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Biomedical subjects

G M Stern

Publications and source records attributed to G M Stern.

At least 73 records · Page 4Linked to original sources
PubMed1987

Mesulergine and pergolide in previously untreated Parkinson's disease.

Seventeen hitherto untreated patients with mild Parkinson's disease were given the dopamine agonists mesulergine or pergolide. Of the 10 patients who received pergolide (mean dosage 3.7 mg/day) five failed to improve, four showed slight improvement and one gained moderate benefit. Of the seven patients who received mesulergine (mean dose 6.4 mg/day) three patients derived no benefit, two slight benefit and two moderate benefit. The incidence of adverse side-effects was high with both drugs despite the use of a peripheral dopamine receptor antagonist, domperidone, when required. These results are less encouraging than those reported from other centres both in respect of response rate and the severity of unwanted effects.

Aged↗
PubMed1987

Neurological involvement in X-linked hypophosphataemic rickets.

X-linked hypophosphataemic rickets is a familial form of Vitamin D resistant rickets in which gross bony and ligamentous changes may occur. Two patients showing severe spinal disease with evidence of spinal cord compression requiring neurosurgical intervention are reported. The management of such lesions may be problematic as cord compression may be found at several levels at presentation, and further difficulties develop after neurosurgical treatment.

Female↗
PubMed1987

Clinical and pharmacokinetic observations with Madopar HBS in hospitalized patients with Parkinson's disease and motor fluctuations.

The efficacy of a novel oral sustained-release preparation of L-dopa (Madopar HBS) was compared to that of previous standard L-dopa treatment in 10 patients with idiopathic Parkinson's disease and severe fluctuations in motor performance in an open inpatient trial. Clinical assessment included evaluation of self-scoring 'on-off' diaries kept by the patients throughout the study. It revealed a reduction of end-of-dose deterioration and, to a lesser degree, of random 'on-off' swings in 6 cases. Doses of Madopar HBS required for an optimal response averaged the 1.6-fold of previous conventional L-dopa. Plasma levels of L-dopa were more stable with Madopar HBS compared to standard L-dopa treatment in 4 of 5 patients.

Benserazide↗
PubMed1986

Treatment of motor fluctuations in Parkinson's disease with an oral sustained-release preparation of L-dopa: clinical and pharmacokinetic observations.

Ten patients with idiopathic Parkinson's disease and severe motor-fluctuations participated in an open inpatient trial comparing the efficacy of standard L-Dopa/benserazide (Madopar) treatment with that of an oral sustained-release preparation (Madopar HBS) combined with the standard drug. Clinical assessments of the patients' parkinsonian disabilities were performed daily by one of the investigators and subjects kept self-scoring "on-off" diaries throughout the trial. Plasma concentrations of L-Dopa were followed during both types of therapy in five cases using standard high performance liquid chromatography technique. Sustained-release L-Dopa treatment led to a reduction in end-of-dose deterioration and on-off swings in six patients and doses needed averaged 1.6-fold of previous standard L-Dopa. Drug-induced dyskinesias decreased in one case with sustained-release therapy, remained unchanged in three, and increased in six cases when compared with conventional L-Dopa. Plasma levels of L-Dopa were more stable with the sustained-release preparation in four of five patients. During subsequent outpatient follow-ups of up to 4 months, three of the six responders in this study continued to obtain benefit from the trial drug. It is concluded that oral sustained-release L-Dopa treatment can reduce response-fluctuations in patients with Parkinson's disease.

Administration, Oral↗
PubMed1986

The pharmacokinetics of intravenous and oral levodopa in patients with Parkinson's disease who exhibit on-off fluctuations.

We have studied the clinical effects and pharmacokinetics of levodopa infusions and oral therapy in seven patients with Parkinson's disease. They all showed on-off fluctuations whilst receiving long-term treatment with levodopa in combination with a peripheral decarboxylase inhibitor. Intravenous infusion at a constant rate for up to 16 h resulted in a smoother clinical response, and maintained plasma levodopa concentrations within narrower limits compared with conventional oral therapy. Following infusion rates of 32-80 mg h-1 (0.5-1.3 mg kg-1 h-1) the plasma concentration associated with optimum therapeutic response lay between 0.3 and 1.6 mg l-1. There was considerable variation in the oral absorption and elimination of levodopa, both within and between subjects. The concentration of 3-OMe dopa in plasma hardly increased during each day's levodopa therapy. In all cases levels were greater than the maximum concentrations of levodopa, sometimes by as much as a factor of 10. In contrast to most previous reports on the pharmacokinetics of levodopa, the data presented here are consistent with a two-compartment kinetic model. It is not known whether the difference in pharmacokinetics is due to chronic therapy or whether it is specific to those patients who show on-off phenomena, but such changes might be related in some way to the development of fluctuations in clinical response.

Absorption↗
PubMed1986

Low-dose L-dopa therapy in Parkinson's disease: a 6-year follow-up study.

Thirty-five patients with early mild Parkinson's disease were treated from the outset with small doses of L-dopa (mean dose, 396 to 454 mg daily) and a peripheral decarboxylase inhibitor, for a mean of 6 years. Overall mortality ratio was 1.2:1, worse for women than for men. After 6 years of treatment, only one-third of patients were better, and drug-related complications were common (peak-dose dyskinesias in 54% of patients, off-period dystonia 20%, wearing-off effects 52%, on-off oscillations 6%, visual hallucinations and toxic confusional states 17%). We found no evidence that long-term results were markedly improved with low-dose regimens.

Aged↗
PubMed1984

Effect of L-dopa on course of Parkinson's disease.

A review of the progress of 176 patients with Parkinson's disease who were given maximum tolerated doses of L-dopa between November, 1969, and December, 1972, showed that the ratio of observed to expected deaths after 12 years' sustained therapy was 2.59 (2.14 for males and 3.64 for females). This contrasts with the overall 6-year follow-up figure for the same patients of 1.45 (1.29 for males and 1.85 for females). These findings indicate that although L-dopa may improve life expectancy during the first 6 years of therapy the protective effect subsequently declines.

Adult↗
PubMed1984

On-off fluctuations in Parkinson's disease. A clinical and neuropharmacological study.

On-off fluctuations have been studied in twenty patients with Parkinson's disease on long-term levodopa treatment. The pattern of fluctuations was related to the timing of oral levodopa ingestion in all patients. 'Predictable' fluctuators were characterized by fewer daily doses taken at longer intervals than 'unpredictable' fluctuators in whom individual dose responses tended to overlap. Most patients at least once a day experienced an unexplained failure of an oral dose to take effect. Administration of levodopa by intravenous infusion at a constant rate brought about a dramatic extension in the duration of mobility and reduced the frequency of fluctuations compared with oral therapy; apomorphine consistently reversed off phases when administered shortly after their onset, whereas lisuride was less often effective. We conclude that the development of a sustained-release formulation of levodopa would lead to improved control of the response fluctuations seen with conventional levodopa preparations.

Adult↗
PubMed1984

Remission in spasmodic torticollis.

In 26 patients with spasmodic torticollis followed up for a median period of 12 years, the frequency of sustained remission was 23%, the median duration of remission was 8 years and duration of torticollis before remission 3 years. These results are more favourable than stated in the literature and should be taken into consideration before recommending surgical treatment.

Adult↗
PubMed1984

Hidradenoma with intracranial involvement.

A case of recurrent hidradenoma of the external ear with intracranial spread is described. The presentation, classification and management of this rare tumour are discussed and the importance of adequate long term review is stressed.

Adenoma, Sweat Gland↗
PubMed1983

Platelet phenolsulphotransferase activity in Parkinson's disease.

Mean platelet phenolsulphotransferase activity was significantly increased in L-dopa-treated parkinsonian patients compared with controls. The degree of rise was associated with dose of and duration of treatment with L-dopa and may thus represent an adaptive increase to circulating dopamine. Alternatively, the increase may reflect changes supervening with duration of illness.

Age Factors↗