[Differentiation of atypical Parkinson syndrome and delineation from idiopathic Parkinson syndrome with routine magnetic resonance tomography]. / Differenzierung atypischer Parkinson-Syndrome und ihre Abgrenzung vom idiopathischen Parkinson-Syndrom mit Hilfe der Routine-Magnetresonanztomographie.

Atrophy of frontal lobe, midbrain, pons, and cerebellum was studied in 16 patients with progressive supranuclear palsy (PSP), 14 with multiple system atrophy of striatonigral type (MSA-P), 20 with idiopathic Parkinson's disease (IPS), and 12 age-matched healthy controls using axial T2-weighted MR images (1.5 Teslar). With <16 mm, the PSP group showed significantly lower anteroposterior midbrain diameters than the IPS, MSA-P, and control groups. We conclude that measurement of the anteroposterior diameter of the midbrain with axial T2-weighted MRI is a useful feature and should be incorporated into the diagnostic criteria for PSP. In addition to the typical slit hyperintensity in margin of putamen and decreased signal intensity in dorsolateral putamen, we found cerebellar atrophy in 64% of patients with MSA-P. Before now, this was considered a typical sign of multiple system atrophy of cerebellar type (MSA-C). The use of this feature in the differential diagnosis of both types of multiple system atrophy is debatable.

Psychopathological symptoms of depression in Parkinson's disease compared to major depression.

Parkinson's disease is frequently associated with depressive symptoms. When depression occurs at early stages and before the onset of characteristic motor symptoms of the disease, differential diagnosis of major depression may be difficult. Differences in psychopathological features of depression in Parkinson's disease and major depression have been reported by some authors. This study presents data of 49 patients with depression in Parkinson's disease and 38 patients with major depression. The severity of depressive symptoms was equivalent in both groups. Depressive features did not differ between the two groups with exception of affective flattening, delusional ideas and suicide attempts. In conclusion, this investigation gives support to the assumption of a common neurobiological origin of depression in Parkinson's disease and major depression.

Differentiation of parkinsonian syndromes according to differences in executive functions.

Groups of patients with Parkinson's disease (PD), striatonigral degeneration-type multiple system atrophy (MSA) or progressive supranuclear palsy (PSP) with motor disability stages II and III according to Hoehn and Yahr, and a healthy control group were compared using neuropsychological tests of executive functions. The results indicate that all three patient groups were impaired in the tests of executive functions. In comparison with healthy subjects, the three patient groups showed impaired performance regarding verbal fluency, problem solving and verbal and figural working memory. Patients with PD differed significantly from healthy subjects in a test of verbal recency, while patients with MSA or PSP were unimpaired. The comparison of patient groups revealed no differences between PD and MSA patients. However, patients with PSP showed greater impairment in both phonemic and semantic fluency than patients with PD or MSA. Using discriminant function analysis, it was found that variables derived from four verbal fluency tasks (simple and alternate semantic and phonemic fluency) discriminated among the three patient groups at a level significantly exceeding chance. Over 90% of patients with PSP were correctly classified. Patients with PD and MSA were correctly classified in over 70% of cases. These results suggest that verbal fluency tasks may be sensitive measures in the differential diagnosis of PD, MSA and PSP.

Identification of the dopaminergic neurotoxin 1-trichloromethyl-1,2, 3,4-tetrahydro-beta-carboline in human blood after intake of the hypnotic chloral hydrate.

1-Trichloromethyl-1,2,3,4-tetrahydro-beta-carboline (TaClo), a potent toxin toward dopaminergic neurons, readily originates in vitro from the biogenic amine tryptamine and the unnatural aldehyde chloral. For this reason, this heterocycle has been postulated to be formed endogenously in humans after administration of the hypnotic chloral hydrate or after exposure to the industrial solvent trichloroethylene by a spontaneous chemical ring closure reaction. In this paper, we report on the first identification of TaClo in blood samples of patients treated orally with chloral hydrate. Using a specific and sensitive gas chromatographic screening procedure based upon electron-capture and mass-selective detection, TaClo was determined after conversion to its volatile trifluoroacetyl derivative. The identity of TaClo in humans was clearly demonstrated by GC-MS analysis in selected-ion-monitoring mode, by the characteristic chlorine isotopic pattern of the molecular ion.

[Effect of early diagnosis and therapy on prognosis of Parkinson syndrome]. / Der Einfluss von Frühdiagnostik und Therapie auf die Prognose des Parkinson-Syndroms.

Parkinson's disease is a chronic-progressive neuro-degenerative syndrome, which should be diagnosed as early as possible because of the therapeutic success in the beginning. Knowing the initial symptoms and using modern technical devices like SPECT and PET we shall be able to influence the course and the prognosis of the disease positively. The application of a current combined drug-therapy and in addition physiotherapy, speech-therapy and psychotherapy enable us to provide quality of life or to restore it. Repeated treatments in Parkinson medical centers intensify the efficacy of therapeutic efforts. Nevertheless even in early stages patients and physicians can be confronted with social medical problems like defining the degree of disability or the time for receiving a pension. The knowledge of specific disease-related findings will help to judge all these problems in accordance with the needs of the patients.

Clinical features and medical treatment of Parkinson's disease in patient groups selected in accordance with age at onset.

In a recent hospital-based study on patients with different age at onset of PD, some clinical and therapeutic features were investigated. In the retrospective analysis three groups were selected: age at onset between 20 and 39 years (young onset), between 40 and 59 years, and from 60 years and up. The evaluation of our data demonstrates some significant differences in the above-mentioned groups: prevalence of male patients and more frequent occurrence of motor fluctuations and dyskinesias in the young onset group, longer duration of PD and L-DOPA treatment, higher L-DOPA dosage, and more multiple combinations in this group. We also noted more habitual smokers in the young onset group. Sex-specific differences in the young onset group were also investigated. A longer duration of disease was found in women, and some symptoms, such as pulsion and freezing and biphasic dyskinesia, are more frequent in women.

R-(-)-deprenyl in the treatment of end-of-dose akinesia.

In two trials, we have studied the effectiveness and tolerability of L-deprenyl, a selective MAO B inhibitor, in the treatment of end of dose akinesia in patients with Parkinson's disease. The first trial was designed as an open controlled trial. In the L-deprenyl phase, an improvement in fluctuations in motor function as well as an overall reduction in the sum score of Webster's rating scale from 12.5 to 8.9 was observed, which almost returned to baseline during the placebo phase. The second trial was designed as a randomized trial comparing L-deprenyl therapy with a low-dose bromocriptine regimen. Both therapeutic approaches yielded the same results with respect to fluctuations; the CURS sum score dropped from 37 to 26. As regards tolerability, however, L-deprenyl was superior to bromocriptine.

[Clinical experience with tiapride in the treatment of extrapyramidal syndromes]. / Expérience clinique du tiapride dans le traitement des syndromes extrapyramidaux.

Tiapride was given at an average dosage of 300-900 mg per day, intramuscularly for the first three days, then by oral route, to 62 patients with abnormal movements of various types. The best responses were recorded in chorea and bucco-lingua-facial dyskinesia as well as in dyskinetic movements induced by levo-dopa in Parkinson patients. Clinical and biological tolerance of tiapride was excellent, with only one case of drowsiness and two cases of galactorrhea.

Chromosome changes in subacute sclerosing panencephalitis.

In two out of a total of 6 cases of subacute sclerosing panencephalitis with manifest chromosome alterations, chromosome studies were repeated 4 and 5 years of standing, respectively, after manifestation of the disease. In one case the incidence of chromosome alterations increased while in the other no change was found. Both cases were clinically similar in their history with remission.