Bromocriptine: long-term low-dose therapy in Parkinson's disease.

Low-dose bromocriptine therapy (average dose 14.5 mg/day at 2 years) produced significant improvement in 25 of 39 parkinsonian patients. Bradykinesia was less in de novo subjects; tremor and rigidity improved most in the levodopa subjects. Five of six patients improved after a low-dose bromocriptine drug "holiday." After the addition of bromocriptine any reductions in levodopa dosage were small, with repeated cuts made gradually over months preventing the deterioration commonly seen with larger sudden reductions in levodopa dosage. Five patients withdrew because of intolerable adverse effects, two because of worsening response. Adverse effects were mild and generally dose dependent, and in some patients they disappeared without reduction in continuing bromocriptine therapy. Eighty percent of those who tolerated bromocriptine maintained response over 2 years. Bromocriptine did not induce dyskinesia, the wearing-off response, or the on-off phenomenon in de novo subjects and was used as a first choice drug in these parkinsonian patients. Best results were obtained from a combination of bromocriptine and levodopa.

Bromocriptine: low-dose therapy in Parkinson disease.

In a double-blind trial with a placebo phase, low-dose bromocriptine therapy (average dose, 15 mg per day) produced a significant improvement in 25 idiopathic parkinsonian patients. Tremor and bradykinesia were equally and significantly improved in both the levodopa-treated and the de novo patients. Rigidity was most improved in the levodopa-treated subjects. Age was not a factor in determining the dose of bromocriptine or the degree of improvement. Adverse effects occurred in 30% but were mild and dose-dependent. Four subjects, unable to tolerate initial doses of bromocriptine, withdrew from the trial. A low initial dose (1 mg per day) and slow escalation in dosage produced an optimal, though delayed improvement. Low-dose bromocriptine therapy is effective, does not induce significant dyskinesia nor on-off phenomenon, and is probably an alternative to levodopa as a drug of first choice in Parkinson disease.

Homolateral ataxia and crural paresis: case report.

Homolateral ataxia and crural paresis is a recognized vascular syndrome. However, confirmation of the causative lesion rests principally on one earlier case with multiple other infarcts. We studied a patient with the clinical syndrome; computerized tomography revealed a lucency that appeared within 1 week of the infarct. Localization of the lesion to the superior portion of the posterior limb of the internal capsule and thalamus is in accord with the original conclusions of Fisher and Cole.

Epileptic aphasia. First onset of prolonged monosymptomatic status epilepticus in adults.

Epileptic aphasia in adults is a rarely described syndrome. Its occurrence in individuals without a clear-cut history of seizures raises diagnostic difficulties with important therapeutic implications. Two such cases are reported in which the diagnosis was confirmed by EEG with a dramatic therapeutic response to anticonvulsant medication. The EEG criteria leading to detection of the epileptic nature of the syndrome are detailed. Maintaining a high index of suspicion in cases with fluctuating symptoms remains crucial for early diagnosis and management, especially in terms of differentiating epileptic aphasia from transient ischemic phenomena.

Aphasia resulting from occlusion of the left anterior cerebral artery. Report of a case with an old infarct in the left Rolandic region.

A 62-year-old right-handed woman was admitted to the hospital with a cerebrovascular accident in the left hemisphere. She was aphasic as well as hemiplegic on the right. She had had a left cerebrovascular accident 18 years earlier that caused weakness in the right hand, but no grossly detectable speech problems. Autopsy disclosed an old infarct along the left Rolandic area, and a recent infarct in the territory of the left anterior cerebral artery. The clinical picture and pathologic changes are discussed in an attempt to relate the findings at autopsy to the recently developed aphasia.

Computerized axial tomography in family members of patients with tuberous sclerosis.

The diagnosis of unsuspected TS has been reached with the aid of computerized axial tomography. Most cases are sporadic, but incomplete forms of the disease may be difficult to detect. We have, therefore, studied nine immediate family members of four cases with TS. The results were negative in all of them, confirming the earlier notions that, in the absence of adenoma sebaceum in either parent, the disease is most probably sporadic.