Prospective, randomized, double-blind study, comparing botulinum toxins type a botox and prosigne for blepharospasm and hemifacial spasm treatment.

Botulinum toxin A (BTA) is considered an effective treatment of blepharospasm and hemifacial spasm, but there are few studies to permit a comparison of its different formulations. This prospective, randomized, double-blind study compared Prosigne, a BTA of Chinese origin, with Botox to establish safety, efficacy, and equivalence of doses between those 2 formulations in blepharospasm and hemifacial spasm treatment. Fifty-seven patients participated in this study: 21 blepharospasm (from whom 11 were treated with Botox; and 10, with Prosigne) and 36 hemifacial spasm patients (17 were treated with Botox; and 19, with Prosigne). All patients were similar in age, disease time span, number of previous shots, and time elapsed since the last BTA application. Pain and burning during the injection and the result of the treatment were similar in both groups. There were no systemic adverse events, and the local ones were observed with similar intensity and frequency for both groups. The mean effect time length was similar for both blepharospasm (11.3 weeks for both toxins) and hemifacial spasm patients (12.8 weeks for Botox and 12.9 weeks for Prosigne). In both blepharospasm groups, only the 36-Item Short-Form Health Survey emotional aspects domain showed improvement from baseline after 16 weeks. There were no differences between the 36-Item Short-Form Health Survey scores before and after the treatment of all hemifacial spasm patients. Therefore, it has been concluded that Botox and Prosigne have similar efficacy, safety, and tolerability profiles, so that a dose equivalence of 1:1 may be considered for blepharospasm and hemifacial spasm treatments.

A prospective, randomized, double-blind study comparing the efficacy and safety of type a botulinum toxins botox and prosigne in the treatment of cervical dystonia.

Botulinum toxin A (BTA) is considered an effective treatment of cervical dystonia. The aim of this prospective, randomized, double-blind study was to compare Botox and Prosigne, a BTA of Chinese origin, with a view to establish the safety, the efficacy, and the equivalence of doses of the 2 formulations in the treatment of cervical dystonia. Twenty-four patients were randomized to receive 300 U of Botox or Prosigne (12 patients in each group). The patients were assessed before the injection and after 4 and 16 weeks by the Toronto Western Spasmodic Torticollis Rating Scale and the Short-Form 36 for quality of life before and 16 weeks after the injection. All patients were comparable in age, time since onset, number of previous injections, and time since last BTA application. According to the Toronto Western Spasmodic Torticollis Rating Scale scores, the patients improved after injection and the scores increased after 16 weeks, without returning to baseline values. Both pain and burning during the injection and the treatment outcomes were similar in both groups. No systemic adverse events occurred, and the severity and frequency of local events were comparable in both groups. Average duration of effect was similar in both groups (11 weeks). The quality-of-life evaluations before and after the injections were comparable in both groups. Social aspects, pain, and vitality improved after 16 weeks in both groups. In conclusion, Botox and Prosigne were determined to have equivalent efficacy, safety, and tolerability profiles and dose equivalence for cervical dystonia treatment is 1:1.

Pain in Parkinson's disease.

Pain may precede the diagnosis in Parkinson's disease (PD). The goal of this study was to assess the pain in a group of 20 females and 30 males with PD, after excluding co-morbidities as causes. It was used the following tools: Unified Parkinson's Disease Rating Scale, McGill questionnaire and Beck Depression Inventory. In 27 patients (54%), the pain was associated with PD, occurring in 22 (44%) in the off period and 5 (10%) in both on and off periods. The off period resulted in an increased frequency of pain, which was related to stiffness. There was no association between pain and tremor in off period, neither between pain and Modified Hoehn and Yahr stage, nor the Schwab and England scale. It was not observed an association between pain and depression, neither between pain and dyskinesia. It was noticed the improvement in pain in 16 patients with levodopa (59.26%).

Pain in Parkinson's disease / Dor na doença de Parkinson

Pain may precede the diagnosis in Parkinson's disease (PD). The goal of this study was to assess the pain in a group of 20 females and 30 males with PD, after excluding co-morbidities as causes. It was used the following tools: Unified Parkinson's Disease Rating Scale, McGill questionnaire and Beck Depression Inventory. In 27 patients (54 percent), the pain was associated with PD, occurring in 22 (44 percent) in the off period and 5 (10 percent) in both on and off periods. The off period resulted in an increased frequency of pain, which was related to stiffness. There was no association between pain and tremor in off period, neither between pain and Modified Hoehn and Yahr stage, nor the Schwab and England scale. It was not observed an association between pain and depression, neither between pain and dyskinesia. It was noticed the improvement in pain in 16 patients with levodopa (59.26 percent).

Dor pode preceder o diagnóstico na doença de Parkinson (DP). O objetivo deste estudo foi avaliar a dor num grupo de 20 mulheres e 30 homens com DP. Após a exclusão das co-morbidades como causa. Foi usado o seguinte: Unified Parkinson`s Disease Rating Scale, o questionário de dor McGill e o Inventário de Depressão de Beck. Em 27 pacientes (54 por cento), a dor associou-se com a DP, ocorrendo em 22 (44 por cento) no período off e em 5 (10 por cento) nos períodos on e off. O período off resultou num aumento da freqüência da dor, o qual se relacionou com a rigidez. Não houve associação entre dor e tremor no período off, estágio Hoehn e Yahr modificado, nem a escala de Schwab e England. Não foi observado associação entre dor e depressão, nem entre dor e discinesia. Foi observada a melhora da dor em 16 pacientes com levodopa (59.26 por cento).

Psychopathological features in patients with Parkinson's disease and related caregivers' burden.

BACKGROUND: Along with classical motor disorders in Parkinson's disease (PD), psychopathological features frequently co-occur, which may increase the caregiver's burden. AIMS: To identify the profile of psychopathological symptoms in patients with PD and the impact imposed by this condition on the caregiver's burden. SUBJECTS: Fifty patients with idiopathic PD seen consecutively at the Movement Disorder Outpatient Clinic at the Hospital of State University of Campinas, Brazil, and their 50 respective caregivers were studied. METHODS: The 50 patients with PD were divided into three groups according to the respective psychiatric diagnosis received (depression: N = 17, dementia: N = 13 and non-depressed and non-demented: N = 20). We divided the caregivers into three groups according to the mental condition of their patients. To assess the mental condition of patients and the caregiver's burden, and to correlate those psychopathological features found with clinical features of PD, we applied the Neuropsychiatric Inventory (NPI). RESULTS: Patients with dementia presented the highest NPI scores of psychopathological symptoms (26.4), followed by patients with depression (24.9). Non-depressed and non-demented patients revealed fewer symptoms (7.2). Caregivers' burden was found to be proportional to the degree of patients' symptomatology. CONCLUSION: Patients with dementia presented more severe motor impairment and lower functionality, followed by patients with depression and those non-demented, non-depressed. Psychotic symptoms, agitation, aberrant motor behaviours and sleep disturbances were higher in dementia group. Neuropsychiatric disturbances correlated with caregiver's burden, which was highest in patients with dementia.

Olfaction and essential tremor.

OBJECTIVE: To characterize the olfactory identification in 40 essential tremor (ET) patients, with the University of Pennsylvania 12 Smell Identification Test (UPSIT), to correlate UPSIT scores to clinical and epidemiological data and to compare it to 89 aged matched controls. METHOD: Patients were assessed using ET Clinical Scale of Evaluation and UPSIT. RESULTS: In patients with ET, the UPSIT medium score was 9.10, similar to the control group (9.11), which was also observed in all age groups. ET severity did not correlate to UPSIT scores. CONCLUSION: This study demonstrated normality of olfactory identification on ET, qualifying UPSIT to be an important tool on tremor differential diagnosis of undetermined origin.

Olfaction and essential tremor / Olfato no tremor essencial

OBJECTIVE: To characterize the olfactory identification in 40 essential tremor (ET) patients, with the University of Pennsylvania 12 Smell Identification Test (UPSIT), to correlate UPSIT scores to clinical and epidemiological data and to compare it to 89 aged matched controls. METHOD: Patients were assessed using ET Clinical Scale of Evaluation and UPSIT. RESULTS: In patients with ET, the UPSIT medium score was 9.10, similar to the control group (9.11), which was also observed in all age groups. ET severity did not correlate to UPSIT scores. CONCLUSION: This study demonstrated normality of olfactory identification on ET, qualifying UPSIT to be an important tool on tremor differential diagnosis of undetermined origin.

OBJETIVO: Caracterizar a identificação olfatória em 40 pacientes com tremor essencial, através do Teste de Identificação de 12 Cheiros da Universidade de Pensilvânia (TICUP), correlacioná-la aos dados clínicos e epidemiológicos e compará-la com 89 indivíduos normais. MÉTODO: Os pacientes foram avaliados com a Escala Clínica de Avaliação do TE e com o TICUP. RESULTADOS: A média de acertos no TICUP nos pacientes com TE foi 9,10, semelhante à do grupo controle (9,11), sendo isso observado em todas as faixas etárias. A gravidade do TE não se correlacionou com o resultado do TICUP. CONCLUSÃO: Este estudo demonstrou normalidade da identificação olfatória no TE, qualificando o TICUP como ferramenta importante no diagnóstico diferencial dos tremores de causa indeterminada.

Depression in patients with Parkinson's disease: impact on functioning.

Depression is a frequently observed neuropsychiatric phenomenon in Parkinson's disease (PD) and it has been lately considered as a manifestation of such disease. The aim of the study was to investigate the relationship between depression and clinical aspects of PD and to assess the impact of the co-occurrence of such condition on the burden imposed by PD. Fifty outpatients diagnosed with idiopathic PD according to the London Brain Bank criteria were examined. PD was evaluated using Hoehn & Yahr staging (H&Y), United Parkinson's Disease Rating Scale (UPDRS) and Schwab & England (S&E) functional capacity evaluation. A semi-structured clinical interview was used. The diagnosis of PD was made by neurologist experts on movement disorders, and the diagnosis of depression was made by a psychiatrist, according to the ICD-10 diagnostic criteria. Depressive symptoms were additionally measured using the Montgomery-Asberg Depression Scale. The analysis of quantitative data was performed using descriptive statistics, univariate linear regression, T-Student Test and ANOVA. Seventeen (34%) patients were diagnosed as clinically depressed and, when compared to the non-depressed ones, presented the following results: H&Y: 3.2 vs. 2.8; UPDRS total: 75.7 vs. 65.3; S&E: 53.5% vs. 65.8% and PD duration: 114.4 months vs. 125.8 months. Depressed patients showed more advanced staging (H&Y), a more severe global clinical condition (UPDRS) and also a greater decrease in their functional capacity (S&E). These data reinforce the hypothesis that depression is associated to poorer functioning in patients with PD.

Pain in Parkinson's disease: analysis of 50 cases in a clinic of movement disorders.

INTRODUCTION: Pain is a common symptom in Parkinson's disease (PD), and is often related to the illness itself. OBJECTIVE: To prospectively establish the occurrence of pain in PD patients. METHOD: This study was conducted within a population composed of 50 patients with PD to evaluate the presence of pain. RESULTS: Twenty-eight patients reported pain; comparing the group with pain and the group without pain, there were no differences related to the beginning of the illness and the motor symptoms of PD. However, many patients related an improvement of pain when antiparkinsonian therapy was initiated or adjusted. CONCLUSION: The use of techniques for analgesia and the adjustment of PD medication contribute to improve the manifestations of pain and the life quality of patients with PD.

Pain in Parkinson’s disease: analysis of 50 cases in a clinic of movement disorders

INTRODUCTION: Pain is a common symptom in Parkinson's disease (PD), and is often related to the illness itself. OBJECTIVE: To prospectively establish the ocurrence of pain in PD patients. METHOD: This study was conducted within a population composed of 50 patients with PD to evaluate the presence of pain. RESULTS: Twenty-eight patients reported pain; comparing the group with pain and the group without pain, there were no differences related to the beginning of the illness and the motor symptoms of PD. However, many patients related an improvement of pain when antiparkinsonian therapy was initiated or adjusted. CONCLUSION: The use of techniques for analgesia and the adjustment of PD medication contribute to improve the manifestations of pain and the life quality of patients with PD.

INTRODUÇÃO: Dor é um sintoma comum na doença de Parkinson (DP) e, às vezes, está relacionada à própria patologia de base. OBJETIVOS: Estabelecer prospectivamente a ocorrência de dor em pacientes com DP. MÉTODO: Foram avaliados consecutivamente 50 pacientes com DP, para comparação entre os que referiam e os que negavam quadro álgico. RESULTADOS: Entre os entrevistados, 28 referiam episódios dolorosos, não havendo diferenças quanto ao início da doença e os sintomas motores da DP, na comparação entre os dois grupos. Porém, muitos pacientes referiam melhora da dor com a introdução ou ajuste da terapia antiparkinsoniana. CONCLUSÃO: O uso de analgesia e ajuste da terapia para a DP ajudam na melhora do quadro álgico e na qualidade de vida dos pacientes.

Dementia and functional decline in patients with Parkinson's disease.

Functional decline in Parkinson's disease (PD), characterized by reduced ability to carry out activities of daily living, usually results from typical motor impairment and may be aggravated by concomitant cognitive impairment. OBJECTIVE: To compare the functional decline in Parkinson's disease between patients with dementia and cognitively preserved patients. METHODS: From an original sample composed of 50 patients with a clinical diagnosis of idiopathic PD seen in a consecutive series, 33 non-depressed patients were selected comprising 13 with dementia and 20 cognitively preserved individuals. All patients enrolled in this study were drawn from a public outpatient clinic, specialized in movement disorders. The clinical stage of PD was determined by the Hoehn & Yahr scale, and the functional capacity was verified using the Unified Parkinson's Disease Rating Scale UPDRS ADL (subscale II: activities of daily living) and the Schwab & England scale. The two last scales measure the functional degree of independence in activities of daily living. The neuropsychological assessment was performed using The Cambridge Examination for Mental Disorders of the Elderly - CAMCOG, Cognitive Section and the Stroop Color Word Test. RESULTS: As expected, in comparison with cognitively preserved patients, the group with dementia presented significantly lower scores throughout the neuropsychological evaluation. The patients with dementia were found to have a longer period of disease, a more advanced clinical staging according to the Hoehn & Yahr, and greater functional decline according both to the UPDRS ADL and Schwab & England, with statistically significant difference between the groups. CONCLUSION: Patients with dementia were at a more advanced clinical stage of Parkinson's disease and evidenced greater functional decline in comparison with patients without dementia.

O declínio funcional na doença de Parkinson (DP), caracterizado pela redução da capacidade para as atividades de vida diária, usualmente resulta do comprometimento motor típico, podendo ainda ser agravado pelo declínio cognitivo concomitante. OBJETIVOS: Comparar o declínio funcional de pacientes com e sem demência na doença de Parkinson. MÉTODOS: De uma amostra original composta por 50 pacientes com diagnóstico clínico de DP idiopática, avaliados em uma série consecutiva, foram selecionados 33 pacientes não deprimidos, sendo 13 com demência e 20 cognitivamente preservados. Todos os pacientes eram acompanhados em um ambulatório público especializado em distúrbios do movimento. Aplicamos a Unified Parkinson's Disease Rating Scale ­ UPDRS (sub-escala II: atividades de vida diária ­ UPDRS ADL), a escala Schwab & England, a escala Hoehn & Yahr, o Cambridge Examination for Mental Disorders of the Elderly ­ Seção Cognitiva (CAMCOG) e o Stroop Color Word Test. RESULTADOS: Como esperado, em comparação com pacientes cognitivamente preservados, o grupo com demência apresentou escores menores na avaliação neuropsicológica. Os pacientes com demência tinham, também, um tempo maior de doença, pertenciam a um estágio clínico mais avançado segundo a Hoehn & Yahr, e seu declínio funcional, segundo a UPDRS ADL e a Schwab & England, mostrava-se mais acentuado, com diferença estatisticamente significativa entre os grupos. CONCLUSÃO: Os pacientes com demência encontravam-se em um estágio clínico mais avançado da doença e seu declínio funcional mostrou-se mais acentuado em comparação com os pacientes sem demência.

[Olfactory dysfunction in Parkinson's disease]. / Alterações do olfato na doença de Parkinson.

OBJECTIVE: To characterize the olfactory dysfunction in 50 Parkinson's disease (PD) patients with the University of Pennsylvania 12 smell identification test (UPSIT), establishing a comparison with 76 age-matched healthy controls, and associate with clinical and epidemiologic picture. METHOD: The PD group was evaluated in phase "on" through United Parkinson's disease rating scale, UPSIT, and Hoehn and Yahr stage and the control group with the UPSIT. RESULTS: The mean UPSIT score was 5.7 in PD patients and 9 in the control group. Patients that presented initially resting tremor and those that currently have tremor, rigidity and bradykinesia had a significant lower scores. There were negative correlation between patients' age and PD stage with the UPSIT scores. There were no correlation between olfactory scores, age at the initial PD symptoms and disease duration. CONCLUSION: Among PD patients 80% had olfactory deficit and, therefore, smell evaluation may be a tool to make PD differential diagnosis.

Alterações do olfato na doença de Parkinson / Olfactory dysfunction in Parkinson's disease

OBJETIVO: Caracterizar o comprometimento olfatório em 50 pacientes com doença de Parkinson (DP) utilizando o teste de identificação de 12 cheiros da Universidade de Pensilvânia (TICUP), comparando-os com 76 indivíduos normais e associá-lo ao quadro clínico e epidemiológico. MÉTODO: Os pacientes foram avaliados na fase "on" com as escalas unificada da doença de Parkinson (UPDRS), Hoehn e Yahr e TICUP e o grupo controle com o TICUP. RESULTADOS: A média geral do número de acertos foi 5,7 nos parkinsonianos e 9 nos controles, com pontuação menor nos que apresentaram como sintoma inicial tremor e naqueles que atualmente apresentavam tremor, rigidez e bradicinesia. A idade e o estágio da DP correlacionaram-se negativamente com o número de acertos, não havendo correlação da perda olfatória com idade de início do quadro e pontuação da UPDRS. CONCLUSÃO: Apresentaram comprometimento olfatório 80 por cento dos pacientes com DP, sendo essa avaliação ferramenta importante no diagnóstico diferencial.

OBJECTIVE: To characterize the olfactory dysfunction in 50 Parkinson's disease (PD) patients with the University of Pennsylvania 12 smell identification test (UPSIT), establishing a comparison with 76 age-matched healthy controls, and associate with clinical and epidemiologic picture. METHOD: The PD group was evaluated in phase "on" through United Parkinson's disease rating scale, UPSIT, and Hoehn and Yahr stage and the control group with the UPSIT. RESULTS:The mean UPSIT score was 5.7 in PD patients and 9 in the control group. Patients that presented initially resting tremor and those that currently have tremor, rigidity and bradykinesia had a significant lower scores. There were negative correlation between patients' age and PD stage with the UPSIT scores. There were no correlation between olfactory scores, age at the initial PD symptoms and disease duration. CONCLUSION:Among PD patients 80 percent had olfactory deficit and, therefore, smell evaluation may be a tool to make PD differential diagnosis.

Vascular parkinsonism: analysis of seven cases.

INTRODUCTION: Neuroimaging studies of elderly individuals reveal alterations in the white matter that are incompatible with the patients parkinsonism, mistakenly classified as vascular parkinsonism (VP). METHOD: This study was conducted on a population composed of 20 patients with Parkinsons disease (PD) whose neuroimaging exams revealed vascular alterations in the white matter and seven patients with VP in order to compare diagnostic criteria. RESULTS: Age at disease onset of patients with PD was 55+/-12 years and patients with VP it was 62+/-13 years. Twelve patients with PD and five patients with VP presented arterial hypertension; three patients with VP and two patients with PD presented gait impairment; all patients with VP presented rigidity and bradykinesia, six of them presented resting tremor; 19 patients with PD presented tremor and 19 of them presented rigidity, while 17 presented bradykinesia. When the symptoms and evolution of both diseases were compared, the vascular alterations in the white matter were considered unspecific. CONCLUSION: Since clinical symptoms are unspecific, a differential diagnosis requires neuroimaging, good response to levodopa and clinical evolution.

Vascular parkinsonism: analysis of seven cases / Parkinsonismo vascular: análise de sete casos

INTRODUCTION: Neuroimaging studies of elderly individuals reveal alterations in the white matter that are incompatible with the patientÆs parkinsonism, mistakenly classified as vascular parkinsonism (VP). METHOD: This study was conducted on a population composed of 20 patients with ParkinsonÆs disease (PD) whose neuroimaging exams revealed vascular alterations in the white matter and seven patients with VP in order to compare diagnostic criteria. RESULTS: Age at disease onset of patients with PD was 55±12 years and patients with VP it was 62±13 years. Twelve patients with PD and five patients with VP presented arterial hypertension; three patients with VP and two patients with PD presented gait impairment; all patients with VP presented rigidity and bradykinesia, six of them presented resting tremor; 19 patients with PD presented tremor and 19 of them presented rigidity, while 17 presented bradykinesia. When the symptoms and evolution of both diseases were compared, the vascular alterations in the white matter were considered unspecific. CONCLUSION: Since clinical symptoms are unspecific, a differential diagnosis requires neuroimaging, good response to levodopa and clinical evolution.

INTRODUÇÃO: Estudos de neuroimagem em idosos mostram alterações na substância branca que são incompatíveis com o parkinsonismo do paciente, erroneamente classificado como parkinsonismo vascular (PV). MÉTODO: Este estudo foi conduzido a partir de uma população de 20 pacientes com doença de Parkinson (DP) cujos exames de neuroimagem revelaram alterações vasculares na substância branca e sete pacientes com PV para comparar os critérios diagnósticos. RESULTADOS: A idade de início da doença dos pacientes com DP foi 55±12 anos e pacientes com PV foi 62±13 anos. Doze pacientes com DP e cinco pacientes com PV apresentaram hipertensão arterial; três pacientes com PV e dois pacientes com DP apresentaram alteração da marcha; todos os pacientes com PV apresentaram rigidez e bradicinesia, seis deles apresentaram tremor de repouso; 19 pacientes com DP apresentaram tremor e 19 deles apresentaram rigidez, enquanto 17 apresentaram bradicinesia. Quando os sintomas e a evolução de ambas as doenças foram comparadas, as alterações vasculares na substância branca foram consideradas inespecíficas. CONCLUSÃO: Como os sintomas clínicos são inespecíficos, um diagnóstico diferencial requer neuroimagem, boa resposta a levodopa e evolução clínica da doença.

Status epilepticus ausência de novo: relato de caso / De novo absence status: case report

Existem poucos relatos na literatura de pacientes adultos com status epilepticus näo convulsivo, do tipo ausência típica. Apresentamos o caso de paciente do sexo feminino de 53 anos de idade, diabética, que iniciou quadro de confusäo mental após crise tônico-clônica generalizada. O eletrencefalograma mostrou descargas contínuas generalizadas caracterizadas por complexos ponta-onda irregulares. As descargas ao eletrencefalograma desapareceram após diazepan endovenoso. A tomografia computadorizada de crânio foi normal. Esse caso mostra que o reconhecimento dessa entidade clínico-eletrencefalográfica é essencial, devido â semelhança com distúrbio psiquiátrico e da pronta resposta ao tratamento medicamentoso.

Neuroesquistossomose / Central nervous system schistosomiasis

O comprometimento neurológico é uma complicação não muito freqüente da esquistossomose. O envolvimento das porções inferiores da medula e da cauda equina é o mais comum. São relatados dois casos em que os pacientes apresentaram instalação subaguda de paraparesia com sorologia positiva para esquistossomose no líquido cefalorraqueano. Tratamento foi efetuado com corticosteróides e oxaminiquine.