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Biomedical subjects

H P Ludin

Publications and source records attributed to H P Ludin.

At least 19 recordsLinked to original sources
PubMed2005

[Idiopathic Parkinson's disease: practical hints for the treatment].

The treatment of patients suffering from idiopathic Parkinson's disease has become more and more complex. From its beginning the treatment has to be tailored to the needs of each patient. Not only the individual symptomatology and its course have to be taken into consideration, but also the short- and longtime reaction to treatment.

Adult↗
PubMed2004

[Are there innovations in the treatment of Parkinson's disease?].

In the group of medication acting on the dopaminergic system the transdermal application of a dopamine agonist (Rotigotine) and a new MAO B inhibitor (Rasigiline) are receiving most attention. With some concern we had to learn that pergolide, a potent dopamine agonist, may be the cause of clinically relevant valvulopathies. Our possibilities to act on non-dopaminergic deficits is still very limited. The studies demonstrating a positive effect of cholinesterase inhibitors on cognitive decline are at least a positive signal.

Antiparkinson Agents↗
PubMed2003

[Comment on revised guidelines in treatment of idiopathic Parkinson syndrome].

Treatment of idiopathic Parkinson's has become increasingly complex during the past years. A revision of the guidelines for treatment which had been published in 1998 by a study group of the Swiss Neurological Society became necessary. Emphasis is again put on the correct choice of medication for the start of treatment. The new guidelines also contain hints to the management of the problems of long term treatment.

Antiparkinson Agents↗
PubMed2003

[Pitfalls in diagnosis of idiopathic Parkinson syndrome].

In general the diagnosis of idiopathic Parkinson's disease is considered to be easy and safe. In the last few years several studies have demonstrated that this in reality is not the case. A number of other syndromes have to be differentiated from idiopathic Parkinson's disease. One must be aware that in substantial number of cases the natural history has to be observed before a safe diagnosis can be made.

Diagnosis, Differential↗
PubMed2002

[Associated symptoms and relevant associated illnesses in idiopathic Parkinson syndrome].

Besides the four cardinal symptoms tremor, rigidity, akinesia and postural instability Parkinsonian patients may suffer from a number of associated symptoms which can have a negative influence on quality of life and which may require specific therapeutic measures. As it is to be expected in elderly people, patients with Parkinson's disease may suffer from other pathologies requiring medical treatment. In order to avoid undesired interactions the various treatments have to balanced carefully.

Aged↗
PubMed2002

[Fatigue, daytime somnolence and sleep disorders in Parkinson patients].

Many patients suffering from Parkinson's disease complain about chronic fatigue and daytime somnolence. During the last few years attention has been drawn to "sleep attacks", which are supposed to be due mainly to dopamine agonists. Sleep disturbances during the night are quite frequent. It is important to search for the probable causes in each individual case in order to be able to install an efficacious treatment.

Aged↗
PubMed2002

Efficacy and tolerability in migraine prophylaxis of flunarizine in reduced doses: a comparison with propranolol 160 mg daily.

This was a phase-IV double-blind equivalence trial designed to assess the efficacy and tolerability of two doses of flunarizine (10 mg o.d.=FLU 10 mg and 5 mg o.d.=FLU 5 mg) in the prophylaxis of migraine, in comparison with slow-release propranolol (160 mg o.d.). A total of 808 subjects were treated in a treatment period of 16 weeks. 142 subjects discontinued the trial prematurely, mainly because of adverse events (n=58). The mean attack frequency in the double-blind period was 2.0 for the FLU 5 mg group, 1.9 for the FLU 10 mg group, and 1.9 for the propranolol group. The mean attack frequency in the last 28 days of the double-blind period was 1.8 for FLU 5 mg, 1.6 for FLU 10 mg, and 1.7 for propranolol. Both flunarizine groups were at least as effective as propranolol (P<0.001 in one-sided test). The percentage of responders (defined as subjects for whom attack frequency decreased by at least 50% compared to run-in) in the last 28 days of the double-blind period was 46% (118/259) for FLU 5 mg, 53% (141/264) for FLU 10 mg, and 48% (125/258) for propranolol. Statistical analysis showed that FLU 10 mg is at least as effective as propranolol (P<0.001) and showed a trend for noninferiority of FLU5 and propranolol (P=0.053). No statistically significant differences between the treatment groups were found for any of the secondary parameters. Overall, 190 subjects reported one or more adverse events during the run-in phase: 54 (20.5%) in the FLU 5 mg group, 76 (27.7%) in the FLU 10 mg group and 60 (22.3%) in the propranolol group. The results of this equivalence trial show that 10 mg flunarizine daily with a drug-free weekend is at least as effective as 160 mg propranolol in the prophylaxis of migraine for all evaluated parameters (one-sided equivalence tests) after 16 weeks of treatment. In addition, 5 mg flunarizine proves to be at least as effective as 160 mg propranolol when looking at the mean attack frequency for both the whole double-blind period and the last 28 days of treatment. However, in the analysis of responders, 160 mg propranolol seems to be slightly better than 5 mg flunarizine. In addition, no significant differences between the three treatments were found with regard to safety: all three treatments were generally well-tolerated and safe.

Adolescent↗
PubMed2001

[Therapy of idiopathic Parkinson syndrome 1817 to 2001. A success story?].

It lasted some 150 years after the first description by James Parkinson in 1817 until levodopa, the first really efficacious treatment, was available for Parkinson's disease. Previously only anticholinergic substances and stereotaxic operations, both acting merely exclusively on tremor, were used for many and a few years respectively. Even today the treatment is purely symptomatic. There is no treatment in sight which would cure the disease or at least stop or slow down its progression.

Antiparkinson Agents↗
PubMed2000

[Senile epilepsy].

Epilepsy is an important factor of neurologic morbidity in the elderly population. The incidence is higher in the age group over 65 years than in children and adolescents. Cerebrovascular disturbances are the most frequent cause of seizures in the elderly. The so-called idiopathic epilepsies on the other hand are rather rare. The frequent co-morbidity and co-medications have to be taken in consideration when evaluating and treating such patients. There is a number of efficacious antiepileptic drugs at disposition. The selection of the drugs and their dosage have to be adapted to the needs of the particular age group.

Aged↗
PubMed2000

Disturbed functional brain interactions underlying deficient tactile object discrimination in Parkinson's disease.

Somatosensory discrimination of cuboid objects was studied in a group of healthy volunteers and patients with Parkinson's disease using regional cerebral blood flow (rCBF) measurements obtained with positron emission tomography (PET) and 15O labeled water [H2 15O]. A 6-[18F]-fluoro-L-dopa (FDOPA) PET scan demonstrated that the patients may be grouped into those with normal and those with abnormally lowA FDOPA uptake in the caudate nucleus. The categorical group comparisons revealed that task-induced rCBF increases were deficient in bilateral motor and sensory cortical areas in the Parkinson patients. Moreover, deficient rCBF increases were evident in the mesial and right dorsolateral prefrontal cortex for patients in a more advanced disease state, who showed low FDOPA uptake in the caudate nucleus. A principal component analysis (PCA), performed on the rCBF data, identified three patterns (principal components, PCs) that differentiated patients from normals. The first PC represented a right-hemisphere dominant, bilateral group of brain areas known to be involved in tactile exploration. A second PC reflected a cortical-subcortical pattern of functional interactions, comprising cortical areas important for working memory processes. The third group-differentiating PC revealed a pattern of functional interactions involving bilateral temporo-parieto-occipital association cortices, which was consistent with a hypothesized supramodal network necessary for object discrimination. In an additional subgroup analysis, greater expression of the third PC pattern predicted greater caudate FDOPA uptake in patients. Our neuroimaging data revealed a disturbance of distinct patterns of brain functional interactions related to the sensorimotor deficit in Parkinson's disease and to deficits of cognitive information processing deficits in the more advanced stage of Parkinson's disease.

Adult↗
PubMed1999

[Recurrent retrobulbar neuritis and extensive myelitis: MS or optic neuromyelitis?].

Two female patients with recurrent optic neuritis and severe myelitis were described. In the first patient the illness began with recurrent myelitis, in the second one with optic neuritis. In both patients spinal MRI showed extensive enhancing lesions of the cervical respectively thoracic spinal cord. An initial cranial MRI was normal. In the first patient an MRJ demonstrated after several years lesions not typical for multiple sclerosis. In both patients cerebrospinal fluid showed especially mononuclear pleocytosis with cell counts between 11 and 126/microliter and severely elevated total protein, while intrathecal oligoclonal bands were not found. During exacerbations in both patients ENA-autoantibody-screening was positive. Intravenous treatment with methylprednisolone improved the clinical situation for some time. In both patients cyclophosphamide at a dose of 100 mg daily had to be given due to relapsing neurological deficits.

Adult↗
PubMed1999

Parkinson's disease in twins: a follow-up study.

OBJECTIVE: To reevaluate concordance rates in 9 monozygotic (MZ) and 12 dizygotic (DZ) twin pairs with PD 8 years after the initial study. BACKGROUND: Longitudinal investigations increase accuracy in clinical diagnosis of PD. METHODS: Follow-up by personal interview and clinical examination. RESULTS: Concordance rates were not different between MZ (3/9) and DZ (5/12) twin pairs at follow-up, even when PD-associated dementia and isolated postural tremor were considered diagnostic of familial Lewy body parkinsonism. Evaluation of medical history, personality traits, and blink rate did not reveal putative early or premorbid parkinsonism in 9 co-twins who were motor-asymptomatic during the follow-up interval. However, these co-twins had reduced semantic fluency in comparison with a healthy control group of similar age. None of 7 co-twins without motor signs who underwent PET investigation 6 years previously showed signs of extrapyramidal disease at follow-up, but verbal memory continued to be reduced in 5 of these co-twins. CONCLUSION: Based on concordance rates only, the findings in our twin sample do not support a major genetic impact for the motor expression of PD.

Adult↗
PubMed1999

[Modern therapeutic possibilities in Parkinson disease].

Several new methods for the treatment of patients suffering from Parkinson's disease have been introduced during the last few years. COMT inhibitors are available in addition to levodopa with a decarboxylase inhibitor. COMT inhibitors enhance and prolong the effect of single levodopa doses. Severe side effects have been mentioned in connection with the COMT inhibitor tolcapone in recent months. Several new dopaminergic agonists now provide efficacious monotherapy in the early stages of the disease. This brings about a reduction in late problems of treatment such as dyskinesias and fluctuations. Stereotaxic operations in the pallidum and the subthalamic afford relief for these late complications of treatment in selected patients.

Antiparkinson Agents↗