A placebo-controlled evaluation of ropinirole, a novel D2 agonist, as sole dopaminergic therapy in Parkinson's disease.

The efficacy and safety of ropinirole, a novel nonergot dopamine D2-like receptor agonist, was assessed as monotherapy for the treatment of patients with early-stage Parkinson's disease. In this double-blind, multicenter trial, patients were randomly allocated in a ratio of 2:1 to receive, over a 12-week period, either ropinirole or placebo. Clinical status was assessed using the Unified Parkinson's Disease Rating Scale (UP-DRS), Clinician's Global Evaluation (CGE), and a finger-tapping score. In all, 41 patients received ropinirole and 22 received placebo. The end-point analysis, on an intention-to-treat basis, revealed a significant difference (p = 0.018) in improvement in UP-DRS motor score from baseline between treatment groups (ropinirole, 43.4%; and placebo, 21.0%). Other parameters, including the number of responders and improvement in CGE, showed similar results. Three patients in the ropinirole group and one patient in the placebo group discontinued the study because of adverse events. There was no significant difference between the treatment groups in the overall incidence of adverse events. Although the dopaminergic side effects were reported significantly more frequently in the ropinirole group than in the placebo group (dizziness, p = 0.0326; nausea, p = 0.001; and somnolence, p = 0.005), none necessitated study withdrawal. There was no evidence of any chronic effect of the study medication on vital signs. In conclusion, ropinirole is a safe and well-tolerated drug and, as monotherapy, provided significant therapeutic benefit compared with placebo to patients in the early stages of Parkinson's disease.

Treatment of neurosyphilis. A comparison of penicillin regimens.

Recommendations for treatment of neurosyphilis and reasons for renewed debate are briefly reviewed and discussed. Experience with 11 patients with neurosyphilis who were treated with different preparations of penicillin by different routes of administration is recorded. The concentration of penicillin was measured in the serum and cerebrospinal fluid in each case. Very high levels were attained by the intravenous administration of penicillin G, but in the follow-up period of 1 year this has not been shown to confer any advantage. The administration of procaine penicillin 1.2 million U intramuscularly daily for 20 days is as effective as a dosage schedule which requires admission to hospital for intravenous administration.

Cellular hypersensitivity to brain antigen in children of a family with hereditary ataxia.

Sensitisation to brain antigen was demonstrated in eight of 24 clinically normal first generation children in a family with hereditary ataxia. This ratio is consistent with that expected in a dominantly inherited condition. It suggests that immunological reactivity may precede the clinical expression of disease, with important implications for presymptomatic diagnosis and for pathogenesis of degenerative disease.

Vestibular dysfunction in hereditary ataxia.

A kindred with a unique autosomal dominantly inherited ataxia of late onset is described. Manifestations of the condition include defective optokinetic nystagmus and absent or abnormal oculo-vestibular responses, in association with normal cochlear function. It is possible that these latter features may serve as "markers" to indicate the presence of the disease in presymptomatic young adults, thereby facilitating important genetic counseling.