MRI abnormalities in tardive dyskinesia.

Most investigators studying tardive dyskinesia (TD) hypothesize that the condition is due to a neurochemical abnormality of the striatum. Recently, numerous CT studies have been done to verify brain abnormalities in patients with TD; the findings have, however, been conflicting. The present study was designed to detect possible neuropathological abnormalities in the basal ganglia in a young sample of schizophrenic patients with TD as compared with schizophrenic patients without TD and normal controls. Magnetic resonance imaging (MRI) was used to measure the volumes of the caudate, putamen, globus pallidus, lateral ventricle, and intracranium. The volumes of the caudate nuclei of the patients with TD were significantly smaller than the volumes of the caudate nuclei of the patients without TD and normal controls. This abnormality in the caudate may be related to some previous conditions, which may prove a substrate that is necessary for TD to establish itself in association with neuroleptic use. Further studies are necessary to confirm our findings and to determine the pathophysiologic nature of these structural alterations and the role played by neuroleptics, whether primary or secondary.

[Increased muscular irritability syndrome: treatment with nifedipine. Report of a case]. / Síndrome de irritabilidade muscular aumentada: tratamento com nifedipina. Registro de um caso.

In 1980 Alberca et al. described a patient with a syndrome of increased muscle irritability, who presented ondulating muscle rolling movements and electrically silent cramps, myoedema and muscle reactions to mechanical stimulation similar to myotonic response, suggesting a disfunction at myofibrillar level. We saw a similar case, of a male patient, 21 years of age, who complained of cramps of severe intensity for the past four years. These cramps were painful in the upper and lower limbs and impaired his locomotion; they were electrically silent. At percussion the patient showed severe idiomuscular contraction, with a period of increased relaxation, similar to a myotonic reaction and also, prolonged myoedema and rolling muscle contractions. Electromyography was normal, as were histochemical and electron microscopy studies. We carried out a therapeutic trial with niphedipine (a calcium antagonist), on the assumption that the patient showed a disturbance of the myofibrillar function--even though physiopathogenesis of the hyperirritability muscle syndrome was not yet clearly defined--and with a basis on the importance of the intracytoplasmatic level of Ca++ free in the muscle contraction mechanism, not only as the initiating factor of the contractile process, but also as a quantitative controller of the mechanic tension development through regulation of the amount of ATP metabolized during muscle activity. Administration of the drug in a dose of 40 mg daily, per os, brought a remission of the symptoms after two weeks, and the patient could walk normally again. On the introduction of a placebo, on two different opportunities, there occurred a recrudescence of the symptoms after about one week's time.(ABSTRACT TRUNCATED AT 250 WORDS)

Sindrome de irritabilidade muscular aumentada: tratamento com nifedipina.Registro de um caso. / Increased muscular irritability syndrome:treatment with nifepidine. Report of a case

Em 1980 Alberca e col. descreveram caso de paciente que apresentava irritabilidade aumentada, com contracoes ondulantes do musculo, mioedema e respostas musculares a estimulacao mecanica semelhantes a miotonia, sugerindo uma disfunsao ao nivel de miofibrilas. Os autores descrevem caso semelhante de paciente com contraturas intensas em membros inferiores, silenciosas eletricamente, principalmente ao iniciar a marcha ou qualquer movimento voluntario, contracao idiomuscular intensa com periodo de relaxamento aumentado, semelhante a reacao miotonica, miodema prolongado e movimentos musculares ondulante em tronco e membros superiores. A EMG assim como estudos histoquimicos e de microscopia eletronica dos musculos foram normais. Apesar da fisiopatogenese do aumento da irritabilidade muscular nao estar elucidada, assim como a acao de nifedipina, bloqueador de Ca++, no musculo esqueletico ser desconhecida, a administracao desta dorga na dose de 40 mg/dia v.o. determinou melhora acentuada da sintomatologia. Com a introducao de placebo, houve reaparecimento dos sintomas. Os autores inferem que provavelmente, a irritabilidade muscular aumentada deve estar relacionada ao metabolismo celular de Ca++

Mitochondrial myopathy with respiratory muscle involvement: a case report.

A case of a 10-year-old patient with a benign congenital myopathy, suddenly aggravated because of an accentuated deficit in respiratory muscles is reported. The institution of assisted respiration at night allowed the patient to return to her daily activities. Examination of muscular biopsy with ultra-microscope permitted the diagnosis of mitochondrial myopathy.

Mitochondrial myopathy with respiratory muscle involvement: a case report

E relatado o caso de uma paciente de 10 anos de idade com miopatia congenita benigna que agravou-se subitamente em virtude do deficit acentuado da musculatura respiratoria. A instituicao de respiracao assistida durante a noite permitiu a volta da paciente a suas atividades diarias. O exame de biopsia muscular ao ultra microscopio permitiu o diagnostico de miopatia mitocondrial