RESUMO
INTRODUCTION: Although the prevalence and pattern of parkinsonism in white caucasian population have been reported, little is known about the pattern and prevalence of parkinsonism in black and Asian patients (from the Indian subcontinent). We recently reviewed this topic and felt that contrary to popular belief parkinsonism may be commoner in UK. Furthermore, the pattern of parkinsonism appears to be different in this group. METHODS AND RESULTS: Based on this observation we have now set up a worldwide and British study involving Afro-Caribbean and India (patients originating from the Indian subcontinent) subjects. In the first leg of this study, we carried out a door to door knocking assessment for Parkinsonism in one electoral ward in London with a high Afro-Caribbean population and identified three cases of atypical parkinsonism. We have subsequently been reviewing the case files of over 150 patients attending Movement Disorders clinical in areas of London with a high population of the Afro-Caribbean and Indian population. So far, we have identified 18 cases of Parkinsonism in patients of Afro-Caribbean and Asian origin. Fourteen out of 18 cases show non familial atypical parkinsonism with signs of progressive supranuclear palsy in five, probable striato nigral degeneration in four, and a levodopa unresponsive progressive parkinsonism which falls but no dystonia in three, spino-cerebellar atrophy type three in one and autopsy proven Pick's disease in 1.4. High field Magnetic resonance imaging and CT brain scanning have been remarkable apart from non-specific cortical atrophy and signs of vascular disease in some. CONCLUSIONS: Our observations suggest that parkinsonism is probably more common than realized in the Afro-Caribbean and Asian populations and these patients may be more susceptible to atypical parkinsonism. The reason for this is unclear and may reflect genetic or environmental factors as has been postulated in relation to higher incidence of diabetes and ischaemic heart disease in migrant Asian population in UK. Further epidemiological studies addressing this issue are in progress. (AU)
Assuntos
Humanos , Doença de Parkinson/epidemiologia , Negro ou Afro-Americano , Etnicidade , Estudos Transversais , Imageamento por Ressonância Magnética/estatística & dados numéricos , Londres/etnologiaRESUMO
An attempt was made to indicate the neuropharmalogical relationship between Parkinson's disease, Huntington's chorea, tardive dyskinesia and Attentional Deficit Disorder. In the case of the latter, an experimental model has been prersented indicating cholinergic dysfunction in the nigro-striatal pathway. Postulates are proposed which will enable us to understand the many factors responsible for these clinical states. (AU)
Assuntos
Humanos , Animais , Ratos , Doença de Huntington/fisiopatologia , Transtornos Motores/fisiopatologia , Doenças do Sistema Nervoso/fisiopatologia , Anfetamina/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Aprendizagem da Esquiva/efeitos dos fármacos , Cérebro/efeitos dos fármacos , Inibidores da Colinesterase/efeitos adversos , Discinesia Induzida por Medicamentos/fisiopatologia , Ácido gama-Aminobutírico/fisiologia , Hipercinese/etiologia , Modelos Neurológicos , Neurotransmissores/fisiologia , Doença de Parkinson/fisiopatologia , Fisostigmina/administração & dosagem , Jamaica , Antipsicóticos/efeitos adversosRESUMO
L-Dopa has now undoubtly proved itself the drug of choice in the vast majority of cases of Parkinson's Disease. When used in combination with a decarboxylase inhibitor it would appear that significant therapeutic advantages are gained (Lancet 5th May, 1973, Marsden et al 1973). The metabolism, use and side effects of L-Dopa are outlined and the role of other forms of treatment discussed (AU)
