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1.
Neurol Sci ; 33(2): 419-21, 2012 Apr.
Article in English | MEDLINE | ID: mdl-21898092

ABSTRACT

We describe a 43-year-old patient who experienced visual loss 4 years after beginning antiepileptic therapy with topiramate. Ophthalmological and neurological examinations led to a preliminary diagnosis of bilateral toxic optic neuritis. Mitochondrial genome sequence analysis detected a Leber hereditary optic neuropathy 11778G>A mutation. The possibility that topiramate might favor a conversion disease, alerts physicians to seek a history of blindness in patients undergoing chronic antiepileptic therapy.


Subject(s)
Anticonvulsants/adverse effects , Blindness/chemically induced , Fructose/analogs & derivatives , Optic Atrophy, Hereditary, Leber/complications , Adult , Blindness/genetics , Epilepsy/drug therapy , Epilepsy/genetics , Fructose/adverse effects , Humans , Male , Mutation , Optic Atrophy, Hereditary, Leber/genetics , Topiramate , Visual Fields/drug effects
2.
Amyotroph Lateral Scler ; 11(4): 359-63, 2010 Aug.
Article in English | MEDLINE | ID: mdl-19929745

ABSTRACT

Botulinum toxin type A (BoNT/A) has been proposed as an alternative treatment for sialorrhoea in patients with amyotrophic lateral sclerosis (ALS). In an open-label prospective study, BoNT/A was injected into the parotid glands bilaterally using anatomic landmarks in 26 ALS patients with bulbar symptoms. Two weeks after injection the severity of sialorrhoea and the related disability were evaluated subjectively and objectively. A group of healthy subjects acted as controls for saliva production. Patients also underwent electrophysiological tests to evaluate possible toxin effects in the nearby non-injected muscles by comparing the amplitude of compound motor action potentials (cMAPs) elicited by electrical stimulation and recorded from the orbicularis oculi and masseter muscles. After BoNT/A injections, of the 26 patients treated, 23 reported that the severity of sialorrhoea improved and the disabling symptoms diminished. Cotton roll weight also decreased after BoNT/A injection, suggesting a reduction in saliva production. Two patients complained of dry mouth. BoNT/A injection left the cMAP amplitude unchanged, suggesting that botulinum toxin does not significantly affect the non-injected facial and masticatory muscles. In conclusion, intraparotid anatomically-guided BoNT/A injection is an effective, easy, and safe treatment for sialorrhoea in patients with bulbar symptoms related to ALS.


Subject(s)
Botulinum Toxins, Type A/therapeutic use , Evoked Potentials, Motor/drug effects , Muscle, Skeletal/physiopathology , Neuromuscular Agents/therapeutic use , Sialorrhea/drug therapy , Aged , Aged, 80 and over , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/drug therapy , Botulinum Toxins, Type A/pharmacology , Case-Control Studies , Dose-Response Relationship, Drug , Electric Stimulation/methods , Electromyography/methods , Female , Humans , Male , Middle Aged , Neuromuscular Agents/pharmacology , Pain Measurement , Parotid Gland/drug effects , Parotid Gland/physiology , Prospective Studies , Sialorrhea/etiology
3.
Neurosci Lett ; 455(1): 1-3, 2009 May 08.
Article in English | MEDLINE | ID: mdl-19429094

ABSTRACT

Repetitive transcranial magnetic stimulation (rTMS) delivered in short trains at 5Hz frequency and suprathreshold intensity over the primary motor cortex (M1) in healthy subjects facilitates the motor-evoked potential (MEP) amplitude by increasing cortical excitability through mechanisms resembling short-term synaptic plasticity. In this study, to investigate whether rTES acts through similar mechanisms we compared the effects of rTMS and repetitive transcranial electrical stimulation (rTES) (10 stimuli-trains, 5Hz frequency, suprathreshold intensity) delivered over the M1 on the MEP amplitude. Four healthy subjects were studied in two separate sessions in a relaxed condition. rTMS and anodal rTES were delivered in trains to the left M1 over the motor area for evoking a MEP in the right first dorsal interosseous muscle. Changes in MEP size and latency during the course of the rTMS and rTES trains were compared. The possible effects of muscle activation on MEP amplitude were evaluated, and the possible effects of cutaneous trigeminal fibre activation on corticospinal excitability were excluded in a control experiment testing the MEP amplitude before and after supraorbital nerve repetitive electrical stimulation. Repeated measures analysis of variance (ANOVA) showed that rTES and rTMS trains elicited similar amplitude first MEPs and a similar magnitude MEP amplitude facilitation during the trains. rTES elicited a first MEP with a shorter latency than rTMS, without significant changes during the course of the train of stimuli. The MEP elicited by single-pulse TES delivered during muscle contraction had a smaller amplitude than the last MEP in the rTES trains. Repetitive supraorbital nerve stimulation left the conditioned MEP unchanged. Our results suggest that 5 Hz-rTES delivered in short trains increases cortical excitability and does so by acting on the excitatory interneurones probably through mechanisms similar to those underlying the rTMS-induced MEP facilitation.


Subject(s)
Evoked Potentials, Motor , Motor Cortex/physiology , Adult , Analysis of Variance , Electric Stimulation , Electromyography , Female , Humans , Male , Muscle Contraction , Muscle, Skeletal/innervation , Muscle, Skeletal/physiology , Transcranial Magnetic Stimulation
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