RESUMO
We studied the effects of oral levetiracetam (LEV) (500 mg twice daily) in three women with stiff-person syndrome in a single-blind, placebo-controlled study. The severity of muscle rigidity and of paroxysmal symptoms was assessed by EMG and clinically by a rating scale of 0-4 and by the Patients Global Impressions Scale. LEV was well tolerated. On active treatment all patients improved as assessed by any of the objective or subjective outcome measures. No response was noticed on placebo. Our data indicate that in patients with SPS, LEV is well tolerated and has a therapeutic role in the management of both muscle stiffness and life-threatening paroxysmal respiratory spasms.
Assuntos
Anticonvulsivantes/uso terapêutico , Piracetam/análogos & derivados , Rigidez Muscular Espasmódica/tratamento farmacológico , Idoso , Eletromiografia , Feminino , Humanos , Levetiracetam , Pessoa de Meia-Idade , Rigidez Muscular/tratamento farmacológico , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/fisiopatologia , Exame Neurológico , Piracetam/uso terapêutico , Respiração/efeitos dos fármacos , Método Simples-Cego , Espasmo/tratamento farmacológicoAssuntos
Adenosina Trifosfatases/genética , Proteínas de Transporte de Cátions/genética , Degeneração Hepatolenticular/genética , Adenosina Trifosfatases/fisiologia , Adulto , Substituição de Aminoácidos , Gânglios da Base/patologia , Proteínas de Transporte de Cátions/fisiologia , Cobre/metabolismo , ATPases Transportadoras de Cobre , Análise Mutacional de DNA , Éxons/genética , Predisposição Genética para Doença , Hepatite C Crônica/complicações , Degeneração Hepatolenticular/metabolismo , Heterozigoto , Humanos , Interações Hidrofóbicas e Hidrofílicas , Cirrose Hepática/complicações , Masculino , Mutação de Sentido Incorreto , Penicilamina/efeitos adversos , Penicilamina/uso terapêutico , Estrutura Secundária de Proteína , Trombocitopenia/induzido quimicamente , Triexifenidil/uso terapêuticoRESUMO
PURPOSE: To date, only one case of asterixis associated with the use of gabapentin (GBT) has been reported. No data, instead, are available on the occurrence of asterixis related to a dementing encephalopathy during GBT therapy in the elderly. METHODS: Case reports of two elderly patients, one with asterixis, the other with asterixis and encephalopathy, associated with the use of GBT, as adjunctive therapy, at dosages of 900 to 3600 mg/day are given. In one patient, GBT was added to oxcarbazepine (OXCBZ). FINDINGS: Both patients experienced resolution of the clinically apparent asterixis, and of the toxic encephalopathy, on discontinuation or reduction of GBT dosages. One patient developed asterixis after drug rechallenge. In the patient on OXCBZ, the analysis of the electromyogram (EMG) activity showed the occurrence of a subclinical asterixis. CONCLUSIONS: Our study indicates that high doses of GBT may induce asterixis related to a reversible encephalopathy. Low doses of GBT, instead, may induce a disabling asterixis when given in combination with OXCBZ because of a synergistic interaction between these drugs.