RESUMO
A dual study was conducted to assess (1) the long-term antiparkinsonian action of amantadine without levodopa and (2) the advantage of combined amantadine and levodopa over single-drug therapy, including changes in symptom severity when placebo replaces amantadine but levodopa is maintained.Good to excellent results were obtained in 25% of the total pool of 77 patients on amantadine. No decline in therapeutic effect took place during a mean follow-up of 21 months.Thirty-seven patients with considerable residual deficit after single-drug therapy derived improvement from the second drug (levodopa or amantadine). Gains in neurological signs and activities of daily living (ADL) ranged between 50 and 60% and for timed skills close to 25%. Depending on the individual indices, between 64 and 100% of patients improved with the second drug.Placebo instead of amantadine produced deterioration. There was 75% loss in ADL, 45% loss in timed skills and losses in neurological signs exceeded gains produced by two-drug therapy.
Assuntos
Amantadina/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Atividades Cotidianas , Idoso , Amantadina/efeitos adversos , Amantadina/uso terapêutico , Ensaios Clínicos como Assunto , Di-Hidroxifenilalanina/administração & dosagem , Di-Hidroxifenilalanina/uso terapêutico , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Destreza Motora/efeitos dos fármacos , Exame Neurológico , Placebos , Fatores de TempoAssuntos
Ácido Fólico/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Administração Oral , Animais , Encéfalo/enzimologia , Ensaios Clínicos como Assunto , Coenzimas/farmacologia , Ácido Fólico/administração & dosagem , Ácido Fólico/efeitos adversos , Ácido Fólico/sangue , Ácido Fólico/farmacologia , Humanos , Ratos , Tirosina 3-Mono-Oxigenase/biossínteseRESUMO
Sixty-eight patients with myasthenia gravis were evaluated and compared to determine the results of medical and surgical treatment; eight patients with thymoma were evaluated separately. In the group of 30 non-thymoma patients treated medically 50% of patients derived moderate to good improvement over a mean follow-up period of 11 years. Ten per cent of patients in this group died from myasthenia.In the group of 30 non-thymoma patients treated by thymectomy, 83% achieved good to excellent improvement. There was no surgical or myasthenic mortality over a mean follow-up period of nine years.The results of treatment in the eight thymoma patients were decidedly inferior and there was no significant difference between the medically and surgically treated patients. Fifty per cent showed only moderate improvement during a mean follow-up of five years and 50%, after initial improvement, deteriorated later and died from myasthenia between three and four years after thymectomy.Two additional patients had thymoma without myasthenia. Neither of them had developed myasthenia, two years following thymectomy in one case and after 25 years in the other, despite recurrence of the tumour with extensive invasiveness in the very long-standing case.
