[Accessibility to the specific pharmacotherapy for Parkinson disease, in Santiago de Chile]. / Accesibilidad a la farmacoterapia específica de la enfermedad de Parkinson, en Santiago de Chile.

BACKGROUND: The high costs of adequate pharmacological treatment for Parkinson disease preclude the universal access of patients to this medication. AIM: To assess the accessibility to pharmacological treatment of Chilean patients with Parkinson disease. PATIENTS AND METHODS: An inquiry about socioeconomic stratification, medical controls, disease features and costs of pharmacological therapy, was applied to 95 patients (56 male, aged 32 to 89 years old) attending the Chilean League Against Parkinson Disease. RESULTS: Among studied patients, the disease had a mean duration of 7.9 +/- 6 years. There was a direct relationship between family income, the frequency of visits to physicians and the dose and cost of pharmacological therapy. CONCLUSIONS: The accessibility to pharmacological therapy among patients with Parkinson disease, depends on their socioeconomic level. Measures to correct this situation and improve the quality of life of these patients should be undertaken by health services.

[Refractory epilepsy in adults and the new antiepileptic drugs: the role of gabapentin]. / La epilepsia refractaria del adulto y los antiepilépticos noveles: el rol de la gabapentina.

The features of refractory epilepsies and the role of functional surgery and new antiepileptic drugs is reviewed. Among the latter, gabapentin, a drug with peculiar pharmacokinetic properties, is highlighted as a therapeutic alternative in refractory epilepsies and eventually for epileptic patients without previous treatment. A new type of relationship between the pharmaceutical industry and physicians, that privileges clinical research, is discussed.

[Nuclear magnetic resonance in the diagnosis of multiple sclerosis. A critical review of the literature]. / Resonancia nuclear magnética en el diagnóstico de la esclerosis multiple: Una revisión crítica de la literatura.

Nuclear magnetic resonance (NMR) has been proposed to be the best diagnostic test for multiple sclerosis (MS). We performed a critical analysis of 13 papers evaluating the use of NMR in MS. Out of an ideal 17 criteria for validation and reproducibility, a top of 11 (65%) was the maximum found. Foremost deficiencies were a lack of blind analysis and inadequate patient samples. Thus the claim that NMR is the diagnostic tool of choice in MS remains to be proven.

[Determination of plasma levels of phenytoin. Evaluation of 2 techniques]. / Determinación de níveles plasmáticos de fenitoina. Evaluación de dos técnicas analíticas.

We compared 2 techniques for determination of plasma levels of phenytoin, liquid-gas chromatography (LGC) and homogeneous enzymatic immunoassay (EI) in samples from 72 patients receiving monotherapy with this drug. Determinations were also made in samples of normal plasma with known concentrations of phenytoin. Good correlation of both techniques was observed in patient samples containing less than 15 micrograms/ml of the drug but not with higher concentrations. LGC was accurate in determination of known concentrations of phenytoin, whereas immunoassay showed an exponential deviation with overestimation of phenytoin levels. Thus LGC is a better technique for determination of phenytoin levels; however EI may be used in most clinical situations when the concentration of phenytoin lies under 20 micrograms/dl.

[Sneddon syndrome. Presentation of 2 cases]. / Sindrome de Sneddon. Presentacion de dos casos.

Sneddon syndrome is a systemic non inflammatory arteriopathy characterized by the association of livedo reticularis, thrombotic cerebrovascular disease, coronary artery disease and hypertension. Middle age females are usually affected. It should be considered in the differential diagnosis of acute ischemic attacks in younger patients. It has been related to the antiphospholipid antibody syndrome. Treatment is based on control of hypertension and cardiovascular risk factors along with antiplatelet agents. Two cases meeting the clinical criteria outlined above are reported.

[Phenytoin pharmacokinetics in young and older adults]. / Farmacocinética de fenitoina en adultos jóvenes y senescentes.

To study the effect of old age on phenytoin pharmacokinetics, twelve young and nine old adults aged 21.7 +/- 1.8 and 71.8 +/- 4.9 years respectively, were studied. No significant differences of phenytoin indicating the drug distribution and elimination does not change with aging. After oral administration, significant differences were observed between young and old adults for absorption, measured through oral residence half time (36.89 +/- 5.07 h in young and 29.25 +/- 8.64 h in old adults p < 0.05), absorption half time (6.91 +/- 3.6 vs 3.29 +/- 2.35 h) and maximal concentration (1.45 +/- 0.37 vs 2.0 +/- 0.79 micrograms/ml). However, absolute bioavailability of the drug was not different in both age groups (72.9 and 67.6% in young and old adults respectively). It is concluded that no modifications of phenytoin dosage are necessary in elderly people.

[Ischemic cerebrovascular syndrome of pregnancy and the puerperium]. / Síndrome cerebrovascular isquémico del embarazo y puerperio.

There is little information on ischemic cerebrovascular pathology of pregnancy and puerperium. The clinical characteristics and the results of tomographic and angiographic evaluation of nine patients with ischemic cerebrovascular syndrome of pregnancy and puerperium are described. Venous thrombosis was the cause of cerebrovascular episode in 4 of the 9 patients presenting characteristic clinical manifestations and occurring particularly during puerperium. The diagnostic method of these cases was angiography since the scanner was normal in almost all the cases. Arterial pathology presented preferentially during pregnancy with no peculiar clinical characteristics being observed. In these cases the cerebral scanner was the best diagnostic technique. Follow-up suggested a better prognosis for venous pathology in terms of sequelae.

[Mitral valve prolapse and cerebral ischemia]. / Prolapso de la válvula mitral e isquemia cerebral.

We report on 10 patients suffering from cerebral ischemic episodes in whom mitral valve prolapse was diagnosed. Neurologic assessment included computerized tomography and angiographic study. In one case, the angiographic study revealed the presence of intracranial vasculitis and one woman was taking the contraceptive pill. The diagnosis of mitral valve prolapse was established on the basis of clinical grounds and electrocardiographic, Doppler study, Holter monitoring and two-dimensional echocardiographic signs. Our findings confirm that mitral valve prolapse is an etiologic factor to be considered in young adults with cerebral ischemia, although mitral valve prolapse does not exclude the possibility of other etiopathogenic conditions occurring.

[Hepatotoxicity induced by valproic acid in adults. Report of 3 cases]. / Hepatotoxicidad inducida por ácido valproico en adultos. Presentación de tres casos.

Valproic acid is a useful antiepileptic drug, with occasional gastrointestinal side effects. Hepatotoxicity is the most serious adverse reaction and, although rare, it can be fatal. Risk factors for hepatotoxicity are an age of less than two years, polytherapy and mental retardation; it has been rarely reported in adults. We report three mentally retarded adult patients receiving polytherapy, who developed valproic acid induced hepatotoxicity. Two patients had a symptomatic hepatitis with a concomitant paradoxical increase in seizure frequency and one an asymptomatic alteration of hepatic function tests. After discontinuing the drug, the hepatitis subsided. We conclude that hepatotoxicity must be considered as a possible side effect of valproic acid and we suggest some recommendations for its early detection.

[Medical care to cerebrovascular syndrome]. / Atención médica del síndrome cerebrovascular.

We analyzed clinical data from all patients with a stroke admitted to the Emergency Service of a General Hospital in Santiago, from 1984 to 1986. 371 patients (196 women and 175 men) were diagnosed as having thrombosis (43%), embolic occlusion (18%), intracerebral hemorrhage (36%) and subarachnoid hemorrhage (3%). CAT scans were performed in 25% and angiography in 16%. The diagnosis was considered proven in 40% of cases. Overall hospital mortality was 46%, raising to 66% for hemorrhages. Prevention of cerebral edema was the main medical treatment. The present data suggest that primary prevention of and technological facilities to treat cerebrovascular episodes are inadequate at a general hospital level in Santiago.

[Computerized registry of medical procedures and diagnostic codification]. / Registro computacional de acciones médicas y codificación diagnóstica.

Retrospective analysis of clinical information requires easy access to reliably stored data. We developed a program running on a microcomputer and using codes from the International classification of diseases, to be used on line. The program stores diagnostic codes, medical actions and a summary for each case. It uses inexpensive hardware and is friendly to inexperienced users.

Phenytoin/clonazepam interaction.

An interaction between phenytoin (PHT) and clonazepam (CZP) occurred in an epileptic patient, who had been treated with PHT with partial seizure control. The addition of CZP brought about a significant decrease of PHT plasma levels (from 24.8 to 16 micrograms/ml) in spite of increases in the PHT dose. Gradual reduction of CZP, without modifying the PHT dosage, caused significant increases in PHT plasma levels to 42.4 micrograms/ml with signs of intoxication. A review of the literature shows contradictions: some authors state that there is no interaction between the drugs; other authors state either an increase or decrease in PHT plasma levels. These paradoxical results could be explained by the bidirectional effect of these drugs in hepatic enzyme metabolism. The importance of monitoring plasma levels of antiepileptic drugs is emphasized when several medications are required in the treatment of epilepsy.

[Carbamazepine: the bioavailability of 4 oral pharmaceutical products]. / Carbamazepina: biodisponibilidad de cuatro productos farmaceuticos orales.

The bioavailability of carbamazepine from 4 commercially available products was evaluated in 12 healthy volunteers. A crossover design was used and each patients received 400 mg of each product. Plasma levels of the drug were determined periodically for 72 h using a gas-liquid chromatographic method. An open model of one compartment for first-order absorption was assumed to derive pharmacokinetic parameters. Dissolution kinetics was also evaluated in each product. Significant differences in bioavailability were shown for one product. Results correlated with the in vitro dissolution findings.

[Adult onset subacute sclerosing panencephalitis. Report of two cases with atypical presentation]. / Panencefalitis esclerosante subaguda de inicio en edad adulta: presentación atípica en 2 pacientes.

Subacute sclerosing panencephalitis is an infrequent central nervous system viral disease and is a late manifestation of persistent infection by a mutant form of measles virus. Since it affects mainly children and teenagers, the diagnosis in older ages is difficult. Its main clinical symptoms are cognitive impairment, behavioral disturbances and myoclonia. We report two males, aged 21 and 22 years old, presenting with the disease with atypical manifestations. One had a catatonic syndrome and the other, amaurosis. The recognition of the different presentation forms of the disease, endemic in developing countries, allows an earlier diagnosis and a more efficient treatment, when available.

[Temporal lobectomy in refractory partial epilepsy. Report of 4 cases]. / Lobectomía temporal en epilepsias parciales refractarias. Comunicación de cuatro casos.

Thirty, out of 1200 patients of North Santiago Adult Epilepsy Program, were admitted to J J Aguirre Hospital due to refractory epilepsy. Looking for candidates for functional epilepsy surgery, these patients were evaluated by neurologists, psychiatrists and psychologists and with standard EEG, video monitored EEG, CAT scan, magnetic resonance imaging and SPECT. So far, four patients with temporal partial complex epilepsy have been studied, operated (anterior temporal lobectomy and amygdalo-hippocampectomy) and followed for more than one year. Of these, two are free of seizures, one has sporadic episodes and one has an important reduction. One of these patients had a postoperative amnestic syndrome of 3 to 4 weeks duration. According to these results and those reported in the literature, the rigorous selection of patients that could be benefitted by surgery is emphasized.

Plasma levels of diphenylhydantoin and the control of adult epileptic seizures: a Chilean experience.

In a prospective study of 117 adult ambulatory patients, 110 of whom were epileptics treated only with oral diphenylhydantoin (DPH), plasma levels of this drug were determined by gas-liquid chromatography. The average follow-up time was 6 months (range, 3 to 13 months); satisfactory control of seizures was obtained with plasma levels in the 10.2 to 25.8 micrograms/ml range, representing 68% of the patients whose seizures had been controlled. The dosage received by this group was from 4.2 to 6 mg/kg, with an average of 5.1. In general, these results agree with those found in European or North American patients, even though some differences or little clarity in the methodology of other trials make comparison difficult. This similarity of results makes one think that genetic or environmental differences do not alter the response to DPH in our patients, but further studies are necessary in that area. This paper can serve as a basis for the extrapolation of data about DPH coming from other latitudes that have been considered supposedly valid for Latin American epileptic patients.