RESUMO
INTRODUCTION: The drug induced psychosis (DIP) that appears in Parkinson s disease (PD) is a frequent complication which is difficult to deal with therapeutically. Treatment is based on lowering the amount of antiparkinson drugs or using classical neuroleptics (haloperidol), which in both cases deteriorates motor function. Recently, antipsychotic drugs have appeared which are called atypical (AA) due to their scarce or null motor effects. METHOD: We carried out a review of the research work that has been published in which one of these AA, olanzapine (OLZ), was used to treat the DIP that appears in PD patients. The results obtained show OLZ to be an effective antipsychotic drug. However, the data on its capacity to deteriorate motor function is contradictory and it has not been possible to pinpoint the reasons why this adverse side effect appears in some patients and not in others. The causes that have been suggested, although they do not account for all the cases, are the use of high doses of OLZ and the prior existence of dementia. Moreover, some cases of OLZ induced agranulocytosis have been detected, although it was thought that this side effect within the AA was exclusive to clozapine. CONCLUSION: Although it is effective as an antipsychotic drug, there exists contradictory data about the capacity of OLZ to deteriorate the state of patients suffering from Parkinson s disease, which means that it does not seem to be the first choice drug in the DIP that appears in PD.
Assuntos
Antipsicóticos/uso terapêutico , Dopaminérgicos/efeitos adversos , Levodopa/efeitos adversos , Doença de Parkinson/tratamento farmacológico , Pirenzepina/análogos & derivados , Pirenzepina/uso terapêutico , Psicoses Induzidas por Substâncias/tratamento farmacológico , Benzodiazepinas , Humanos , Olanzapina , Psicoses Induzidas por Substâncias/etiologiaRESUMO
INTRODUCTION: Hemifacial spasms consist in tonic clonic, involuntary, asymmetrical and asynchronous contractions in the territory innerved by the facial nerve. Several different causes may give rise to this disorder, the most frequent of which are vascular abnormalities in the cerebellopontine angle. Its clinical features and electrophysiological studies are commonly used in diagnosis and its etiological diagnosis is most frequently performed by means of magnetic resonance imaging. Symptoms are treated using local injections of Botulinum toxin Type A in the affected muscles. AIMS: To review our experience in the handling of this pathological condition and to determine the results of employing Botulinum toxin. PATIENTS AND METHODS: We describe the cases of bilateral hemifacial spasms that have been diagnosed in the Virgen Macarena Hospital in Seville and La Fe in Valencia since 1980, as well as the follow up after treatment with Botulinum toxin. RESULTS: We describe eight cases of this pathological condition in which patients were treated with Botulinum toxin, and in all cases there was an improvement in the symptoms. CONCLUSIONS: Treatment with Botulinum toxin is considered to be satisfactory and provides a marked improvement in the patients quality of life.
Assuntos
Espasmo Hemifacial , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/tratamento farmacológico , Humanos , Pessoa de Meia-IdadeRESUMO
We describe a family and three sporadic cases of startle disease, or hyperekplexia. Sudden unexpected noises caused the patients to fall rigidly, often injuring themselves but retaining consciousness. This unusual entity differs from startle epilepsy and cataplexy. Clonazepam proved ineffective in three patients. Valproic acid, 5-hydroxytryptophan, or piracetam markedly reduced the abnormal startle in three patients.