[Continuous dopaminergic stimulation - clinical experience]. / Ciagla stymulacja dopaminergiczna - doswiadczenia kliniczne.

Both disease progression and pulsatile stimulation of dopaminergic receptors are responsible for development of fluctuations and dyskinesia in about 50% of patients with Parkinson disease (PD) after 4-6 years of therapy with levodopa. In order to prevent motor complications, the ideal therapy should secure continuous dopaminergic stimulation (CDS). The concept of CDS is supported by the results of both experimental and clinical studies. Several treatment options are available to achieve CDS. Dopamine agonists have a longer half-life than levodopa and the development of dyskinesia is delayed when they are used as monotherapy in early PD. Continuous delivery of agonists can be improved with prolonged-release oral preparations, a transdermal delivery system or continuous subcutaneous infusion. Continuous enteral infusion of levodopa is another way to achieve CDS and it is very effective in reducing motor complications in advanced PD.

Experiencia con 123I-Iodobenzamida en el diagnóstico diferencial de enfermedad de Parkinson frente a Parkinson plus / Experience with 123I-Iodobenzamide in the differential diagnosis of Parkinson's disease and Parkinson-plus disease

ObjetivoRealizar un análisis descriptivo de la implicación clínico-diagnóstica de la exploración con 123I-Iodobenzamida (IBZM) en los pacientes estudiados en nuestro centro por trastornos del movimiento sugerentes de Parkinson plus (PP).Material y métodoSe realizó SPECT con 123I-IBZM a 46 pacientes, procedentes de la consulta de trastornos del movimiento, por sospecha de PP. Según la clínica se distribuyeron en 3 grupos: 35 pacientes presentaban clínica atípica (CA) para enfermedad de Parkinson, 2 mostraban falta de respuesta al tratamiento habitual (FR) y en 9 se presentaban ambos factores (CA y FR). El resultado del SPECT se valoró únicamente de forma cualitativa.ResultadosDe los 35 pacientes con CA el 123I-IBZM apoyó el diagnóstico de PP en 15(42,9%), de los 2 con FR el estudio fue patológico en 1 y, de los 9 que presentaban ambos factores (CA y FR), el 123I-IBZM fue patológico en 6 casos (66,7%).ResultadosEn el 95,7% de la muestra (44 pacientes) la CA, con o sin FR, era el principal factor de sospecha de PP, y sólo en el 47,7% (22 pacientes) el 123I-IBZM resultó alterado. De estos 22 casos, en 20 el diagnóstico definitivo fue de PP (elevado valor predictivo positivo).ConclusiónEl estudio con 123I-IBZM es de gran utilidad en la práctica clínica, al proporcionar una información diagnóstica objetiva con implicaciones en el tratamiento y pronóstico de los pacientes con sospecha de PP(AU)

ObjectiveTo perform a descriptive analysis of the clinical and diagnostic implications of 123I-IBZM SPECT in the patients studied in our center for movement disorders suggestive of Parkinson-Plus Disease (PP).Subjects and methods123I-IBZM SPECT was performed in 46 patients referred from the movement disorders consultation due to suspicion of PP. According to their symptoms, they were distributed into 3 groups: 35 patients had atypical symptoms (AS) for Parkinson's Disease, 2 showed no response to standard therapy (NR) and 9 presented both factors (AS, NR). The results of SPECT were only assessed qualitatively.ResultsThe 123I-IBZM supported the diagnosis of PP in 15(42.9%) out of the 35 patients with AS. The 123I-IBZM was pathological in one of the two NR patients. Regarding the third group of patients (AS+NR), the 123I-IBZM was pathological in 6 cases (66.7%).ResultsIn 95.7% of our sample (44 patients), AS with or without NR was the main factor leading to suspicion of PP and the 123I-IBZM was altered in only 47.7% (22 patients). Of these 22 cases, the final diagnosis was PP (with high positive predictive value) in 20(91%).ConclusionThe study with 123I-IBZM is useful in the clinical practice because it provides objective diagnostic information with implications for the treatment and prognosis of patients with suspicion of PP(AU)

Prolongación del intervalo QT en dos pacientes intoxicados por amisulprida / Prolonged QT interval in two cases of amisulpride overdose

No disponible

No disponible

Constant dopaminergic stimulation by transdermal delivery of dopaminergic drugs: a new treatment paradigm in Parkinson's disease.

Current dopaminergic therapies for the treatment of Parkinson's disease are associated with the development of long-term motor complications. Abnormal pulsatile stimulation of dopamine receptors is thought to underlie the development of motor complications. There is thus a need for therapies that mimic the normal physiological state more closely by resulting in constant dopaminergic stimulation (CDS). Several studies support the hypothesis that CDS can reverse levodopa-induced motor complications. Other potential benefits of CDS include alleviating nocturnal disturbances, minimizing daytime sleepiness, avoiding priming for motor fluctuations and dyskinesia, preventing the development of gastrointestinal dysfunction and reducing the risk of developing psychosis or behavioural disturbances. Continuous infusion of dopaminergic therapies is impractical for the routine treatment of large numbers of patients. Although catechol-O-methyltransferase inhibitors or sustained-release preparations of levodopa may be beneficial, they do not entirely eliminate pulsatile stimulation of dopamine receptors. A new dopamine agonist (rotigotine), delivered over 24 h by a once-daily transdermal patch, has been investigated in several clinical trials. Continuous delivery of rotigotine has been shown to provide 'true' CDS in animal models. The potential of true CDS therapy to prevent or reduce long-term motor and non-motor complications requires investigation in appropriately designed clinical trials.

Uso de fármacos psicoestimulantes en drogodependencias / Psychoestimulants drugs use in dependence disorders

El uso de medicamentos estimulantes es una cuestión de plena actualidad en psiquiatría, aunque su utilización y prescripción es controvertida . Fármacos como el metilfenidato, las anfetaminas, o el modafinilo están siendo utilizados y estudiados en distintas enfermedades psiquiátricas como el trastorno por déficit de atención e hiperactividad (TDAH), la dependencia de cocaína, en trastornos del sueño y en la depresión resistente. Todos estos fármacos tienen en común, igual que las drogas de abuso, que son medicamentos que actúan sobre el sistema dopaminérgico, que constituye la base neurobiológica del refuerzo fisiológico. Los estimulantes como el metilfenidato o el modafinilo son fármacos eficaces en el TDAH y han sido estudiados en el tratamiento de la dependencia de cocaína. En niños con TDAH el metilfenidato es un factor protector para el desarrollo de drogodependencias. Existen estudios experimentales con modafinilo que muestran la utilidad del fármaco en la dependencia de cocaína, aunque son estudios preliminares, por lo que no se debe considerar que este totalmente demostrado que los fármacos psicoestimulantes sean eficaces en el tratamiento de esta dependencia. Aunque no son conocidos todos los mecanismos fisiopatológicos, parece crítico que el refuerzo, y por lo tanto el riesgo de dependencia, aparece cuando se producen incrementos rápidos dopaminérgicos y que los efectos terapéuticos aparecen cuando son lentos y mantenidos. Las características de uso a dosis bajas administradas por vía oral disminuyen el riesgo de abuso. Para realizar una adecuada prescripción es necesario aclarar, definitivamente, los mecanismos neuroquímicos en los que intervienen, y sus indicaciones en drogodependencias

Stimulant drugs prescription is a controversial and current topic in psychiatry. Drugs such as methylphenidate, amphetamine compounds and modafinil have been trialed and used in attention deficit hyperactivity disorder (ADHD), sleep conditions, cocaine dependence and as an adjunct to antidepressants for depression. All these drugs, like stimulant drugs abuse, increase extracellular dopamine in the brain.This effect is associated with reinforcing as well as therapeutic effects. Methylphenidate and modafinil treatment of ADHD are associated with a reduced risk for later substance abuse among ADHD patients. There is evidence of the beneficial effects of the use of modafinil in cocaine dependence, altough there isn´t conclusive evidence for the stimulants´ efficacy in treatment of the stimulants´ dependence. At this time, the physiopathology of drug abuse and dependence is unknown, but it´s known that the very critical point is that the reinforcing effects are associated with rapid changes in dopamine increases, whereas the therapeutic effects are associated with slowly and smoothly rising dopamine levels, such as are achieved with low doses and oral administration. Due to this, it´s necessary to study the neurobiological bases on which stimulants drugs are related, and their clinical use in dependence treatments