RESUMO
OBJECTIVE: The association of anorexia nervosa (AN) with organic brain lesions may offer insight into underlying illness neuropathology. A systematic review reported an association between AN and lesions located in the right frontal lobe. To date, no studies have studied such a case longitudinally. A case of a male presenting with AN and a frontal lobe glioma is described. METHOD: The clinical symptoms and subsequent medical and neuropsychological investigations before and after surgery are reviewed. RESULTS: The remission of ED symptoms is observed at 2 year post-surgery follow up. DISCUSSION: The features of this case are set into the context of recent conceptualizations of AN and the clinical implications for identifying individuals with underlying organic causes.
Assuntos
Anorexia Nervosa/etiologia , Neoplasias Encefálicas/complicações , Lobo Frontal/patologia , Glioma/complicações , Giro do Cíngulo/patologia , Adulto , Anorexia Nervosa/patologia , Neoplasias Encefálicas/patologia , Glioma/patologia , Humanos , MasculinoRESUMO
We have shown previously that intraparenchymal infusion of glial cell line-derived neurotrophic factor (GDNF) continuously into the posterior putamen in five Parkinson's disease patients is safe and may represent a new treatment option. Here, we report a continuation of this phase I study. After 2 years of continual GDNF infusion, there were no serious clinical side effects and no significant detrimental effects on cognition. Patients showed a 57% and 63% improvement in their off-medication motor and activities of daily living subscores of the Unified Parkinson's Disease Rating Scale, respectively, and health-related quality-of-life measures (Parkinson's Disease Questionnaire-39 and Short Form-36) showed general improvement over time.
Assuntos
Fatores de Crescimento Neural/administração & dosagem , Fatores de Crescimento Neural/efeitos adversos , Fármacos Neuroprotetores/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Putamen/efeitos dos fármacos , Atividades Cotidianas , Cateteres de Demora , Cognição , Fator Neurotrófico Derivado de Linhagem de Célula Glial , Humanos , Injeções Intraventriculares , Atividade Motora/efeitos dos fármacos , Fármacos Neuroprotetores/efeitos adversos , Testes Neuropsicológicos , Qualidade de Vida , Resultado do TratamentoRESUMO
Glial cell line-derived neurotrophic factor (GDNF) is a potent neurotrophic factor with restorative effects in a wide variety of rodent and primate models of Parkinson disease, but penetration into brain tissue from either the blood or the cerebro-spinal fluid is limited. Here we delivered GDNF directly into the putamen of five Parkinson patients in a phase 1 safety trial. One catheter needed to be repositioned and there were changes in the magnetic resonance images that disappeared after lowering the concentration of GDNF. After one year, there were no serious clinical side effects, a 39% improvement in the off-medication motor sub-score of the Unified Parkinson's Disease Rating Scale (UPDRS) and a 61% improvement in the activities of daily living sub-score. Medication-induced dyskinesias were reduced by 64% and were not observed off medication during chronic GDNF delivery. Positron emission tomography (PET) scans of [(18)F]dopamine uptake showed a significant 28% increase in putamen dopamine storage after 18 months, suggesting a direct effect of GDNF on dopamine function. This study warrants careful examination of GDNF as a treatment for Parkinson disease.