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1.
Arq. neuropsiquiatr ; 79(11): 989-994, Nov. 2021. tab
Article in English | LILACS | ID: biblio-1350142

ABSTRACT

ABSTRACT Background: Impulse control disorders (ICD) occur frequently in individuals with Parkinson's disease. So far, prevention is the best treatment. Several strategies for its treatment have been suggested, but their frequency of use and benefit have scarcely been explored. Objective: To investigate which strategy is the most commonly used in a real-life setting and its rate of response. Methods: A longitudinal study was conducted. At the baseline evaluation, data on current treatment and ICD status according to QUIP-RS were collected. The treatment strategies were categorized as "no-change", dopamine agonist (DA) dose lowering, DA removal, DA switch or add-on therapy. At the six-month follow-up visit, the same tools were applied. Results: A total of 132 individuals (58.3% men) were included; 18.2% had at least one ICD at baseline. The therapeutic strategy most used in the ICD group was no-change (37.5%), followed by DA removal (16.7%), DA switch (12.5%) and DA lowering (8.3%). Unexpectedly, in 20.8% of the ICD subjects the DA dose was increased. Overall, nearly 80% of the subjects showed remission of their ICD at follow-up. Conclusions: Regardless of the therapy used, most of the subjects presented remission of their ICD at follow-up Further research with a longer follow-up in a larger sample, with assessment of decision-making processes, is required in order to better understand the efficacy of strategies for ICD treatment.


Resumen Antecedentes: Los trastornos del control de impulsos (TCI) son frecuentes en personas con enfermedad de Parkinson. A la fecha, la prevención es el mejor tratamiento. Existen varias estrategias sugeridas para su tratamiento, pero su frecuencia de uso y beneficio ha sido escasamente explorada. Objetivo: Investigar qué estrategia es la más utilizada en un entorno de la vida real y su tasa de respuesta. Métodos: Se realizó un estudio longitudinal. En la evaluación inicial, se recopiló el tratamiento actual y el estado del TCI de acuerdo con el QUIP-RS. La estrategia de tratamiento se clasificó como "sin cambios", reducción de la dosis de agonista de la dopamina (AD), eliminación de AD, cambio de AD o terapia complementaria. En la visita de seguimiento a los 6 meses, se aplicaron las mismas herramientas. Resultados: Se incluyeron un total de 132 (58.3% hombres) personas. El 18.2% tenía al menos un TCI al inicio del estudio. La estrategia terapéutica más utilizada en el grupo de TCI fue sin cambios (37.5%), seguida de eliminación de DA (16.7%), cambio de AD (12.5%) y reducción de DA (8.3%). En el 20.8% de los sujetos con TCI se aumentó la dosis de AD. Casi el 80% de los sujetos tuvieron una remisión del TCI al seguimiento. Conclusiones: Independientemente de la terapia utilizada, la mayoría de los sujetos tuvieron una remisión del TCI. Se requiere más investigación con un seguimiento y una muestra mayor para evaluar l proceso de toma de decisiones para comprender mejor la eficacia de las estrategias.


Subject(s)
Humans , Male , Female , Parkinson Disease/complications , Parkinson Disease/drug therapy , Disruptive, Impulse Control, and Conduct Disorders/therapy , Longitudinal Studies , Dopamine Agonists/therapeutic use
2.
Arq. bras. med. vet. zootec. (Online) ; 72(2): 355-361, Mar./Apr. 2020. tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1128195

ABSTRACT

Os agonistas dopaminérgicos são utilizados para induzir estro em cadelas, pois atuam na síntese e liberação de prolactina. Objetivou-se avaliar o efeito da piridoxina como indutor de estro em cadelas por agir na neurotransmissão dopaminérgica. Foram selecionadas 40 cadelas em anestro, divididas em quatro grupos experimentais, tratadas com 10mg/kg/dia (G1) e 50mg/kg/dia (G2) de cloridrato de piridoxina, 5µg/kg/dia (G3) de cabergolina e grupo controle/placebo (G4) por até 20 dias. Foram realizadas citologias vaginais a cada 24h para acompanhamento do ciclo estral e análises hormonais (FSH, LH e PRL) no dia zero e 120h do início do tratamento. As cadelas do G3 (100%) manifestaram proestro após 12 dias de tratamento aproximadamente, tempo inferior aos demais grupos (P<0,05). Apenas uma cadela do G1 e uma do G2 ficaram gestantes contra oito fêmeas do G3 e nenhuma do G4 (P<0,05). As concentrações plasmáticas de prolactina foram reduzidas nas fêmeas do G2 e G3 (P<0,05). As demais avaliações hormonais não sofreram influência do tratamento (P>0,05). O cloridrato de piridoxina foi ineficiente para induzir estro em cadelas, mas foi capaz de suprimir a prolactina, de forma semelhante à cabergolina, quando utilizado na dose de 50mg/kg/dia.(AU)


Dopaminergic agonists are used to induce estrus in female dogs as they act in the synthesis and release of prolactin. The objective of this study was to evaluate the effect of pyridoxine as an inducer of estrus by acting on dopaminergic neurotransmission. A total of 40 female dogs in anestrous were divided into four experimental groups treated with 10mg/kg/day (G1) and 50mg/kg/day (G2) of pyridoxine hydrochloride, 5µg/kg/day (G3) of cabergoline and control group/placebo (G4) for up to 20 days. Vaginal cytologies were performed every 24h for follow-up of the estrous cycle and hormonal analyzes (FSH, LH and PRL) on day zero and 120 hours after the start of treatment. The female dogs from G3 (100%) showed proestrus after 12 days of treatment, less time than the other groups (P< 0.05). Only one female from G1 and one from G2 were pregnant against eight from G3 and none from G4 (P< 0.05). Plasma concentrations of prolactin were reduced by treatment in females from G2 and G3 (P< 0.05). The other hormonal evaluations were not influenced by the treatment (P> 0.05). Pyridoxine chloridrate was inefficient to induce estrus in female dogs but was able to suppress prolactin when used at a dose of 50mg/kg/day.(AU)


Subject(s)
Animals , Female , Dogs , Prolactin , Pyridoxine/administration & dosage , Anestrus/drug effects , Estrus/drug effects , Vitamin B 6/administration & dosage , Dopamine Agonists
3.
Arq. neuropsiquiatr ; 78(4): 206-216, Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1098084

ABSTRACT

Abstract Background: There are currently no methods to predict the development of levodopa-induced dyskinesia (LID), a frequent complication of Parkinson's disease (PD) treatment. Clinical predictors and single nucleotide polymorphisms (SNP) have been associated to LID in PD. Objective: To investigate the association of clinical and genetic variables with LID and to develop a diagnostic prediction model for LID in PD. Methods: We studied 430 PD patients using levodopa. The presence of LID was defined as an MDS-UPDRS Part IV score ≥1 on item 4.1. We tested the association between specific clinical variables and seven SNPs and the development of LID, using logistic regression models. Results: Regarding clinical variables, age of PD onset, disease duration, initial motor symptom and use of dopaminergic agonists were associated to LID. Only CC genotype of ADORA2A rs2298383 SNP was associated to LID after adjustment. We developed two diagnostic prediction models with reasonable accuracy, but we suggest that the clinical prediction model be used. This prediction model has an area under the curve of 0.817 (95% confidence interval [95%CI] 0.77‒0.85) and no significant lack of fit (Hosmer-Lemeshow goodness-of-fit test p=0.61). Conclusion: Predicted probability of LID can be estimated with reasonable accuracy using a diagnostic clinical prediction model which combines age of PD onset, disease duration, initial motor symptom and use of dopaminergic agonists.


Resumo Introdução: No momento, não há métodos para se predizer o desenvolvimento de discinesias induzidas por levodopa (DIL), uma frequente complicação do tratamento da doença de Parkinson (DP). Preditores clínicos e polimorfismos de nucleotídeo único (SNP) têm sido associados às DIL na DP. Objetivo: Investigar a associação entre variáveis clínicas e genéticas com as DIL e desenvolver um modelo de predição diagnóstica de DIL na DP. Métodos: Foram avaliados 430 pacientes com DP em uso de levodopa. A presença de DIL foi definida como escore ≥1 no item 4.1 da MDS-UPDRS Parte IV. Nós testamos a associação entre variáveis clínicas específicas e sete SNPs com o desenvolvimento de DIL, usando modelos de regressão logística. Resultados: Em relação às variáveis clínicas, idade de início da doença, duração da doença, sintomas motores iniciais e uso de agonistas dopaminérgicos estiveram associados às DIL. Apenas o genótipo CC do SNP rs2298383 no gene ADORA2A esteve associado com DIL após o ajuste. Nós desenvolvemos dois modelos preditivos diagnósticos com acurácia razoável, mas sugerimos o uso do modelo preditivo clínico. Esse modelo de predição tem uma área sob a curva de 0,817 (intervalo de confiança de 95% [IC95%] 0,77‒0,85) e sem perda significativa de ajuste (teste de qualidade de ajuste de Hosmer-Lemeshow p=0,61). Conclusão: A probabilidade prevista de DIL pode ser estimada, com acurácia razoável, por meio do uso de um modelo preditivo diagnóstico clínico, que combina a idade de início da doença, duração da doença, sintomas motores iniciais e uso de agonistas dopaminérgicos.


Subject(s)
Humans , Parkinson Disease/drug therapy , Levodopa/therapeutic use , Dyskinesia, Drug-Induced , Dopamine Agonists , Polymorphism, Single Nucleotide , Antiparkinson Agents
4.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(1): 33-39, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055365

ABSTRACT

Objective: To evaluate body dissatisfaction and distorted body self-image in women with prolactinoma. Methods: Body dissatisfaction and distorted body self-image were evaluated in 80 women with prolactinoma. All patients were in menacme, 34% had normal body mass index (BMI), and 66% were overweight. Most patients (56.2%) had normal prolactin (PRL) levels and no hyperprolactinemia symptoms (52.5%). The Body Shape Questionnaire (BSQ) was used to assess the patients' dissatisfaction with and concern about their physical form, and the Stunkard Figure Rating Scale (FRS) was used to assess body dissatisfaction and distorted body self-image. The patients were divided according to PRL level (normal vs. elevated) and the presence or absence of prolactinoma symptoms. Results: The normal and elevated PRL groups had similar incidences of body dissatisfaction and distorted body self-image. However, symptomatic patients reported a higher incidence of dissatisfaction than asymptomatic patients. Distorted body self-image was less common among symptomatic patients. Conclusion: Symptomatic patients showed higher body dissatisfaction, but lower body self-image distortion. The presence of symptoms may have been responsible for increased body awareness. The perception of body shape could have triggered feelings of dissatisfaction compared to an ideal lean body. Therefore, a distorted body self-image might not necessarily result in body dissatisfaction in women with prolactinomas.


Subject(s)
Humans , Female , Adult , Young Adult , Pituitary Neoplasms/psychology , Hyperprolactinemia/psychology , Prolactinoma/psychology , Body Dysmorphic Disorders/psychology , Pituitary Neoplasms/blood , Prolactin/blood , Psychiatric Status Rating Scales , Reference Values , Body Image/psychology , Hyperprolactinemia/drug therapy , Hyperprolactinemia/blood , Prolactinoma/blood , Body Mass Index , Surveys and Questionnaires , Statistics, Nonparametric , Dopamine Agonists/therapeutic use , Middle Aged
5.
Arq. neuropsiquiatr ; 78(1): 28-33, Jan. 2020. tab
Article in English | LILACS | ID: biblio-1088982

ABSTRACT

Abstract Prolactin (PRL) secreting adenomas are associated with high incidence of headache. The role of hyperprolactinemia in the headache context is not clear, nor is the effect of its treatment on headache. Methods: The present longitudinal study evaluated hyperprolactinemic patients (69), in terms of presence and characteristics of headache before and after hyperprolactinemia treatment. Results: Headache was reported by 45 (65.2%) patients, independent of the etiology of hyperprolactinemia. The migraine phenotype was the most prevalent (66.6%). Medications used in the treatment of headache not changed during the study. The first line of treatment of hyperprolactinemia was dopaminergic agonists. In the last reevaluation, PRL level under treatment was within the reference range in 54.7% of the cases, and it was observed complete or partial resolution of the headache in 75% of the cases. The median PRL at this time in patients with complete headache resolution was 17 ng/mL, in those who reported partial recovery was 21 ng/mL, and in those in whom the headache did not change was 66 ng/mL, with a significant difference between the group with complete headache resolution vs. the group with unchanged headache (p=0.022). In the cases with complete headache resolution, the median fall on PRL levels was 89% and in those cases with partial headache resolution 86%, both significantly different (p<0.001) from the fall in the cases with an unchanged headache. Conclusion: Data allow us to conclude that, in this series, in the majority of cases the reduction in the level of PRL was followe3d by cessation or relief of the pain.


Resumo Os adenomas secretores de prolactina (PRL) estão associados à alta incidência de cefaleia. O papel da hiperprolactinemia no contexto da dor de cabeça não está claro, nem o efeito da redução dos níveis da PRL na cefaleia. Métodos: O presente estudo longitudinal avaliou pacientes hiperprolactinêmicos (69), quanto à presença e às características da cefaleia antes e após o tratamento da hiperprolactinemia. Resultados: Cefaleia foi relatada por 45 (65,2%) pacientes, independente da etiologia da hiperprolactinemia. O fenótipo de enxaqueca foi mais prevalente (66,6%). Os medicamentos usados ​​no tratamento da cefaleia não foram alterados durante o estudo. A primeira linha de tratamento da hiperprolactinemia foram os agonistas dopaminérgicos. Na última reavaliação, o nível de PRL sob tratamento estava dentro da faixa de referência em 54,7% dos casos, observando-se resolução completa ou parcial da cefaleia em 75% dos casos. A mediana de PRL neste momento em pacientes com resolução completa da cefaleia foi de 17 ng/mL, nos que relataram recuperação parcial foi de 21 ng/mL, e naqueles em que a cefaleia não se alterou foi de 66 ng/mL, com uma diferença significativa entre o grupo com resolução completa da cefaleia versus o grupo com cefaleia inalterada (p=0,022). Nos casos com resolução completa da cefaleia, a queda mediana nos níveis de PRL foi de 89% e nos casos com resolução parcial de cefaleia de 86%, ambos significativamente diferentes (p<0,001) da queda nos casos com cefaleia inalterada. Conclusão: Os dados permitem concluir que, nesta série, na maioria dos casos, a redução do nível de PRL foi seguida pela cessação ou alívio da dor.


Subject(s)
Humans , Male , Adult , Middle Aged , Prolactin/blood , Hyperprolactinemia/therapy , Headache/prevention & control , Headache/blood , Pituitary Neoplasms/complications , Pituitary Neoplasms/therapy , Reference Values , Hyperprolactinemia/complications , Adenoma/complications , Adenoma/therapy , Analysis of Variance , Longitudinal Studies , Treatment Outcome , Statistics, Nonparametric , Dopamine Agonists/therapeutic use , Headache/etiology
6.
Article in Korean | WPRIM | ID: wpr-811247

ABSTRACT

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an urge to move the legs or arms and is associated with discomfort and paresthesia in the legs. RLS is diagnosed based on the clinical symptoms, and polysomnography is performed to quantify the periodic limb movements during sleep or in patients who undergo the suggested immobilization test. Determining the cause of RLS is important for accurately diagnosing and evaluating this condition. The treatment of RLS varies according to the etiology, severity, and frequency of the patients' symptoms. Accurate identification and treatment of the cause of RLS are important in patients with secondary RLS. Iron supplementation could be useful in patients with uremia, iron deficiency, and for RLS during pregnancy. Dopamine agonists have been used as the first-line treatment for primary RLS. On the other hand, augmentation is a known adverse effect associated with the long-term use of dopamine agonists. Therefore, recent treatment guidelines recommend the administration of anticonvulsants, such as pregabalin and gabapentin, to treat RLS. Iron, opioids, or benzodiazepines may be useful in patients refractory to anticonvulsants or dopamine agonists. RLS is a chronic condition. Therefore, it is essential to establish a long-term treatment plan, considering both the efficacy and adverse effects of therapeutic agents used in patients.


Subject(s)
Analgesics, Opioid , Anticonvulsants , Arm , Benzodiazepines , Diagnosis , Dopamine Agonists , Extremities , Hand , Humans , Immobilization , Iron , Leg , Paresthesia , Polysomnography , Pregabalin , Pregnancy , Restless Legs Syndrome , Sleep Wake Disorders , Uremia
7.
Article in English | WPRIM | ID: wpr-816615

ABSTRACT

BACKGROUND: Acromegaly is a rare disease primarily caused by growth hormone (GH)-secreting pituitary adenomas, and its treatment is costly. Moreover, some patients are unresponsive to treatment. Hence, there are increasing efforts to develop new drugs with improved effectiveness for this disease. BIM23B065 is a novel chimeric molecule that acts on both somatostatin and dopamine receptors. This study aimed to investigate the effects of BIM23B065 compared with those of a somatostatin receptor analog and a dopamine agonist.METHODS: The effects of BIM23B065 on the proliferation, GH and insulin-like growth factor-1 (IGF-1) levels, and extracellular signal-regulated kinase (ERK) 1/2 and cyclic AMP response element binding (CREB) phosphorylation of GH3 cells were investigated with MTS assay, enzyme-linked immunosorbent assay, and Western blotting, respectively. The dosage and treatment duration of BIM23B065 were tested in animal models of GH-secreting pituitary adenoma. The effect of BIM23B065 (3 mg/kg/day) on changes in IGF-1 levels before and after treatment was further investigated.RESULTS: In vitro, BIM23B065 treatment decreased GH release in the culture media and downregulated ERK 1/2 and CREB phosphorylation to 22% and 26%, respectively. In vivo, IGF-1 expression decreased to 50 % after 4 weeks of treatment with BIM23B065 using an osmotic pump implant. Moreover, magnetic resonance imaging results showed that the tumor size decreased significantly following treatment with BIM23B065 for 4 weeks.CONCLUSION: The novel chimeric molecule was effective in decreasing IGF-1 and GH levels and may serve as an effective therapeutic agent for acromegaly.


Subject(s)
Acromegaly , Blotting, Western , Culture Media , Cyclic AMP , Dopamine Agonists , Dopamine , Enzyme-Linked Immunosorbent Assay , Growth Hormone , Growth Hormone-Secreting Pituitary Adenoma , Humans , In Vitro Techniques , Insulin-Like Growth Factor I , Magnetic Resonance Imaging , Models, Animal , Phosphorylation , Phosphotransferases , Pituitary Neoplasms , Rare Diseases , Receptors, Dopamine , Receptors, Somatostatin , Response Elements , Somatostatin
8.
Article in English | WPRIM | ID: wpr-785547

ABSTRACT

We present a 33-year-old male patient with cerebellar ataxia. He was first considered to have a psychiatric conversion disorder but finally found to have chromosomal deletion in 7q31.2-31.32 involving Ca2⁺-dependent activator protein for secretion (CADPS) gene. When a targeted gene sequencing using next-generation sequencing panel and chromosomal microarray analysis were performed, an 8.6 Mb deletion within chromosome 7q31.2-31.32 was discovered. Deletion of CADPS gene in the 7q31.2-31.32 was suggested as the causative factor of cerebellar ataxia. Functional levels evaluated by Berg balance scale and modified Barthel index were improved via comprehensive rehabilitation including balance training and a dopamine agonist medication. To the best of our knowledge, this is the first report of chromosomal deletion in 7q31.2-31.32 including CADPS gene detected in patients with cerebellar ataxia.


Subject(s)
Adult , Cerebellar Ataxia , Chromosome Disorders , Conversion Disorder , Dopamine Agonists , Humans , Male , Microarray Analysis , Rehabilitation
9.
Rev. chil. endocrinol. diabetes ; 13(4): 150-153, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1123620

ABSTRACT

Los adenomas hipofisarios ectópicos (EPA) constituyen un reto diagnóstico, dada su escasa prevalencia y variada presentación en la que puede incluirse un síndrome de hipersecreción de hormonas hipofisarias. La clínica suele ser larvada e inespecífica, no presentan ninguna característica radiológica diferencial y el diagnóstico habitualmente es anatomopatológico. Sin embargo, a pesar de ser tumores benignos, pueden presentar un comportamiento agresivo, con invasión ósea y difícil resección completa, por lo que un diagnóstico de sospecha precoz podría resultar en un tratamiento más eficaz y con un menor número de complicaciones. Presentamos el caso de una paciente con un adenoma hipofisario ectópico silente en el seno esfenoidal con inmunohistoquímica positiva para Hormona de crecimiento (GH) y prolactina que presentaba restos tumorales tras la intervención quirúrgica y ha sido manejada con tratamiento médico conservado, con buenos resultados.


Ectopic pituitary adenomas constitute a diagnostic challenge, given their low prevalence and varied presentation in which a pituitary hormone hypersecretion syndrome may be included. Clinical symptoms are usually latent and nonspecific, they have no differential radiological characteristics and the diagnosis is usually anatomopathological. However, despite being benign tumors, they can exhibit aggressive behavior, with bone invasion and difficult complete resection, so a diagnosis of early suspicion could result in more effective treatment and fewer complications. We present the case of a patient with a silent ectopic pituitary adenoma in the sphenoid sinus with positive immunohistochemistry for Growth Hormone (GH) and prolactin who had tumor remnants after surgery and was managed with conservative medical treatment, with good results.


Subject(s)
Humans , Female , Aged , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/drug therapy , Sphenoid Sinus , Adenoma/diagnosis , Adenoma/drug therapy , Postoperative Period , Prolactin/metabolism , Growth Hormone/metabolism , Immunohistochemistry , Magnetic Resonance Imaging , Radionuclide Imaging , Tomography, X-Ray Computed , Dopamine Agonists/therapeutic use , Cabergoline/therapeutic use
10.
Arch. endocrinol. metab. (Online) ; 63(6): 646-652, Nov.-Dec. 2019.
Article in English | LILACS | ID: biblio-1055016

ABSTRACT

ABSTRACT Advances in combination medical treatment have offer new perspectives for acromegaly patients with persistent disease activity despite receiving the available medical monotherapies. The outcomes of combination medical treatment may reflect both additive and synergistic effects. This review focuses on combination medical treatment and its current position in acromegaly, based on clinical studies evaluating the efficacy and safety of combined medical treatment(s) and our own experiences with combination therapy. Arch Endocrinol Metab. 2019;63(6):646-52


Subject(s)
Humans , Somatostatin/analogs & derivatives , Receptors, Somatostatin/administration & dosage , Receptors, Somatostatin/antagonists & inhibitors , Dopamine Agonists/administration & dosage , Human Growth Hormone/analogs & derivatives , Quality of Life , Acromegaly/drug therapy , Somatostatin/administration & dosage , Human Growth Hormone/administration & dosage , Drug Therapy, Combination
11.
Arch. endocrinol. metab. (Online) ; 63(4): 320-327, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019363

ABSTRACT

ABSTRACT Objective To describe the long term safety and efficacy of pegvisomant (PEGV), and the predictors of treatment response in patients with acromegaly in the real life setting. Subjects and methods We retrospectively reviewed the clinical, hormonal and radiological data of acromegalic patients treated with PEGV in 17 Argentine centers. Results Seventy-five patients (age range 22-77, 51 females) with acromegaly have been treated with PEGV for up to 118 months (median 27 months). Before PEGV, 97.3% of patients had been treated with medical therapy, surgery and/or radiotherapy, two patients had no previous treatment. At that time, all patients had an IGF-1 above the upper normal limit (ULN) (mean 2.4 x ULN ± 0.98, range 1.25-7). At diagnosis of acromegaly 84% presented macroadenomas, prior to PEGV only 23,5% of patients remained with tumor remnant > 1 cm, the remaining showed normal or less than 1 cm images. Disease control (IGF-1 ≤ 1.2 x ULN) was achieved in 62.9% of patients with a mean dose of 11.8 mg/day. Thirty-four patients (45%) received PEGV monotherapy, while 41 (55%) received combined therapy with either somatostatin analogues and/or cabergoline. Adverse events related to PEGV were: local injection site reaction in 5.3%, elevated liver enzymes in 9.3%, and tumor size growth in 9.8%. Pre-PEGV IGF-I level was the only predictor of treatment response: 2.1 x ULN vs 2.8 x ULN in controlled and uncontrolled patients respectively (p < 0.001). Conclusion this long term experience indicates PEGV treatment was highly effective and safe in our series of Argentine patients with acromegaly refractory to standard therapies. Arch Endocrinol Metab. 2019;63(4):320-7


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Acromegaly/drug therapy , Somatostatin/analogs & derivatives , Dopamine Agonists/therapeutic use , Human Growth Hormone/analogs & derivatives , Cabergoline/therapeutic use , Argentina , Insulin-Like Growth Factor I/analysis , Predictive Value of Tests , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Dopamine Agonists/administration & dosage , Human Growth Hormone/administration & dosage , Human Growth Hormone/therapeutic use , Drug Therapy, Combination , Cabergoline/administration & dosage
12.
Article in Korean | WPRIM | ID: wpr-766827

ABSTRACT

Parkinson's disease is one of the most common neurodegenerative disorders world widely. Although curable therapies are practically not available yet, symptomatic managements using anti-Parkinson medications have shown to be quite effective to improve patients' quality of life. The discovery of dopaminergic deficits in Parkinson's disease in 1960s have brought about the human clinical trials of levodopa, which opened an “Era of Dopamine” in treatment history of the Parkinson's disease. Levodopa still remains gold standard. Dopamine agonists have proved their efficacies and delayed the development of long-term complications of levodopa use. Inhibitors of respective enzyme monoamine oxidase-B and catechol-O-methyltransferase, anticholinergics, and amantadine strengthen the therapeutic effects via either monotherapy or adjunctive way. Strategy of continuous dopaminergic stimulation and disease modification are weighing in current advances. This article is providing evidence-based review of pharmacological treatment of Parkinson's disease from early to advanced stages as well as management its unavoidable adverse reactions.


Subject(s)
Amantadine , Catechol O-Methyltransferase , Cholinergic Antagonists , Dopamine Agonists , Drug Therapy , Humans , Levodopa , Neurodegenerative Diseases , Parkinson Disease , Quality of Life , Therapeutic Uses
13.
Article in English | WPRIM | ID: wpr-763028

ABSTRACT

Limonene is a cyclic terpene found in citrus essential oils and inhibits methamphetamine-induced locomotor activity. Drug dependence is a severe neuropsychiatric condition that depends in part on changes in neurotransmission and neuroadaptation, induced by exposure to recreational drugs such as morphine and methamphetamine. In this study, we investigated the effects of limonene on the psychological dependence induced by drug abuse. The development of sensitization, dopamine receptor supersensitivity, and conditioned place preferences in rats was measured following administration of limonene (10 or 20 mg/kg) and methamphetamine (1 mg/kg) for 4 days. Limonene inhibits methamphetamine-induced sensitization to locomotor activity. Expression of dopamine receptor supersensitivity induced by apomorphine, a dopamine receptor agonist, was significantly reduced in limonene-pretreated rats. However, there was no significant difference in methamphetamine-induced conditioned place preferences between the limonene and control groups. These results suggest that limonene may ameliorate drug addiction-related behaviors by regulating postsynaptic dopamine receptor supersensitivity.


Subject(s)
Animals , Apomorphine , Citrus , Dopamine Agonists , Dopamine , Methamphetamine , Morphine , Motor Activity , Oils, Volatile , Rats , Receptors, Dopamine , Illicit Drugs , Substance-Related Disorders , Synaptic Transmission
14.
Braz. j. med. biol. res ; 52(11): e8899, 2019. tab, graf
Article in English | LILACS | ID: biblio-1039258

ABSTRACT

Few behavioral tests allow measuring several characteristics and most require training, complex analyses, and/or are time-consuming. We present an apparatus based on rat exploratory behavior. Composed of three different environments, it allows the assessment of more than one behavioral characteristic in a short 3-min session. Factorial analyses have defined three behavioral dimensions, which we named Exploration, Impulsivity, and Self-protection. Behaviors composing the Exploration factor were increased by chlordiazepoxide and apomorphine and decreased by pentylenetetrazole. Behaviors composing the Impulsivity factor were increased by chlordiazepoxide, apomorphine, and both acute and chronic imipramine treatments. Behaviors composing the Self-protection factor were decreased by apomorphine. We submitted Wistar rats to the open-field test, the elevated-plus maze, and to the apparatus we are proposing. Measures related to exploratory behavior in all three tests were correlated. Measures composing the factors Impulsivity and Self-protection did not correlate with any measures from the two standard tests. Also, compared with existing impulsivity tests, the one we proposed did not require previous learning, training, or sophisticated analysis. Exploration measures from our test are as easy to obtain as the ones from other standard tests. Thus, we have proposed an apparatus that measured three different behavioral characteristics, was simple and fast, did not require subjects to be submitted to previous learning or training, was sensitive to drug treatments, and did not require sophisticated data analyses.


Subject(s)
Animals , Male , Anxiety/psychology , Behavior, Animal/physiology , Behavioral Research/instrumentation , Exploratory Behavior/physiology , Fear/physiology , Impulsive Behavior/physiology , Time Factors , Anti-Anxiety Agents/pharmacology , Behavior, Animal/drug effects , Apomorphine/pharmacology , Chlordiazepoxide/pharmacology , Rats, Wistar , Maze Learning/drug effects , GABA Antagonists/pharmacology , Dopamine Agonists/pharmacology , Exploratory Behavior/drug effects , Fear/drug effects , Impulsive Behavior/drug effects , Antidepressive Agents, Tricyclic/pharmacology
15.
Arq. neuropsiquiatr ; 76(12): 840-848, Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-983858

ABSTRACT

ABSTRACT Optimizing idiopathic Parkinson's disease treatment is a challenging, multifaceted and continuous process with direct impact on patients' quality of life. The basic tenet of this task entails tailored therapy, allowing for optimal motor function with the fewest adverse effects. Apomorphine, a dopamine agonist used as rescue therapy for patients with motor fluctuations, with potential positive effects on nonmotor symptoms, is the only antiparkinsonian agent whose capacity to control motor symptoms is comparable to that of levodopa. Subcutaneous administration, either as an intermittent injection or as continuous infusion, appears to be the most effective and tolerable route. This review summarizes the historical background, structure, mechanism of action, indications, contraindications and side effects, compares apomorphine infusion therapy with other treatments, such as oral therapy, deep brain stimulation and continuous enteral infusion of levodopa/carbidopa gel, and gives practical instructions on how to initiate treatment.


RESUMO A optimização do tratamento da doença de Parkinson idiopática se faz um desafio, pois tem impacto direto na qualidade de vida do paciente. O melhor esquema terapêutico é o que permite o melhor controle motor com os menores efeitos adversos, através de terapêutica individualizada. A apomorfina é o único medicamento antiparkinsoniano que pode ser comparável à potência da levodopa no controle dos sintomas motores. Trata-se de um agonista dopaminérgico empregado na terapia de resgate em pacientes com flutuações motoras e também contribui para a melhora de muitos sintomas não motores. A via subcutânea, com injeções intermitentes, ou com infusão contínua, parece ser a melhor opção pela eficácia e tolerabilidade. Essa revisão resume aspectos históricos, estrutura da molécula, mecanismo de ação, indicação, contra-indicação e efeitos colaterais, compara a terapia de infusão com apomorfina com outros tratamentos, como a terapia oral, estimulação cerebral profunda e infusão enteral contínua de levodopa/carbidopa gel, e fornece instruções práticas de como iniciar o tratamento.


Subject(s)
Humans , Parkinson Disease/drug therapy , Apomorphine/administration & dosage , Dopamine Agonists/administration & dosage , Antiparkinson Agents/administration & dosage , Carbidopa , Levodopa , Deep Brain Stimulation , Drug Combinations
16.
Rev. méd. Chile ; 146(9): 1041-1049, set. 2018. tab
Article in Spanish | LILACS | ID: biblio-978795

ABSTRACT

Restless Legs Syndrome (RLS) or Willis-Ekbom Disease is an under-diagnosed chronic and progressive primary sensory-motor disorder. It can lead to severe sleep disturbances, a usual cause of consultation. It is characterized by an urgent need to move the legs in resting situations, a cardinal symptom that is usually accompanied by an unpleasant sensation in legs. These symptoms appear or aggravate at the end of the day and in resting situations and are alleviated with movement. Based on these clinical characteristics, it has been defined as a quiescegenic focal akathisia. The diagnosis is essentially clinical. As a guide, there are five cardinal diagnostic criteria. The treatment consists of non-pharmacological measures and the use of medications such as dopamine agonists. Despite the treatment, the symptoms persist in 40% of patients. Psychiatrists should be aware of the syndrome since many drugs used by them such as antipsychotics, antidepressants and anxiolytics can worsen the symptoms. Moreover, the syndrome may be associated with depressive and anxiety diseases.


Subject(s)
Humans , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/psychology , Antipsychotic Agents/adverse effects , Restless Legs Syndrome/chemically induced , Restless Legs Syndrome/drug therapy , Dopamine Agonists/therapeutic use , Diagnosis, Differential
17.
Arq. neuropsiquiatr ; 76(8): 517-521, Aug. 2018. tab
Article in English | LILACS | ID: biblio-950571

ABSTRACT

ABSTRACT The wearing-off phenomenon is common in patients with Parkinson's disease. Motor and non-motor symptoms can fluctuate in relation to the "on/off" periods. Objective: To assess the impact of motor and non-motor wearing-off on activities of daily living and quality of life of patients with PD. Methods: A cross-sectional study was carried out. All patients were evaluated using the Movement Disorders Society Unified Parkinson's Disease Rating Scale. Wearing-off was assessed using the Wearing-Off Questionnaire-19, and quality of life was assessed using the Parkinson's Disease Questionnaire-8. Results: A total of 271 patients were included; 73.4% had wearing-off; 46.8% had both motor and non-motor fluctuations. Patients with both motor and non-motor wearing-off had a worst quality of life compared with those with only motor fluctuations (p = 0.047). Conclusions: Motor and non-motor fluctuations have an impact on activities of daily living and quality of life. Non-motor wearing-off may have a higher impact.


RESUMO O fenômeno de encurtamento do fim de dose é comum em pacientes com doença de Parkinson. Tanto os sintomas motores quanto os não motores podem flutuar em relação aos períodos de "on/off". Objetivo: Avaliar o impacto das flutuações motoras e não-motoras nas atividades da vida diária e qualidade de vida em pacientes com doença de Parkinson. Métodos: Um estudo transversal foi realizado. Todos os sujeitos foram avaliados utilizando a escala unificada para a doença de Parkinson da Sociedade de Distúrbios do Movimento. O encurtamento do fim de dose foi avaliado através do questionário WOQ-19 e a qualidade de vida foi avaliada através do PDQ-8. Resultados: Um total de 271 pacientes foram incluídos, 73,4% tiveram deterioração de fim de dose. A maioria dos pacientes tiveram tanto flutuações motoras quanto não-motoras (46,8%). Os pacientes com ambos os tipos de flutuações motoras e não-motoras tiveram pior qualidade de vida do que pacientes apenas com flutuações motoras (p = 0.047). Conclusões: Pacientes com flutuações motoras e não-motoras tiveram impacto significativo nas atividades da vida diária e na qualidade de vida. As flutuações não-motoras parecem ter um impacto maior que as flutuações motoras sobre a qualidade de vida.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Parkinson Disease/physiopathology , Quality of Life , Activities of Daily Living , Motor Activity/physiology , Parkinson Disease/drug therapy , Reference Values , Levodopa/therapeutic use , Cross-Sectional Studies , Surveys and Questionnaires , Analysis of Variance , Statistics, Nonparametric , Dopamine Agonists/therapeutic use , Disability Evaluation , Educational Status , Antiparkinson Agents/therapeutic use
18.
Rev. cuba. invest. bioméd ; 37(1): 95-108, ene.-mar. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-991095

ABSTRACT

NCS-1 es una proteína unidora de calcio, que regula el funcionamiento de otras proteínas, con las cuales interactúa a nivel molecular. Su expresión es amplia y no limitada a neuronas. Sus efectos incluyen la regulación de receptores, canales iónicos y enzimas que intervienen en múltiples funciones neuronales. NCS-1 regula la actividad del receptor D2 de dopamina y del receptor A2A de adenosina, ambos fundamentales en diversos procesos de comunicación que involucran control emocional y control de movimientos en varios circuitos. NCS-1 también regula la actividad del receptor de IP3, un canal de calcio intracelular fundamental en la regulación de la homeostasis de este ion, interactúa con IP kinasas, las cuales a su vez desencadenan cascadas de señalización intracelular y modula la actividad de canales de calcio presinápticos; todos estos efectos redundan en regulación de la liberación de neurotransmisores y por ende, de la plasticidad sináptica, lo cual ha sido probado en diversos modelos experimentales. NCS-1 también parece estar involucrada en la regulación de otros canales iónicos de calcio y de potasio que podrían influir en la homeostasis eléctrica de las neuronas y en la supervivencia neuronal a través de la regulación de vías proapoptóticas. Estos amplios efectos de NCS-1 motivan a profundizar la investigación en los mecanismos involucrados en la regulación que ejerce sobre sus proteínas blanco y en nuevos efectos que ayuden a entender el rol de esta proteína en diversos procesos fisiológicos y fisiopatológicos(AU)


NCS-1 is a calcium-binding protein, which regulates the functioning of diverse proteins, with which interacts to a molecular level. Its expression is widespread and it is not limited to neurons. Its effects include the regulation of receptors, ion channels and enzymes, which intervene in multiple neuronal functions. NCS-1 regulates the functioning of D2 dopamine receptor and adenosine A2A receptor, both fundamental in diverse communication processes that involve emotional and movement control in a variety of neural circuits. NCS-1 also regulates the activity of IP 3 receptor, an intracellular calcium ion channel (which is crucial in the regulation of calcium homeostasis), interacts with the IP kinases, which trigger intracellular signaling cascades, and modulates the activity of presynaptic calcium channels. All these effects lead to the regulation of neurotransmitters release and thus, synaptic plasticity, which had been proved in diverse experimental models. NCS-1 also appears to be involved in the regulation of other calcium and potassium channels, which can influence the neuron electric homeostasis and survival through the modulation of proapoptotic pathways. These broad NCS-1 effects motivates further research of the specific mechanisms that are involved in the regulation that this protein exerts on its target proteins and in new effects that may help to understand the role of this protein in physiological and pathophysiological processes(AU)


Subject(s)
Humans , Male , Receptors, Purinergic P1 , Dopamine Agonists , Intracellular Signaling Peptides and Proteins , Neurons
19.
Arch. endocrinol. metab. (Online) ; 62(2): 236-263, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-887642

ABSTRACT

ABSTRACT Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.


Subject(s)
Humans , Male , Female , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/therapy , Hyperprolactinemia/diagnosis , Hyperprolactinemia/therapy , Prolactinoma/diagnosis , Practice Guidelines as Topic , Prolactin/blood , Brazil , Prolactinoma/therapy , Bromocriptine/therapeutic use , Dopamine Agonists/therapeutic use , Ergolines/therapeutic use , Cabergoline , Antineoplastic Agents/therapeutic use
20.
Rev. cuba. pediatr ; 90(1): 141-148, ene.-mar. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-901473

ABSTRACT

Introducción: los prolactinomas corresponden a la mitad de las causas etiológicas de los adenomas de presentación en la población pediátrica, lo cual les proporciona una gran importancia para tenerlos como diagnóstico diferencial ante el estudio de un tumor hipofisario. Las alteraciones visuales no corresponden al síntoma más común, sin embargo, es necesario tenerlo presente, especialmente ante la identificación de un macroadenoma. Presentación del caso: paciente femenina, de 16 años de edad, con un macroadenoma en estudio, que fue identificado como un macroprolactinoma. La sintomatología principal de consulta correspondió a alteraciones visuales y cefalea. Recibió tratamiento médico por Endocrinología Pediátrica con cabergolina, con estabilidad en el tamaño y características de la masa tumoral, y disminución de los niveles de prolactina sérica. Conclusiones: en la población pediátrica los prolactinomas que producen afectaciones visuales son más frecuentes en el sexo masculino, sin embargo, también puede ocurrir en el femenino; su diagnóstico implica la realización de estudios de laboratorio especializados y neuroimágenes, así como la participación activa de Endocrinología Pediátrica. Se resalta la importancia del tratamiento médico con agonistas dopaminérgicos, como la primera opción en esta entidad antes de plantear decisión quirúrgica, y es necesario un seguimiento médico cuidadoso al respecto(AU)


Introduction: prolactinomas account for half of the etiological causes of presentation adenomas in the pediatric population, hence their important role as differential diagnosis in the study of a pituitary tumor. Visual alterations are not their most common symptom, but they should be borne in mind, particularly in the identification of a macroadenoma. Case presentation: female 16-year-old patient with a macroadenoma under study which was identified as a macroprolactinoma. The main symptoms at presentation were visual alterations and headaches. She received medical treatment with cabergoline at the Pediatric Endocrinology service, achieving stability in the size and characteristics of the tumor mass, and a reduction in serum prolactin levels. Conclusions: in the pediatric population, prolactinomas causing visual alterations are more common in males, but they can also occur among females. Their diagnosis includes specialized laboratory tests and neuroimaging, as well as the active involvement of the Pediatric Endocrinology service. Mention must be made of the medical treatment with dopaminergic agonists as the first choice for this condition before indicating surgery, and careful medical follow-up is required in this respect(AU)


Subject(s)
Humans , Female , Adolescent , Prolactinoma/therapy , Dopamine Agonists/therapeutic use , Vision Disorders/complications
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