Mirtazapine in the treatment of essential tremor: an open-label, observer-blind study.

INTRODUCTION: Essential tremor (ET) is the most common movement disorder in the adult population. At present ET treatment shows limited efficacy, particularly in patients with severe and disabling symptoms. This study evaluates the clinical efficacy of mirtazapine in an untreated ET patient population. MATERIALS AND METHODS: 30 ET patients (female/male = 19/11; average age = 71.4 +/- 8.3 years) were examined by clinical criteria, electromyographic (EMG), and apomorphine tests to study the cortical silent period. The patients were all treated with mirtazapine 30 mg daily. RESULTS: Mirtazapine proved to be a good control agent for tremor symptomatology in 23/27 patients (85%) who completed 1 month of treatment, with a marked reduction of tremor; the benefit was maintained during the 12-month follow-up. No significant variation in EMG parameters was observed aside from two prevalent and distinct frequencies of tremors (5-6 Hz and 7-8 Hz) and a group of selected patients whose cortical silent period (SP) was markedly reduced. There were no clinical differences between the two subgroups. All apomorphine-tested patients showed an SP with no significant modifications. CONCLUSIONS: Mirtazapine proved to be an efficacious drug treatment for tremor symptoms in patients suffering from ET. It had limited side effects and excellent overall tolerability, could be used as daily monotherapy, and did not interfere with any of the many other medications being taken simultaneously by the patients.

Gabapentin in painful HIV-related neuropathy: a report of 19 patients, preliminary observations.

The objective of this study was to assess the efficacy and safety of Gabapentin as the sole analgesic in patients with HIV-related painful neuropathy. Nineteen patients with HIV-related painful neuropathy were administered Gabapentin. Efficacy was evaluated with two 100-mm Visual Analogue Scales (VAS) (0: no symptom; 100: worst symptom), rating pain and interference of pain with sleep, performed at baseline and monthly intervals. Main Pain VAS score decreased from a baseline of 55.7 +/- 19.1 mm to a final 14.7 +/- 18.6 mm (ANOVA P = 0.0001) and mean Sleep Interference VAS score decreased from a baseline of 60.4 +/- 31.9 mm to a final 15.5 +/- 27.7 mm (ANOVA P = 0.0001). Gabapentin provided significant pain relief in our patients with HIV-associated painful sensory neuropathy.

Basilar artery migraine: transcranial Doppler EEG and SPECT from the aura phase to the end.

Transcranial Doppler, electroencephalography, and single photon emission computed tomography were performed in a case of basilar migraine during the different phases of the attack. In the aura phase, the patient had bilateral blindness and ataxia. Doppler ultrasound studies showed a reduction in the mean flow velocity of the posterior cerebral arteries, electroencephalography showed slow activity confined to the posterior regions, and single photon emission computed tomography, an area of hypoperfusion in the right parietal and occipital regions. During the headache phase, when the neurological examination was normal, transcranial Doppler showed an increase in the mean flow velocity of both posterior cerebral arteries and the electroencephalogram revealed an increase in the slow activity over the occipital regions. When the pain subsided, the electroencephalogram showed a progressive reduction of the slow abnormalities and transcranial Doppler was reported as normal. After a week, single photon emission computed tomography and cranial magnetic resonance imaging were normal. After a month, a follow-up electroencephalogram was also normal. All these findings indicated a transient focal reduction of cerebral blood flow during the aura phase.

Dyskinesia of vascular origin. Clinical data and response to therapy in 7 cases.

Seven patients with dyskinesia due to cerebrovascular lesions are described. They presented hemichorea, hemiballism and focal dystonia; the site(s) of the lesion responsible, as defined by MRI (magnetic resonance imaging) or CT (computerized tomography) scan were the putamen, the caudatus, the thalamus and the subthalamic body of Luys. Data of similar cases in the literature are reviewed with reference to the location of the responsible lesions, which can aid in predicting the outcome of illness or prescribing treatment.

Transcranial Doppler monitoring of a migraine with aura attack from the prodromal phase to the end.

Transcranial Doppler sonography (TCD) was performed in a case of migraine with aura during the different phases of the attack. In the prodromic period our patient showed a slight central deficit of the seventh right cranial nerve and hypesthesia in her right arm. TCD indicated a remarkable decrease of the mean flow velocity (MFV) of the left middle cerebral artery (MCA). During the headache phase and when the signs and symptoms subsided, TCD showed an increase in MFV of both middle cerebral arteries with normal symmetry. An electroencephalogram (EEG) demonstrated a left temporal disorder. A month later a cranial CT scan, an EEG, and TCD were normal. In our opinion all these findings suggest a focal reduction in cerebral blood flow in the prodromic phase.

Acute cholangitis induced by carbamazepine.

We report a case of a patient with fever and intrahepatic cholestasis induced by carbamazepine (CBZ). This adverse reaction has been described in only a single case. We observed complete resolution of the hepatic damage once the agent was discontinued. CBZ rechallenge was followed by recurrence of all symptoms and abnormalities. Hepatic function improved again when CBZ was discontinued.

Brain contusion in minor cranial traumas.

Minor cranial traumas without surgical emergency account for about 4% of admissions to our Neurological Service. We consider here 226 consecutive cases. Investigations include: clinical examination, skull X-rays, CSF, EEG, CT, isotopic cisternography. The aim of this study is to define the clinical characteristics of patients with minor head trauma and the priority of instrumental investigations. Correlation between clinical and laboratory findings suggests that: X-ray examination is not predictive of CSF hemorrhage or brain contusion; the CSF is bloody in 1/3 of asymptomatic cases and in 1/6 of cases without fracture; the EEG shows indirect signs of brain contusion even in cases without CT evidence; small subdural hematomas are best diagnosed by CT scan.