Assuntos
Cefaleia/etiologia , Cefaleia/fisiopatologia , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Dissecação da Artéria Vertebral/fisiopatologia , Artéria Vertebral/fisiopatologia , Adulto , Fatores Etários , Idoso , Angiografia Cerebral , Diagnóstico Diferencial , Progressão da Doença , Diagnóstico Precoce , Feminino , Cefaleia/patologia , Humanos , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/patologia , Ataque Isquêmico Transitório/fisiopatologia , Síndrome Medular Lateral/etiologia , Síndrome Medular Lateral/patologia , Síndrome Medular Lateral/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/patologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/patologiaAssuntos
Transtornos de Enxaqueca/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma/patologia , Angiografia , Artéria Carótida Interna/patologia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/patologiaRESUMO
We studied nitrogen radical nitric oxide (.NO) release and reactive oxygen species (ROS) production by isolated neutrophils after phorbol myristate acetate (PMA) stimulation in 12 newly diagnosed and nine treated Parkinson's disease (PD) patients and 10 age-matched healthy controls. Neutrophils of both groups of PD patients had an elevated PMA-activated release of .NO [61 and 57%, respectively, higher than that of controls (p < 0.05)]. In contrast, H2O2 release was only significantly increased by 56% in chronically treated patients. In agreement, the maximum rate of luminol-dependent chemiluminescence, which partly represents O2- H2O2- .NO interactions, was increased only in the treated group. When other blood markers of oxidative stress were compared, only erythrocyte catalase activity was decreased in both PD patient series by 33 and 39%, respectively (p < 0.05), whereas plasma antioxidant capacity and erythrocyte superoxide dismutase activity levels were decreased only in treated PD patients. This study suggests that neutrophils express a primary alteration of .NO release in PD patients, whereas H2O2 and oxidative-stress parameters are more probably related to the evolution of PD or to effects of treatment with L-dopa.
Assuntos
Neutrófilos/fisiologia , Óxido Nítrico/fisiologia , Estresse Oxidativo , Doença de Parkinson/fisiopatologia , Espécies Reativas de Oxigênio/metabolismo , Antiparkinsonianos/administração & dosagem , Carbidopa/administração & dosagem , Catalase/sangue , Quimioterapia Combinada , Eritrócitos/enzimologia , Feminino , Radicais Livres , Humanos , Peróxido de Hidrogênio/sangue , Levodopa/administração & dosagem , Medições Luminescentes , Masculino , Pessoa de Meia-Idade , Neutrófilos/efeitos dos fármacos , Doença de Parkinson/tratamento farmacológico , Superóxido Dismutase/sangueRESUMO
Argentina is facing an increase in cocaine use by adolescents and young adults from every socioeconomic background. It is calculated that up to 10% of all cocaine passing through this country is locally sold and consumed. Nevertheless, local information describing common cocaine-related neurological events is scarce. From August 1988 to March 1993, 13 patients were evaluated with neurological disease associated with cocaine abuse. Among these 13 patients (Table 1), the mean age was 29; 70% were men. Patients most commonly used the nasal route (snorting). Concomitant abuse of other intoxicants, especially alcohol, was frequent (85%). The major neurological complications included one or more seizures (n = 7), ischemic stroke (n = 2) (Fig. 1-2), hemorrhagic stroke (n = 2) associated with arteriovenous malformation (Fig. 3a-b), memory disturbances (n = 1) and paroxysmal dystonia (n = 1). Psychiatric complaints were present in all patients. Mortality was not observed. There was no correlation between the appearance of complications and the amount of cocaine used, or prior experience with this drug. Only one of the 7 patients with seizures had a previous history of seizures. All had generalized tonic-clonic seizures, and one had concomitant absence episodes. Cocaine modulates central neurotransmitters and has direct cerebrovascular effects. The neurological complications appear to be related to cocaine hyperadrenergic effects, striatal dopaminergic receptor hypersensitivity and perhaps vasculitis. Structural changes in the brain of long-term cocaine abusers could explain the persistence of neurologic symptoms after drug withdrawl.
Assuntos
Encefalopatias/etiologia , Cocaína , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Alcoolismo/complicações , Coma/etiologia , Distonia/etiologia , Feminino , Humanos , Masculino , Parestesia/etiologia , Convulsões/etiologia , Tomografia Computadorizada por Raios XRESUMO
Argentina is facing an increase in cocaine use by adolescents and young adults from every socioeconomic background. It is calculated that up to 10
of all cocaine passing through this country is locally sold and consumed. Nevertheless, local information describing common cocaine-related neurological events is scarce. From August 1988 to March 1993, 13 patients were evaluated with neurological disease associated with cocaine abuse. Among these 13 patients (Table 1), the mean age was 29; 70
were men. Patients most commonly used the nasal route (snorting). Concomitant abuse of other intoxicants, especially alcohol, was frequent (85
). The major neurological complications included one or more seizures (n = 7), ischemic stroke (n = 2) (Fig. 1-2), hemorrhagic stroke (n = 2) associated with arteriovenous malformation (Fig. 3a-b), memory disturbances (n = 1) and paroxysmal dystonia (n = 1). Psychiatric complaints were present in all patients. Mortality was not observed. There was no correlation between the appearance of complications and the amount of cocaine used, or prior experience with this drug. Only one of the 7 patients with seizures had a previous history of seizures. All had generalized tonic-clonic seizures, and one had concomitant absence episodes. Cocaine modulates central neurotransmitters and has direct cerebrovascular effects. The neurological complications appear to be related to cocaine hyperadrenergic effects, striatal dopaminergic receptor hypersensitivity and perhaps vasculitis. Structural changes in the brain of long-term cocaine abusers could explain the persistence of neurologic symptoms after drug withdrawl.
RESUMO
El consumo de cocaina ha adquirido proporciones epidemiológicas en los EEUU. Actualmente en nuestro país, sitio de paso de la droga, un 10 por ciento es retenida para su consumo, calculandose que un 80 por ciento de los drogadictos utilizan este alcaloide. Presentamos 13 paciente, 9 hombres y 4 mujeres con edades que oscilan entre 19 y 43 años que presentaron sintomatología por consumo de cocaína. Siete pacientes presentaron convulsiones y en uno de ellos se asociaron ausencias. Cuatro casos sufrieron accidentes cerebrovasculares, 2 de ellos isquémico y los otros hemorrágico, secundario a ruptura de malformaciones vasculares. Un paciente presentó fallas mnésicas severas y otro crisis distónicas paroxísticas. Todo menos uno consumían la cocaína por vía nasal y salvo 2 pacientes, el resto utilizaba otras drogas. El consumo concomitante de etanol era una práctica frecuente. La discontinuidad en el consumo del acaloide provó mejoría en las crisis epilépicas durante el período de seguimiento, salvo en el paciente con ausencias. El paciente con fallas mnésicas evidenció una marcada mejoría al cabo de 4 años de suspendida la cocaína. La paciente con crisis distónicas paroxísticas, al cabo de 2 años de haber suprimido la droga, persistía con el cuadro distónico. En 11 casos hubo una relación temporal entre el consumo de cocaína y la sintomatología neurológica, mientras que en los 2 restantes se debería al consumo crónico. Esto se debe a cambios farmacológicos y eventualmente estructurales en el sistema nervioso central. La frecuencia de estos casos, otrora excepcionales en nuestro medio, ha aumentado sensiblemente, obligando a considerar el consumo de este alcaloide en el enfoque diagnóstico de pacientes jóvenes con eventos neurológicos (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Transtornos Relacionados ao Uso de Substâncias/complicações , Cocaína , Manifestações Neurológicas , Alcoolismo/complicações , Parestesia , Coma , Distonia , Tomografia Computadorizada por Raios XRESUMO
El consumo de cocaina ha adquirido proporciones epidemiológicas en los EEUU. Actualmente en nuestro país, sitio de paso de la droga, un 10 por ciento es retenida para su consumo, calculandose que un 80 por ciento de los drogadictos utilizan este alcaloide. Presentamos 13 paciente, 9 hombres y 4 mujeres con edades que oscilan entre 19 y 43 años que presentaron sintomatología por consumo de cocaína. Siete pacientes presentaron convulsiones y en uno de ellos se asociaron ausencias. Cuatro casos sufrieron accidentes cerebrovasculares, 2 de ellos isquémico y los otros hemorrágico, secundario a ruptura de malformaciones vasculares. Un paciente presentó fallas mnésicas severas y otro crisis distónicas paroxísticas. Todo menos uno consumían la cocaína por vía nasal y salvo 2 pacientes, el resto utilizaba otras drogas. El consumo concomitante de etanol era una práctica frecuente. La discontinuidad en el consumo del acaloide provó mejoría en las crisis epilépicas durante el período de seguimiento, salvo en el paciente con ausencias. El paciente con fallas mnésicas evidenció una marcada mejoría al cabo de 4 años de suspendida la cocaína. La paciente con crisis distónicas paroxísticas, al cabo de 2 años de haber suprimido la droga, persistía con el cuadro distónico. En 11 casos hubo una relación temporal entre el consumo de cocaína y la sintomatología neurológica, mientras que en los 2 restantes se debería al consumo crónico. Esto se debe a cambios farmacológicos y eventualmente estructurales en el sistema nervioso central. La frecuencia de estos casos, otrora excepcionales en nuestro medio, ha aumentado sensiblemente, obligando a considerar el consumo de este alcaloide en el enfoque diagnóstico de pacientes jóvenes con eventos neurológicos
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Cocaína , Manifestações Neurológicas , Transtornos Relacionados ao Uso de Substâncias/complicações , Alcoolismo/complicações , Coma , Distonia , Parestesia , Convulsões , Tomografia Computadorizada por Raios XRESUMO
The common signs of hypoglycemia include: tachycardia, diaphoresis and vertigo which may be associated to disturbances of the consciousness. Occasionally, focal neurological signs occur with conservation of consciousness which are erroneously interpreted as cerebral vascular disease. An insulin dependent diabetic patient is presented with an initial diagnosis of transient ischemic attack (TIA) with right hemiparesis and dysarthria associated to hypoglycemia (35 mg %) whose remission occurred following the correction of glycemia. The different physiopathogenic mechanisms were also revised postulating (selective neuronal vulnerability, vasospasms and subjacent vascular disease) and the need for considering this diagnosis must be emphasized in those diabetic patients with focal neurological symptoms.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Hemiplegia/etiologia , Hipoglicemia/complicações , Diagnóstico Diferencial , Suscetibilidade a Doenças , Disartria/etiologia , Feminino , Hemiplegia/diagnóstico , Humanos , Hipoglicemia/diagnóstico , Ataque Isquêmico Transitório/diagnóstico , Pessoa de Meia-IdadeRESUMO
As Parkinson's disease worsens, many patients develop motor fluctuations which usually correlate directly or indirectly with L-dopa plasma levels. A new L-dopa-benserazide HBS preparation (Madopar) a control release pharmaceutical formulation which is activated when it contacts gastric fluid thus providing more stable L-dopa plasma levels, was assayed. Ten patients with a diagnosis of idiopathic Parkinson's disease and motor fluctuations otherwise unresponsive to conventional therapy were selected. The average age was 62 years and the duration of the disease 9 years. The motor status was evaluated on an hourly basis with the King's College Parkinson's disease rating scale; in addition, a nocturnal disability scale (Lees) was used. Out of the 10 patients, 2 dropped out within the first month due to worsening of parkinsonian signs, while 7 of the remainders preferred HBS preparation to the previous treatment. The number of off hours in this group was reduced by 58% and motor fluctuation became less severe. In only 3 cases was it possible to use HBS as monotherapy while in the rest standard L-dopa had to be added, specially as morning doses. The average L-dopa daily dose was increased by 36%. Unwanted effects included psychiatric disturbances in two (in one L-dopa dose had to be reduced) and epigastralgia in one. Our findings suggest that this L-dopa-benserazide control release may be considered an able therapeutic formulation in the control of motor fluctuations in Parkinson's disease.
Assuntos
Benserazida/uso terapêutico , Levodopa/uso terapêutico , Transtornos dos Movimentos/tratamento farmacológico , Doença de Parkinson/tratamento farmacológico , Adulto , Idoso , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Doença de Parkinson/complicaçõesRESUMO
As Parkinsons disease worsens, many patients develop motor fluctuations which usually correlate directly or indirectly with L-dopa plasma levels. A new L-dopa-benserazide HBS preparation (Madopar) a control release pharmaceutical formulation which is activated when it contacts gastric fluid thus providing more stable L-dopa plasma levels, was assayed. Ten patients with a diagnosis of idiopathic Parkinsons disease and motor fluctuations otherwise unresponsive to conventional therapy were selected. The average age was 62 years and the duration of the disease 9 years. The motor status was evaluated on an hourly basis with the Kings College Parkinsons disease rating scale; in addition, a nocturnal disability scale (Lees) was used. Out of the 10 patients, 2 dropped out within the first month due to worsening of parkinsonian signs, while 7 of the remainders preferred HBS preparation to the previous treatment. The number of off hours in this group was reduced by 58
and motor fluctuation became less severe. In only 3 cases was it possible to use HBS as monotherapy while in the rest standard L-dopa had to be added, specially as morning doses. The average L-dopa daily dose was increased by 36
. Unwanted effects included psychiatric disturbances in two (in one L-dopa dose had to be reduced) and epigastralgia in one. Our findings suggest that this L-dopa-benserazide control release may be considered an able therapeutic formulation in the control of motor fluctuations in Parkinsons disease.
RESUMO
As Parkinsons disease worsens, many patients develop motor fluctuations which usually correlate directly or indirectly with L-dopa plasma levels. A new L-dopa-benserazide HBS preparation (Madopar) a control release pharmaceutical formulation which is activated when it contacts gastric fluid thus providing more stable L-dopa plasma levels, was assayed. Ten patients with a diagnosis of idiopathic Parkinsons disease and motor fluctuations otherwise unresponsive to conventional therapy were selected. The average age was 62 years and the duration of the disease 9 years. The motor status was evaluated on an hourly basis with the Kings College Parkinsons disease rating scale; in addition, a nocturnal disability scale (Lees) was used. Out of the 10 patients, 2 dropped out within the first month due to worsening of parkinsonian signs, while 7 of the remainders preferred HBS preparation to the previous treatment. The number of off hours in this group was reduced by 58
and motor fluctuation became less severe. In only 3 cases was it possible to use HBS as monotherapy while in the rest standard L-dopa had to be added, specially as morning doses. The average L-dopa daily dose was increased by 36
. Unwanted effects included psychiatric disturbances in two (in one L-dopa dose had to be reduced) and epigastralgia in one. Our findings suggest that this L-dopa-benserazide control release may be considered an able therapeutic formulation in the control of motor fluctuations in Parkinsons disease.
RESUMO
As Parkinsons disease worsens, many patients develop motor fluctuations which usually correlate directly or indirectly with L-dopa plasma levels. A new L-dopa-benserazide HBS preparation (Madopar) a control release pharmaceutical formulation which is activated when it contacts gastric fluid thus providing more stable L-dopa plasma levels, was assayed. Ten patients with a diagnosis of idiopathic Parkinsons disease and motor fluctuations otherwise unresponsive to conventional therapy were selected. The average age was 62 years and the duration of the disease 9 years. The motor status was evaluated on an hourly basis with the Kings College Parkinsons disease rating scale; in addition, a nocturnal disability scale (Lees) was used. Out of the 10 patients, 2 dropped out within the first month due to worsening of parkinsonian signs, while 7 of the remainders preferred HBS preparation to the previous treatment. The number of off hours in this group was reduced by 58
and motor fluctuation became less severe. In only 3 cases was it possible to use HBS as monotherapy while in the rest standard L-dopa had to be added, specially as morning doses. The average L-dopa daily dose was increased by 36
. Unwanted effects included psychiatric disturbances in two (in one L-dopa dose had to be reduced) and epigastralgia in one. Our findings suggest that this L-dopa-benserazide control release may be considered an able therapeutic formulation in the control of motor fluctuations in Parkinsons disease.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Benserazida/uso terapêutico , Levodopa/uso terapêutico , Transtornos dos Movimentos/tratamento farmacológico , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Combinação de Medicamentos , Transtornos dos Movimentos/etiologiaRESUMO
Blepharospasm is a relatively frequent cranial dystonia which may be seen either alone or related to orofacial-mandibular dystonia (Meige's syndrome). In its maximum degree it can cause functional blindness.Twelve patients with blepharospasm (4 essential and 8 Meige's syndrome) who had been previously treated unsuccessfully with drugs (trihexyphenidyl, biperiden, carbamazepine, lithium, baclofen, lisuride, imipramine, clonazepam and butyrophenones) were treated for 12 months with periocular injections of botulinum toxin (BOTOX). A "low" dose of 12,5 U per eye was employed. With this dose, eleven out of twelve patients experienced significant improvement which lasted from five to fifteen weeks. The only nonresponder obtained complete relief upon duplicating the dose. The only side effect was uni or bilateral ptosis in six patients which improved completely in seven to twenty one days. One patient developed a peripheral facial palsy with complete remission in nineteen days. No systemic side effects were noted. There was only one desertion from this study due to depression enhanced by prolonged (21 days) ptosis. All patients (including the deserter) agreed that treatment with BOTOX provided more relief than any other previous therapeutic method. Our results confirm those obtained by others but a more prolonged study is needed to better evaluate long term effects.
Assuntos
Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas/uso terapêutico , Idoso , Blefaroptose/induzido quimicamente , Toxinas Botulínicas/efeitos adversos , Paralisia Facial/induzido quimicamente , Feminino , Humanos , Injeções Intramusculares , Pessoa de Meia-IdadeRESUMO
Blepharospasm is a relatively frequent cranial dystonia which may be seen either alone or related to orofacial-mandibular dystonia (Meiges syndrome). In its maximum degree it can cause functional blindness.Twelve patients with blepharospasm (4 essential and 8 Meiges syndrome) who had been previously treated unsuccessfully with drugs (trihexyphenidyl, biperiden, carbamazepine, lithium, baclofen, lisuride, imipramine, clonazepam and butyrophenones) were treated for 12 months with periocular injections of botulinum toxin (BOTOX). A [quot ]low[quot ] dose of 12,5 U per eye was employed. With this dose, eleven out of twelve patients experienced significant improvement which lasted from five to fifteen weeks. The only nonresponder obtained complete relief upon duplicating the dose. The only side effect was uni or bilateral ptosis in six patients which improved completely in seven to twenty one days. One patient developed a peripheral facial palsy with complete remission in nineteen days. No systemic side effects were noted. There was only one desertion from this study due to depression enhanced by prolonged (21 days) ptosis. All patients (including the deserter) agreed that treatment with BOTOX provided more relief than any other previous therapeutic method. Our results confirm those obtained by others but a more prolonged study is needed to better evaluate long term effects.
RESUMO
El blefaroespasmo, ya sea aislado o en el contexto de una disquinesia oro-facio-mandibular (síndrome de Meige) es una distonía cranial relativamente frecuente. En su máxima expresión puede dar origen a marcada minusvalía e incluso ceguera funcional. Doce pacientes con respuesta poco satisfactoria a tratamientos medicamentosos (trihexifenidilo, hiperideno, imipramina, carbamazepina, baclofén, litio, lisuride, clonazepam, butirofenonas) fueron tratados con inyecciones perioculares de toxina botulínica (Botox), utilizando una dosis "baja" de 12,5 UI por ojo. Once de los doce pacientes obtuvieron mejoria significativa que duró entre cinco y quince semanas. Una sola paciente no respondió y lo hizo al duplicar la dosis de toxina inyectada. Los únicos efectos secundarios observados fueron ptosis uni o bilateral en 6 pacientes, reversible antes de los 21 días de la inyección y no se observaron efectos secundarios sistemáticos. Una paciente tuvo una parálisis facial periférica de 19 días de duración con remisión completa. Hubo una sola deserción del estudio en una paciente depresiva con ptosis prolongada (21 días). Todos los pacientes (inclusive la desertora) coincidieron en que el tratamiento con Botox fue más eficaz que cualquier ensayo medicamentoso previo. A pesar que estos resultados son similares a comunicaciones previas, creemos aconsejable acumular experiencia para evaluar los resultados a largo plazo (AU)
Assuntos
Pessoa de Meia-Idade , Idoso , Humanos , Feminino , Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas/uso terapêutico , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas/efeitos adversos , Blefaroptose/induzido quimicamente , Paralisia Facial/induzido quimicamente , Ensaios Clínicos como Assunto , Injeções Intramusculares/métodosRESUMO
Cinco pacientes (2 hombres y 3 mujeres) con enfermedad de parkinson idiopático (PI) y severas fluctuaciones motoras refractarias a L_Dopa y agonistas dopaminérgicos orales (Bromocriptina o lisuride) fueron seleccionados para este estudio. Sus edades oscilaron entre 56 y 75 años (X 62,6) y la duración de los síntomas variaron entre 7 y 18 años. Cuatro casos presentaban PI con estadio IV según Hoehn y Yahr, y uno se hallaba en el estadio III, presentando todos ellos fluctuaciones predecibles. El estado clínico fue evaluado empleando la escala para enfermedad de parkinson del kings college, las diskinesias fueron valoradas de acuerdo al grado de interferencia con movimientos voluntarios, su distribución, tipo y relación con la administración de L-Dopa. La administración de L-Dopa fue mantenida constante (300-875 mg/d) durante el estudio. La infusión dubcutánea de lisuride (ISL) fue realizada empleando bombas portátiles TECENSA AIP-62 (Madrid-España) o una BETATRON II CPI lilly (USA) en dosis gradualmente crecientes hasta estabilizarlas entre 41 ug/h y 104 ug/h. Todos los pacientes mejoraron marcadamente en las primeras semanas manteniéndose este beneficio durante 12 meses. Las diskinesias bifásicas y distonías del período off respondieron cediendo en ISL. Los efectos colaterales fueron fundamentalmente psiquiátricos en 2 casos, lo que motivó en uno la supresión de ISL y en otro la reducción de la dosis (con regímenes de infusión menores durante la noche). En todos los casos se observaron nódulos en el sitio de infusión los que en 2 pacientes tuvieron características hemorrágicas, en un caso se produjo infección de un nódulo. Nuestros resultados sugieren que la ISL puede constituir un valioso suplemento terapéutico de la L-Dopa en PI con fluctuaciones motoras incapacitantes, desafortunadamente efectos colaterales locales y psiquiátricos pueden limitar su aplicación sobre todo para su empleo prolongado. (AU)
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Doença de Parkinson/tratamento farmacológico , Lisurida/uso terapêutico , Levodopa/efeitos adversos , Interações Medicamentosas , Estimulação QuímicaRESUMO
Cinco pacientes (2 hombres y 3 mujeres) con enfermedad de parkinson idiopático (PI) y severas fluctuaciones motoras refractarias a L_Dopa y agonistas dopaminérgicos orales (Bromocriptina o lisuride) fueron seleccionados para este estudio. Sus edades oscilaron entre 56 y 75 años (X 62,6) y la duración de los síntomas variaron entre 7 y 18 años. Cuatro casos presentaban PI con estadio IV según Hoehn y Yahr, y uno se hallaba en el estadio III, presentando todos ellos fluctuaciones predecibles. El estado clínico fue evaluado empleando la escala para enfermedad de parkinson del king's college, las diskinesias fueron valoradas de acuerdo al grado de interferencia con movimientos voluntarios, su distribución, tipo y relación con la administración de L-Dopa. La administración de L-Dopa fue mantenida constante (300-875 mg/d) durante el estudio. La infusión dubcutánea de lisuride (ISL) fue realizada empleando bombas portátiles TECENSA AIP-62 (Madrid-España) o una BETATRON II CPI lilly (USA) en dosis gradualmente crecientes hasta estabilizarlas entre 41 ug/h y 104 ug/h. Todos los pacientes mejoraron marcadamente en las primeras semanas manteniéndose este beneficio durante 12 meses. Las diskinesias bifásicas y distonías del período off respondieron cediendo en ISL. Los efectos colaterales fueron fundamentalmente psiquiátricos en 2 casos, lo que motivó en uno la supresión de ISL y en otro la reducción de la dosis (con regímenes de infusión menores durante la noche). En todos los casos se observaron nódulos en el sitio de infusión los que en 2 pacientes tuvieron características hemorrágicas, en un caso se produjo infección de un nódulo. Nuestros resultados sugieren que la ISL puede constituir un valioso suplemento terapéutico de la L-Dopa en PI con fluctuaciones motoras incapacitantes, desafortunadamente efectos colaterales locales y psiquiátricos pueden limitar su aplicación sobre todo para su empleo prolongado.
Assuntos
Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Doença de Parkinson/tratamento farmacológico , Levodopa/efeitos adversos , Lisurida/uso terapêutico , Interações Medicamentosas , Estimulação QuímicaRESUMO
El blefaroespasmo, ya sea aislado o en el contexto de una disquinesia oro-facio-mandibular (síndrome de Meige) es una distonía cranial relativamente frecuente. En su máxima expresión puede dar origen a marcada minusvalía e incluso ceguera funcional. Doce pacientes con respuesta poco satisfactoria a tratamientos medicamentosos (trihexifenidilo, hiperideno, imipramina, carbamazepina, baclofén, litio, lisuride, clonazepam, butirofenonas) fueron tratados con inyecciones perioculares de toxina botulínica (Botox), utilizando una dosis "baja" de 12,5 UI por ojo. Once de los doce pacientes obtuvieron mejoria significativa que duró entre cinco y quince semanas. Una sola paciente no respondió y lo hizo al duplicar la dosis de toxina inyectada. Los únicos efectos secundarios observados fueron ptosis uni o bilateral en 6 pacientes, reversible antes de los 21 días de la inyección y no se observaron efectos secundarios sistemáticos. Una paciente tuvo una parálisis facial periférica de 19 días de duración con remisión completa. Hubo una sola deserción del estudio en una paciente depresiva con ptosis prolongada (21 días). Todos los pacientes (inclusive la desertora) coincidieron en que el tratamiento con Botox fue más eficaz que cualquier ensayo medicamentoso previo. A pesar que estos resultados son similares a comunicaciones previas, creemos aconsejable acumular experiencia para evaluar los resultados a largo plazo
Assuntos
Pessoa de Meia-Idade , Humanos , Feminino , Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas/uso terapêutico , Blefaroptose/induzido quimicamente , Ensaios Clínicos como Assunto , Paralisia Facial/induzido quimicamente , Injeções Intramusculares/métodos , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas/efeitos adversosRESUMO
Meige's disease is a distressing complaint, the treatment of which often poses a challenge to the neurologist. The patient described here had blepharospasm-oromandibular dystonia, which responded transiently to oral lisuride. On three occasions, drug holidays successfully restored efficacy but thereafter further trials proved fruitless. Continuous subcutaneous lisuride administration in 0.35 mg doses per day, by means of a portable infusion pump, led to sustained improvement for 7 months. No major side effects were observed. Our findings suggest that this treatment deserves further trials.
Assuntos
Domperidona/uso terapêutico , Ergolinas/uso terapêutico , Lisurida/uso terapêutico , Síndrome de Meige/tratamento farmacológico , Distonia/tratamento farmacológico , Feminino , Humanos , Injeções Subcutâneas , Lisurida/administração & dosagem , Lisurida/efeitos adversos , Pessoa de Meia-IdadeRESUMO
Se presentan 10 pacientes con ectasias sintomáticas de arterias cerebrales. Todos los pacientes son de sexo masculino y padecían de hipertensión arterial leve o moderada. Las ectasias estaban presentes en la arteria basilar en el 20%, en las arterias carótidas en el 20% y en ambos sistemas en el 60% restante. Predominaron los síntomas motores y sensitivos, ataxia, diplopía y demencia. Asismismo se presenta el segundo caso en la literatura con hemorragia subaracnoidea a partir de la ruptura de una arteria basilar ectásia. Se discute la presencia de trastornos autonómicos en un paciente con severo compromiso neurológico por compresión del tronco encefálico. Todos los pacientes fueron estudiados con tomografía computada cerebral con infusión de sustancia de constraste y arteriografía cerebral de los cuatro vasos. En uno de los casos la tomografía cerebral resultó insuficiente para el diagmnóstico de ectasia, sugiriendo un tumor del ángulo pontocerebeloso. Cinco pacientes fueron tratados con antiagregantes plaquetarios y dos pacientes recibieron anticoagulación. La evolución clínica fue desfavorable, no observándose benefício aparente en los casos tratados (AU)