Actualización en enfermedad con cuerpos de Lewy / Update in Lewy body disease

La enfermedad con cuerpos de Lewy incluye 2 entidades que podrían ser consideradas variantes clínicas de una misma patología: la demencia con cuerpos de Lewy y la demencia en enfermedad de Parkinson. Con la finalidad de describir correctamente lo que sucede en la evolución de la enfermedad se divide el cuadro en etapa prodrómica y de demencia propiamente dicha. La primera está clínicamente representada por aquel período en el cual, si bien el paciente exhibe algunos signos y síntomas propios de la enfermedad, no reúne criterios de demencia. A pesar de ser difícil de definir y por carecerse todavía de contundentes datos clínicos y biomarcadores, se caracteriza principalmente por deterioro leve selectivo en función atencional ­ visuoespacial, trastorno del sueño REM y disautonomía‒. La segunda etapa está claramente caracterizada en los criterios de consenso del año 2005. Recientemente hemos publicado la validación de un instrumento llamado ALBA Screening Instrument, que permite diagnosticar con alta sensibilidad y especificidad la enfermedad aun en etapas tempranas y diferenciarla de otras patologías semejantes. La tomografía por emisión de positrones (PET) para transportador de dopamina es el procedimiento de referencia (gold standard) del diagnóstico. El tratamiento sintomático con anticolinesterásicos y neurolépticos atípicos favorece una buena evolución de la enfermedad y es fundamental tener en cuenta evitar medicamentos que pueden dañar gravemente a los pacientes como los anticolinérgicos y antipsicóticos típicos. Los avances en el diagnóstico y la difusión del impacto de esta enfermedad en la población contribuirán a generar mayores esfuerzos de investigación para hallar un tratamiento eficaz, preventivo o curativo o de ambas características. (AU)

Lewy body disease includes 2 entities that could be considered clinical variants of the same pathology: Dementia with Lewy bodies and Parkinson's disease Dementia. Two stages of the disease are described in this review, a prodromal stage and one of explicit dementia. The first one is clinically represented by that period in which, the patient exhibits some typical features of the disease, but not dementia criteria. Despite being difficult to define the prodromal stage and that strong clinical data and biomarkers are still lacking, there is evidence to characterize it mainly by mild selective impairment in attention and visuo-spatial function, REM sleep disorder and dysautonomia. The second stage is clearly characterized in the known consensus criteria of 2005. We have recently published the validation of an instrument called ALBA Screening Instrument which showed a high sensitivity and specificity for diagnosis of the disease even in the early stages. It´s useful to differentiate the disease from other similar pathologies. Positron Emission Tomography for dopamine transporter is the gold standard of diagnosis in life. Symptomatic treatment with anticholinesterases and atypical neuroleptics help patients in their evolution of the disease. Anticholinergics and typical antipsychotics are agents to avoid in the treatmen of the disease because can severely damage patients. Future advances in the diagnosis and dissemination of the knowledge of the disease will contribute to generate greater research efforts to find an effective preventive and / or curative treatment. (AU)

Adicción a biperideno y síndrome anticolinérgico: a propósito de un caso / Biperiden addiction and anticholinergic syndrome: a case report

Se reporta el caso de un paciente de 46 años de edad, con diagnóstico de esquizofrenia, en tratamiento desde los 26 años, con trifluoperazina y decanoato de flufenazina y uso concomitante de biperideno por los efectos adversos, que desarrolló dependencia al biperideno llegando a tomar, en la última semana antes de su hospitalización 14 mg diarios. El día de su ingreso tomó 20 mg, desarrollando un cuadro compatible con síndrome anticolinérgico, que se complicó con hiponatremia severa, acidosis metabólica con alcalosis respiratoria, leucocitosis, fiebre y elevación de la creatinfosfoquinasa, por lo que la impresión diagnóstica inicial fue de síndrome neuroléptico maligno. Su evolución fue favorable, saliendo de alta a la semana.

We report the case of a 46-year-old man diagnosed with schizophrenia, treated with trifluoperazine and fluphenazine decanoate since he was 26 years old, with concomitant use of biperiden for adverse effects. He developed dependence to biperiden, taking in the last week, prior to his hospitalization, 14 mg daily. The day of his admission he took 20 mg, developing an anticholinergic syndrome, complicated with severe hyponatremia, metabolic acidosis with respiratory alkalosis, leukocytosis, fever and creatine phosphokinase elevation, due to this he was initially focused as a neuroleptic malignant syndrome. He had a favorable outcome; being discharged one week later.

biochemical, cognitive, and psychiatric effects of anticholinergics benzhexol hydrochloride and biperiden hydrochloride in schizophrenic patients

It is estimated that 45 million people suffer from schizophrenia around the world; it is among the top ten leading causes of disability. By 2050, this number will have grown to approximately 71 million people. Mental illnesses contribute more to the global burden of disease than all cancers combined. The present study has been planned to evaluate the effect of anticholinergic parkinol [benzhexol hydrochloride] and akineton [biperiden hydrochloride] on erythrocyte acetyl cholinesterase [AChE] activity and serum activities of gamma-glutamyl transferase [GOT], alanine transaminase [ALT], aspartate transaminase [AST], and alkaline phosphatase [ALP] in schizophrenic patients treated with haloperidol, and also to study the effect of the previously mentioned two anticholinergics on both the cognitive functions and psychiatric symptoms in such patients. The study was carried out on 30 male schizophrenic patients who were divided into two main groups [group 1 and group 2] each of 15 patients of comparable age. The present results revealed that the total score of [PANSS] showed a significant decrease in all studied groups. The total score of [MMSE] showed a significant increase in all studied groups. The AChE activity didn't show any significant difference in all comparisons in all studied groups. In our study, there was a significant elevation of serum GGT, ALT, AST and ALP levels in some groups of treated patients as compared to pretreatment groups. The results obtained in our study showed a significant increase in serum GGT, ALT, AST, and ALP levels in groups treated with either [haloperidol + benzhexol hydrochloride] or [haloperidol + biperiden hydrochloride] as compared to the corresponding levels in groups treated with haloperidol only, respectively. From all results we can concluded that the biochemical parameters used in this study are useful in detecting any side effects of antipsychotic and anticholinergic drugs on liver functions. The treatment with [haloperidol + benzhexol hydrochloride] and [haloperidol + biperiden hydrochloride] are effective in decreasing the positive and negative symptoms of schizophrenia

Demência reversível e quedas associadas ao biperideno / Reversible dementia and falls associated with biperiden

As drogas anticolinérgicas podem causar efeitos adversos, mais freqüentemente nos pacientes idosos. Relatamos um caso de demência reversível e quedas, associadas ao uso de biperideno. A paciente, com 82 anos, foi admitida em lar geriátrico devido a quedas freqüentes no domicílio, acentuado déficit cognitivo, tremores de extremidades ao movimento e perda de autonomia. Na verdade, era portadora de tremor essencial, que foi confundido com doenca de Parkinson e tratado com biperideno; posteriormente, desenvolveu déficit cognitivo que foi erroneamente diagnosticado como demência do tipo Alzheimer. Após submeter-se à avaliacão especializada, foi suspensa a droga anticolinérgica e houve reversão completa do quadro demencial; o tremor essencial foi controlado com uso de propranolol. Ao avaliar um paciente com déficit cognitivo, o clínico deve descartar possíveis causas de demência reversível, em especial, o grupo das iatrogênicas.