摘要:

We review the literature on quantifying parkinsonian rigidity and present data from 124 subjects to demonstrate the clinical utility of activated stiffness to model rigidity. This method eliminates many of the confounding variables associated with the subjective assessment of rigidity. This 5-min computer-assisted procedure was highly reliable and sensitive to pharmacologic influences that produce and reduce parkinsonian rigidity.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Behavioral hyposensitivity to repeated apomorphine administration has been observed in fluctuating parkinsonian patients. To investigate whether a similar phenomenon occurs in patients never treated with levodopa, we studied the response to apomorphine in 20 de novo patients with Parkinson's disease. Six patients showed no or minimal improvement after apomorphine injections (maximal dose 3.5 mg). Fourteen patients responded and were then given up to four repeated subcutaneous injections of apomorphine [minimal effective dose (MED)]. The responses of de novo patients were compared with responses in 10 patients with motor fluctuations previously studied by the same protocol. There was no significant difference in latency and duration of motor responses after repeated apomorphine injections in de novo patients. MED was similar in de novo and fluctuating patients, but duration of improvement induced by each apomorphine bolus was longer in the de novo group. These results indicate that response duration to apomorphine is longer in previously untreated patients and that behavioral tolerance associated with pulsatile dopaminergic stimulation by apomorphine occurs mainly in patients with more advanced disease under chronic levodopa therapy.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Parkinsonism is a well-known side effect of some calcium channel blockers (CCB). Its long-term evolution, however, is unknown. To clarify this issue, we performed a prospective follow-up study involving 32 patients diagnosed with CCB-induced parkinsonism. After the baseline examination, the CCB were discontinued and serial evaluations were carried out according to the same protocol. Despite a global improvement, cognitive and mood disturbances subsided slowly, and tremor persisted in most patients. After 18 months of CCB withdrawal, 44% of patients had depression, 88% had tremor, and 33% still had criteria for diagnosis of parkinsonism. During the survey, only three patients were found to be fully recovered. The improvement of some clinical symptoms was related to age: Patients younger than 73 years recovered better than older patients did. Our data indicate that CCB-induced parkinsonism is not the benign condition previously thought, and suggest an age-related prognosis of this entity.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The effect of a single dose (10 mg P.O.) of trihexyphenidyl (THP) on plasma cortisol, growth hormone (GH), and immunoreactive β-endorphin (ir-β-EP) was studied in seven major depressed patients and seven controls. GH secretion was suppressed (34–41%) by THP in both groups. THP did not affect cortisol secretion in depressed patients and controls. An increase (18%;p< 0.05) in plasma ir-β-EP levels was detected in the healthy subjects only. The results of this study do not support the hypothesized altered responsiveness to anticholinergic provocation in major depression. The inhibitory activity of THP on GH secretion indicates the involvement of the cholinergic system in the regulation of GH release in humans.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To investigate the prevalence of tardive dyskinesia (TD) in a group of psychiatric patients receiving low doses of antipsychotic drugs, we examined 647 Japanese inpatients (361 men and 286 women) with a mean age of 49.8 years, receiving a mean dose of antipsychotic drugs of 276.8 mg of chlorpromazine equivalent. TD was diagnosed according to the criteria of Schooler and Kane with the Abnormal Involuntary Movement Scale. The overall prevalence of TD was 22.3%. Mild TD was found in 67.4% of TD patients, moderate TD in 29.2%, and severe TD in 3.5%. The TD patients were older (59.0 years) than those without this condition (47.2 years). The prevalence of TD increased with advancing age until the 7th decade, when it reached a plateau. The dose of daily antipsychotic drugs was lower in the TD patients (207.6 mg) than in the patients without TD (296.6 mg). The duration of primary illness was longer in the TD patients (28.9 years) than in the patients without TD (20.4 years). Patients receiving antiparkinsonism drugs showed TD less frequently (20.7%) than those not receiving such drugs (31.0%). No significant associations were found between the presence of TD and sex or primary illness.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Brain-injured patients involved in rehabilitation programs are susceptible to the occurrence of acute seizures or severe behavioral episodes. Effective pharmacological management in this setting should ideally include rapid onset without severe adverse effects. Previous treatments have generally included intramuscular diazepam or lorazepam, as well as intramuscular anti-psychotic drugs. These options have proved problematic due to poor absorption, slow onset of activity, or potential for unacceptable side effects. We report 10 cases involving the use of intramuscular midazolam, a rapid-acting, short half-life benzodiazepine, in treating acute seizures or behavioral problems. We conclude that this drug demonstrates great promise for the rapid, effective treatment of these conditions without significant adverse effects and deserves further study in these areas.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We studied the clinical characteristics and therapeutic response of 10 patients who presented with seizures shortly after falling asleep as the only or main manifestation of their epilepsy. The clinical evaluation was designed to investigate the appearance of seizures during diurnal and nocturnal sleep. The pharmacological response to coffee or amphetamine was investigated after normalization of previous anticonvulsant treatment. Seven of 10 patients (70%) presented with seizures during the siesta, and in 3 of 10, seizures occurred if they fell asleep at any time of the day. Seizures were detected in later hours of the night in five patients as sleep reinitiation seizures or seizures without previous awakening. The response to anticonvulsants alone was disappointing. The addition of coffee or amphetamine suppressed seizures of sleep beginning at night or during the siesta. Neither of them had an influence on sleep diurnal seizures outside of the siesta or on seizures of nocturnal sleep reinitiation. Suppression of coffee or amphetamine was followed by reappearance of the seizures.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Four cases of baclofen intoxication are reported, with a review of 33 cases from the literature. Analysis of these 37 cases suggests that there are two types of baclofen intoxication syndrome. Patients with acute intoxication present with four major clinical manifestations: encephalopathy (disturbance of consciousness and/or seizure), respiratory depression, muscular hypotonia, and generalized hyporeflexia. Patients with chronic intoxication present with hallucinosis, impaired memory, catatonia, or acute mania. The acute intoxication syndrome has a faster onset, shorter duration, more severe clinical manifestations, and higher incidence of seizures than the chronic intoxication syndrome. Baclofen intoxication, although it may cause grave encephalopathic manifestations and electroencephalographic findings, has a benign outcome if actively managed.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We describe the second reported case of neuroleptic malignant syndrome (NMS) related to tetrabenazine therapy in Huntington's disease. In the previously reported case, factors capable of potentiating NMS included a high dosage of tetrabenazine exceeding the accepted therapeutic range, and comedication with the dopamine-synthesis inhibitor α-methylparatyrosine, while in the present case abrupt introduction of the drug and discontinuation of concomitant neuroleptics may have contributed to this important adverse reaction. Uneventful recovery occurred in both cases without the need for drugs specifically enhancing dopaminergic transmission, while rechallenge by tetrabenazine with conventional doses and slow upward titration was not followed by recurrence of the NMS. Tetrabenazine has proved to be a safe and frequently useful drug in the long-term treatment of approximately 400 dyskinetic patients. We believe that NMS related to this drug is rare, provided that it is properly administered.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A patient with melanoma and sporadic positive melanuria developed Parkinson's disease. Treatment with levodopa failed to modify tumoral progress. However, during chemotherapy with dacarbazine, the patient experienced a significant impairment to levodopa response.

ISSN:0362-5664    

出版商:OVID    

年代:1992

数据来源: OVID