Effectiveness of melatonin in tardive dyskinesia / Efectividad de la melatonina en la discinesia tardía

Tardive Dyskinesia (TD) is a movement disorder associated with the clinical administration of antipsychotics. It is believed that TD is due, among other factors, to an increase in the oxidative damage produced by free radicals. Antioxidants, like vitamin E, have been used in the treatment of TD but there is no evidence of their effectiveness. Melatonin (MEL) is 6 to 10 times more effective, as an antioxidant, than vitamin E and it has been used with an apparent higher effectiveness in the treatment of TD, although the results have not been conclusive. A randomized, double blind, placebo controlled design was used to determine the effectiveness of MEL (20mg/day) during 12 weeks in 7 patients with TD. Six patients with TD were treated with placebo. The Abnormal Involuntary Movement Scale (AIMS) was chosen to assess the severity of TD initially and after 4, 8 and 12 weeks. The psychiatric evaluation was done following the Brief Psychiatric Rating Scale. In two patients treated with MEL a significant improvement (more than 60%) of the values of AIMS was detected. In the remainder five, as well as in the patients treated with placebo, no difference was observed during the 12 weeks. When compared the AIMS score in all the MEL-treated patients with the values in the placebo-treated patients, no significant differences were detected during the 12 weeks of the study. However, the significant clinical improvement observed in two patients must be considered before reaching a final conclusion on the usefulness of MEL in TD.

La Discinesia Tardía (DT) es un trastorno de los movimientos asociado al uso crónico de antipsicóticos que parece producirse, entre otros factores, por un incremento en los procesos oxidativos. La vitamina E se ha utilizado en su tratamiento, pero no hay evidencia de su efectividad. Como la melatonina (MEL) es 6 a 10 veces más efectiva como antioxidante que la vitamina E, se ha utilizado con una aparente mayor efectividad, aunque los resultados no han sido concluyentes. Se realizó un estudio doble ciego, al azar y controlado con placebo, para determinar la efectividad de la administración de la MEL durante 12 semanas en 7 pacientes con DT. Seis pacientes con DT fueron tratados con placebo. La Escala de Movimientos Involuntarios Anormales (AIMS) se usó para evaluar la evolución de los movimientos al inicio y a las 4, 8 y 12 semanas de tratamiento. La evaluación clínica psiquiátrica se hizo con la Escala Breve de Evaluación Psiquiátrica. En dos pacientes tratados con MEL se observó una mejoría clínica superior al 60% pero en los restantes, así como en los tratados con placebo los valores de la AIMS no variaron significativamente en el transcurso de las 12 semanas. Cuando se compararon los valores de la AIMS de la totalidad de los pacientes tratados con MEL, con los del grupo placebo, no se detectó ninguna diferencia significativa. Sin embargo, la mejoría clínica significativa de dos de los pacientes estudiados debe considerarse para llegar a una conclusión sobre la utilidad de la MEL en la DT.

Movement disorders in children: Recent advances in management.

In recent years there has been a growing interest towards pediatric movement disorders (PMD). The data derived from the synthesis of clinical observation, neuroimaging, biochemical and, molecular genetics studies have allowed for the identification of a significant number of pediatric diseases featuring movement disorders. The purpose of this review is to outline an approach to the advances in management of dystonia, neurotransmitter disorders, tics, and paroxysmal dyskinetic syndromes starting in children younger than 18 yr of age.

Effect of compound 11 g as a novel selective cox-2 inhibitor on movement disorders in a rat model of parkinson's disease

To test the effect of selective COX-2 inhibitors compound 11g on movement disorders of Parkinson's disease [PD]. In the study the rat Left substantia nigra pars compacta [SNc] has been destroyed using electrical Lesion [10 Sec; 1 mA DC] to generate PD model. Then 11g [2, 4mg/kg] and celecoxib a well known and standard COX-2 inhibitor [4, 8mg/kg] have been administrated orally to parkinsonian rats. Then the rigidity and locomotor activity of parkinsonian rats were evaluated. Both selective COX-2 inhibitors decreased the rigidity and improved the locomotor activity of parkinsonian rats P>O.05 as compared to the control groups. Based on the results of the locomotor activity and rigidity tests using parkinsonian rats, we found that compound 11g had remarkable rigidity-improving effect

Laryngeal electromyography in movement disorders: preliminary data

Este estudo descreve dados preliminares de eletromiografia laríngea (LEMG) e tratamento com toxina botulínica em pacientes com disfonia associada a distúrbios do movimento. Foram estudados 25 pacientes, 19 com distonia laríngea ou disfonia espasmódica, 5 com tremor vocal e 1 com síndrome de Gilles de la Tourette. LEMG realizada com eletrodos monopolares, antes da administração de toxina botulínica, foi compatível com distonia em 14 pacientes (normal em 5), sugeriu tremor essencial em 3 e Parkinson em 2. Os diferentes padrões de LEMG e melhora considerável obtida com administração de toxina botulínica instituíram LEMG como rotina no ambulatório de distúrbios do movimento da UNICAMP.

Neuroacantocitose: relato de caso / Neuroacanthocytosis: a case report

Relatamos o caso de um paciente de 45 anos com neuroacantocitose. O paciente apresenta crises parciais complexas como automatismos e crises generalizadas tônico-clônicas, assim com distúrbios do movimento caracterizados por coréia do tronco e membros superiores, e discinesia orofacial. Os exames complementares revelam acantocitose de 11 por cento, eletrencefalograma com foco irritativo no lobo temporal direito, creatino fosfoquinase sérica de 101 U/L e imagem de ressonância magnética com redução volumétrica e hiper-intensidade do sinal no núcleo caudado e putâmen bilateralmente.

Manejo farmacológico de algunos problemas asociados al trauma craneo-encefálico / Pharmacological management of several dysfunctions related to traumatic brain injury

El presente trabajo constituye una recopilación de los avances en el manejo farmacológico de varias disfunciones asociadas al traumatismo cerebral, en la fase sub-aguda de recuperación. Se ofrecen varias alternativas de tratamiento, debiendo considerarse una guía para el manejo terapéutico de pacientes con secuelas de trauma cráneo-encefálico en la etapa subaguda de rehabilitación

Treatment of various movement disorders with botulinum A toxin injection: an experience of 900 patients.

A prospective open study of botulinum toxin A treatment for patients with various movement disorders at Siriraj Hospital, Mahidol University was analysed to evaluate its efficacy. The grand total of 900 patients comprised of a) 592 patients (65.78 per cent) with hemifacial spasm; b) 92 patients (10.22 per cent) with occupational cramp; c) 79 patients (8.78 per cent) with blepharospasm and Meige syndrome; d) 72 patients (8.00 per cent) with spasmodic torticollis; e) 19 patients (2.11 per cent) with hemidystonia and generalised dystonia; f) 11 patients (1.22 per cent) with spasmodic dysphonia; g) 10 patients (1.11 per cent) with spastic hemiparesis; and h) 25 patients (2.78 per cent) with miscellaneous group (i.e. tics, Gilles de la Tourette, facial myokimia, benign fasciculation, etc.). The results of treatment for hemifacial spasm were classified as excellent in 486 patients (82.09 per cent), moderate improvement in 60 patients (10.14 per cent), mild improvement in 39 patients (6.59 per cent) and no improvement or worse in 7 patients (1.18 per cent). There were complications of mild transient facial weakness in 50 patients (8.45 per cent) and mild ptosis in 12 patients (2.02 per cent). The effect of botulinum toxin treatment lasted 3-6 months. In occupational cramp and spasmodic torticollis the good response rate was around two-thirds of all patients, whereas, blephalospasm, spasmodic dysphonia, spastic hemiparesis and tics responsed in 79-88 per cent of the patients. Botulinum toxin A injection is thus a simple, safe, and effective out-patient treatment for patients with various kinds of movement disorders but it is a costly therapy.

Tratamiento de las fluctuaciones motoras de la enfermedad de Parkinson con inyecciones subcutaneas de apomorfina / Treatment of motor fluctuations in Parkinson's disease with subcutaneous injections of apomorfine

Dieciseis pacientes con enfermedad de Parkinson y severas fluctuaciones motoras fueron tratados con inyecciones subcutáneas de apomorfina y seguidos prospectivamente durante un año. La utilización de la droga mejoró el número de hroas "off" diarias en un 52 por ciento; la eficacia del tratamiento se mantuvo constante al cabo de un año sin la aparición de tolerancia (ANOVA con mediciones repetidas p=0.0002). No se registraron efectos adversos severos que justificaran la suspensión del tratamiento. La apomorfina demostró ser una droga segura y eficaz en el tratamiento de las fluctuaciones motoras

Efecto de la apomorfina sobre monos hemiparkinsonianos evaluados por escala clínica: estudio preliminar de las discinesias / Effect of apomorphine in hemiparkinsonian monkeys assessed with a clinical scale: preliminar study of dyskinesias

El presente estudio fue realizado en cuatro monos hemiparkisonianos de cola corta Macaca arctoides, machos, adultos (12-15 años de edad), cuyos pesos oscilaban entre 10-13 Kg. Los animales fueron lesionados por inyección de 1-metil-4-fenil-1,2,3,6 tetrahidropiridina (MPTP) (0,4 mg/Kg) en la carótida interna derecha. Se realizó la evaluación con escala clínica para monos hemiparkinsonianos después de suministrar diferentes dosis de apomorfina (1,5-35µg/Kg), con el objetivo de evaluar el efecto de dichas dosis en la calidad y duración de la mejoría motora. Simultáneamente se registraron por dosis y por individuo la duración (min) de la mejoría motora, duración (min) y el tipo de discinesias. Los resultados mostraron diferencias entre dosis en la duración de la mejoría motora con un aumento de 30 seg por cada ug de incremento en la dosis. Las discinesias observadas fueron movimientos coreicos localizados en las extremidades superiores. Nuestros resultados concuerdan con los otros autores que reportan la duración de la respuesta la duración de la respuesta motora como un parámetro más sensible al cambio de dosis que la calidad de dicha mejoría evaluada por escala clínica

Un nuevo preparado de levodopa benserazida en parkinsonianos con fluctuaciones motoras refractarias a tratamientos con L-dopa standard / [A new levodopa benserazide preparation for Parkinson’s disease with motor fluctuations refractory to standard L-dopa]

As Parkinson’s disease worsens, many patients develop motor fluctuations which usually correlate directly or indirectly with L-dopa plasma levels. A new L-dopa-benserazide HBS preparation (Madopar) a control release pharmaceutical formulation which is activated when it contacts gastric fluid thus providing more stable L-dopa plasma levels, was assayed. Ten patients with a diagnosis of idiopathic Parkinson’s disease and motor fluctuations otherwise unresponsive to conventional therapy were selected. The average age was 62 years and the duration of the disease 9 years. The motor status was evaluated on an hourly basis with the King’s College Parkinson’s disease rating scale; in addition, a nocturnal disability scale (Lees) was used. Out of the 10 patients, 2 dropped out within the first month due to worsening of parkinsonian signs, while 7 of the remainders preferred HBS preparation to the previous treatment. The number of off hours in this group was reduced by 58

and motor fluctuation became less severe. In only 3 cases was it possible to use HBS as monotherapy while in the rest standard L-dopa had to be added, specially as morning doses. The average L-dopa daily dose was increased by 36

. Unwanted effects included psychiatric disturbances in two (in one L-dopa dose had to be reduced) and epigastralgia in one. Our findings suggest that this L-dopa-benserazide control release may be considered an able therapeutic formulation in the control of motor fluctuations in Parkinson’s disease.