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Biomedical subjects

C M Tanner

Publications and source records attributed to C M Tanner.

At least 91 records · Page 5Linked to original sources
PubMed1987

Clonidine and Gilles de la Tourette's syndrome: double-blind study using objective rating methods.

Clonidine has been suggested to be effective in Gilles de la Tourette's syndrome (GTS), but no double-blind study has ever evaluated its effects using objective measures. Thirty patients with GTS completed a 6-month placebo-controlled crossover study of the effectiveness of clonidine. Videotapes were obtained at each 3-week visit and were evaluated randomly at the end of the study for distribution, frequency, and severity of motor and vocal tics. Quantifiable psychometric examinations were performed as well. The use of clonidine did not significantly (p less than 0.05) reduce motor tics, vocalizations, or behavior. The effect of a low dose (0.0075 mg/kg/day) was no different from that of a high dose (0.015 mg/kg/day); children's responses were no different from adults'; and those also receiving neuroleptic agents showed the same lack of efficacy as seen in patients on no other medication. Dosing schedule did not affect the objective ratings; scores from clonidine given twice a day were equivalent to those for three times a day.

Adolescent↗
PubMed1987

The autonomic nervous system in Gilles de la Tourette's syndrome.

Twenty-three patients with Gilles de la Tourette's syndrome (GTS) underwent noninvasive investigation of autonomic nervous system (ANS) function, as did 23 age-matched controls. ANS function in GTS patients was no different from that of controls, and patients receiving neuroleptic drugs had the same ANS function as untreated patients. All 23 patients later received clonidine and were retested. The ANS values before administration of clonidine were compared with those while patients were taking clonidine. The only significant change (p less than 0.01) with clonidine was a reduced resting pulse rate. The combination of clonidine and neuroleptic drugs did not induce significant autonomic changes compared with neuroleptic therapy alone. These results indicate that the ANS in GTS patients is normal and that the drugs used to abate tics do not produce clinically significant changes in ANS when chronically given. The findings suggest that the pathophysiology and treatment of GTS do not directly involve the nuclei or tracts of autonomic regulation.

Adolescent↗
PubMed1987

Environmental factors in the etiology of Parkinson's disease.

Parkinson's disease (PD) has been proposed to result from the interaction of aging and environment in susceptible individuals. Defective metabolism of debrisoquine, inherited as an autosomal recessive, has been associated with this susceptibility. In 35 PD patients and 19 age-matched controls, no significant differences in debrisoquine metabolism were found, although a trend to impaired metabolism was noted in patients with disease onset less than or equal to 40. Foci of PD patients were associated with rural living and well water drinking, or rural living coupled with market gardening or wood pulp mills. In a questionnaire survey, patients with PD onset less than or equal to age 47 were significantly more likely to have lived in rural areas and to have drunk well water than those with onset greater than or equal to age 54 (p less than or equal to 0.01). Because of population mobility in North America, a case-control study designed to test environmental, occupational, dietary and other proposed risk factors for PD was conducted in China, where the population is more stationary and the environment more stable. No significant differences in incidences of head trauma, smoking or childhood measles were found between patients and controls.

Adult↗
PubMed1987

Neuroleptic malignant syndrome responsive to carbidopa/levodopa: support for a dopaminergic pathogenesis.

A 31-year-old man with psychosis and neuroleptic-induced tardive dystonia developed neuroleptic malignant syndrome (NMS) while taking haloperidol. Muscle rigidity responded to dantrolene, but hyperthermia did not abate until therapy with carbidopa/levodopa was initiated, after which temperature varied in direct relationship to subsequent levodopa administration. This supports the role for central dopaminergic mechanisms in the pathogenesis of NMS.

Adult↗
PubMed1987

Amantadine and motor fluctuations in chronic Parkinson's disease.

Twenty patients with idiopathic Parkinson's disease (PD) and motor fluctuations received open-label amantadine (100-200 mg/d) in addition to their other antiparkinson medications. One patient had unpredictable motor fluctuations (on-off) and the others had end-of-dose wearing-off. The effect of amantadine on motor fluctuations and parkinsonian disability was tested at 1, 2, and 3 months. Moderate improvement in motor fluctuations occurred in 55% of the patients at 2 months and 65% of patients at 3 months of treatment (p less than 0.01). There was also significant improvement in parkinsonian disability. The duration of improvement averaged 5.7 months, and all patients deteriorated to their baseline level of function within 12 months. This study suggests that the addition of amantadine can transiently improve motor fluctuations and have a significant impact on overall disability in patients with chronic PD.

Adult↗
PubMed1987

Progression of Parkinson's disease without levodopa.

We studied 100 consecutive patients with Parkinson's disease (PD) who were not receiving levodopa and followed them until symptoms advanced and levodopa was given. Eighty-three patients eventually received levodopa; 50% started within 36 months after a mean duration of symptoms of 48 months. Patients starting on levodopa showed significant progression of their disease compared with their baseline examination. These data have direct applicability to the design and implementation of future protocols aimed at preventing disease progression of PD.

Humans↗
PubMed1987

Parkinson's disease and motor fluctuations: long-acting carbidopa/levodopa (CR-4-Sinemet).

Long-acting levodopa/carbidopa combination (CR-4-Sinemet) was compared with traditional levodopa/carbidopa (Sinemet) open label in 20 patients with Parkinson's disease and "wearing-off" phenomena. After 4 to 6 weeks of therapy with CR-4-Sinemet, the number of daily doses of medication dropped significantly compared with traditional Sinemet, disability improved, and "on" time increased. In nine patients receiving CR-4-Sinemet for 3 months, the number of daily doses and the on time without chorea remained significantly improved. CR-4-Sinemet peaked in plasma after 2 hours, and moderately high levels remained at 4 hours after the dose. Side effects were similar between traditional Sinemet and CR-4 Sinemet.

Adult↗
PubMed1987

A rating scale for Gilles de la Tourette's syndrome: description, reliability, and validity data.

We developed a rating scale for tic disorders that uses only objective criteria and accommodates the variety of tic manifestations. Using short videotaped recordings with the examiner out of the taping room, we measured five tic variables: number of body areas affected, frequency of motor tics and vocalizations, and severity of motor tics and vocalizations. The rating scale fulfilled tests for inter-rater reliability and temporal stability, and correlated well with scales used to assess global changes over prolonged periods. It objectively detected improvement in tics with neuroleptics, the one pharmacotherapy accepted to abate tics in most patients.

Clonidine↗
PubMed1986

The effect of thioridazine on haloperidol induced behavioral hypersensitivity.

Behavioral Hypersensitivity (BH) to dopamine agonists occurs following chronic treatment with most neuroleptics including haloperidol. In the present study we observed that the concurrent administration of thioridazine and haloperidol prevented the development of BH. In contrast, another neuroleptic, fluphenazine, coadministered with haloperidol, potentiated the degree of BH relative to animals treated with haloperidol only. In rats already made hypersensitive by chronic treatment with haloperidol, a 4 week subsequent treatment with normal saline, thioridazine alone of thioridazine in combination with haloperidol, produced normal behavioral responsiveness. These results suggest that thioridazine prevents the development of BH and can reverse the expression of haloperidol-induced BH.

Animals↗
PubMed1986

The effect of antimuscarinic agents on haloperidol induced behavioral hypersensitivity.

Varying doses of scopolamine, trihexyphenidyl and benztropine were administered to rats or guinea-pigs by themselves or in combination with 0.5 mg/kg haloperidol for 24 days. All animals were then challenged with 0.75 mg/kg apomorphine and assessed for stereotypic behavior following a 96 h drug free interval. Animals treated with haloperidol alone exhibited behavioral hypersensitivity to apomorphine challenge. Animals treated with both an antimuscarinic agent and haloperidol exhibited a significant reduction in behavioral responsiveness relative to animals treated with only haloperidol. This reduction was directly proportional to the antimuscarinic dose administered. A non-significant trend toward hyposensitivity was observed in animals who had been treated with antimuscarinic agents alone. These results suggest that the development of behavioral hypersensitivity may reflect CNS alterations in cholinergic as well as dopaminergic activity.

Animals↗
PubMed1986

Pain in Parkinson's disease.

We studied the prevalence and character of pain in Parkinson's disease (PD) and its association with motor fluctuations. Of 95 outpatients, 46% experienced pain they attributed to PD. Patients with pain were younger but no more disabled on objective motor scores than patients without pain. Musculoskeletal, dystonic, and joint pains were most frequent. Painful episodes, especially musculoskeletal cramps, usually occurred when parkinsonian disability was maximal.

Age Factors↗
PubMed1986

Myoclonus and parkinsonism.

We have observed three patients in whom the onset of parkinsonian signs was clinically associated with myoclonic movements. In each case, the parkinsonian signs were relatively mild and myoclonus was the major abnormality. The presentation of these three unusual cases within 1 year may be coincidental or may reflect a common pathogenetic mechanism. Adrenocorticotropic hormone was given to all three patients. It ameliorated the myoclonus in two patients but had no effect on the third.

Adrenocorticotropic Hormone↗
PubMed1986

Autonomic dysfunction in Parkinson's disease.

We studied autonomic functions in 31 chronically treated patients with Parkinson's disease. They were tested twice: before a dose of medication and after medication. Before a dose of medication, when motor disability was maximal ("off"), patients had higher resting pulse rate, greater orthostatic fall in blood pressure, and decreased responses to Valsalva and cold pressor stimuli than their spouse-controls. To a heat stimulus, sweating was increased in the head and neck, and skin temperatures were cooler. After medication when function was optimal ("on"), the cardiovascular reflex abnormalities remained but were no worse. Skin temperature alterations and sweating abnormalities resolved.

Adult↗