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)

Efectividad de la terapia farmacológica oral utilizada para el tratamiento del control postural en niños con parálisis cerebral disquinética: una revisión sistemática / Effectiveness of oral pharmacologic therapy usedfor treatment of postural control in children withdyskinetic cerebral palsy (DCP): a systematic review

Objective: To evaluate the effectiveness of oral pharmacologic therapy in improving postural control and functionality in patients with DCP, with less than 20 years old, compared with any therapy or placebo. Methods: Randomized clinical trials and quasi-experimental with no restriction in publication date or language were included. The search was conducted in PubMed, EMBASE, The Cochrane Library (CENTRAL), Virtual Health Library (LILACS, SCIELO), ClinicalTrials.gov and Opengrey. The risk of bias was assessed according to the Cochrane Handbook for Interventions Systematic Reviews. Results: 3 cross over studies were included, according to the established criteria. The three drugs that were analyzed were: levodopa, and trihexyphenidyl and tetrabenazine, compared to placebo. No study had significant favorable results for the use of the drug over placebo. Conclusion: At the moment there is no evidence to support the use of oral medication in patients with DCP, based on the small number of high quality studies found, it is necessary to increase research on oral pharmacologic therapy in this group of patients.

Objetivo: Evaluar la efectividad del tratamiento farmacológico oral destinado a mejorar el control postural y la funcionalidad en pacientes con parálisis cerebral disquinética (PCD) menores de 20 años comparado con cualquier terapia o placebo. Métodos: Se incluyeron ensayos clínicos aleatorizados y cuasi experimentales sin restricción de fecha de publicación o lenguaje. La búsqueda se realizó en Pubmed, EMBASE, The Cochrane Library (CENTRAL), Biblioteca Virtual de la Salud (LILACS, SCIELO), ClinicalTrials.gov y Opengrey. El riesgo de sesgo fue evaluado de acuerdo al Manual Cochrane de Revisiones Sistemáticas de Intervenciones. Resultados: Se incluyeron 3 estudios cross-over de acuerdo a los criterios establecidos. Los tres fármacos analizados fueron: levodopa, tetrabenazina y trihexifenidilo, comparados con placebo. Ningún estudio tuvo resultados favorables de manera significativa para el uso del medicamento sobre placebo. Conclusión: Por el momento no existe evidencia que sustente el uso de la medicación oral en los pacientes con PCD en base al escaso número de estudios de alta calidad encontrados, siendo necesario que se aumente la investigación sobre el tratamiento farmacológico oral en este grupo de pacientes.

Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2009-2013

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) with high mortality and have a significant public health impact because of high mortality and morbidity. OBJECTIVE: To describe data the epidemiological features, etiology, and treatment of retrospectively reviewed data of all patients with SJS and TEN. METHODS: Retrospective study was conducted in patients with SJS and TEN treated from January 1, 2009 to December 31, 2013 in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. RESULTS: A total of 57 patients were enrolled in the study. Thirty-nine cases of SJS (21 males and 18 females), 7 cases of SJS overlapping TEN (4 males and 3 females), and 11 cases of TEN (5 males and 6 females) were reported. All cases of SJS and TEN were caused by drugs, such as paracetamol (16.56%), carbamazepine (7%), amoxicillin (5.73%), ibuprofen (4.46%), rifampicin (3.18%), and trihexyphenidyl (3.18%). All cases were treated systemically with corticosteroid alone (100%). Seven from 57 patients (12,28%) died; 5 cases developed sepsis and 2 cases developed respiratory failure. The mortality rate was 7.69% in SJS, 0% in SJS/TEN overlap, and 36.36% in TEN. CONCLUSION: The role of systemic corticosteroids in SJS and TEN are still controversial, but with a prompt and earlier treatment reduces mortality and improves outcomes of SJS and TEN patients.

Paliperidone Palmitate-induced Urinary Incontinence: A Case Report

Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients' compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.

Simultaneous determination of trihexyphenidyl, chlorpromazine and clozapine in blood by GC-MS / 法医学杂志

OBJECTIVE@#To develop a method to measure trihexyphenidyl, chlorpromazine and clozapine in human blood with GC-MS.@*METHODS@#The specimens were alkalized (pH > 10) and extracted with V (benzene):V(ethyl acetate) = 1:1, and qualitatively analyzed using GC-MS-Full Scan with internal standard SKF525A. The specimens were alkalized (pH > 10) and extracted with V(benzene):V(ethyl acetate) = 1:1, and quantitatively analyzed using GC-MS-SIM with internal standard diazepam-d5.@*RESULTS@#The lowest detection limits of trihexyphenidyl, chlorpromazine and clozapine were 0.3, 0.3 and 0.7 ng/mL (S/N > or = 3) respectively. The calibration curve in 20-10 000 ng/mL showed a good linear distribution. The recovery rate was 79.9% to 85.5%. The RSDs of intraday and interday were less than 5.1%.@*CONCLUSION@#The established method was simple, sensitive and accurate for simultaneous determination of trihexyphenidyl, chlorpromazine and clozapine in human blood, and can be applied in forensic toxicological cases.

Biochemical and cellular changes due to trihexphenidyl [parkinol] dependence in albino rats

Trihexphenidyl [Parkinol] is one of anticholinergics which is an important member of hallucinogens. It may be abused for its euphoriant and hallucinogenic effects, and it may be combined with street drugs for enhanced effect. To investigate the effect of trihexphenidyl [parkinol] dependence on biochemical parameter [liver functions tests] and histopathological examination of the liver and brain of albino rat. Twenty adult male albino rats of an average weight [150-200 grams] were divided into two equal groups as follow: Group I: [Control group]: Formed of 10 rats. Group II: [Dependent group]: Consisted of 10 rats that was given trihexphenidyl orally in gradually increasing doses until they reached the dependent dose in one month. Blood samples were collected. Biochemical parameter [liver functions tests] was done on the sera of the rats. Liver and brain tissues were taken for histological examination. Biochemical study, it was found that serum liver function tests, ALT and AST showed highly significant increased, P was <0.001, while serum albumin was significantly decreased P was<0.05 in dependent group than in control group. Histopathological examination of the liver, it showed small foci of hepatic cell necrosis with moderate periportal mononuclear cell infiltration, with subcapsular fatty degeneration and chronic venous congestion. On the other hand the brain of trihexphenidyl dependent group showed congestion, edema and degenerative changes in some neurons. From the present results, it can be concluded that trihexphenidyl [parkinol] abuse can lead to hepatotoxicity, as it affects liver function tests and the histological picture of the liver. Also trihexphenidyl abuse causes histopathological changes in the brain. So health educational programs should be held to pay attention about trihexphenidyl dependence and its deleterious effects on health and the relation between trihexphenidyl and other types of drug dependence. Neurologists and psychiatrists should be aware about the potential trihexphenidyl [parkinol] toxicity over the long term medical use by the patients, and its capability of being addicted. Also media and press should explain the deleterious effects of trihexphenidyl use for prolonged time

Clinical presentation of Parkinson's disease among sudanese patients

Parkinson Disease [PD] is a neurodegenerative disorder affecting motor system. It is a chronic progressive disorder leading to long standing disability. To study the clinical presentation of PD among Sudanese patients seen at Elshaab Teaching Hospital during the period from May 2004 - April 2008. In this descriptive prospective, cross sectional hospital based study, 94 patients were studied using standardized questionnaire including history and clinical examination. The total number diagnosed to have PD was 94 patients. Male to female ratio was found to bel .5:1. Common age group affected was 70-80 years [24.47%]. The common presenting symptom was found to be poverty of movement [93.6%] followed by tremor [82.9 8%]. On neurological examination; rigidity, dyskinesia and festinate gait were the common signs. Primitive reflexes were found in significant number of patients. Idiopathic PD was found to be the common type [75.53%]. Of the side effects of benzhexol, 66.67% of our patients developed dry mouth. Postural hypotension was seen in 10.42% of the patients who were taking levodopa. The clinical presentations of our patients does not differ from what was mentioned in the literature

Multicenter clinical study on the treatment of children's tic disorder with Qufeng Zhidong Recipe / 中国结合医学杂志

<p><b>OBJECTIVE</b>To assess the effect and adverse reaction of Qufeng Zhidong Recipe (QZR) in treating children's tic disorder (TD).</p><p><b>METHODS</b>With multicenter randomized parallel open-controlled method adopted, the patients enrolled were assigned to two groups, 41 cases in the Chinese medicine (CM) group and 40 in the Western medicine (WM) group. They were treated by QZR and haloperidol plus trihexyphenidyl respectively for 12 weeks as one course. In total, two courses of treatment were given. The curative effect and adverse reactions were evaluated by scoring with Yale Global Tic Severity Scale (YGTSS), Traditional Chinese Medicine Syndrome Scale (TCMSS), and Treatment Emergent Symptom Scale (TESS), as well as results of laboratory examinations.</p><p><b>RESULTS</b>After one course of treatment, the markedly effective rate in the CM and the WM group was 14.6% and 17.5%, respectively, and the total effective rate 43.9% and 47.5%, respectively, which showed insignificant difference between groups (P>0.05). However, after two courses of treatment, markedly effective rate in them was 73.2% and 7.5%, and the total effective rate was 100.0% and 57.5%, both showing significant differences between groups (P<0.05). Besides, the adverse reactions occurred in the CM group was less than that in the WM group obviously.</p><p><b>CONCLUSION</b>QZR has definite curative effect with no apparent adverse reaction in treating TD, and it can obviously improve the symptoms and signs and upgrade the quality of life and learning capacities in such patients.</p>

[ case report of clozapine induced oculogyric crisis]

Oculogyric crisis which is a dystonic reaction is commonly caused by neuroleptics and rarely occurs with atypical antipsychotics specially Clozapine. In this article a case of Clozapine induced oculogyric crisis is reported. The patient was a 25-years-old woman with auditory hallucination, loosening of association and persecutory delusion that was admitted and treated. Because of poor response to typical antipsychotics, she was prescribed Clozapine. Then she experienced multiple episodes of oculogyric crisis and was treated successfully with anticholinergic medication [Artane]. In this special case, Clozapine caused oculogyric crisis. This side effect is rare but should be considered as a possible adverse effect of Clozapine. On the basis of this report, Clozapine induced oculogyric crisis may be treated successfully with Artane

Extra Pontine Myelinolysis without Striatal involvement Presenting as Pathological Crying, Reversible Parkinsonism and Dystonia.

A case of Central Pontine Myelinolysis and Extrapontine Myelinolysis presented with dystonia, Parkinsonism, and pathological crying that developed few days after gradual correction of hyponatremia. EEG slowing was evident before onset of symptoms, and disappeared with clinical improvement. Thalamic lesions alone produced these features. It dramatically responded to the Trihexyphenidyl therapy. Thus, basal ganglia involvement is not mandatory to produce this clinical picture; early onset of symptoms, resolution of EEG slowing and prompt response to anticholinergics may indicate better prognosis.

Multi-drug overdose risperidone, ziprasidone, valproate, trihexyphenidyl, and clonazepam.

Risperidone and ziprasidone are commonly used as first line drugs for the treatment of psychotic disorders and overdose with these agents is increasingly being reported. Relatively few of these reports have involved co-ingestion of multiple psychotropic agents. We report a case of overdose with risperidone, ziprasidone, valproate, trihexyphenidyl and clonazepam in a 25 years female, who recovered uneventfully with supportive management. Notwithstanding the benign outcome in this instance, age, co-ingested drugs, active metabolites and medical co-morbidity are critical issues in overdose with atypical antipsychotics. As prescription of these drugs continues to increase in developing countries, systematic studies evaluating their clinical toxicity and management are necessary. The issues associated with overdose of multiple psychotropic agents and appropriate management policies are highlighted.

Parkinsonism and Tremor Disorders: A Clinical Approach

Differentiation of idiopathic Parkinson's disease from other causes of Parkinsonism; such as Multiple System Atrophy; Progressive Supranuclar Palsy and Vascular Parkinsonism can be difficult. Clinicopathological studies suggest that the clinical diagnosis of idiopathic Parkinson's disease is 76reliable. Also; clinical differentiation of tremor prominent Parkinsonism from Essential Tremor or Drug induced Parkinsonism may be problematic; especially in the early stages of the disease. Since these disorders are obviously different in clinical progress; it is important for the clinician to address the patient's and family's concerns about prognosis from a firm diagnostic footing. In this article the clinical features of the common and important causes of Parkinsonism and tremor disorders are reviewed and a practical approach is suggested

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

Síndrome extrapiramidal inducido por neurolépticos / Extrapiramidal Syndrome induced by neuroleptics

Los psicofármacos son medicamentos que por determinar efectos significativos sobre las funciones psíquicas se utilizan en el tratamiento de las enfermedades mentales. De ellos los neurolépticos se caracterizan por ser fármacos antipsicóticos por excelencia y por provocar manifestaciones extrapiramidales. Con el objetivo de realizar una valoración del comportamiento del síndrome extrapiramidal inducido por neurolépticos se realizó un estudio descriptivo tomando como universo de trabajo los 55 pacientes con trastornos mentales ingresados en las Salas E y C de larga estadía del Hospital Psiquiátrico Docente Provincial Antonio Guiteras Holmes, en el período comprendido de enero a marzo del 2004. La muestra quedó conformada por aquellos pacientes que tenían indicado neurolépticos en su tratamiento. Se utilizó como instrumento para obtener la información requerida las historias clínicas, realizándose una valoración de diferentes variables necesarias para el estudio, entre ellas: conocer el tratamiento neuroléptico, determinar el número de pacientes que presentaron reacciones extrapiramidales, tipo de manifestación extrapiramidal y la conducta asumida ante la misma. Posteriormente se realizó una comparación del consumo del trihexifenidilo antes y después de las nuevas indicaciones fármaco-epidemiológicas. Para el análisis de los resultados se confeccionaron tablas que dan respuesta a los objetivos planteados. Un gran porciento de los pacientes tenían indicado neuroléptico . Aparecen reacciones extrapiramidales agudas en un escaso número de ellos. La más frecuente fue la distonía aguda. La conducta asumida fue la sedación con ansiolíticos y antihistamínicos e iniciar el tratamiento con trihexifenidilo según la susceptibilidad de los pacientes. El consumo de trihexifenidilo en el cuarto trimestre del 2003 estaba elevado en 1823 tabletas y disminuyó en el primer trimestre del 2004 a una cantidad de 447...

Patrón de prescripción de trihexifenidilo posterior a una intervención / Prescription pattern of trihexifenidilo after intervention

Introducción: El trihexifenidilo es una sustancia psicoestimulante con peligro de adicción, por lo que su prescripción exige el cumplimiento de una serie de requisitos con el objetivo de regular su consumo. Objetivos: Caracterizar la prescripción de trihexifenidilo e identificar diferencias entre el patrón de prescripción de trihexifenidilo posterior a una intervención y el caracterizado en el año 2002. Métodos: Se realizó estudio de utilización de medicamentos clasificado como de intervención en 23 municipios del país en 2 periodos (año 2002 y 2005) . Se incluyeron todos los pacientes inscriptos con trihexifenidilo y la información recogida fue la referente a: edad, sexo, municipio, provincia, diagnóstico, presentación de la tableta, dosis diaria, especialidad, nivel de atención y otros fármacos consumidos por el paciente. Resultados: Se comprobó que las indicaciones fueron justificadas en el 90 por ciento de los casos para el 2005 con respecto al 81,8 por ciento en el 2002. El rango de dosis fue correcto en el 99,8 por ciento en el año 2005 y del 87,2 por ciento en el año 2002. La indicación predominante en el 2005 fue el síndrome extrapiramidal con el 35,3 por ciento de los casos. Alrededor del 70 por ciento de los certificados fueron emitidos por la especialidad de Psiquiatría en ambos años y predominó la emisión de certificados en la atención primaria para ambos periodos (79,6 por ciento para el 2005 y 63 por ciento en el 2002). Conclusiones: E l impacto de las intervenciones realizadas es positivo, pues se observa una mejoría en la calidad de las prescripciones de trihexifenidilo

Caracterización de la prescripción de trihexifenidilo y metilfenidato / Characterization of the prescription of trihexyphenidyl and methylphenidate

Se realizó un estudio de utilización de medicamentos de tipo prescripción-indicación, de carácter observacional, descriptivo y de corte transversal, con el objetivo de caracterizar el patrón de prescripción del trihexifenidilo y metilfenidato. Se incluyeron la totalidad de pacientes inscritos por metilfenidato y trihexifenidilo, con 348 y 420 respectivamente en el período enero-septiembre de 2004, en el municipio Playa de Ciudad de La Habana. Se comprobó que: persisten dificultades en los diagnósticos para los que se prescribe trihexifenidilo y de lo cual difiere el metilfenidato, que los esquemas de tratamiento empleados fueron adecuados para ambos fármacos y que predominó el nivel de atención primaria en la prescripción del trihexifenidilo y terciaria para el metilfenidato

Trihexifenidilo: droga con dificultades en su prescripción, mal usada y poco conocida / Trihexyphenidyl: a drug with difficulties in its prescription, poorly used and little known

Se realizó una amplia revisión de lo descrito en la literatura sobre el trihexifenidilo, droga anticolinérgica empleada básicamente en enfermedades psiquiátricas y neurológicas, con el fin de contribuir desde el punto de vista educativo a la información del personal de salud sobre las potencialidades farmacológicas de este medicamento en cuanto a su consumo. Se valoró el binomio riesgo-beneficio, se particularizó en los detalles de sus indicaciones, dosificaciones y posibles alternativas de sustitución del fármaco, así como implicaciones de su consumo de riesgo y su poder adictivo. Se hacen recomendaciones para ejecutar buenas prácticas en medicina y la valoración de sus aspectos médico-legales. Finalmente, se hacen referencias de la función del personal de la salud como divulgador de la temática y su responsabilidad en la consecución de estilos de vida saludables y mayor calidad de vida de nuestra población