In vivo proton magnetic resonance spectroscopy in patients with neuroacanthocytosis.

We report the 'H-Magnetic Resonance Spectroscopy findings in two siblings with neuroacanthocytosis (NAC), along with six matched controls. Proton spectra recorded from single voxels containing putamen and globus pallidus showed a significantly higher intensity of myoinositol and choline peaks in patients when compared with controls. The myoinositol/creatine, myoinositol/N-acetyl-aspartate, and choline/creatine ratios were significantly higher in the patients than in the controls. Although the increased myoinositol signal could be a non-specific finding, it could not be excluded that it had a possible role in the pathogenesis of NAC.

Calcium channel blocker-induced parkinsonism: clinical features and comparisons with Parkinson's disease.

Parkinsonism is a frequent side effect of some calcium channel blockers (CCB). CCB-induced parkinsonism (CCBIP) usually improves spontaneously after discontinuation of the offending drug, but many patients exhibit persistent symptoms. It is not known whether CCBIP represents subclinical idiopathic Parkinson's disease (IPD) unmasked by drugs. We prospectively studied (mean follow-up 18.9+/-13months) the spontaneous evolution of 36 patients with CCBIP, and compared the clinical and epidemiological characteristics with those of 38 patients with IPD. Most patients with CCBIP improved spontaneously. Twenty-four months after CCB withdrawal, only 14% exhibited akinetic rigid syndrome, but 92% of patients still had tremor. The CCBIP group differed from the IPD group in: age at onset (70.8+/-8.2 versus 59.1+/-10years, p<0.001), gender (30/36 female versus 20/38 male, p<0.01), presenting symptom (tremor at first evaluation: 34/36 in CCBIP versus 28/38 in IPD, p<0.03) and history of arterial hypertension (21/36 versus 7/38, p<0.001). Asymmetrical onset of symptoms was frequent in IPD, but not in the CCBIP group (24/38 versus 13/36, p<0.05).

Clinical features of essential tremor seen in neurology practice: a study of 357 patients.

To assess the clinical features of essential tremor (ET), we studied 357 patients with diagnostic criteria for this disease who were referred to the Neurology departments of three urban hospitals. This is not a true epidemiological study, and can be biased in favour of patients with functional disability. There was a predominance of affectation of females and a peak of age at onset in the sixth and seventh decades. Family history of tremor was positive in 46.8% of patients. Females showed a a significantly higher frequency of inheritance through maternal than through paternal line, and had a higher frequency of head and voice tremor, than males. When compared with patients without family history, those with family history of tremor had lower age at onset of tremor, and lower frequency of jaw and trunk tremor in non-familial cases.