[Occurrence of malignant neuroleptic syndrome due to the intake of risperidone in low-risk patients]

Neuroleptic Malignant Syndrome [NMS] is a rare but potentially fatal problem induced by the consumption of antipsychotic drugs, especially traditional drugs which are more common in youngsters and males. This paper describes the first reported case of a clinical presentation of NMS [induced by the consumption of Risperidone] in an old woman, who was suffering from psychotic processes. Due to psychotic depression and with differential diagnosis of schizoaffective, the woman had been prescribed a low and medium dosage of Risperidone, but she suddenly and unexpectedly developed clinical NMS. Despite special treatments and services, she passed away after 14 days. In spite of rare universal reports regarding the development of NMS induced by the consumption of Risperidone, so far no occurrence of NMS in aged women has been reported

Neurocysticercosis presenting as midbrain syndrome.

Brainstem is infrequently involved in patients with neurocysticercosis, usually, it occurs in association with disseminated form of neurocysticercosis. We are reporting two cases who had large multiple cysticercus lesions and presented as acute midbrain syndrome. The diagnosis of neurocysticercosis was established by presence of characteristic granulomatous extraaxial lesions around the midbrain, and in cerebral parenchyma, along with strongly positive ELISA for cysticercal antigen in cerebrospinal fluid as well as in serum. Both patients responded well to corticosteroids. However, repeat follow-up CT scan income case did not show significant alteration in the size of the lesion.

Oral zinc therapy in diabetic neuropathy.

The present double blind randomized study was conducted on 50 subjects; 20 age and sex matched healthy controls (Group--I); 15 patients of diabetes mellitus with neuropathy who received placebo for 6 weeks (Group--IIA); and 15 patients of diabetes mellitus with neuropathy who were given supplemental zinc sulphate (660 mg) for 6 weeks (Group--IIB). Serum zinc level, fasting blood sugar (FBS) and post prandial blood sugar (PPBS) levels and motor nerve conduction velocity (MNCV) were estimated on day 0 and after 6 weeks in all subjects. Serum zinc levels were significantly low (p < 0.001) in group IIA and IIB as compared to healthy controls (Group--I) at baseline. After 6 weeks the change in pre and post therapy values of FBS, PPBS and MNCV (median and common peroneal nerve) were highly significant (P = < 0.001) for group IIB alone with insignificant change (P = > 0.05) in group IIA. No improvement (P = > 0.05) in autonomic dysfunction was observed in either groups. Therefore, oral zinc supplementation helps in achieving better glycemic control and improvement in severity of peripheral neuropathy as assessed by MNCV.

The effect of aspirin on neurodeficit and platelet aggregability in acute ischemic cerebral strokes.

We examined the role of aspirin in modifying platelet aggregability (PA) and neurodeficit (ND) in patients presenting within 48 hours of acute ischemic cerebral strokes of the carotid territory. 28 adult patients were studied at baseline and after 7 days of treatment with a single daily dose of aspirin 325mg (group A, n = 12) and 160 mg (Group B, n = 16). We also evaluated the neurologic outcome at the beginning and at the end of 7 days using a scoring system. There was no significant difference in the ND scores and in vitro PA between these two groups. PA, as measured in vitro, does not appear to have any significant role as a predictor of neurologic outcome in acute ischemic strokes. The change in ND scores of patients with ischemic cerebral strokes treated acutely with aspirin was not significant upto first 7 days therapy.

Vitamin E in the treatment of tardive dyskinesia.

In a double-blind placebo controlled trial, the efficacy of Vitamin E in the treatment of tardive dyskinesia (TD) was studied in 32 patients. After a two week wash-out phase a baseline (0 week) TD rating was assessed on the tardive dyskinesia rating scale (TDRS). Subsequently, the patients entered a four week treatment phase during which 17 patients received capsules of vitamin E (600 mg) and 15 patients received identical placebo capsules. In the first week the patients received 1 capsule daily which was then increased to two capsules per day from the second to the fourth week. All patients were rated on the TDRS at the end of each week. The baseline TDRS score in the vitamin E group was significantly higher than the placebo group. This was hence adjusted and the results were then subjected to analysis of co- variance. The TDRS score after four weeks treatment was significantly lower in the vitamin E group as compared to the placebo group (p = 0.03).

Combination therapy of parkinsonism with deprenyl.

In view of the encouraging results in various trials with deprenyl as an added drug therapy for Parkinson's disease, a pilot study to study deprenyl's efficacy in the Indian population was undertaken. Eleven patients were recruited in this open trial and were objectively assessed by Unified Rating Scale for Parkinsonism of Columbia University, Modified Hoehn and Yahr Staging and Schwab and England activities of daily living. Side effects, mood changes, changes in dyskinesia percentage, early morning dystonia and off period percentage were also noted. This study suggests improvement in the above parameters with minimal side effects.

Atypical presentations of falciparum malaria.

To identify the uncommon presentations of falciparum malaria in an endemic area and to assess the outcome of treatment, a study was carried out on 35 proved cases whose clinical presentations were either dominated by features other than fever or the history of fever was totally absent. Both urban and rural patients were included. Seventeen cases (48.3%) presented with features of cerebral malaria. Acute abdomen, urticaria, and unexplained shock were the other atypical presentations. Five cases (14.3%) of cerebral malaria died. We conclude that awareness of atypical presentations is important to detect cases of falciparum malaria in an endemic area. Intravenous quinine may need to be given promptly even when cerebral malaria is diagnosed empirically.