Assuntos
Distonia , Distúrbios Distônicos , Humanos , Sertralina/efeitos adversos , Distonia/induzido quimicamente , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Distúrbios Distônicos/induzido quimicamente , Distúrbios Distônicos/diagnóstico , Distúrbios Distônicos/tratamento farmacológicoRESUMO
Objectives: Young patients with intellectual disability (ID) have both diagnostic and therapeutic challenges. These include, inter alia, diagnostic overshadowing, diagnostic slippage and heightened vulnerability to adverse drug reactions. These would portent a generally poor prognostication. Methods: This is a case-study of an adolescent with intellectual disability long-hospitalized for co-morbid treatment-resistant bipolar mood disorder that failed to respond to ECT. Patient partially responded to LAI risperidone with repeated ADRs. Top-up with low-dose clozapine (100 mg/d) was pursued. Results: Low-dose clozapine top-up complemented therapeutic response (mood lability and paranoia) and strikingly safeguarded effectively against risperidone-related extrapyramidal side effects. Conclusions: Add-on clozapine remains a viable option, albeit off-label, in young patients with ID and treatment-resistant affective/schizophreniform psychoses. Clozapine has an edge over other agents in the setting of dyskinesias.
Assuntos
Antipsicóticos , Clozapina , Distonia , Distúrbios Distônicos , Deficiência Intelectual , Adolescente , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Distonia/induzido quimicamente , Distonia/tratamento farmacológico , Distúrbios Distônicos/induzido quimicamente , Distúrbios Distônicos/tratamento farmacológico , Humanos , Deficiência Intelectual/induzido quimicamente , Deficiência Intelectual/tratamento farmacológico , Risperidona/efeitos adversosRESUMO
Botulinum toxin treatment is most commonly used for blepharospasm, spastic torticollis, upper limb dystonia, and local dystonia in Japan. Botulinum toxin treatment is the first choice in these conditions. However, it has the disadvantages that the therapeutic effect is transient, that there are cases in whom the treatment is ineffective, and a high cost. In ineffective cases, botulinum toxin treatment involves medication and rehabilitation. Various medications have been used for the treatment of focal dystonia mainly in open trials. As these treatments have low evidence levels, each case should be dealt with individually. Operative treatment should be considered for severe cases.
Assuntos
Blefarospasmo , Toxinas Botulínicas Tipo A , Toxinas Botulínicas , Distúrbios Distônicos , Torcicolo , Blefarospasmo/induzido quimicamente , Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Distúrbios Distônicos/induzido quimicamente , Distúrbios Distônicos/tratamento farmacológico , Humanos , Japão , Torcicolo/induzido quimicamente , Torcicolo/tratamento farmacológicoRESUMO
This review provides an overview of the synaptic dysfunctions of neuronal circuits and underlying neurochemical alterations observed in the hyperkinetic movement disorders, dystonia and dyskinesia. These disorders exhibit similar changes in expression of synaptic plasticity and neuromodulation. This includes alterations in physical attributes of synapses, synaptic protein expression, and neurotransmitter systems, such as glutamate and gamma-aminobutyric acid (GABA), and neuromodulators, such as dopamine, acetylcholine, serotonin, adenosine, and endocannabinoids. A full understanding of the mechanisms and consequences of disruptions in synaptic function and plasticity will lend insight into the development of these disorders and new ways to combat maladaptive changes.
Assuntos
Discinesias , Distonia , Distúrbios Distônicos , Antiparkinsonianos , Corpo Estriado/metabolismo , Discinesias/metabolismo , Distonia/induzido quimicamente , Distonia/metabolismo , Distúrbios Distônicos/induzido quimicamente , Distúrbios Distônicos/metabolismo , Humanos , Levodopa/efeitos adversosRESUMO
OBJECTIVE: To investigate the risk factors of neutralizing antibody (NAB)-induced complete secondary treatment failure (cSTF) during long-term botulinum neurotoxin (BoNT) treatment in various neurologic indications. METHODS: This monocenter retrospective cohort study analyzed the data of 471 patients started on BoNT therapy between 1995 and 2015. Blood samples of 173 patients were investigated for NABs using the mouse hemidiaphragm test (93 with suspected therapy failure, 80 prospective study participants). The frequency of NAB-cSTF was assessed for various indications: hemifacial spasm, blepharospasm, cervical dystonia, other dystonia, and spasticity. A priori defined potential risk factors for NAB-cSTF were evaluated, and a stepwise binary logistic regression analysis was performed to identify independent risk factors. RESULTS: Treatment duration was 9.8 ± 6.2 years (range, 0.5-30 years; adherence, 70.6%) and number of treatment cycles 31.2 ± 22.5 (3-112). Twenty-eight of 471 patients (5.9%) had NAB-cSTF at earliest after 3 and at latest after 103 treatment cycles. None of the 49 patients treated exclusively with incobotulinumtoxinA over 8.4 ± 4.2 (1-14) years developed NAB-cSTF. Independent risk factors for NAB-cSTF were high BoNT dose per treatment, switching between onabotulinumtoxinA and other BoNT formulations (except for switching to incobotulinumtoxinA), and treatment of neck muscles. CONCLUSIONS: We present a follow-up study with the longest duration to date on the incidence of NAB-cSTF in patients treated with various BoNT formulations, including incobotulinumtoxinA. Whereas the overall risk of NAB-cSTF is low across indications and BoNT formulations, our findings underpin the recommendations to use the lowest possible dose particularly in cervical dystonia, and to avoid unnecessary switching between different formulations.
Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Distúrbios Distônicos/tratamento farmacológico , Espasticidade Muscular/tratamento farmacológico , Animais , Blefarospasmo/induzido quimicamente , Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas Tipo A/uso terapêutico , Distúrbios Distônicos/induzido quimicamente , Feminino , Seguimentos , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Fármacos Neuromusculares/efeitos adversos , Fármacos Neuromusculares/uso terapêutico , Fatores de Risco , Torcicolo/induzido quimicamente , Torcicolo/tratamento farmacológicoRESUMO
Myoclonus dystonia (DYT11) is a movement disorder caused by loss-of-function mutations in SGCE and characterized by involuntary jerking and dystonia that frequently improve after drinking alcohol. Existing transgenic mouse models of DYT11 exhibit only mild motor symptoms, possibly due to rodent-specific developmental compensation mechanisms, which have limited the study of neural mechanisms underlying DYT11. To circumvent potential compensation, we used short hairpin RNA (shRNA) to acutely knock down Sgce in the adult mouse and found that this approach produced dystonia and repetitive, myoclonic-like, jerking movements in mice that improved after administration of ethanol. Acute knockdown of Sgce in the cerebellum, but not the basal ganglia, produced motor symptoms, likely due to aberrant cerebellar activity. The acute knockdown model described here reproduces the salient features of DYT11 and provides a platform to study the mechanisms underlying symptoms of the disorder, and to explore potential therapeutic options.
Assuntos
Distúrbios Distônicos/genética , Distúrbios Distônicos/mortalidade , Sarcoglicanas/genética , Sarcoglicanas/metabolismo , Animais , Córtex Cerebelar/metabolismo , Cerebelo/metabolismo , Cerebelo/patologia , Modelos Animais de Doenças , Distonia , Distúrbios Distônicos/induzido quimicamente , Distúrbios Distônicos/patologia , Etanol/efeitos adversos , Feminino , Gânglios/metabolismo , Predisposição Genética para Doença/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , RNA Interferente PequenoRESUMO
RATIONALE: Promethazine is an antihistamine agent used commonly for nausea and allergy. Along with its anticholinergic and antidopaminergic functions, promethazine is also used for psychiatric symptoms, such as troubling sleep, anxiety, and agitation. Previous studies have reported that promethazine may occasionally elicit acute dystonia in some individuals, especially for young children and pregnant women. PATIENT CONCERNS: The 68-year-old female patient was admitted to our hospital because of feeling anxious and intermittent palpitation for over 1 year. She developed acute orofacial dystonia following promethazine treatment. DIAGNOSES: Her diagnoses was generalized anxiety disorder. INTERVENTIONS: Discontinuation of the offending agent, promethazine, and injection of Botulinum toxin. OUTCOMES: The acute orofacial dystonia was finally alleviated by local injection of Botulinum toxin. LESSONS: Careful assessment of the risk of developing acute dystonia is also needed in old patients when initiating the promethazine treatment.
Assuntos
Distúrbios Distônicos/induzido quimicamente , Músculos Faciais/efeitos dos fármacos , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Prometazina/efeitos adversos , Doença Aguda , Idoso , Toxinas Botulínicas Tipo A/uso terapêutico , Distúrbios Distônicos/tratamento farmacológico , Distúrbios Distônicos/fisiopatologia , Músculos Faciais/fisiopatologia , Feminino , Humanos , Fármacos Neuromusculares/uso terapêuticoRESUMO
We propose the use of the term tardive dyskinesia to refer to the original description of repetitive and complex oral-buccal-lingual (OBL) movements and the analogous repetitive movements of the limbs, trunk, or pelvis. The term tardive syndrome is an umbrella term to be used to refer to the spectrum of all persistent hyperkinetic, hypokinetic, and sensory phenomenologies resulting from chronic dopamine receptor blocking agent (DRBA) exposure. TD is a type of TS. The term tardive dystonia (TDyst) should be used when dystonia is the main feature of TS. Retrocollis and oromandibular dystonia appear to be the most common form of Tdyst. Tardive akathisia refers to the inability to remain still with an urge to move, giving the appearance of restlessness. In tardive tourettism, the patient has complex motor and phonic tics associated with premonitory urge and relief of tension after performing the tic behavior, thus resembling Tourette's syndrome. Tardive tremor is composed of mainly postural and kinetic tremors. It differs from the resting tremor seen in drug-induced parkinsonism. Tardive pain occurs in association with chronic use of DRBAs and involves the mouth, tongue, and genital region with no physical findings. In tardive parkinsonism, the patient has persistent parkinsonism even after discontinuation of the DRBA although this diagnosis is in question and may represent DRBA-uncovered idiopathic Parkinson's disease or coincident development of Parkinson's disease while taking DRBAs.
Assuntos
Acatisia Induzida por Medicamentos/etiologia , Doenças dos Gânglios da Base/induzido quimicamente , Antagonistas de Dopamina/efeitos adversos , Distúrbios Distônicos/induzido quimicamente , Dor/induzido quimicamente , Doença de Parkinson Secundária/induzido quimicamente , Discinesia Tardia/induzido quimicamente , Transtornos de Tique/induzido quimicamente , Acatisia Induzida por Medicamentos/diagnóstico , Acatisia Induzida por Medicamentos/fisiopatologia , Doenças dos Gânglios da Base/diagnóstico , Doenças dos Gânglios da Base/fisiopatologia , Distúrbios Distônicos/diagnóstico , Distúrbios Distônicos/fisiopatologia , Humanos , Dor/diagnóstico , Dor/fisiopatologia , Doença de Parkinson Secundária/diagnóstico , Doença de Parkinson Secundária/fisiopatologia , Discinesia Tardia/diagnóstico , Discinesia Tardia/fisiopatologia , Transtornos de Tique/diagnóstico , Transtornos de Tique/fisiopatologiaRESUMO
Common cold is an acute illness affecting pediatric population in particular. The use of antihistamines is a common practice, with cetirizine being a frequently used drug with a good safety profile. However, adverse events due to the use of antihistamines have been rarely reported, such as drug-induced dystonia with the use of cetirizine. In our present case, dystonia due to the intake of cetirizine was observed, which the patient responded well to the use of benzodiazapines, namely, clonazepam. We report this case to highlight the occurrence of this adverse event with the use of cetirizine.
Assuntos
Antialérgicos/efeitos adversos , Anticonvulsivantes/uso terapêutico , Cetirizina/efeitos adversos , Clonazepam/uso terapêutico , Distúrbios Distônicos/induzido quimicamente , Doença Aguda , Criança , Humanos , MasculinoRESUMO
TITLE: Sindrome de Pisa asociado a codeina.
Assuntos
Codeína/efeitos adversos , Distúrbios Distônicos/induzido quimicamente , Acetaminofen/uso terapêutico , Idoso , Analgésicos/efeitos adversos , Analgésicos/uso terapêutico , Dor nas Costas/tratamento farmacológico , Dor nas Costas/etiologia , Neoplasias da Mama/terapia , Carcinoma Lobular/secundário , Codeína/uso terapêutico , Substituição de Medicamentos , Quimioterapia Combinada , Distúrbios Distônicos/diagnóstico , Feminino , Humanos , Cetorolaco/uso terapêutico , Neoplasias da Coluna Vertebral/secundário , SíndromeRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Distonia/induzido quimicamente , Postura , Distúrbios Distônicos/induzido quimicamente , Codeína/efeitos adversos , Doenças do Sistema Nervoso/induzido quimicamente , Distonia/fisiopatologia , Distúrbios Distônicos/fisiopatologia , Diagnóstico DiferencialAssuntos
Doença de Alzheimer/tratamento farmacológico , Antipsicóticos/administração & dosagem , Inibidores da Colinesterase/efeitos adversos , Clozapina/administração & dosagem , Distúrbios Distônicos/induzido quimicamente , Rivastigmina/efeitos adversos , Esquizofrenia/tratamento farmacológico , Idoso , Inibidores da Colinesterase/administração & dosagem , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Rivastigmina/administração & dosagemAssuntos
beta-Histina/efeitos adversos , Disfunção Cognitiva/fisiopatologia , Distúrbios Distônicos/induzido quimicamente , Vertigem/tratamento farmacológico , Idoso , Distúrbios Distônicos/etiologia , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/tratamento farmacológico , Síndrome , Vertigem/diagnóstico por imagemRESUMO
BACKGROUND: Oculogyric crises are involuntary movements of the eyeballs and can occur due to different etiologies. PHENOMENOLOGY SHOWN: This video abstract shows a man with oculogyric crises due to side effect of neuroleptics. EDUCATIONAL VALUE: Oculogyric crises are easy to recognize if once seen.
Assuntos
Antipsicóticos/efeitos adversos , Distúrbios Distônicos/induzido quimicamente , Transtornos da Motilidade Ocular/induzido quimicamente , Antipsicóticos/uso terapêutico , Dibenzocicloeptenos , Compostos Heterocíclicos de 4 ou mais Anéis/efeitos adversos , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Adulto JovemRESUMO
We report a case of Pisa syndrome (PS) due to the acetylcholinesterase inhibitor donepezil which may have been precipitated by pharmacokinetic interactions with commonly used medications. PS is defined as a reversible lateral bending of the trunk with a tendency to lean to one side. This is a rare but very distressing complication with this commonly used medication which was not initially recognised, leading to increasing disability for the patient and significant carer stress. Cessation of donepezil and modulation of potential interacting medications resulted in complete resolution.
Assuntos
Inibidores da Colinesterase/efeitos adversos , Distúrbios Distônicos/induzido quimicamente , Indanos/efeitos adversos , Piperidinas/efeitos adversos , Equilíbrio Postural/efeitos dos fármacos , Idoso de 80 Anos ou mais , Inibidores da Colinesterase/farmacocinética , Donepezila , Interações Medicamentosas , Distúrbios Distônicos/diagnóstico , Distúrbios Distônicos/fisiopatologia , Humanos , Indanos/farmacocinética , Masculino , Omeprazol/efeitos adversos , Omeprazol/farmacocinética , Piperidinas/farmacocinética , Polimedicação , Inibidores da Bomba de Prótons/efeitos adversos , Inibidores da Bomba de Prótons/farmacocinética , Fatores de RiscoRESUMO
We report the case of a 29-year-old male patient with a generalized and progressive dystonia that led him unable to stand. Multiple antidystonic treatments were tried without benefit. Alcohol test was positive with a dramatic improvement. To the best of our knowledge, this is the first reported case of generalized dystonia without other clinical manifestations sensitive to alcohol.
Assuntos
Álcoois/efeitos adversos , Depressores do Sistema Nervoso Central/efeitos adversos , Distúrbios Distônicos/induzido quimicamente , Adulto , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: The aims of the study were to report the case of a male patient who developed a first episode of Pisa syndrome (PS) to the right side and a second episode to the left side and to discuss the hypothesis that states that denervation is one of the main mechanisms implicated in the development of PS. METHODS: We report on the case of a 71-year-old patient with Parkinson disease who developed PS to the right side while on dopaminergic treatment with pramipexol and levodopa. The dopamine agonist was discontinued and the postural abnormality was corrected increasing the levodopa dose. Six years later, while on ropinirole and levodopa, he developed PS again but this time the lean was to the left. Even though the dopamine agonist was discontinued, this condition failed to improve. CONCLUSIONS: Mechanisms other than denervation and its relationship with the more or less affected side contribute to the development of the syndrome.This is the first report of a case of recurrent alternating PS and highlights the need for research on this topic to better understand this disorder.