[Efficacy and safety of ropinirole in the treatment of Parkinson's disease: a multi-center, randomized, double-blind and bromocriptine-controlled trial].

OBJECTIVE: To explore the efficacy and safety of ropinirole in the treatment of Parkinson's disease. METHODS: From November 2005 to April 2007, a total of 221 subjects from 7 hospitals of Beijing, Lanzhou and Wuhan participated in a 12-week multi-center, randomized, bromocriptine-controlled, double-blind, double-dummy and parallel-group trial. The efficacy of ropinirole was assessed with the unified Parkinson's disease rating scale (UPDRS) score, "off" time according to the patient's diary and the overall evolution of clinical efficacy. The safety was assessed on the basis of adverse events, blood pressure, pulse, laboratory measurement and electrocardiographic recordings. And the statistical analyses were performed with t, paired t, χ(2) and covariance tests. RESULTS: In the intent-to-treat population, the average UPDRSIII score decreased to (11 ± 9) in ropinirole group and (11 ± 10) in bromocriptine group while the UPDRSIIscore decreased to (4 ± 4) and (3 ± 5) respectively at Week 12 versus baseline. It showed that ropinirole was non-inferior to bromocriptine. The "off" time at Week 12 [(3.0 ± 1.2)h, (3.8 ± 1.6)h] versus baseline [(4.2 ± 2.0)h, (4.4 ± 1.7)h] decreased (t = 10.772, t = 5.746, P = 0.000) in ropinirole and bromocriptine groups. Ropinirole offered a better overall improvement rate (q = 7.241, P = 0.007). The adverse events occurring at a ratio of over 5% caused by ropinirole included orthostatic hypotension, nausea, dizziness, upper abdominal discomfort, insomnia and palpitation. No significant difference existed in the frequency of adverse events between two groups. CONCLUSIONS: Ropinirole is both effective and safe in the treatment of Chinese patients with Parkinson's disease.

[Significance of sympathetic skin response in diagnosis diabetic small fiber neuropathy].

OBJECTIVE: To investigate the significance of sympathetic skin response (SSR) in the diagnosis of diabetic small fiber neuropathy. METHODS: 38 diabetic patients with paraesthesia and 30 healthy controls underwent SSR test on the 4 limbs. The latencies of the initiation and waves N and P of SSR were analyzed. The results of nerve conduction velocities of these patients with paraesthesia were normal. RESULTS: The latencies of the initiation and waves N or P in SSR were prolonged in 37 limbs of the 38 patients, and there was no SSR response in 21 limbs. The latencies of the initiation and waves N and P of SSR test in both upper extremity and lower extremities were prolonged significantly in the diabetic patients as compared to the controls (all P < 0.05). The frequency of abnormality in the latency of SSR was 51% in the lower extremities, and 38% in the upper extremities. The frequency of abnormal latency of SSR in the lower extremities was higher, however, not significantly, than that in the upper extremities (P > 0.05). Twenty-eight of the 38 patients (74%) demonstrated abnormal SSR in at least one limbs. CONCLUSION: SSR can be used to detect the early dysfunction of the small fibers in diabetic peripheral neuropathy, especially in the diabetic patients with normal nerve conduction velocities. SSR test may be a useful and sensitive neuroelectrophysiologic testing for the early diagnosis of diabetic small fiber neuropathy.

Pathogenesis and electrodiagnosis of cubital tunnel syndrome.

BACKGROUND: Cubital tunnel syndrome is a well-recognized clinical condition and is the second most common peripheral compression neuropathy. This study was designed to investigate the causes of cubital tunnel syndrome by surgical means and to assess the clinical value of the neurophysiological diagnosis of cubital tunnel syndrome. METHODS: Twenty-one patients (involving a total of 22 limbs from 16 men and 5 women, aged 22 to 63, with a mean age of 49 years) with clinical symptoms and signs indicating a problem with their ulnar nerve underwent motor conduction velocity examinations at different sites along the ulnar nerve and examinations of sensory conduction velocity in the hand, before undergoing anterior transposition of the ulnar nerve. RESULTS: Electromyographic abnormalities were seen in 21 of 22 limbs [motor nerve conduction velocity (MCV) range (15.9 - 47.5) m/s, mean 32.7 m/s] who underwent motor conduction velocity examinations across the elbow segment of the ulnar nerve. Reduced velocity was observed in 13 of 22 limbs [MCV (15.7 - 59.6) m/s, mean 40.4 m/s] undergoing MCV tests in the forearms. An absent or abnormal sensory nerve action potential following stimulation was detected in the little finger of 14 of 22 limbs. The factors responsible for ulnar compression based on observations made during surgery were as follows: 15 cases involved compression by arcuate ligaments, muscle tendons, or bone hyperplasia; 2 involved fibrous adhesion; 3 involved compression by the venous plexus or a concurrent thick vein; 2 involved compression by cysts. CONCLUSIONS: Factors inducing cubital tunnel syndrome include both common factors that have been reported and rare factors, involving the venous plexus, thick veins, and cysts. Tests of motor conduction velocity at different sites along the ulnar nerve should be helpful in diagnosis cubital tunnel syndrome, especially MCV tests indicating decreased velocity across the elbow segment of the ulnar nerve.

Value of sympathetic skin response test in the early diagnosis of diabetic neuropathy.

BACKGROUND: Diabetic neuropathy is common in diabetes mellitus. The early stage of diabetic neuropathy is often symptomless and difficult to be treated. The aim of this study was to assess the correlation between the results of the sympathetic skin response (SSR) test and the development of diabetic neuropathy, and explore the use of SSR as an objective basis for the early diagnosis of diabetic neuropathy. METHODS: The latencies and amplitudes of initiation and of the N and P waves were determined by SSR testing of the extremities of 80 diabetic patients and 30 healthy controls. RESULTS: The latencies of initiation and of the N and P waves were significantly (P <0.001) longer in diabetic patients than in the controls, while there was no significant difference in the amplitudes (P >0.05). All but two patients (97.5%) demonstrated abnormal SSR in at least one limb. CONCLUSIONS: SSR can detect early dysfunction of the small sympathetic fibers in people affected by diabetes mellitus, and may be a useful electrophysiological test for the early diagnosis of diabetic neuropathy.