[Rivastigmine as adjunctive therapy in the therapeutic dilemma for the treatment of hallucinations due to Parkinson disease]. / Rivastigmine als ondersteuning bij het dilemma van de behandeling van hallucinaties optredend bij ziekte van Parkinson.

We report three cases of patients with Parkinson's disease without dementia, admitted to our hospital because of hallucinations. The anti-Parkinson medication was adapted and the patients started with rivastigmine. As a result, hallucinations no longer occurred. A 79 years old man also required short-term quetiapine because of agitation and anti-Parkinson doses were without side effects, as a result of which mobility improved. An 84 years old woman reported mild side effects of rivastigmine, without consequences, whereas her mobility appeared to be good. A 72 years old woman reported mild memory problems upon admission, which improved during admission, as did her mobility after increasing the anti-Parkinson medication doses. Treatment of rivastigmine can be useful in the therapeutic dilemma in the treatment of hallucinations in patients with Parkinson's disease (start anti-psychotic or reduce anti-Parkinson medication). In addition to adapting anti-Parkinson doses and sometimes short-term treating with an anti-psychotic, treatment with rivastigmine appears to be a quick improvement, without serious side effects. Also, mobility can improve, due to the possibility of increasing the anti-Parkinson doses, if necessary. Because of the many remaining questions, prospective randomised trials are needed.

Eletriptan for the treatment of migraine in patients with previous poor response or tolerance to oral sumatriptan.

To determine the tolerability and efficacy of eletriptan in patients who had discontinued oral sumatriptan due to lack of efficacy or intolerable adverse events (AEs) during previous clinical treatment (not a controlled trial). Eletriptan is a potent, selective 5-HT1B/1D receptor agonist with beneficial pharmacokinetic properties compared with sumatriptan. In a double-blind, parallel group, placebo-controlled multicentre study, patients with and without aura (n = 446) were randomized to 40 mg eletriptan (E40, n = 188), 80 mg eletriptan (E80, n = 171) or placebo (n = 87) for treatment of up to three migraine attacks. Two-hour headache response, based on first-dose, first-attack data, was 59% for eletriptan 40 mg, 70% for eletriptan 80 mg, and 30% for placebo (P < 0.0001 for both doses of eletriptan vs. PBO; P < 0.05 for E80 vs. E40). Onset of action was rapid, with 1-h headache response rates significantly superior for E40 and E80 vs. placebo (40%, 48%, 15%; P < 0.0005). Both E40 and E80 were significantly superior to placebo, based on first-dose, first-attack data, for 2-h pain-free response (35%, 42%, and 7%; P < 0.0001). Both E40 and E80 demonstrated significant consistency of response, with headache relief rates at 2 h on at least two of three attacks in 66% and 72% vs. 15% on placebo (P < 0.001). AEs were mild to moderate in severity and dose related. The most commonly reported AEs included nausea, vomiting, asthenia, and chest symptoms. E40 and E80 produce an effective response in patients who had previously discontinued treatment with sumatriptan due to lack of efficacy or side-effects.

A dose-comparison trial of topiramate as monotherapy in recently diagnosed partial epilepsy.

OBJECTIVE: To evaluate topiramate as monotherapy in adults and children with recently diagnosed, localization-related epilepsy, comparing two dosages of topiramate in a multicenter, randomized, double-blind study. METHODS: Adults and children (>/=3 years of age) were eligible if the maximum interval since epilepsy diagnosis was 3 years and patients had one to six partial-onset seizures during a 3-month retrospective baseline. At study entry, patients (N = 252) were untreated or receiving one antiepileptic drug for less than 1 month. After randomization to 50 or 500 mg/d topiramate (25 or 200 mg/d if weight

Ophthalmoplegic and lower cranial nerve variants merge into each other and into classical Guillain-Barré syndrome.

We delineated the place of cranial nerve variants within the concept of clinically defined Guillain-Barre syndrome (GBS). In the ophthalmoplegic variant (n = 7) the oculomotor nerves were early involved. In a lower cranial nerve variant (n = 9) the cranial nerves IX, X, and XI were early involved. During progression considerable overlap occurred between these two variants, but also with the classically ascending variant of clinically defined GBS. These findings indicate common immune mechanisms in all GBS variants.

Cognitive function in early adult and adult onset myotonic dystrophy.

INTRODUCTION: Most studies revealing intellectual deficits in myotonic dystrophy (MyD) involved heterogeneous groups of patients with respect to intelligence and onset of disease. The present study was undertaken to investigate whether patients with early adult and adult MyD show subtle cognitive deficits despite a normal intelligence. MATERIALS AND METHODS: We compared 26 MyD patients of normal intelligence with mild symptoms and early adult and adult onset to 25 matched control subjects (CS) on a range of neuropsychological tests and a number of motor tasks of increasing complexity, which required increasing cognitive control. RESULTS: The groups did not differ as far as the neuropsychological tests were concerned, with the exception of the Stroop Color Word Test. With respect to motor performance, the MyD patients were poorer scorers on simple and automatic motor tasks than CS, but the difference disappeared as the complexity of the tasks increased and required correspondingly more cognitive control. CONCLUSION: We found hardly any evidence of cognitive dysfunction in our group of MyD patients with early adult and adult onset.

Aseptic spondylodiscitis: a complication of chemonucleolysis? A case report.

Discitis after intradiscal injection of chymodiactin is nearly always associated with an infection introduced by the needle tip. The authors report a patient with a postchemonucleolysis spondylodiscitis who recovered complete without surgery or antibiotics. The clinical findings and results of CRP and MRI suggested an aseptic spondylodiscitis due to chymodiactin.

Foveal photopigment kinetics--abnormality: an early sign in myotonic dystrophy?

Twelve subjects with minimal expression of the myotonic dystrophy (MyD) gene were investigated by retinal densitometry, a technique which has been used to study the properties of photopigments in the living eye and to detect photoreceptor abnormalities. Other investigations included slit-lamp examination, funduscopy, raleigh matches with the anomaloscope, tonometry, and neurological examination, including electroretinography (ERG) and pattern visual evoked potentials recording. Foveal densitometry demonstrated reduced values of the macular photopigment density difference with normal photopigment kinetics in early phases of the disease, even in asymptomatic individuals. The densitometric values correlated with decreased amplitudes of the photopic ERG a-wave. These findings may be explained by loss or dysfunction of the outer segments of foveal receptors. It is yet unknown whether or not these changes are secondary to other observed neuroretinal abnormalities in MyD. The most likely explanation might be an abnormality of the Na, Ca:K exchanger at the level of the outer segments of the photoreceptors whether or not in combination with a dysfunction of voltage generation systems, involving both photoreceptors and retinal pigment epithelium.

Oculomotor, auditory, and vestibular responses in myotonic dystrophy.

In 13 patients with myotonic dystrophy, oculomotor, auditory, and vestibular tests were performed. All 13 patients showed one or more abnormalities. There was a significant increase in the penetrance of the separate abnormalities with age. Saccadic slowing was found in 10 patients, in a severe form in three. Seven patients had a sensorineural high-tone hearing loss (30 to 85 dB at 8 kHz), which was in excess of that expected for their age, that could be attributed to myotonic dystrophy. Brain-stem auditory evoked potentials showed a significant interwave delay of the I-V interval (0.35 to 0.7 milliseconds). An abnormal vestibulo-ocular reflex was found in six patients; three had vestibular hyperreflexia with increased gain, and three had hyporeflexia with short time constants. This study confirms that in myotonic dystrophy, sensory system involvement can be found on both a peripheral and a central level.

Eye movement disorder: an early expression of the myotonic dystrophy gene?

Eye movement recording (EMR) has been performed in 5 asymptomatic myotonic dystrophy (MyD) gene carriers, 7 mildly affected MyD patients, and 23 age- and sex-matched healthy controls. The purpose of the study was to evaluate whether eye movement abnormalities are an early expression of the MyD gene, and to determine the value of this procedure for detection of otherwise asymptomatic gene carriers. EMR did not reveal any abnormalities in the asymptomatic group, but in the mildly affected group showed significantly (P less than 0.01) decreased maximum velocities of the saccades, compared with controls. The results indicate that EMR may aid in the detection of mildly affected MyD patients. However, true presymptomatic diagnosis with EMR has not yet proven possible.

[Balloon embolization of a large carotid-cavernous fistula]. / Ballonembolisatie van een grote carotico-caverneuze fistel.

A 58-year-old male patient with a giant carotid-cavernous fistula was treated by means of endovascular balloon embolisation. The fistula was closed, and good antegrade flow in the carotid artery and intracranial vessels was obtained. Based on this case history, the pathophysiology, ultrasonographic and angiographic evaluation and treatment options are reviewed.

[The value of tumor markers in germ cell tumors]. / De waarde van tumormarkers bij kiemceltumoren.

We present a patient with a germ cell tumour in the region of the pineal gland and discuss the symptomatology and diagnostic procedures of tumours in this region, emphasizing the value of tumourmarker determinations in serum and cerebrospinal fluid.

[The exploding head syndrome]. / Het syndroom van het exploderend hoofd.

The case is reported of a 47-year old female suffering from the exploding head syndrome. This syndrome consists of a sudden awakening due to a loud noise shortly after falling asleep, sometimes accompanied by a flash of light. The patient is anxious and experiences palpitations and excessive sweating. Most patients are more than fifty years of age. Further investigations do not reveal any abnormality. The pathogenesis is unknown, and no therapy other than reassurance is necessary.

Disorders of eye movement in myotonic dystrophy.

Horizontal saccades and smooth pursuit eye movements were studied in 26 patients with myotonic dystrophy. Clinical neuro-ophthalmological investigations in 1 patient revealed an inability to achieve a full range of eye movements. Electro-oculography showed a significant decrease of the maximum velocity of the visually-guided saccades in 83% of the patients. Smooth pursuit eye movements were not significantly different from age-matched controls. Visual evoked potential (VEP) latencies (P100) were significantly prolonged compared with controls in 64% of the patients. The saccadic latency of the visually-guided saccades was correlated with the prolonged VEP latencies, indicating that lesions in the primary visual pathways probably contribute to the oculomotor dysfunction. The isolated decrease of the maximum velocity of the saccades in combination with EMG findings favours a peripheral (dystrophic) pathophysiological mechanism.

Crural and axial myoclonic dystonia following meralgia paraesthetica.

A 49-year-old man developed a syndrome of crural-axial dystonia combined with segmental myoclonus 3 months after the onset of meralgia paraesthetica of the left leg. The association of this remarkable movement disorder with the pain syndrome is discussed.

Migrant sensory neuritis of Wartenberg. A case history.

A case history of a patient with a Migrant sensory neuritis of Wartenberg is presented. In this syndrome several isolated cutaneous nerves are affected, apparently due to traction lesions. This benign disease should be differentiated from other, more serious neurological diseases.

Rapid diagnosis of herpes encephalitis by enzyme immuno-assay.

Five cases of encephalitis caused by herpes simplex virus (HSV) are described. HSV-specific IgM and IgM antibodies were detected in cerebrospinal fluid and serum by use of antibody-capture noncompetitive enzyme-linked immunosorbent assay. The tests seem suitable for rapid diagnosis in the second week after onset of neurological symptoms. The clinical importance of early diagnosis and therapy in patients of HSV encephalitis has been discussed.

Octavus nerve neurovascular compression syndrome.

The octavus nerve neurovascular compression syndrome is a neuropathy of the 8th cranial nerve caused by vascular compression. The clinical, neurophysiological and therapeutic aspects of this syndrome will be discussed on the basis of 10 patients.

Locked-in syndrome associated with ocular bobbing.

Locked-in syndrome together with an ocular bobbing phenomenon was observed in a 41-year-old man, an association which has not been reported earlier. Computerized tomography demonstrated an infarction of the medio-ventral portion of the pons. The patient survived and is still alive ten months after the onset of the disease with severe neurological deficit.