Factors affecting the efficacy of pramipexole in patients with restless legs syndrome

Dopamine agonists, particularly nonergot dopamine agonists such as pramipexole, have become the mainstay of therapy for patients with symptoms of restless legs syndrome [RLS]. This study was designed to evaluate the factors affecting the efficacy of pramipexole in patients with RLS. Fifty-nine eligible RLS patients referred to neurology clinic of Rasoul-e-Akram Hospital [Tehran, Iran] were recruited in this study. All of the patients received an oral dose of 0. 1 8 mg pramipexole. The severity of RLS symptoms were evaluated including sleep disorder, symptomatic days per week and symptomatic hours per day, both at the beginning and at the end of follow-up time. Different baseline and follow-up variables were also recorded and their relationships with the outcomes were assessed. The mean severity values of different symptoms significantly decreased after treatment with pramipexole [P0.00l]. Female gender [P0.05] and duration of treatment [P0.05] were significant factors to achieve >50% reduction in symptomatic days per week and symptomatic hours per day. Moreover, the cutoff point of 3.5 mo for duration of treatment could potentially differentiate >50% reduction in severity of sleep disorder from the ones with <50% reduction with sensitivity and specificity of 56.8% and 78.6%, respectively. Our findings show that female gender and duration of treatment were the factors affecting the effectiveness of pramipexole in RLS patients. If tolerated by the patients, a longer duration of treatment with pramipexole is more effective in RLS

Primary angiitis of the central nervous system

Primary angiitis of the central nervous system [PACNS] is an idiopathic disorder [vasculitis] restricted to the central nervous system [CNS]. It often presents with focal neurological deficits suggesting stroke or a combination of confusion and headache. We herein report three cases with various combinations of fever, partial seizure, encephalopathy, paresis, headache and ataxia. One of them was initially treated as herpes simplex meningoencephalitis, but further investigations revealed primary angiitis. Primary angiitis of the CNS has protean manifestations and should always be considered in patients suspicious to have CNS infection or stroke, particularly who does not respond to the routine treatments. Clinical data, exclusion of differential diagnoses and typical angiography seem to be enough to justify the diagnosis in the majority of cases

frequency of cerebral microembolism in acute myocardial infarction

Stroke is more common in patients with cerebral microembolisms. Frequency of cerebral microembolisms [high intensity transient signals, HITS] in acute myocardial infarction has been reported about 17%. The factors that influence on microembolism after myocardial infarction [MI] are not definitive. Type of MI, Ejection fraction, Hx of Streptokinase is the factors that were studied. During three years we studied the frequency of cerebral microembolisms in AMI patients, we studied forty patients with microembolism as a case group and ninety patients without microembolism as a control group. We detected microembolism in patients by transcranial doppler study within 72 houre after myocardial infarction. Two-dimensional echocardiogram was performed for all patients during hospitalization. Excluding criteria were prosthetic heart valves, carotid stenosis >50% and poor window for TCD monitoring. number of patients who had history of receiving SK were significantly more common in case group in comparison to control group. OR 2.4 CI [1.1-5.2]. The frequency was more prevalent in anterolateral MI in comparison to inferior MI.OR=3.3 CI [1.4-7.4]. Ejection fraction has no significant effect on frequency of microembolism. OR 0.5 CI [0.2-1.3]. Hypokinesia is also a risk factor for increasing risk of microembolism. OR 4.5 CI [1.4.13.8] frequency of microembolism has been increased in patients with history of streptokinase or in the type of Anterolateral MI or wall motion abnormality, so we should be careful for risk of microembolism in this groups