Ipsilateral Ptosis and Contralateral Ataxic Hemiparesis as Initial Symptoms of Combined Tuberothalamic and Paramedian Artery Infarction.

Thalamic infarcts, accounting for approximately 14% of lacunar infarcts, exhibit varied clinical manifestations due to complex anatomy of nuclei and varying blood supply. Pure and combined types of thalamic infarctions have been summarized in some paper, but information of cerebral angiography was not mentioned. Here we report a rare case of combined tuberothalamic and paramedian artery occlusion presenting with ipsilateral ptosis and contralateral ataxic hemiparesis.

Antidepressant-like effects of the Radix Bupleuri and Radix Paeoniae Alba drug pair.

The Radix Bupleuri and Radix Paeoniae Alba drug pair plays a pivotal role in Xiaoyaosan, a famous Chinese herbal preparation that is popular in clinical medicine. To investigate the antidepressant-like effects and potential mechanism of action of the Radix Bupleuri and Radix Paeoniae Alba drug pair, we carried out the forced swim test (FST) and tail suspension test (TST), as the mouse models of depression; and the open field test (OFT) to exclude false-positive results. Subsequently, ptosis and hypothermia induced by reserpine were assessed. Finally, the concentrations of monoamine neurotransmitters and their metabolites, namely epinephrine (NE), 5-hydroxytryptamine (5-HT), and 5-hydroxyindoleacetic acid (5-HIAA) in the hippocampal and cortical tissues of mice were detected with HPLC with electrochemical detector. The Radix Bupleuri and Radix Paeoniae Alba (1:1) drug pair at low, medium, and high doses decreased immobility time in both the FST and TST, and counteracted hypothermia induced by reserpine in mice. After the administration of reserpine, the concentrations of 5-HT and NE in the hippocampal and cortical tissues were decreased; however, pre-treatment with the Radix Bupleuri and Radix Paeoniae Alba drug pair significantly elevated the concentrations of 5-HT and NE in the hippocampal and cortical tissues. The results suggested that, compared with single dose of fluoxetine and the drugs used individually, the Radix Bupleuri and Radix Paeoniae Alba drug pair had an excellent antidepressant-like effect. These data revealed a possible mechanism of action, as the regulation of the central monoaminergic neurotransmitter system in the hippocampal and cortical tissues.

Desarrollo de miastenia gravis tras administración de toxina botulínica en el síndrome de dolor miofascial / Development of myasthenia gravis after botulinum toxin management in myofascial pain syndrome

El síndrome de dolor miofascial (SDM) es una patología muscular dolorosa que se define como dolor local o referido asociado a la presencia de nódulos palpables hipersensibles en el trayecto de ese músculo y constituye una patología frecuente en las consultas de dolor crónico.La toxina botulínica es una exotoxina producida por el Clostridium botulinum, cuyos serotipos A, B y F tienen utilidad clínica (fundamentalmente tipo A- Botox®, Dysport®). Se trata de una de las neurotoxinas más potentes que existen. Se utiliza como uso compasivo en el tratamiento del síndrome de dolor miofascial. El efecto beneficioso analgésico del uso de la toxina se origina de reducir la hiperactividad muscular pero estudios recientes sugieren que esta neurotoxina puede tener efectos analgésicos directos diferentes de sus acciones neuromusculares. Su uso no está exento de riesgos. Los efectos adversos se relacionan con la migración de la toxina y son en general leves o moderados y pasajeros. Se han descrito casos de debilidad muscular prolongada e incluso cuadros de miastenia gravis, síndrome de Eaton Lambert desencadenados por el uso de la toxina.Presentamos el caso clínico de un varón afecto de síndrome de dolor miofascial del cuadrado lumbar y psoas tratado con infiltraciones con toxina botulínica. Tras la mejoría del cuadro clínico muscular se desarrolla diplopía y ptosis palpebral reiterante, siendo diagnosticado de miastenia gravis. Revisamos la etiopatogenia del síndrome de dolor miofascial y de la miastenia gravis, así como el uso de la toxina botulínica y sus relaciones entre ellos Concluimos que es necesaria una anamnesis detallada previa a la utilización de toxina botulínica sobre patología muscular o signos de debilidad muscula (AU)

Myofascial pain syndrome is a painful muscle condition which is defined as local or referred pain associated with hypersensitive palpable nodules in the way of that muscle and is a frequent pathology in consultations on chronic pain.Botulinum toxin is an exotoxin produced by Clostridium botulinum, of which serogroups A, B and F have clinical utility (mainly type A- Botox®, Dysport®). This is one of the most potent neurotoxins and is administered compassionatelly in the treatment of myofascial pain syndrome. The toxin has a beneficial analgesic effect by reducing muscle hyperactivity but recent studies suggest that this neurotoxin may also induce analgesia by non-neuromuscular actions. Its use is not without risks. Adverse effects are related to the migration of the toxin and are usually mild or moderate and transient. There have been reports of prolonged muscle weakness and diseases like myasthenia gravis or Lambert Eaton syndrome triggered by the use of the toxin.We report a case of a male patient with myofascial pain syndrome whose psoas and quadratus muscles were treated with injections of botulinum toxin. Following the improvement in clinical muscle situation, repetitive diplopia and ptosis developed and the patient was diagnosed of myasthenia gravis.We review the pathogenesis of myofascial pain syndrome and myasthenia gravis and the use of botulinum toxin and relationships between them.We conclude that a detailed history is required prior to the use of botulinum toxin on patients with muscle pathology or signs of muscle weakness (AU)

Effect of NMDAR antagonists in the tetrabenazine test for antidepressants: comparison with the tail suspension test.

OBJECTIVE: The N-methyl-d-aspartate receptor (NMDAR) antagonist ketamine, produces rapid and enduring antidepressant effect in patients with treatment-resistant depression. Similar dramatic effects have not been observed in clinical trials with other NMDAR antagonists indicating ketamine may possess unique pharmacological properties. Tetrabenazine induces ptosis (a drooping of the eyelids), and the reversal of this effect, attributed to a sympathomimetic action, has been used to detect first-generation antidepressants, as well as ketamine. Because the actions of other NMDAR antagonists have not been reported in this measure, we examined whether reversal of tetrabenazine-induced ptosis was unique to ketamine, or a class effect of NMDAR antagonists. METHODS: The effects of ketamine and other NMDAR antagonists to reverse tetrabenazine-induced ptosis were examined and compared with their antidepressant-like effects in the tail suspension test (TST) in mice. RESULTS: All the NMDAR antagonists tested produced a partial reversal of tetrabenazine-induced ptosis and, as expected, reduced immobility in the TST. Ketamine, memantine, MK-801 and AZD6765 were all about half as potent in reversing tetrabenazine-induced ptosis compared to reducing immobility in the TST, while an NR2B antagonist (Ro 25-6981) and a glycine partial agonist (ACPC) were equipotent in both tests. CONCLUSION: The ability to reverse tetrabenazine-induced ptosis is a class effect of NMDAR antagonists. These findings are consistent with the hypothesis that the inability of memantine, AZD6765 (lanicemine) and MK-0657 to reproduce the rapid and robust antidepressant effects of ketamine in the clinic result from insufficient dosing rather than a difference in mechanism of action among these NMDAR antagonists.

Antidepressant-like effect of peony glycosides in mice.

AIM OF THE STUDY: The root part of Paeonia lactiflora Pall. (Ranunculaceae), known as peony, is often used in Chinese herbal formulae for the treatment of depression-like disorders. Previous studies in our laboratory have shown that an ethanol extract of peony produced antidepressive effects in mouse models of depression. It is well known that peony contains glycosides such as paeoniflorin and albiflorin, yet it remains unclear whether the total glycosides of peony (TGP) are effective. The present study aims to evaluate the antidepressant-like effects of TGP. MATERIALS AND METHODS: The antidepressant-like effects of TGP was determined by using animal models of depression including forced swim and tail suspension tests. The acting mechanism was explored by determining the effect of TGP on the activities of monoamine oxidases. RESULTS: Intragastric administration of TGP at 80 and 160 mg/kg for seven days caused a significant reduction of immobility time in both forced swim and tail suspension tests, yet TGP did not stimulate locomotor activity in the open-field test. In addition, TGP treatment antagonized reserpine-induced ptosis and inhibited the activities of monoamine oxidases in mouse cerebrum. CONCLUSION: These results suggest that the antidepressive effects of TGP are mediated, at least in part, by the inhibition of monoamine oxidases.

Auricular acupuncture to resolve the exacerbations in ocular myasthenia--a case report.

Ocular myasthenia is a neuromuscular autoimmune disorder in which the clinical symptoms are restricted to the external ocular muscles with either ptosis or diplopia, or both. The condition may follow a relapsing and remitting course. Conventional therapy consists of anticholinergic drugs, corticosteroids and immunosuppressants. We report a case in which auricular acupuncture was used as an adjunct to pharmacological treatment. The time course of the response suggests that acupuncture appeared to help resolve the current relapse.

Pharmacological properties of beta-amyrin palmitate, a novel centrally acting compound, isolated from Lobelia inflata leaves.

Effects of beta-amyrin palmitate isolated from the leaves of Lobelia inflata were studied on the central nervous system of mice and were compared with those of antidepressant drugs, mianserin and imipramine. In the forced swimming test, beta-amyrin palmitate, like mianserin and imipramine, reduced the duration of immobility of mice significantly in a dose-dependent manner (5, 10 and 20 mg kg-1). beta-Amyrin palmitate (5, 10 and 20 mg kg-1) or mianserin (5, 10 and 20 mg kg-1) elicited a dose-related reduction in locomotor activity of mice and antagonized locomotor stimulation induced by methamphetamine. In contrast, imipramine (5, 10 and 20 mg kg-1) increased locomotor activity and potentiated methamphetamine-induced hyperactivity. beta-Amyrin palmitate showed no effect on reserpine-induced hypothermia, whilst mianserin (10 mg kg-1) and imipramine (10 and 20 mg kg-1) antagonized the reserpine-induced effect. Unlike imipramine, beta-amyrin palmitate and mianserin did not affect haloperidol-induced catalepsy, tetrabenazine-induced ptosis and apomorphine-induced stereotypy. beta-Amyrin palmitate and imipramine had no effects on the head-twitch response induced by 5-hydroxytryptophan, whereas mianserin (5, 10 and 20 mg kg-1) decreased it in a dose-dependent manner. A potentiating effect of beta-amyrin palmitate (5, 10 and 20 mg kg-1) on narcosis induced by sodium pentobarbitone was stronger than that of imipramine (10, 20 and 40 mg kg-1) but weaker than that of mianserin (2.5, 5 and 10 mg kg-1). These results suggest that beta-amyrin palmitate has similar properties in some respects to mianserin and might possess a sedative action.(ABSTRACT TRUNCATED AT 250 WORDS)

3-[(2-ethoxyphenoxy)methyl]piperidine derivatives. Synthesis and antidepressant activity.

The 3-[(2-ethoxyphenoxy)methyl]piperidine derivatives 3-5 were synthesized and screened as potential antidepressant agents by the reserpine interaction test in mice and the evaluation of reuptake inhibition of biogenic amines in pig brain synaptosomal fractions. In addition, their anticonvulsant activity, tested by pentyleneetrazole antagonism, and approximate acute toxicity were evaluated. In vivo and in vitro tests showed that compounds 3 and 5 possess a biological activity comparable to that of the antidepressant drug viloxazine.

Syntheses and primary pharmacological screening of tandamine and related tetrahydrothiopyranoindoles with potential antidepressant properties.

A series of novel 1,3,4,9-tetrahydro-1-methyl-thiopyrano-[3,4-b]indole-1-ethanamines has been synthesized and examined for effects on reserpine-induced ptosis and reserpine-induced hypothermia in mice. One member of the series, the 9-ethyl-N,N-dimethyl derivative V (tandamine), was selected for further studies in regard to its possible use as an antidepressant agent. Tandamine has been resolved, and the levorotatory enantiomer was found to be more active than the racemic compound. The N-desmethyl derivative XIII, a metabolite of tandamine, has been prepared. The 5-ethyl-1,3,4,5-tetrahydro-N,N,1-trimethylthiopyrano[4,3-b]indole-1-ethanamine XXI, an analog of tandamine with the isomeric ring system, has also been synthesized and evaluated. In the primary pharmacological screening and in the drug-interaction studies with reserpine, tetrabenazine, and tremorine, tandamine was compared to the clinically effective tricyclic antidepressants--desipramine, imipramine, and amitriptyline. Tandamine was more effective than these agents in several screening procedures indicative of potential antidepressant activity.