Non convulsive refractory status epilepticus induced by thiocolchicoside (TCC) intrathecal injection: A case report.

TCC is a semisynthetic molecule widely used in clinical settings as a pain killer and myorelaxant. Several neurological side effects have been reported in association with TCC treatment including somnolence, confusion and seizure, the latter in a lower percentage of patients. Some previous reports described seizure onset after TCC intake in adulthood. However, major epileptological complication, namely status epilepticus, has never been previously reported in association with TCC treatment. In our report, we describe a case of acute refractory non-convulsive status epilepticus (NCSE) in the context of a TCC-induced acute toxic encephalopathy (ATE) in a woman without any previous neurological or physical comorbidities.

End-of-dose deterioration in non ergolinic dopamine agonist monotherapy of Parkinson's disease.

The study was designed to investigate the possible occurrence of "wearing-off" (WO) during dopamine agonist (DA) monotherapy. Sixty patients with "de novo" idiopathic PD were randomised into one of two DA monotherapy branches to receive oral ropinirole at 15 mg per day, or pramipexole at 2.1 mg per day. DA doses could be increased in the following two years but levodopa could not be added until the study ended. WO was assessed by self-evaluation charts confirmed by a blinded observation of a 30% or greater deterioration in the Unified Parkinson's Disease Rating Scale (UPDRS) motor score. Proc Mixed and Kaplan-Meier curves evaluated treatment variables as a function of time. T-tests were used to compare post-hoc variables reclassified according to WO occurrence. Thirty patients received ropinirole, and 30 pramipexole monotherapy. Eighteen patients (30%) experienced "wearing-off" 15-21 months after beginning monotherapy. No differences were observed between treatments. WO phenomena was observed 3.4+/-0.3 hours after intake of the morning or afternoon dose and consisted of UPDRS score worsening by 11.1+/-2.1 points (69-111% more than "on" score). Statistical evaluation gave evidence of differences between patients who experienced WO and those who did not: UPDRS motor scores obtained at admission to the study were higher (by 3.4+/-0.2 points, p=0.01 t-test) and DA doses at 6-12 months were higher in fluctuating patients. UPDRS motor scores deteriorated, however. similarly and there were no differences, in UPDRS scores recorded in ON conditions, between fluctuating and non-fluctuating patients at the end of the study. Our findings provide evidence of WO phenomena in patients with early PD receiving non-ergolinic DA monotherapy.

Delayed blink reflex in dementia with Lewy bodies is sensitive to cholinergic modulation.

OBJECTIVES: To assess the possible responsiveness of blink reflex alterations present in dementia with Lewy bodies (DLB) to treatment with cholinesterase inhibitors. METHODS: Twenty-six patients with DLB and 20 patients with Alzheimer disease underwent clinical, neuropsychological (including assessment of cognitive fluctuations, with the Cognitive Assessment of Fluctuations and the One-Day Fluctuation Assessment questionnaires), and the blink reflex evaluation at baseline, 1 week after vitamin E administration (to assess test-retest reliability), and 1 and 2 weeks after donepezil administration at the dose of 10 mg/d. Results were compared with data obtained from 30 healthy controls treated with vitamin E capsules for 2 weeks. RESULTS: Treatment with donepezil did not cause modifications of cognitive or motor performances in both groups of patients. In DLB patients, One-Day Fluctuation Assessment scores were modified by donepezil treatment with a mean reduction of 2.8 +/- 1.8 compared with baseline (P < 0.05). After 2 weeks of treatment with donepezil, R2 latency was significantly decreased in DLB patients. The mean R2 latency reduction was by 3.0 +/- 3.2 milliseconds (P < 0.0001 compared with baseline). R2 mean latency reduction was significantly correlated with R2 mean latency delay at baseline (Spearman rho = 0.8). CONCLUSIONS: Short-term donepezil administration can correct the alterations of the blink response together with the daily occurrence of cognitive fluctuations present in DLB patients.