RESUMO
A patient affected by an ischaemic lesion of the right medial thalamic nucleus presented with a uniocular dissociation of upward vertical saccades and pursuit movement, with absent upward vertical saccades in the left eye. Clinical observations were confirmed by magnetic field scleral search coils analysis. During the vertical eye movement the patient denied any diplopia, thus suggesting a transient visual suppression in the left eye.
Assuntos
Isquemia Encefálica/patologia , Diplopia/diagnóstico , Movimentos Sacádicos/fisiologia , Tálamo/patologia , Anticorpos Antifosfolipídeos/imunologia , Isquemia Encefálica/diagnóstico , Circulação Cerebrovascular/fisiologia , Diplopia/fisiopatologia , Feminino , Fixação Ocular/fisiologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tálamo/irrigação sanguíneaRESUMO
In 22 patients with idiopathic Parkinson's disease we observed a sudden worsening of motor symptoms and severe akinesia during hospitalization because of infectious diseases, bone fractures, surgery for gastrointestinal tract diseases, and iatrogenic causes. Of these patients, 12 recovered completely, 6 had a partial recovery, and 4 died. Treatments included subcutaneous apomorphine/lisuride infusion and dantreolene (with a creatine phosphokinase level higher than 200 IU). In all patients a definite refractoriness to therapy was shown with a transient lack of response to apomorphine.
Assuntos
Transtornos dos Movimentos/etiologia , Doença de Parkinson/complicações , Idoso , Antiparkinsonianos/uso terapêutico , Estudos de Casos e Controles , Infecção Hospitalar/complicações , Infecção Hospitalar/tratamento farmacológico , Dantroleno/uso terapêutico , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Atividade Motora/efeitos dos fármacos , Transtornos dos Movimentos/classificação , Transtornos dos Movimentos/tratamento farmacológico , Relaxantes Musculares Centrais/uso terapêutico , Avaliação de Resultados em Cuidados de Saúde , Doença de Parkinson/tratamento farmacológicoRESUMO
BACKGROUND: Recent short-term studies suggested that amantadine (Ama) might ameliorate dyskinesia in patients with Parkinson's disease. A double-blind study programmed over 12 months was designed to assess the duration of the antidyskinetic effect of amantadine on levodopa induced dyskinesia. METHODS: 40 patients treated for 7.5 (2.2) years with levodopa (729.3 (199.4) mg/day) and dopaminoagonists, having peak dose or dyphasic dyskinesia with or without pain, were assessed with the Unified Parkinson's Disease Rating Scale subscale IV, Items 32-34, the Dyskinesia Rating Scale and Investigator Global Assessment. Twenty patients received amantadine chloridrate (100 mg) and 20 received a placebo. The Ama or placebo could be withdrawn when scores indicated worsening of dyskinesia, after agreement with the patient. RESULTS: After 15 days of amantadine treatment there was a reduction by 45% in the total dyskinesia scores. All patients in the placebo group were withdrawn in 1-3 months and all patients in the Ama group were withdrawn in 3-8 months (p = 0.01, p<0.001). Ama withdrawal induced a rebound with increase of dyskinesia by 10-20% in 11 patients. CONCLUSION: 300 mg amantadine reduces dyskinesia in Parkinson's disease by approximately 45% but the benefit lasted less than eight months.