Botulinum A toxin treatment for blepharospasm and Meige syndrome: report of 100 patients.

One hundred patients (9.09 per cent) with blepharospasm from a grand total of 1,100 patients (at the Movement Disorders Clinic at Siriraj Hospital) who had been treated with botulinum A toxin (BTX-A) injection between 1989 and 1996 were analysed. The 100 patients comprised 65 females and 35 males with a female to male ratio of 1.86:1. Their mean age was 53.3 years (S.D. 12.03). Sixty patients had idiopathic blepharospasm, 31 patients were diagnosed with Meige syndrome (blepharospasm plus oromandibular dystonia) and nine patients with segmental dystonia (Meige syndrome plus cervical dystonia). The mean duration of suffering was 39.22 months (S.D. 44.83). Each patient received 30-50 IU of BTX-A injections according to the standard Siriraj injection pattern. Nine patients were lost to follow-up. The results of BTX-A injection were classified as: excellent result (an improvement of more than 75 per cent) in 83.51 per cent; a good response (an improvement of 50-75 per cent) in 13.19 per cent; a moderate response (an improvement of 25-50 per cent) in 2.20 per cent; and minimal or no response in 1.10 per cent. The complications of BTX-A injection were transient minimal ptosis (9.89 per cent), transient double vision (1.10 per cent) and excessive lacrimation (1.10 per cent). The efficacy of BTX-A injection lasted one to two months in 1.10 per cent, two to three months in 23.08 per cent, three to four months in 45.05 per cent, four to five months in 16.48 per cent, five to six months in 4.40 per cent and more than six months in 9.89 per cent. Botulinum A toxin injection is a simple and effective out-patient treatment for patients with blepharospasm, causing no systemic side-effects and minor transient local complications. The only drawback of this treatment is its high cost (100 IU cost 300 US dollars).

Dementia in Thai patients with Parkinson's disease: analysis of 132 patients.

A cross-sectional design study was done at Siriraj Hospital from 1990 to 1994 to determine the prevalence of dementia in Thai patients with Parkinson's disease. There were 81 males and 51 females with a male to female sex ratio of 1.59:1. One hundred and thirty two patients with Parkinson's disease were enrolled in this study. The mean duration of illness was 3.5 (S.D. 3.53) years. All patients were screened for depression by using the Thai Geriatric Depression Scale and patients with Alzheimer's disease or stroke were excluded from the study. The Thai Mental State Examination (TMSE) is a standard test used in this study to identify dementia in Thai patients with Parkinson's disease. Thirty four patients (25.76 per cent) scored TMSE below 23 points (cut-off point for dementia) and were considered as having dementia. Twenty four patients (18.18 per cent) scored below 20 points and were considered as having severe dementia, 12 patients (9.09 per cent) scored between 20-22 points (classified as mild to moderate dementia). Thirty seven patients (28.03 per cent) were in the borderline group as they had TMSE scores between 23-25 points. Fifty nine patients (44.70 per cent) were determined as nondemented as their TMSE scores were over 25 points. The items of cognitive function tests in TMSE which were severely impaired in the demented group were recall, attention and calculation whereas registration was relatively unaffected. Orientation and language were moderately impaired in the demented group. Dementia in Thai patients with Parkinson's disease is a significant problem for long term care of patients because of its high prevalence (one-fourth of all patients) and nearly one-fifth had severe dementia. Prompt recognition and proper management of dementia are required for family members and medical personnel to handle patients with Parkinson's disease.

Dementia in Thai stroke survivors: analysis of 212 patients.

A cross-sectional designed study was done at Siriraj Hospital from 1990 to 1994 to determine the prevalence of dementia in Thai stroke survivors. Two hundred and twelve Thai stroke (both hemorrhage and infarction) survivors (132 males and 80 females) were enrolled in this study. The mean age of the study group was 62.78 (S.D. 11.12) years with the mean duration of stroke suffering of 2.09 (S.D. 2.74) years. All patients were screened for depression by using Thai Geriatric Depression Scale and patients with Alzheimer disease were excluded from the study. The Thai Mental State Examination (TMSE) is a standard test used in this study to identify stroke patients with dementia. Seventy stroke patients (33.02 per cent) scored below 23 points (cut-off point for dementia) and considered as dementia. Forty patients (18.88 per cent) scored below 20 points and were considered as having severe dementia, 30 patients (14.15 per cent) scored between 20-22 points (classified as mild to moderate dementia). Fifty-eight patients (27.36 per cent) were in the borderline group as they had TMSE scores between 23-25 points. Eighty four patients (39.62 per cent) of stroke survivors were determined as nondemented as their TMSE scores were over 25 points. The items of cognitive function tests in TMSE which were severely impaired in demented group were recall and calculation whereas registration and attention were relatively unaffected. Orientation and language were moderately impaired in the demented group.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of various movement disorders with botulinum A toxin injection: an experience of 900 patients.

A prospective open study of botulinum toxin A treatment for patients with various movement disorders at Siriraj Hospital, Mahidol University was analysed to evaluate its efficacy. The grand total of 900 patients comprised of a) 592 patients (65.78 per cent) with hemifacial spasm; b) 92 patients (10.22 per cent) with occupational cramp; c) 79 patients (8.78 per cent) with blepharospasm and Meige syndrome; d) 72 patients (8.00 per cent) with spasmodic torticollis; e) 19 patients (2.11 per cent) with hemidystonia and generalised dystonia; f) 11 patients (1.22 per cent) with spasmodic dysphonia; g) 10 patients (1.11 per cent) with spastic hemiparesis; and h) 25 patients (2.78 per cent) with miscellaneous group (i.e. tics, Gilles de la Tourette, facial myokimia, benign fasciculation, etc.). The results of treatment for hemifacial spasm were classified as excellent in 486 patients (82.09 per cent), moderate improvement in 60 patients (10.14 per cent), mild improvement in 39 patients (6.59 per cent) and no improvement or worse in 7 patients (1.18 per cent). There were complications of mild transient facial weakness in 50 patients (8.45 per cent) and mild ptosis in 12 patients (2.02 per cent). The effect of botulinum toxin treatment lasted 3-6 months. In occupational cramp and spasmodic torticollis the good response rate was around two-thirds of all patients, whereas, blephalospasm, spasmodic dysphonia, spastic hemiparesis and tics responsed in 79-88 per cent of the patients. Botulinum toxin A injection is thus a simple, safe, and effective out-patient treatment for patients with various kinds of movement disorders but it is a costly therapy.

Mitochondrial genome analysis in Kearns-Sayre syndrome.

We analysed the mitochondrial genome of one patient with chronic and progressive bilateral ophthalmoplegia. This patient also had abnormal EKG showing cardiac conduction defects and pigmentary retinopathy, suggestive of the Kearns-Sayre syndrome. On muscle biopsy, with Gomori trichrome stain, the fibers showed an increase in red-staining material in the intermyofibrillary network and the subsarcolemmal region. On electron microscopy, aggregations of abnormal mitochondria were demonstrated, confirming the diagnosis of mitochondrial myopathy. Analysis of mitochondrial DNA (mtDNA) from the patient and her mother showed no deleted mtDNA.