RESUMEN
We performed a 6-month open-label study on the use of the transdermal rivastigmine patch in clinical routine in 103 patients with Alzheimer's disease from 25 outpatient services in Austria. After baseline, safety and tolerability of the 10 cm2--rivastigmine patch was assessed at week 4, 12 and 24 in all patients. A Mini Mental State Examination was done at baseline and at week 12 and 24. Skin adherence of the patch was very good or good in 85% of study participants. Only 2.9% of patients had gastrointestinal adverse events. Local skin reactions occurred in 23% of individuals. Skin alteration were mostly mild in severity. In only 6.8% of subjects did they result in termination of treatment. At the earliest skin reactions were observed after 3 months of treatment. Cognitive functioning of patients improved comparable to the controlled trial which led to approval of the rivastigmine patch. In daily routine the safety profile of the rivastigmine patch is favourable, as is the response to treatment. Local, mostly mild skin reactions affect approximately every fifth patient, and they occur relatively late in the course of therapy. Patients and their caregivers should receive detailed information about skin reactions to omit unnecessary drop outs to treatment.
Asunto(s)
Enfermedad de Alzheimer/tratamiento farmacológico , Inhibidores de la Colinesterasa/administración & dosificación , Fenilcarbamatos/administración & dosificación , Administración Cutánea , Anciano , Anciano de 80 o más Años , Inhibidores de la Colinesterasa/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Escala del Estado Mental , Fenilcarbamatos/efectos adversos , Rivastigmina , Resultado del TratamientoRESUMEN
Cholinesterase inhibitors and memantine can slow the course of Alzheimer's disease. In Austria the frequency of treatment is in the upper third among countries of the EU. Yet, the majority of Alzheimer patients does not receive adequate medication. Compliance to treatment is low. Studies on cholinesterase inhibitors show that only one third and one fifth of patients adhere to medication after 3 months and 12 months, respectively. Causes for low compliance are only partly patient-related, many factors are system-inherent. Knowledge of these factors is a pre-requisite for the treating physician to improve current unfavourable situation. Present treatment strategies are symptomatic, causal disease-modifying therapies are urgently needed. Research activity in the field is high and dominated by the amyloid hypothesis. We here review the basis and recent studies on secretase-inhibitors, immunization, aggregation of Abeta, statins and PPARgamma-agonists. Research towards strategies against tau-pathology is less dominant and focuses on inhibition of kinases and increase of activity of phosphatases. Causal therapies would have great effects on a population basis even if efficacy is only moderate. A disease-modifying therapy which delays the onset of Alzheimer disease by 5 years, will probably reduce the number of patients by nearly 50% during the next 50 years.
Asunto(s)
Enfermedad de Alzheimer/tratamiento farmacológico , Inhibidores de la Colinesterasa/uso terapéutico , Memantina/uso terapéutico , Nootrópicos/uso terapéutico , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/etiología , Vacunas contra el Alzheimer/uso terapéutico , Secretasas de la Proteína Precursora del Amiloide/antagonistas & inhibidores , Péptidos beta-Amiloides/inmunología , Péptidos beta-Amiloides/metabolismo , Animales , Encéfalo/efectos de los fármacos , Inhibidores de la Colinesterasa/efectos adversos , Contraindicaciones , Interacciones Farmacológicas , Utilización de Medicamentos/estadística & datos numéricos , Drogas en Investigación/efectos adversos , Drogas en Investigación/uso terapéutico , Humanos , Inmunoterapia , Memantina/efectos adversos , Ovillos Neurofibrilares/efectos de los fármacos , Nootrópicos/efectos adversos , Cooperación del Paciente/estadística & datos numéricos , Placa Amiloide/efectos de los fármacosRESUMEN
Since multiple sclerosis (MS) and autoimmune thyroiditis (AIT) are presumed to be of autoimmune origin the correlation of these two diseases is of special interest. The aim of this study was to determine whether there are differences in the prevalence of thyroid disease with special emphasis on AIT compared with MS and normal subjects and whether the presence of thyroid disease correlates with disability, disease course, age, and disease duration. 353 consecutive patients with clinically definite MS, without interferon-beta treatment and 308 patients with low back pain or headache were extensively examined for the presence of non-immune or autoimmune thyroid disease. We found a significantly higher prevalence of AIT in male MS patients (9.4 %) than in male controls (1.9 %; p = 0.03). The prevalence of AIT in female MS patients (8.7 %) did not differ from female controls (9.2 %). Hypothyroidism, caused by AIT in almost all cases, showed a tendency to be more severe and more often present in patients with MS. There was no association between relapsing-remitting and secondary progressive disease course of MS and the prevalence of AIT. MS patients with AIT were significantly older but did not differ in disease duration and expanded disability status scale (EDSS). Further studies are warranted, to see if there is a difference in sex-hormone levels between MS patients with and without AIT and healthy controls. Longitudinal studies comparing MS patients with or without AIT could show whether there is an influence of AIT on the disease course or progression.
Asunto(s)
Enfermedades Autoinmunes/epidemiología , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/epidemiología , Enfermedades de la Tiroides/epidemiología , Tiroiditis Autoinmune/epidemiología , Adulto , Autoanticuerpos/metabolismo , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/etiología , Estudios de Casos y Controles , Estudios Transversales , Demografía , Diabetes Mellitus Tipo 2 , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Hipotiroidismo/patología , Técnicas para Inmunoenzimas , Masculino , Esclerosis Múltiple/sangre , Prevalencia , Caracteres Sexuales , Enfermedades de la Tiroides/sangre , Enfermedades de la Tiroides/clasificación , Enfermedades de la Tiroides/etiología , Glándula Tiroides/patología , Hormonas Tiroideas/sangre , Tiroiditis Autoinmune/etiologíaRESUMEN
Huntington's disease (HD) is a relentlessly progressive neuropsychiatric disorder with an underlying autosomal dominantly inherited genetic defect. Classical antipsychotics (i.e. phenothiazines or butyrophenones) are the most used medication to reduce the (probably dopamine-born) choreiform hyperkinesias. Ziprasidone is the latest of a new class of atypical antipsychotics; it has not been studied so far in this indication. We report three genetically confirmed HD patients who improved significantly in several categories of the motor scale of the Unified HD Rating Scale.
Asunto(s)
Antagonistas de Dopamina/uso terapéutico , Enfermedad de Huntington/tratamiento farmacológico , Piperazinas/uso terapéutico , Tiazoles/uso terapéutico , Adulto , Femenino , Humanos , Enfermedad de Huntington/genética , Masculino , Persona de Mediana EdadRESUMEN
Since 1928, among the thousands of patients treated for insulinoma, only 32 cases with peripheral neuropathy have been reported. None of these described an affection of the cranial nerves. We present a 56 old woman, who suffered from chronic hyperinsulinism due to an insulinoma. For ten years, the patient has developed progressively marked hypoglycemic attacks of up to 20 mg/dl. Recently we have observed the development of a paresis of the right abducens nerve lasting for 6 weeks.