Biomedical subjects
G Linazasoro
Publications and source records attributed to G Linazasoro.
[Subcutaneous apomorphine in the treatment of Parkinson's disease].
Motor and psychiatric complications are the main limitations for chronic treatment with levodopa in patients with Parkinson's disease (PD). Apomorphine (APM) is a potent D1 and D2 dopaminergic agonist that has been proven useful in the management of PD. Ten patients with complicated PD involving fluctuations in mobility and dyskinesia were treated with subcutaneous APM (1 with continuous infusion and 9 with multiple injections). The patient with continuous infusion experienced an initial stabilization of the motor reaction but treatment had to be stopped due to decrease of efficacy and appearance of local side effects. Of the 9 patients who began it with multiple injections of APM, 5 abandoned it due to various side effects. The remaining patients continued in the study for a mean time of 14.3 months, experiencing a clear clinical improvement. Subcutaneous APM is a useful therapeutic alternative for some patients with complicated PD.
[The primary care physician facing Parkinson's disease: practical approach. Medical Counseling Committee of the Spanish Parkinson Association].
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Generalized chorea induced by nonketotic hyperglycemia.
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Nocturnal akathisia in Parkinson's disease: treatment with clozapine.
We present the results obtained using low doses of clozapine (mean dose 26.4 mg at bedtime) in the treatment of nocturnal akathisia in nine patients with Parkinson's disease for a mean period of 12.5 months. The results were excellent in all the patients. Furthermore, three patients experienced a remarkable improvement in rest tremor and in five patients the confusional state that accompanied the akathisia also disappeared. No serious side-effects were observed. We believe that clozapine is a very useful drug for the relief of nocturnal akathisia in parkinsonian subjects.
[The apomorphine test in Parkinson's disease: diagnostic value].
The diagnosis of Parkinson's disease (PD) is difficult despite the use of strict clinical criteria. Apomorphine (APP) is a strong dopaminergic D1 and D2 agonist which has been used as a diagnostic test for PD by several authors. Sixty patients with a Parkinson's syndrome received subcutaneous doses of APP with diagnostic objectives. Ninety-four percent of the subjects with clinical criteria of PD responded positively to the bolus of subcutaneous APP. The remaining six percent had secondary effects limiting the usefulness of the test. Two point seven percent of the patients with atypical data of PD improved during performance of the test. Despite the limitations, this easily carried out test may be added to the recently proposed criteria of clinical diagnosis and may contribute greater certainty in diagnosis.
Atypical presentation of Gilles de la Tourette syndrome.
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Paget's disease and hemifacial spasm.
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[Hemiballism and acquired immunodeficiency syndrome].
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Acute dystonia induced by sulpiride.
We report a 15-year-old boy who, after the administration of 100 mg i.v. of sulpiride, presented an acute dystonic reaction consisting of oculogyric crises, retrocollis, opysthotonus, and dystonic postures in the left arm and hand. The symptoms were reversed after the injection of biperiden. This side effect has not been described previously. Sulpiride can induce the same extrapyramidal adverse reactions as the classical neuroleptic drugs.
[Paroxysmal dystonia induced by exercise secondary to flecainide].
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Effects of gabapentin on the motor response to levodopa: a double-blind, placebo-controlled, crossover study in patients with complicated Parkinson disease.
BACKGROUND: Motor fluctuations and dyskinesias affect many parkinsonian patients chronically treated with levodopa. Imbalance between gabaergic direct and indirect striatopallidal pathways may originate them. Manipulating GABA neurotransmission may be effective in the treatment of these patients. Gabapentin is an antiepileptic drug that increases the synthesis and release of GABA. Previous studies suggest that gabapentin may be useful in Parkinson disease (PD). OBJECTIVE: To know the effects of gabapentin on the motor response to levodopa in PD patients with motor complications. DESIGN: A randomized double-blind, placebo-controlled, cross-over trial with four weeks of treatment. SETTING: A tertiary referral center. PARTICIPANTS: Twenty subjects with PD and motor fluctuations and dyskinesias on stable antiparkinsonian treatment, took gabapentin up to a maximum dose of 2.400 mg/d in three doses and placebo. METHODS: Three levodopa challenges were performed: at the beginning of the study and at the end of each period of treatment (4 weeks). Basal (off) and best (on) motor status were assessed by the UPDRS III. Latency to peak effect, magnitude of motor response (difference between "on" and "off" scores in the UPDRS III), duration of motor response and severity and duration of dyskinesias after each levodopa challenge were assessed. Patients' diaries were administered. RESULTS: : Fifteen patients completed the study. A significant improvement in the basal UPDRS III resulting in a significant reduction in the magnitude of the motor response after gabapentin was obtained (P < 0.001). No other changes were observed, either on pharmacological parameters or in levodopa-induced dyskinesias. Number of daily hours spent in "on," "on with dyskinesias" and "off" also remained unchanged. Tolerance was good, dizziness being the most common side effect. CONCLUSION: Gabapentin improved parkinsonian symptoms (basal UPDRS III and magnitude of the motor response) following levodopa. This improvement was not reflected in the daily motor situation of patients. Dyskinesias remained unchanged. Gabapentin was well tolerated. Further studies are needed to know the impact of these results in the long-term.
Controlled release levodopa in Parkinson's disease: influence of selection criteria and conversion recommendations in the clinical outcome of 450 patients. STAR Study Group.
We present the results of an open, prospective, multicentric study including 450 patients with mild to moderate Parkinson's disease (PD) converted from standard Sinemet to Sinemet CR (controlled release; Dupont Pharma, Pavia, Italy). Patients with complex fluctuations and diphasic dyskinesias were excluded and the conversion was made after some recommendations, depending on the clinical problems and the daily dosage and administration schedule of standard (STD) Sinemet. The condition of more than 60% of the patients improved after the change and 80% of them preferred the CR formulation by the end of the study. We found a moderate, but significant, improvement in most of the efficacy parameters used, such as the Unified Parkinson's Disease Rating Scale (UPDRS), the Schawb and England scale, and dyskinesias and sleep questionnaires. Forty-five patients (10%) discontinued the study due to adverse effects (mainly gastrointestinal disturbances, functional deterioration, and dyskinesias). We conclude that Sinemet CR is a useful and safe therapeutic option in patients with mild and moderate PD. Selection of the patients is the most important outcome factor.
Modification of dopamine D2 receptor activity by pergolide in Parkinson's disease: an in vivo study by PET.
It is well known that chronic administration of pergolide and other dopamine agonists may induce a downregulation of dopamine D2 receptors in the rat model of Parkinson's disease (PD). To our knowledge, this effect has not been demonstrated in vivo in patients with PD. At present, the status of striatal dopamine D2 receptors can be studied with use of positron emission tomographic (PET) technology. Five patients with PD chronically treated with levodopa were studied with use of PET and [11C]-raclopride before and after 6 months of pergolide treatment (dose range = 4.5-7.5 mg/d). We found a slight reduction in the specific striatal [11C]-raclopride uptake index (mean reduction 14% in putamen and 9% in caudate) after pergolide treatment. This reduction appears to be related to downregulation of the receptor, although competitive binding of pergolide at the D2 receptor cannot be excluded.
Conversion to controlled-release levodopa/carbidopa treatment and quality of life as measured by the Nottingham Health Profile. The STAR Study Group.
BACKGROUND: Controlled-release levodopa-carbidopa (CRLC) improves some aspects of Parkinson's disease (PD) in patients previously treated with standard levodopa formulations (SL). However, little is known about the effect of this strategy on the health-related quality of life (QoL). OBJECTIVE: To assess the QoL and clinical changes due to the conversion of treatment from SL to CRLC in patients with mild to moderate PD. PATIENTS AND METHODS: Through the Nottingham Health Profile (NHP), QoL was measured in 276 non-selected PD patients included in a multicenter, open study. Guidelines for switching to CRLC and optimization of treatment were given. Assessment of patients was carried out by means of the Hoehn & Yahr, UPDRS, and Schwab & England scales, and questionnaires for dyskinesias and sleep. Examination of the NHP-Spanish Version-scaling properties by fitting data to the Rasch model, disclosed that 3 NHP scales (Emotional reactions, Pain, and Physical mobility) and the NHP distress index (NHPD) were suitable for efficacy analysis. RESULTS: Comparison of scores at baseline and at the end of the study showed significant improvement (paired Student t-test, p < 0.0001) in all these four scales associated with the change to CRLC. Responsiveness to change of the NHP was high. In the present study, changes in QoL were not contingent to baseline factors such as age, gender, stage of disease or ADL capabilities. CONCLUSION: Conversion to CRLC significantly improves the QoL of patients with mild to moderate PD.
[Surgery of the subthalamic nucleus in Parkinson's disease].
INTRODUCTION AND DEVELOPMENT: The subthalamic nucleus (STN) plays a crucial part in the pathophysiology of Parkinsonism. Its inactivation improves all the main signs and symptoms of Parkinson's disease. Surgery of the STN in patients with the disease is effective and the benefit/risk relationship very favorable. Although the dyskinesias are not a definite limitation, it seems most reasonable to use techniques of deep cerebral stimulation until greater experience has been obtained with subthalamotomy. The long term efficacy is being studied and preliminary data indicate that the clinical benefit obtained is maintained in the long term. CONCLUSIONS: More studies are necessary to determine the mechanism of action of surgery on the STN. The potential neuroprotector effect of subthalamic surgery requires more extensive study.
[Surgical treatment of dystonia].
INTRODUCTION AND DEVELOPMENT: Dystonia is a neurological syndrome which is often progressive and disabling. The pathophysiological basis is only partly understood. Medical treatment often fails. Peripheral surgical techniques can alleviate the symptoms of many patients with diverse forms of focal dystonia. In patients with generalized dystonia, central surgical techniques are preferable. Thalamotomy is the best known technique, although the target is not fully defined. Experience with surgery of the pallidum and subthalamus is very limited, but results are promising. CONCLUSIONS: More studies are necessary to discover the precise potential benefit of these techniques and define the ideal candidates. It is important that such studies should be done using rigorous methodology and be similar for all groups working on this.
[Utility of new tools in the diagnosis of Parkinson's disease: need for regulation].
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