L-dopa and favism.
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Biomedical subjects
Publications and source records attributed to I Sarova-Pinhas.
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Reduction of dopamine concentrations in the brains of patients with Parkinsonism, together with reported clinical improvement after the administration of dihydroxyphenylalanine, has led to the hypothesis that impaired hydroxylation of tyrosine may be associated with the disease. To test this hypothesis oral loading tests with L-phenylalanine and tyrosine were carried out in patients and controls. After phenylalanine lower blood levels of this were found in Parkinsonian patients than in controls, but tyrosine levels were the same. After tyrosine lower levels of this were also found in patients compared with controls. It is suggested that these findings indicate a decreased rate of tyrosine utilization in Parkinson's disease together with intestinal malabsorption; the latter is supported by the finding of abnormal D-xylose tolerance in these patients.
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A variety of psychiatric disorders accompany multiple sclerosis (MS), affecting the spheres of cognition, affect, and personality. These disorders may be of primary and/or secondary nature, reflecting, respectively, neurologic damage and/or functional distress associated with a disabling disease. Evaluation of the nature, severity, and frequency of affective symptoms of MS patients is of importance to sensitize the treating physician to the possible need for specific psychiatric treatment. We conducted a prospective cross-sectional study assessing correlations of psychiatric symptomatology and the neurologic parameters of disease duration, disease activity (as expressed by the number of disease exacerbations per year), and disease severity (as measured by the Kurtzke Expanded Disability Status Scale [EDSS]) in 20 relapsing-remitting (RR)-MS patients. Patients were also evaluated by a semistructured psychiatric interview and the following rating scales: Hamilton Anxiety Scale (HAS), Hamilton Depression Scale (HDS), Hackett-Cassem Denial Scale, and Lubin Adjective Affective List. Results demonstrated a high prevalence of anxiety (90%) and to a lesser extent depression (50%) in RR-MS patients. Depression and anxiety were found to be associated with disease activity, but not with disease duration or severity. The mechanism of denial played a significant role in the psychiatric profile of the disease and was correlated with disease duration. We suggest that in RR-MS patients, psychiatric evaluation should also include assessment of defense and coping mechanisms, which in turn could guide specific individualized treatment.
Some recent studies have shown that clozapine (CLZ) has myopathic side effects and causes alterations in motor force control. The aim of this study was to evaluate the neurologic and electrophysiologic characteristics of patients with schizophrenia who are undergoing long-term CLZ treatment. Ninety-four patients with schizophrenia treated with CLZ for 18.2 +/- 15.5 months were studied retrospectively and prospectively (40% and 60%, respectively) for serum creatine kinase (CK) levels before and after initiation of CLZ treatment. An electrodiagnostic study was performed on patients with CK elevation above normal limits, complained of general weakness or muscle pains, and/or had abnormal clinically significant findings. In 13 patients (13.8%), abnormal CK levels were found. Six patients complained of some muscular weakness. In two patients, clinical assessment revealed mild general muscular weakness; one revealed decreased tendon reflexes and, in both, CK levels were above 1,750 IU/L. On electrophysiologic examinations performed in the six patients with abnormal neurologic findings, the motor and sensory nerve conduction velocity were within normal range in all but one patient, who exhibited some prolongation of distal latency in the lower limbs. In two patients, the electromyography demonstrated a myopathic pattern. In 2.1% of medically healthy patients with schizophrenia treated with clozapine on a long-term basis, signs of myotoxicity were found. It seems warranted to discontinue CLZ therapy in patients who exhibit abnormal CK levels and myopathic features during treatment. Further studies are needed to provide more objective data on the impact of CLZ treatment on muscle tissue.
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