Assessment of sexual dysfunction in patients with Parkinson's disease: a case-control study.

BACKGROUND: Sexual dysfunction (SD) in patients with Parkinson's disease (PD) has not been very well studied, as most of the research has methodological restrictions like having no control group, using invalid assessment tools, unidimensional investigation of sexual functions and inclusion of males/females only. This study aimed to examine different sexual functions in patients with PD and compare with matched non-parkinsonian controls by using a valid instrument. Predicting factors of SD in PD were also investigated. METHODS: The sample consisted of 45 patients with PD and 45 age- and sex-matched healthy controls. Sexual functions were evaluated by Arizona Sexual Experiences Scale (ASEX). RESULTS: Female patients had reduced sexual drive and they were less satisfied with orgasm, while male patients had easier orgasms than did the controls. Regression analysis identified increased age and female sex predictive of reduced sexual drive and sexual arousal. Ability to reach orgasm and satisfaction with orgasm were associated with female sex, while erection/lubrication was associated with marital status. The severity and duration of PD, as well as the severity of anxiety and depression were not associated with SD. CONCLUSION: Using ASEX in the detection of SD in PD might be important in directing patients to further evaluation and treatment.

Visual evoked potentials in Parkinson's disease-correlation with clinical involvement.

A total of 18 patients with Parkinson's disease were evaluated clinically and by transient checker-board VEP study. There were significant differences between bradykinesia (P<0.01), rigidity (P<0.02), and tremor (P<0.05) subscores of the more and less severely affected sides. There were no asymmetry of VEP latency or amplitude between the more and less severely affected sides by stimulation of the corresponding eye. There were no significant correlations between the VEP latency or amplitude and any of the clinical features except the bradykinesia scores. The bradykinesia scores on the more severely involved side (r: 0.57; P=0.014) and less severely involved side (r: 0.82; P=0.00003) showed medium to high degree positive correlations with VEP amplitudes by stimulation of the corresponding eye. By studying monocular fullfield responses our data can only suggest that there is no prechiasmal asymmetry. The positive correlation between the VEP amplitude and bradykinesia score might indicate that D2 receptors dominate in the retina.

Antioxidant status in cerebrovascular accident.

Ischemia is associated with the pathological changes caused by the accumulation of reactive oxygen metabolites (ROM) in cerebrovascular accident (CVA). The aim of this study was to determine red cell copper/zinc-superoxide dismutase (Cu/Zn-SOD) and catalase activities and copper and zinc concentrations both in plasma and in red cells in CVA. Cu/Zn-SOD and catalase activities of 16 patients, with an average age of 64 yr, were measured spectrophotometrically; copper and zinc concentrations were determined by atomic absorption spectrophotometer. The results showed that Cu/Zn-SOD activity was increased markedly in patients compared to the young controls and reached a peak on the d 5 of the disease, whereas the catalase activity of the patients on d 3 and d 5 were in the normal range, but higher on d 10. The enzyme activities of the elderly group were generally increased compared to the young controls. Copper and zinc concentrations showed corresponding alterations. These findings suggested that the effects of oxidative stress in CVA might be reflected in red cell and plasma parameters.

Erythrocyte superoxide dismutase activity differs in clinical subgroups of Parkinson's disease patients.

There is controversy as to whether there are clinical subgroups in Parkinson's disease (PD). Six tremor-dominant and six bradykinesia-dominant patients identified among 29 cases with PD were compared in terms of erythrocyte superoxide dismutase (SOD) activity and several clinical variables. Erythrocyte SOD activity in tremor-dominant patients was higher than in bradykinesia-dominant patients. According to our preliminary results obtained from small number of patients, the difference of SOD activity in clinically distinct subgroups suggests there may be separate clinical subgroups of PD which can be differentiated by a biological marker.

Hemidystonia secondary to cervical demyelinating lesions.

Hemidystonia is usually associated with a structural lesion in the contralateral basal ganglia. We report a patient with definite multiple sclerosis, according to Poser's criteria, presenting with an acute-onset sustained left hemidystonia. Cranial T2-weighted magnetic resonance imaging (MRI) showed several hyperintense lesions in the centri semiovali and in the periventricular area without basal ganglia involvement. Moreover cervical spinal cord T2-weighted MRI showed two hyperintense lesions in the left posterolateral spine at C2 and C3, and one lesion in the right posterolateral spine at C4 levels. The hemidystonia improved completely after daily treatment with 1000 mg of methylprednisolone, and cervical MRI was performed after the improvement which showed that the lesions had become smaller and less intense. Finally we consider that the hemidystonia may be caused by the cervical spinal cord lesions of multiple sclerosis.

Familial cerebellar ataxia and hypogonadism associated with sensorimotor axonal polyneuropathy.

In this article, we report two siblings who have familial cerebellar ataxia and hypogonadism associated with sensorimotor axonal polyneuropathy documented by light microscopy. This combination has not been reported previously in the literature. Cerebellar ataxia and hypogonadism is reviewed according to the clinical and laboratory features of the reported cases in the literature.

Difference of disability between electrophysiologic subgroups of essential tremor.

OBJECTIVE: The aim of the study was to test the validity of the controversial subdivision of essential tremor (ET) patients into electrophysiological subgroups. METHODS: We evaluated a hundred patients with ET using surface electromyographic (EMG) recordings of antagonists forearm muscles and distinguished three groups: the first group showed synchronous activity of antagonistic muscles, the second showed alternating activity of antagonist muscles; and the third group consisted of patients whose EMG recordings were not compatible with the other two groups. We compared patients with synchronous and alternating activity in terms of sex, age at onset, duration of illness, family history of tremor, symmetry and frequency of tremor, and the scores of a disability scale. RESULTS: The only significant difference between the patients with synchronous and alternating activity was that the patients with synchronous activity were more disabled. CONCLUSION: This result adds to the evidence for distinct electrophysiological subgroups of ET with distinct clinical properties.

Tardive dyskinesia, mild drug-induced dyskinesia, and drug-induced parkinsonism: risk factors and topographic distribution.

This study attempted to contribute to the subtyping of tardive dyskinesia (TD) by studying the effects of age, sex, psychiatric diagnosis and duration of illness on the severity and topographic distribution of dyskinesia, and to describe the topographic distribution of drug-induced dyskinesia (DID) and drug-induced parkinsonism (DIP) in detail by examining 170 consecutive inpatients on antipsychotic treatment. Age, sex, psychiatric diagnosis or total duration of exposure to antipsychotics had no significant effect on either the severity or the distribution of DID. Drug-induced dyskinesia and DIP did not show a conspicuous pattern of lateralisation. Progression of mild DID to TD may not be a rule and factors other than age, sex, psychiatric diagnosis or duration of antipsychotic exposure might be operating in the development of clinically significant TD. Gait abnormalities and falls might be frequent manifestations of DIP as well as other side effects in these patients.

Stereotactic ventral intermedial thalamotomy for the treatment of essential tremor: results of a series of 37 patients.

We have analyzed 43 ventral intermediate thalamotomies performed in our center for treatment of medically intractable essential tremor (ET) in 37 patients. The mean age of patients was 70.9 years (range 42-84), duration of symptoms 33.3 years (1-65). The surgery in all cases was performed with stereotactic technique using MRI or CT localization. Intraoperative neurophysiological confirmation of the target location was obtained using a macrostimulation technique. All patients experienced either complete abolition of the contralateral tremor or significant improvement in tremor intensity immediately after the surgery. At follow-up examination 1-13 months after the operation, 60.5% of patients had no tremor, and 13.9% had mild residual tremor without interference with daily life. Tremor recurrence was observed in 5 patients, all of whom underwent repeat ventral intermedial (VIM) thalamotomy with excellent results. Transient problems with speech and motor functions were observed after 15 thalamotomies, permanent hemiparesis and speech difficulties were seen in 6 patients. We conclude that VIM thalamotomy is a highly effective procedure for medically intractable ET and may be performed with no mortality and low morbidity rate.

Cavernous angioma presenting with hemidystonia.

We present a 34-year-old woman with right hemidystonia. She had a cavernous angioma (CA) of left thalamo-mesencephalic junction, revealed by magnetic resonance imaging (MRI). Her symptoms were moderately alleviated by biperiden 20 mg daily. We identified 11 patients reported in the literature to have movement disorders due to a cavernous angioma. None of them presented with hemidystonia. Some clinical properties of patients with CA associated with a movement disorder were evaluated.