摘要:

SummaryPatients with advanced Parkinson's disease often develop severe fluctuations and dyskinesias while receiving long-term levodopa therapy. These complications can prove increasingly difficult to control. Here we review our strategies for coping with such problems. These include establishing the best rational schedule of levodopa treatment, optimizing levodopa absorption, the use of oral dopaminergic agonists, and the use of subcutaneous injections or infusions of apomorphine or lisuride. The problems of severe dyskinesias, sleep disturbances, psychotoxicity, and urinary difficulties also are considered. Finally, the role of new surgical procedures to treat Parkinson's disease is reviewed.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryThis study examined rebound insomnia after discontinuation of chronic use of zolpidem (10 mg), a short elimination half-life imidazopyridine. The zolpidem group was bracketed by a placebo group and a positive control group taking 0.5 mg of triazolam (twice the recommended dose), which is known to produce rebound insomnia. Ninety-nine patients with sleep complaints that were polysomnographically documented participated in the study. After randomization, patients completed a 2-night, single-blind, placebo baseline period, a 28-night double-blind treatment phase, and a 3-night, single-blind, placebo substitution period. Polysomnographic and subjective sleep variables indicated a lack of rebound insomnia for the zolpidem group. The positive triazolam control group had rebound insomnia only on the first discontinuation night. There was no significant correlation between rebound insomnia and the level of initial insomnia, the degree of response to treatment in week 4, or the amount of tolerance that developed during drug use. During the 4-week treatment period, efficacy diminished for both drugs. From these data, it cannot be determined whether the lack of rebound insomnia with zolpidem is a result of drug dose or some property of the drug such as receptor selectivity.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryKleptomania, one of the rare impulse-control disorders, is characterized by an irresistible impulse to steal objects not needed for personal use or monetary value. There is a comorbidity between mood disorders, eating disorders, anxiety disorders, personality disorders, and kleptomania. Several recent case reports have suggested that serotonin reuptake inhibitors could be effective in the treatment of obsessive-compulsive spectrum disorders and specifically in kleptomania. We describe three depressed patients who paradoxically experienced kleptomanic behavior during treatment with serotonin selective reuptake inhibitors.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryTo improve the response of parkinsonian patients to L-Dopa treatment, a new preparation of L-Dopa/benserazide with dual-release properties was developed. The breakable three-layer tablets with biphasic dissolution kinetics combine the advantages of the standard and sustained-release formulations. The clinical efficacy of this new formulation was assessed in an open-label, pilot study for 14 weeks conducted by Swiss neurologists. Sixty-one parkinsonian patients were included: 5 (8%) patients were de novo, 39 (64%) had fluctuations, and 17 (28%) without fluctuations. The mean Hoehn and Yahr stage was 2.6 and the mean duration of disease was 7.4 years. The best prestudy treatment was kept stable for 2 weeks before entering the first 8-week period in which standard and/or sustained L-Dopa treatment could be either entirely or partially substituted by the dual-release formulation, which was as far as possible kept unchanged during the second 6-week period. During the substitution period, the overall dose of L-Dopa was significantly increased by 11.5%, probably reflecting some differences in the bioavailability of the various galenical formulations, and the mean daily drug intakes were reduced from 5.4 at baseline to 4.1 at week 8 (a 24% reduction, p < 0.001). Sixteen percent of the patients dropped out of the study because of unsatisfactory results, but none left for safety reasons. At the end of the study, complete substitution was attained in 71% of the patients. The remaining 27% combined the dual-release formulation with standard and/or sustained-release L-Dopa. The efficacy of treatment was assessed with the Webster Score and qualified with a mean decrease of 27% (p < 0.001) between baseline and week 14. A significant decrease of the reported adverse events such as dyskinesias and end-of-dose or wearing-off akinesias was also observed before (27 patients, 44%) and after (9 patients, 17%) the substitution (p < 0.02). These results infer that the dual-release formulation is as good as or superior to any other galenic form of L-Dopa. In conclusion, the dual-release formulation of L-Dopa either introduced or substituted for the best treatment available showed good clinical efficacy and tolerability in all stages of the evolution of idiopathic Parkinson's disease treatment in this 14-week open-label study.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryA similar pattern of psychosexual disorders has been observed after long-term treatment with levodopa therapy in four male parkinsonian patients treated with apomorphine for severe on-off motor fluctuations. An acute episode in each case had led them to the hospital in the context of a psychiatric emergency (after punishable sexual acts in two cases). In each case, this episode had been preceded by an increase of self-administered apomorphine, whereas other antiparkinsonian drugs remained unchanged. Questioning had revealed psychosexual disturbances as early as the onset of apomorphine treatment, which tended to progressively worsen with the number of apomorphine daily doses. A decrease in the dosage of apomorphine had been followed by the improvement of the psychiatric condition without worsening of the motor status. Recurrence of psychiatric disorders with similar features had been observed when two patients again increased the number of apomorphine daily injections. The absence of somatic manifestations when apomorphine treatment was withdrawn or reduced, with persistence of psychosexual disturbances, could suggest a psychological dependence from the drug.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryGabapentin is a well tolerated anticonvulsant, structurally related to γ-aminobutyric acid, with an unknown mechanism of action. Restless legs syndrome (RLS) is a disorder characterized by sensory and motor symptoms in the legs that is best treated with dopaminergic drugs and opiates. In this open-label study, eight patients with RLS were treated with gabapentin. Four of the eight had a beneficial response, three with almost complete resolution of symptoms for up to 6 months. For a disorder that is often difficult to treat, these results are encouraging, and they suggest that a placebo-controlled trial is warranted.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryThe effects of thalidomide and, for reference, dexamethasone on T- and B-cell functions were assayed in vitro in Lewis rats with experimental allergic neuritis induced by active immunization with bovine peripheral nerve myelin (BPM) and complete Freund's adjuvant. Thalidomide and dexamethasone at the concentration ranges 10-5-10-7g/ml and 4 × 10-5-4 × 10-9g/ml, respectively, both inhibited phytohemagglutinin (PHA)- and BPM-induced T-cell proliferation as well as levels of PHA- and BPM-reactive interferon (IFN)-γ-secreting cells, reflecting the suppression of Th l -like cells. The effect of dexamethasone was most pronounced on PHA-induced T-cell proliferation and IFN-γ secretion, whereas the effect of thalidomide was most pronounced on BPM-induced T-cell proliferation and IFN-γ secretion. Thalidomide reduced the B-cell responses to both BPM andMycobacterium tuberculosispurified protein derivative, but to a lesser extent than dexamethasone. The in vitro design described could be useful to evaluate compounds with putative immunomodulatory activities. The inhibitory effects of thalidomide on autoantigen-induced Th l-cell functions may warrant the use of this substance in T-cell-mediated autoimmune diseases.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryTwelve parkinsonian patients with severely fluctuating symptoms were given a single dose of apomorphine or Dispersible Madopar on 2 consecutive days, to confirm the latter drug's usefulness in “off” period rescue. According to our results, apomorphine proved faster in reverting “off” periods and should still be regarded as the drug of choice for this treatment modality.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryClozapine often causes low-grade fever and less frequently spiking fever. We describe three cases of spiking fever that occurred in the first 3 weeks of clozapine therapy. A new set of side effects of clozapine is identified, which includes spiking fever, respiratory and gastrointestinal symptoms, and neutrophilia. Possible mechanisms are discussed.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

SummaryHemiballism is a relatively rare hyperkinetic disorder; treatment is based mainly on neuroleptics and drugs that decrease release of dopamine. We report the cases of two patients with hemiballism. After a period of 1 month of nonresponsiveness to haloperidol, amelioration of ballistic movements was observed only a few days after the initiation of clozapine therapy (50 mg/day). Our report suggests that clozapine may be a valuable alternative for patients with hemiballism.

ISSN:0362-5664    

出版商:OVID    

年代:1997

数据来源: OVID