Clinical Usefulness of ¹⁸F-FC119S Positron-Emission Tomography as an Auxiliary Diagnostic Method for Dementia: An Open-Label, Single-Dose, Evaluator-Blind Clinical Trial

A Patient of Sweet Syndrome Associated with Encephalitis

No abstract available.

Ropinirole as an Adjunct to Levodopa in the Treatment of Parkinson's Disease

BACKGROUND: Ropinirole is a non-ergoline D2 agonist which has a highly selective affinity to D2 receptor. The aim of this study was to evaluate the efficacy and safety of ropinirole in the treatment of Parkinson's disease (PD). METHODS: Seventy-six cases with PD (Hoehn and Yahr stage II to IV) were included in this trial. Each patient was randomly allocated to receive either ropinirole (n=37) or bromocriptine (n=39) over a 16-week period. All subjects were not optimally controlled on levodopa due to motor fluctuations. The response rate was defined as the percentage of patients who had at least 20% reduction of levodopa doses. The clinical status was also assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), Clinical Global Impression (CGI), and reduction of off durations. RESULTS: The end-point analysis, on an intention-to-treat basis, revealed significantly higher response rate in the ropinirole group compared with the bromocriptine group (odds ratio 2.995, 95% C.I. (1.157, 7.751)). A statistically significant improvement in CGI was also observed in the ropinirole group (p=0.046). The mean off duration was significantly reduced in the ropinirole group (p=0.0001). Other parameters using the UPDRS motor score or off duration did not show significant differences between the two groups. The overall incidence of adverse effects was not significantly different between the two groups. The most common side effects were dizziness, dyskinesia, and nausea/vomiting. No subjects were withdrawn from the study due to side effects. CONCLUSION: Ropinirole is a safe and well-tolerated drug and provides superior overall efficacy compared with bromocriptine as an adjunct to levodopa. (J Korean Neurol Assoc 19(2):102~109, 2001)

Ropinirole as an Adjunct to Levodopa in the Treatment of Parkinson's Disease

BACKGROUND: Ropinirole is a non-ergoline D2 agonist which has a highly selective affinity to D2 receptor. The aim of this study was to evaluate the efficacy and safety of ropinirole in the treatment of Parkinson's disease (PD). METHODS: Seventy-six cases with PD (Hoehn and Yahr stage II to IV) were included in this trial. Each patient was randomly allocated to receive either ropinirole (n=37) or bromocriptine (n=39) over a 16-week period. All subjects were not optimally controlled on levodopa due to motor fluctuations. The response rate was defined as the percentage of patients who had at least 20% reduction of levodopa doses. The clinical status was also assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), Clinical Global Impression (CGI), and reduction of off durations. RESULTS: The end-point analysis, on an intention-to-treat basis, revealed significantly higher response rate in the ropinirole group compared with the bromocriptine group (odds ratio 2.995, 95% C.I. (1.157, 7.751)). A statistically significant improvement in CGI was also observed in the ropinirole group (p=0.046). The mean off duration was significantly reduced in the ropinirole group (p=0.0001). Other parameters using the UPDRS motor score or off duration did not show significant differences between the two groups. The overall incidence of adverse effects was not significantly different between the two groups. The most common side effects were dizziness, dyskinesia, and nausea/vomiting. No subjects were withdrawn from the study due to side effects. CONCLUSION: Ropinirole is a safe and well-tolerated drug and provides superior overall efficacy compared with bromocriptine as an adjunct to levodopa. (J Korean Neurol Assoc 19(2):102~109, 2001)

A Case of Monochorea Caused by a Striatal Lesion

The sudden onset of involuntary movement is usually attributed to a vascular lesion in the contralateral deep hemispheric structure. A majority of involuntary movement cases record that all the limbs on one side are affected. The concurrence of venous and cavernous malformations may be relatively rare, but is important because of the possibility of bleeding which should be related to the presence of cavernous angioma. A 67-year-old woman was admitted to our hospital to be evaluated for choreic movement restricted to the right leg for 20 days. A brain MRI revealed hemorrhage with the cavernous angioma involving the left striatum and adjacent venous angioma. Haloperidol diminished the monochoreic movement. We report monochoreic movement restricted to the right leg due to a left striatal lesion.

Capsular Genu Infarction Presenting with Confusional Syndrome: An Analysis of Clinical and Neuroradiologic Findings

We reviewed 5 patients with infarcts involving the genu of the internal capsule, who revealed behavioral changes and cognitive defects. They developed an acute confusion and/or dementic feature along with other behavioral changes characterized by apathy, hypersomnia, memory impairment, and cognitive impairment, mimicking frontal lobe dysfunction. Brain MRI and/or CT scan localized the lesion to the genu of the internal capsule. Brain perfusion SPECT performed in 3 patients showed hypoperfusion in ipsilateral cerebral hemisphere. Two mechanisms are suggested to explain the development of confusion or dementia after capsular genu infarct. (I) a disconnection or diaschisis of thalamo-cortical interconnection (ii) selective neuronal loss of cerebral cortex due to chronic MCA or ICA occlusion with insufficient collateral blood flow. We suggest that capsular-genu infarction as a cause of acute confusion or dementia must be included in differential diagnosis.

Proton Nuclear MR Spectroscopy (H-MRS) in Adult Onset Hallervorden-Spatz Disease

Background & Significance : Hallervorden-Spatz disease (HSD) is a rare neurologic disorder characterized by progressive dystonia, retinal degeneration, pyramidal sign, and mental deterioration. The neuropathological findings include preferential deposition of iron within the extrapyramidal nuclei, including globus pallidus, substantia nigra, and red nuclei. The final diagnosis depends on the typical pathologic findings. MRI brain imaging study commonly shows so-called "eye-of-the-tiger" in the globus pallidus. However 1H-MRS findings of HSD have not been reported. We experienced a case with clinically suspicious HSD whose diagnosis was further supported by 1H-MRS. Case : A forty four year-old man presented with slowly progressive dystonia for six years. He had been well until age of thirty eight, when he noticed clumsy hand-writing. Three years later, he developed difficulty in chewing. Clumsiness of his hands and arm movements progressed to the point of difficulty in using spoon and chopsticks. While walking, arm swing was decreased and both arms and neck took more dystonic posture. Brain MRI (T2Wl) showed symmetric high signal intensity lesions in the globus pallidus, surrounded by a peripheral zone of exaggerated low signal. On 1H-MRS of basal ganglia, although choline, creatine and N-acetyl-aspartate (NAA) peaks were detected, marked noise probably due to paramagnetic substance (iron), made quantitative analysis difficult. Conclusion : 1H-MRS of HSD is characterized by "noise", which may be suggestive of HSD.