[Parkinson's disease: from pallidotomy to L-dopa and back to pallidotomy]. / Enfermedad de Parkinson. De la palidotomía a la Levodopa y de vuelta a la palidotomía.

Until the introduction of L-dopa in the therapeutics of idiopathic Parkinson's disease (IPD) at the end of the 60's, treatment was essentially limited to anticholinergic drugs and surgical procedures devised to produce discrete lesions in the pallidum, ansa lenticularis and thalamus. L-dopa, associated with dopa decarboxylase inhibitors and dopaminergic agonists, gave rise to an almost complete standstill of surgical procedures. Nevertheless, natural progression of IPD with motor fluctuations and the appearance of L-dopa related abnormal involuntary movements caused surgery to reappear as a primary treatment option. The MPTP epidemic in heroin addicts was responsible for obtaining an experimental model of IPD and became the starting point for a wealth of information concerning the physiopathology of basal ganglia circuitry, neurotransmitters and specific dopaminergic, gabaergic and glutamaergic receptor subtypes involved in motor control. This information, in the context of new stereotactic techniques with modern neuroimaging, enabled old surgical procedures on the internal globus pallidus (Gpi) and thalamus to be reformulated. Additional neurophysiological guidance further improved accuracy in target finding thereby giving rise to impressive results in the symptomatic improvement of IPD including L-dopa induced dyskinesias.

[Treatment of blepharospasm with botulinum toxin]. / Tratamiento del blefaroespasmo con toxina botulínica.

Blepharospasm is a relatively frequent cranial dystonia which may be seen either alone or related to orofacial-mandibular dystonia (Meige's syndrome). In its maximum degree it can cause functional blindness.Twelve patients with blepharospasm (4 essential and 8 Meige's syndrome) who had been previously treated unsuccessfully with drugs (trihexyphenidyl, biperiden, carbamazepine, lithium, baclofen, lisuride, imipramine, clonazepam and butyrophenones) were treated for 12 months with periocular injections of botulinum toxin (BOTOX). A "low" dose of 12,5 U per eye was employed. With this dose, eleven out of twelve patients experienced significant improvement which lasted from five to fifteen weeks. The only nonresponder obtained complete relief upon duplicating the dose. The only side effect was uni or bilateral ptosis in six patients which improved completely in seven to twenty one days. One patient developed a peripheral facial palsy with complete remission in nineteen days. No systemic side effects were noted. There was only one desertion from this study due to depression enhanced by prolonged (21 days) ptosis. All patients (including the deserter) agreed that treatment with BOTOX provided more relief than any other previous therapeutic method. Our results confirm those obtained by others but a more prolonged study is needed to better evaluate long term effects.

Tratamiento del blefaroespasmo con toxina botulínica / Treatment of blepharospam with botulinum toxin

El blefaroespasmo, ya sea aislado o en el contexto de una disquinesia oro-facio-mandibular (síndrome de Meige) es una distonía cranial relativamente frecuente. En su máxima expresión puede dar origen a marcada minusvalía e incluso ceguera funcional. Doce pacientes con respuesta poco satisfactoria a tratamientos medicamentosos (trihexifenidilo, hiperideno, imipramina, carbamazepina, baclofén, litio, lisuride, clonazepam, butirofenonas) fueron tratados con inyecciones perioculares de toxina botulínica (Botox), utilizando una dosis "baja" de 12,5 UI por ojo. Once de los doce pacientes obtuvieron mejoria significativa que duró entre cinco y quince semanas. Una sola paciente no respondió y lo hizo al duplicar la dosis de toxina inyectada. Los únicos efectos secundarios observados fueron ptosis uni o bilateral en 6 pacientes, reversible antes de los 21 días de la inyección y no se observaron efectos secundarios sistemáticos. Una paciente tuvo una parálisis facial periférica de 19 días de duración con remisión completa. Hubo una sola deserción del estudio en una paciente depresiva con ptosis prolongada (21 días). Todos los pacientes (inclusive la desertora) coincidieron en que el tratamiento con Botox fue más eficaz que cualquier ensayo medicamentoso previo. A pesar que estos resultados son similares a comunicaciones previas, creemos aconsejable acumular experiencia para evaluar los resultados a largo plazo

Tratamiento del blefaroespasmo con toxina botulínica. / [Treatment of blepharospasm with botulinum toxin]

Blepharospasm is a relatively frequent cranial dystonia which may be seen either alone or related to orofacial-mandibular dystonia (Meiges syndrome). In its maximum degree it can cause functional blindness.Twelve patients with blepharospasm (4 essential and 8 Meiges syndrome) who had been previously treated unsuccessfully with drugs (trihexyphenidyl, biperiden, carbamazepine, lithium, baclofen, lisuride, imipramine, clonazepam and butyrophenones) were treated for 12 months with periocular injections of botulinum toxin (BOTOX). A [quot ]low[quot ] dose of 12,5 U per eye was employed. With this dose, eleven out of twelve patients experienced significant improvement which lasted from five to fifteen weeks. The only nonresponder obtained complete relief upon duplicating the dose. The only side effect was uni or bilateral ptosis in six patients which improved completely in seven to twenty one days. One patient developed a peripheral facial palsy with complete remission in nineteen days. No systemic side effects were noted. There was only one desertion from this study due to depression enhanced by prolonged (21 days) ptosis. All patients (including the deserter) agreed that treatment with BOTOX provided more relief than any other previous therapeutic method. Our results confirm those obtained by others but a more prolonged study is needed to better evaluate long term effects.

Tratamiento del blefaroespasmo con toxina botulínica / Treatment of blepharospam with botulinum toxin

El blefaroespasmo, ya sea aislado o en el contexto de una disquinesia oro-facio-mandibular (síndrome de Meige) es una distonía cranial relativamente frecuente. En su máxima expresión puede dar origen a marcada minusvalía e incluso ceguera funcional. Doce pacientes con respuesta poco satisfactoria a tratamientos medicamentosos (trihexifenidilo, hiperideno, imipramina, carbamazepina, baclofén, litio, lisuride, clonazepam, butirofenonas) fueron tratados con inyecciones perioculares de toxina botulínica (Botox), utilizando una dosis "baja" de 12,5 UI por ojo. Once de los doce pacientes obtuvieron mejoria significativa que duró entre cinco y quince semanas. Una sola paciente no respondió y lo hizo al duplicar la dosis de toxina inyectada. Los únicos efectos secundarios observados fueron ptosis uni o bilateral en 6 pacientes, reversible antes de los 21 días de la inyección y no se observaron efectos secundarios sistemáticos. Una paciente tuvo una parálisis facial periférica de 19 días de duración con remisión completa. Hubo una sola deserción del estudio en una paciente depresiva con ptosis prolongada (21 días). Todos los pacientes (inclusive la desertora) coincidieron en que el tratamiento con Botox fue más eficaz que cualquier ensayo medicamentoso previo. A pesar que estos resultados son similares a comunicaciones previas, creemos aconsejable acumular experiencia para evaluar los resultados a largo plazo (AU)