RESUMO
A 76-year-old patient, since the age of 45, presented with frequent attacks often triggered by emotional stimuli and characterised by forward head drop and a fall to the ground without loss of consciousness. Clinically these episodes were misinterpreted as pseudoseizures and treated with clomipramine for more than 20 years. In spite of this chronic therapy, during the last year, the attacks presented with a daily recurrence and, moreover, after arbitrary clomipramine withdrawal, they increased in frequency until they became subcontinuous. Videopolygraphic analysis, multiple sleep latency test (MSLT) and human leukocyte antigen (HLA) association studies were suggestive of narcolepsy and the recurrent episodes, diagnosed as status cataplecticus, recovered after citalopram administration.
Assuntos
Cataplexia/diagnóstico , Erros de Diagnóstico , Síncope/diagnóstico , Idoso , Eletroencefalografia/métodos , Antígenos HLA-DQ/análise , Cadeias beta de HLA-DQ , Antígeno HLA-DR2/análise , Humanos , Imageamento por Ressonância Magnética , Masculino , Recidiva , Síncope/fisiopatologiaRESUMO
The aim of this study was to assess whether patients with Parkinson's disease (PD) develop cognitive and psychiatric complications more frequently during prolonged therapy with continuous apomorphine infusion compared with standard oral treatment. Thirty consecutive PD patients with severe motor fluctuations were included in the study. Twelve patients accepted the treatment with subcutaneous continuous apomorphine infusion, while the remaining 18 preferred to continue with oral dopaminergic therapy. The two groups were evaluated with neuropsychological, psychiatric, and motor tests at baseline and after 1 year. The off daily duration and the levodopa dosage were significantly reduced in infused patients. The neuropsychiatric assessment did not change in both groups compared with baseline, except for a significant improvement of mood in the apomorphine group.
Assuntos
Apomorfina/efeitos adversos , Transtornos Cognitivos/induzido quimicamente , Agonistas de Dopamina/efeitos adversos , Doença de Parkinson/complicações , Idoso , Apomorfina/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Vias de Administração de Medicamentos , Esquema de Medicação , Humanos , Levodopa/efeitos adversos , Estudos Longitudinais , Pessoa de Meia-Idade , Atividade Motora , Testes Neuropsicológicos , Doença de Parkinson/tratamento farmacológico , Escalas de Graduação PsiquiátricaRESUMO
UNLABELLED: The authors evaluated the ability of rHuEPO (recombinant human erythropoietin) in performing a vasoactive calcium-mediated action. Forty healthy volunteers were evaluated for the muscle blood flow at rest (RBF) and after reactive hyperemia by Xenon 133 clearance. Pre-treatments with several calcium antagonists were used. RESULTS: The i.v. infusion of rHuEPO brought about a reduction of the RBF and MBF (maximal blood flow). This reduction was maintained with nifedipine or verapamil. Gallopamil and ketanserine prevented the reduction of blood flow induced by rHuEPO. CONCLUSIONS. The rHuEPO has a vasoconstrictive action in vivo since gallopamil and ketanserine, drugs able to prevent intracellular mobilisation of the Ca++, can block the rHuEPO induced vasoconstriction. The action exerted by rHuEPO could be due not an increased flow of the Ca++ from the extracellular department but to a mobilisation from Ca++ deposits.
