Treatment of putative immune-mediated and idiopathic cervical dystonia with intravenous methylprednisolone.

A young pregnant woman developed a persistent dystonic head tremor a few days after Rho (D) immune globulin administration; further deterioration occurred after a second administration of Rh(o) (D) immune globulin with the development of marked retrocollis. This persisted and she was treated 2 months later with a 5-day course of intravenous (1 g daily) methylprednisolone (IVMP) with resolution of her condition. We proceeded to treat similarly the next four patients with idiopathic cervical dystonia who were seen in our practice and who had current symptoms of less than 6 months duration.

Total shoulder arthroplasty in patients with Parkinson's disease.

Treatment of orthopaedic problems in patients with Parkinson's disease can be problematic and include failure of fixation or prosthetic dislocation. A study was undertaken to assess the outcome of total shoulder arthroplasty in this patient group. Fifteen patients with Parkinson's disease underwent 16 unconstrained shoulder arthroplasties.

Treatment of early Parkinson's disease: are complicated strategies justified?

A variety of medical treatment strategies have been proposed as a means of slowing the progression of Parkinson's disease. This includes administration of selegiline (deprenyl) therapy, early use of bromocriptine or pergolide, and delay of levodopa therapy or restriction of the dose. There is no compelling evidence supporting the use of any of these treatment strategies for this purpose.

Adjunctive cabergoline therapy of Parkinson's disease: comparison with placebo and assessment of dose responses and duration of effect.

Adjunctive cabergoline or placebo, in doses up to 5 mg daily, were administered to Parkinson's disease patients with short-duration levodopa responses in a 6-month double-blind trial. The 13 patients randomized to cabergoline and completing the study had significantly improved Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and timed hand-tapping test scores. Serial measurements on test days documented improved scores: (a) before the first levodopa (and cabergoline) dose of the day, (b) at the time of the peak levodopa effect, and (c) at the end of the levodopa response cycle, 5 h after test doses.

Intranasal apomorphine rescue therapy for parkinsonian "off" periods.

Eleven patients with levodopa-related motor fluctuations were scored before and after intranasal apomorphine monotherapy, and the motor responses were compared with those with levodopa/carbidopa in this openlabel study. Oral trimethobenzamide was used to prevent apomorphine-induced nausea. Three measures of motor performance were employed: (a) the Unified Parkinson's Disease Rating Scale (UPDRS) motor battery; (b) a timed hand-tapping test; and (c) the Webster's step-seconds test.

Amantadine treatment is an independent predictor of improved survival in Parkinson's disease.

Amantadine has been used for more than 20 years in the symptomatic treatment of Parkinson's disease (PD). Several recent discoveries suggest that amantadine could also have a neuroprotective effect in PD. We studied survival in all parkinsonism (including PD and other parkinsonian syndromes) patients attending a single clinic, employing standard survival curves and a Cox regression model, to identify independent predictive variables for survival (while taking into account factors potentially associated with both outcome and treatment selection).

Comparative Review of Dopamine Receptor Agonists in Parkinson's Disease.

Limitations of long term levodopa therapy for Parkinson's disease represent a major problem in the management of many patients. Dopamine receptor agonists provide antiparkinsonian effects and their use is most clearly defined in the context of complications from levodopa therapy. As such, dopamine receptor agonists are useful adjunctive agents to levodopa.

Multicenter, placebo-controlled trial of cabergoline taken once daily in the treatment of Parkinson's disease.

Cabergoline is a dopaminergic agonist relatively specific for the D2 receptor and much longer-acting than other dopamine agonists. We conducted a randomized, placebo-controlled, double-blind study of cabergoline in 188 levodopa/carbidopa-treated patients with suboptimally controlled Parkinson's disease (PD). The cabergoline patients had significantly better Activities of Daily Living (p = 0.

Plasma catechols and monoamine oxidase metabolites in untreated Parkinson's and Alzheimer's diseases.

Prior studies have documented functional and pathological compromise of the peripheral sympathetic nervous system in patients with Parkinson's disease, suggesting the possibility of reduced catecholamine release into the circulation. We measured free plasma catechols in early and untreated patients with Parkinson's disease, but found no evidence of reduced concentrations, compared to control subjects or a group of patients with probable Alzheimer's disease. Rather, there was a significant elevation of plasma norepinephrine within the Parkinson's disease group.

Levodopa and deprenyl treatment effects on peripheral indices of oxidant stress in Parkinson's disease.

The oxidant stress theory of Parkinson's disease (PD) hypothesizes that levodopa treatment may be potentially harmful and this is supported by studies demonstrating levodopa toxicity to cultured dopaminergic neurons. These in vitro experiments, however, lack the physiologic protective mechanisms present in vivo. Oxyradical damage to cell membranes liberates malondialdehyde, which we measured in the serum of 27 PD patients just before and after levodopa (with carbidopa) administration.

No evidence for systemic oxidant stress in Parkinson's or Alzheimer's disease.

Oxidant stress secondary to dopamine metabolism has been proposed as a pathogenic factor in the development of Parkinson's disease. Biochemical abnormalities extending beyond the central nervous system have been identified in patients with this condition. Previous investigators have found abnormally elevated concentrations of the lipid peroxidation product, malondialdehyde, in the plasma and serum of patients with Parkinson's disease.

Guamanian neurodegenerative disease: investigation of the calcium metabolism/heavy metal hypothesis.

Objective: There is a high prevalence of neurodegenerative disease (parkinsonism, dementia, and motor neuron disease) on the western Pacific island of Guam. We sought evidence in support of the hypothesis that these conditions are triggered by nutritional deficiencies of calcium and magnesium leading to secondary hyperparathyroidism that then facilitates the entry of calcium and toxic heavy metals into the brain.

Methods: We analyzed indices of calcium metabolism plus blood-serum, urine, nail, and hair heavy metal concentrations in 12 patients with Guamanian neurodegenerative disease and 12 Chamorro control subjects.

Hereditary late-onset chorea without significant dementia: genetic evidence for substantial phenotypic variation in Huntington's disease.

We examined five individuals and obtained information concerning six other members from two unrelated families, nearly all of whom developed chorea after age 50 (one patient developed chorea at age 40). The severity of chorea progressed in all patients and became disabling in some individuals approximately 15 years after onset. Cognitive impairment was absent or minimal.

Progressive supranuclear palsy: neuropathologically based diagnostic clinical criteria.

All cases examined postmortem at the Mayo Clinic that met the classic neuropathological criteria for progressive supranuclear palsy (PSP) were identified for retrospective clinical analyses. The necropsy material was re-examined by a second neuropathologist to confirm the pathological diagnosis of PSP, yielding 12 cases. A range of clinical signs were documented in these patients, with numerous findings beyond those noted in the original descriptions of this disorder.

Diagnostic steps for suspected Parkinson's disease.

The diagnosis is made clinically, often independent of special tests, through a series of simple, carefully planned observations and maneuvers. The objective is to separate true Parkinson's disease from other conditions with parkinsonian features.

Fluctuating Parkinson's disease. Treatment with the long-acting dopamine agonist cabergoline.

Objective: Assessment of the very long-acting dopamine agonist medication cabergoline in the control of motor fluctuations in Parkinson's disease.

Design: Open-label trial (13 weeks).

Setting: Referral centers (Mayo Clinic, Rochester, Minn, and Scottsdale, Ariz).

Utility of an objective dyskinesia rating scale for Parkinson's disease: inter- and intrarater reliability assessment.

Although dyskinesia is a frequent and important problem in Parkinson's disease (PD), a reliable assessment measure has not been thoroughly developed and tested. We modified the Obeso dyskinesia scale to create an objective rating scale for dyskinesia assessment during activities of daily living. Thirteen physicians and 15 study coordinators involved in a clinical trial independently reviewed videotape segments of PD patients performing three tasks: walking, putting on a coat, and lifting a cup to the lips for drinking.

Treatment of Parkinson's disease.

Preview Although the early symptoms of Parkinson's disease can be ameliorated, the illness is relentlessly progressive. Studies have therefore been conducted in hopes of finding therapy to delay its disabling course. In this article, Dr Ahlskog examines recent proposals and their application in cases of early and advancing disease.

Treatment of Parkinson's disease. From theory to practice.

Parkinson's disease responds rather dramatically to levodopa therapy during the first several years of treatment. With advancing disease, however, symptom control becomes more erratic, and some symptoms may become refractory to treatment. The use of selegiline hydrochloride (Eldepryl) has been proposed to slow the progression of Parkinson's disease; however, current evidence suggests that it is only partially effective at best, and there is no definite proof of a neuroprotective effect.

Idiopathic intracranial hypertension.

Objective: This review was undertaken to summarize the significant progress that has been made in the epidemiology of idiopathic intracranial hypertension (IIH), the changing nosology, and the diagnostic criteria and therapeutic strategy.

Design: We reviewed the pertinent literature on IIH published in major English-language journals for the last 20 years.

Material And Methods: The diagnosis, epidemiology, pathophysiology, complications, and treatment of IIH are described.

Levodopa therapy and survival in idiopathic Parkinson's disease: Olmsted County project.

We studied survival in all Olmsted County Parkinson's disease (PD) patients seen at the Mayo Clinic from 1964 to 1978, attempting to answer two questions: (1) What effect does levodopa have on survival in PD? and (2) Does the timing of levodopa administration influence survival? We chose this period because it allowed us to study patient records with a spectrum of disease durations before levodopa treatment; in many patients, the treatment delay was exclusively due to levodopa being unavailable prior to 1969. Mortality of the entire PD cohort (N = 179; 61% levodopa-treated) was greater than that of the general population (matched chronologically, geographically, and by age and gender). Lower age at onset of motor symptoms, lower Hoehn and Yahr stage at first neurologic visit for parkinsonism, and treatment with levodopa were all independent predictors of improved survival.

Multicenter study of cabergoline, a long-acting dopamine receptor agonist, in Parkinson's disease patients with fluctuating responses to levodopa/carbidopa.

We administered cabergoline, a potent, once-a-day dopamine against, to 61 patients with advanced Parkinson's disease (PD) and response fluctuations--"wearing-off" and "on-off" phenomena. The patients were on stable doses of levodopa/carbidopa. During the first 5 weeks, patients were randomized to allow equal numbers to end titration at each of five daily doses of cabergoline from 0.

Cerebral transplantation for Parkinson's disease: current progress and future prospects.

Cerebral transplantation has received considerable attention from both the medical community and lay press as a potential treatment for Parkinson's disease. Animal models have demonstrated feasibility, although the experience in subhuman primates was very limited when the first human trials were initiated in the mid-1980s. The dramatic success reported for adrenal-to-brain transplantation in some initial trials could not be consistently replicated by other centers.

Posttraumatic cervical dystonia.

Posttraumatic cervical dystonia has been described as a distinct syndrome with some similarities to idiopathic nontraumatic cervical dystonia (torticollis). We describe five patients in whom cervical dystonia developed immediately after relatively mild trauma to the neck. Four of the five patients had persistent contractions of all cervical muscles including the trapezius muscles, which almost completely prevented motion of the neck and resulted in muscle hypertrophy.