Flunarizine- and cinnarizine-induced extrapyramidal reactions.

Cinnarizine and flunarizine are selective calcium blockers that have been used to treat and prevent vertigo. We studied 15 patients who had extrapyramidal syndromes after taking these drugs. Eleven patients had parkinsonism, one with persistent akathisia as well; one had an orofacial tremor; one, acute akathisia alone; and one an acute dystonic reaction. All but one improved when the drug therapy was discontinued. Seven patients were also depressed during treatment. Cinnarizine and flunarizine must therefore be added to the list of potentially risky drugs known to induce extrapyramidal reactions and depression.

Dopa-responsive dystonia masquerading as idiopathic kyphoscoliosis.

A 19-year-old girl with a long-standing history of kyphoscoliosis misdiagnosed as idiopathic was offered corrective surgery on several occasions but fortunately refused, since neurological examination later found evidence of mild dystonic posturing in the neck and right leg. Symptoms worsened toward evening but improved with rest. Treatment with low doses of levodopa led to total remission within a month. Our case illustrates that dopa-responsive dystonia can manifest spinal curvature as the major symptom and warrants its inclusion in the differential diagnoses of idiopathic kyphoscoliosis.

Clenbuterol-induced tardive dyskinesia.

A 73-year-old man with a history of obstructive lung disease who received clenbuterol 20 mg b.i.d. over 5 years developed dyskinetic movements mainly of the respiratory muscles, closely resembling neuroleptic-induced dyskinesias. Despite drug withdrawal, abnormal movements persisted unchanged. Treatment with reserpine successfully controlled the dyskinetic movements. Clinicians should be aware of this potentially harmful effect of long-term clenbuterol therapy.

Dextro-phenylalanine as inhibitor of the noradrenaline release from the isolated rat hypothalamus.

In slices of isolated rat hypothalamus, the dextrophenylalanine (d-Phe) 3x10(-3)M produced an inhibition of a 47% in the fractional release of 3H-NA to the preparations of Holtzman rats, and of 39% to the Wistar rats, when the concentration of d-Phe (in this last) was of 1x10(-2)M, pointing that the effectiveness of the d-Phe is variable with the employed rat root. The mentioned effect is calcium dependent, for it was antagonized when the Ca++ was incremented in the medium of 1,68mM (normal) to 2,6mM. Neither atropine, nor phenoxybenzamine interfer the effect to the d-Phe, showing that it will not be due to mechanisms of alpha-adrenergic or muscarinic cholinergic negative feedback. For the moment it cannot be interpretated that the d-Phe effect is performed through specific negative feed-back receivers, for the possible operability of other kind of receptors such as PGs angiotensin, morphinic, etc., has not been discarded yet.

Blepharoclonus and parkinsonism associated with aqueductal stenosis.

A 28-year-old man with a history of congenital hydrocephalus due to aqueductal stenosis shunted at 45 days of age is presented. At age 4 years the valve had to be removed because of septicemia. Twenty-three years later he developed parkinsonian signs and abnormal, involuntary rhythmic contractions of the eyelids. The latter were elicited on gentle eye closure. Parkinsonism promptly improved after ventriculoperitoneal shunting, but blepharoclonus persisted unchanged.