ABSTRACT
Fifteen patients with chronic inflammatory demyelinating neuropathy (CIDP) were treated with pulse intravenous cyclophosphamide (IVCY) monthly for up to 6 months. Eleven patients reached a complete remission; only one patient worsened. Complications included nausea, vomiting, anemia, and hair loss. This case series suggests that monthly IVCY is beneficial in the treatment of CIDP and warrants a controlled study.
Subject(s)
Cyclophosphamide/administration & dosage , Demyelinating Diseases/drug therapy , Immunosuppressive Agents/administration & dosage , Polyneuropathies/drug therapy , Adult , Chronic Disease , Female , Humans , Injections, Intravenous , Male , Middle Aged , Pulsatile FlowABSTRACT
A 51 year old man developed progressive cranial and proximal muscle weakness, hyperreflexia and mental change. The disorder progressed over 9 days following the fifth weekly spraying with the organophosphate (OP) insecticide, phosmet, with limited symptoms of acute toxicity. Marked decremental responses of 50-80% on slow and fast rates of stimulation were improved to 15% by edrophonium or neostigmine. Intracellular recordings at the endplate region of intercostal muscle revealed small miniature endplate potentials (mepps), reduced mean acetylcholine sensitivity and normal membrane potentials. Electronmicroscopy revealed degeneration and regeneration of the endplates. This study demonstrates that OP poisoning due to phosmet can produce a subacute postsynaptic neuromuscular syndrome without marked symptoms of acute toxicity.
Subject(s)
Drug Overdose/physiopathology , Neuromuscular Diseases/chemically induced , Neuromuscular Junction/drug effects , Phosmet/poisoning , Synaptic Transmission/drug effects , Critical Care , Drug Overdose/diagnosis , Drug Overdose/therapy , Electromyography/drug effects , Humans , Male , Microscopy, Electron , Middle Aged , Motor Endplate/drug effects , Motor Endplate/physiopathology , Motor Endplate/ultrastructure , Muscles/innervation , Neurologic Examination/drug effects , Neuromuscular Diseases/diagnosis , Neuromuscular Diseases/physiopathology , Neuromuscular Diseases/therapy , Neuromuscular Junction/physiopathology , Peripheral Nerves/drug effects , Peripheral Nerves/physiopathology , Synaptic Transmission/physiologyABSTRACT
Although sleep disturbances following head injury are common, well-documented posttraumatic narcolepsy has rarely been reported. A patient with all four major features of narcolepsy following significant head injury is presented. Tissue typing revealed the presence of the human lymphocyte antigen DR2, which is strongly associated with idiopathic narcolepsy. Interaction between the brain injury and a genetic predisposition appears to be involved in the development of posttraumatic narcolepsy.
