty minutes after the consumption of a standard meal, patients received their usual levodopa-benserazide postprandial dose, on one occasion in the standard formulation and on the other one in the dispersible form. Blood venous samples for analysis of plasma levodopa concentrations were drawn at 15-minute intervals for the first 2 hours, then half-hourly until 5 hours alter dosing. Motor response to the levodopa test dose was assessed by the finger tapping test at the same times as blood was sampled. The only statistically significant finding was a shorter time to peak plasma levodopa concentration with the levodopa-benserazide dispersible formulation compared with the standard form, whereas comparisons of levodopa pharma-codynamics showed little advantage of either formulation. Considering that liquid formulations of levodopa are less practical, we suggest reserving dispersible levodopa-benserazide tablets for selected patients and carefully monitoring drug dose motor response.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A case is presented of a 65-year-old man with chronic schizophrenia who, after tour years of remission, developed psychotic symptoms after pneumonia. The patient was found to be deficient in vitamin B12. His psychosis remitted within 5 days of administration of vitamin B12 and folie acid. This case emphasizes the need to measure vitamin BI2 in psyehogeriatric patients, especially when they present with a severe infection and organic mental symptoms.

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0362-5664    

出版商:OVID    

年代:1999

数据来源: OVID