Is bupropion useful in the treatment of post-stroke thalamic apathy? A case report and considerations.

Post-stroke apathy is considered to be one of the clinical consequences of lesions affecting the structures of the prefrontal cortex, basal ganglia, thalamus and limbic system. However, there is no current consensus on the treatment of post-stroke apathy, which mainly depends on the underlying etiology and comorbidities. A 62-year-old man, affected by hemorrhagic stroke in the left thalamus, presented with mood depression, anhedonia, hyporexia and marked apathy. The patient underwent clinical evaluation before and after receiving two different pharmacological therapies: escitalopram and bupropion. Only after treatment with the latter drug did the patient show changes: high motivation and willingness to pursue activities, greater interest in the external environment and social life activities, and an overall reduction of apathy. On the basis of our observations in this case, we hypothesize that the thalamic lesion resulted in disconnection of the fronto-striatal-thalamic circuits, and that loss of the dopaminergic striatal innervation caused the patient's apathetic state. The resolution of the apathetic disorder may be attributable to the action of the dopaminergic drug bupropion on the mesocortical pathway.

Should we care about sativex-induced neurobehavioral effects? A 6-month follow-up study.

OBJECTIVE: Sativex® is an exclusive cannabinoid-based drug approved for the treatment of spasticity due to Multiple Sclerosis (MS). The most common side effects include dizziness, nausea, and somnolence. However, it is still under debate whether the drug could cause negative cognitive effects. The aim of our study was to investigate the effect of Sativex® on functional and psychological status in cannabis-naïve MS patients. PATIENTS AND METHODS: All the study participants (i.e. 40 patients affected by MS) underwent a specific clinical and neuropsychological assessment to investigate spasticity and associated symptoms, besides the cognitive and psychiatric domains commonly impaired in MS, before and after 1 and 6 months of Sativex® administration. RESULTS: After the treatment, we did not observe any significant neurobehavioral impairment in all the patients, but one. CONCLUSIONS: Our findings suggest that Sativex® treatment does not significantly affect the cognitive and neurobehavioral functions. However, the study supports the relevance of an extensive neuropsychological evaluation in MS patients selected for the drug administration, in an attempt to early detect the uncommon but important neurobehavioral side effects.

A comparison of relaxation training and competing response training to eliminate hair pulling and nail biting.

A 17-year-old female with a 14-year history of hair pulling and nail biting was treated with relaxation training and competing response training. While introduction of relaxation training produced an initial decline in hair pulling, there was a gradual recovery of the maladaptive behavior to baseline levels. The competing response procedure consisted of clenching fists for 3 min whenever hair pulling or nail biting occurred or were likely to occur. By the use of the competing response hair pulling and nail biting decreased, eventually to zero. Follow-up over a 2-year period revealed that the treatment effects were maintained.

[Ear-acupuncture and endocrine secretion]. / Auricolopuntura e secrezione endocrina.

We have investigated the possible influence of auricolar puncture over hormonal secretion. We have studied in 5 subjects the course of hormonal incretion determinable by only auricolar puncture and the second time making the same methodology united with the test of hypophyseal stimulation by "LH-RH-insulina-TRH". The results show that it is not get any changes of the plasmatic rates of hypophiseal hormones, while we have observed a decrease of the plasmatic hydrocortisone rate when it was practised the only auricolar puncture.