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Biomedical subjects

J Jankovic

Publications and source records attributed to J Jankovic.

At least 343 records · Page 19Linked to original sources
PubMed1982

Treatment of hyperkinetic movement disorders with tetrabenazine: a double-blind crossover study.

Tetrabenazine, a presynaptic monoamine depleting agent, has been reported to have an ameliorating effect in a variety of hyperkinetic movement disorders. In a double-blind crossover trial of tetrabenazine versus placebo, 19 patients with a variety of hyperkinetic movement disorders were evaluated. During the evaluation period, all but 4 patients were treated for three or more weeks at a maximum dosage of 200 mg per day. The patients were examined and rated using clinical assessment of hyperkinesia, and movies of their activities were randomized and rated by an independent group of neurologists. A good correlation was found between the clinical examination scale and the film analysis score. Improvement was seen in all 4 patients with tardive dyskinesia, 4 of 6 patients with Meige disease, and 5 of 6 patients with other dystonias. One patient with Huntington disease showed marked improvement and 2 patients with congenital choreoathetosis showed only mild improvement. The most frequent side effects included daytime drowsiness, drooling or sialorrhea, insomnia, restlessness and anxiety, parkinsonian features, and mild postural hypotension. The adverse effects resolved with continued administration or with reduction in dosage. Tetrabenazine is a useful and safe therapeutic agent in some patients with hyperkinetic movement disorders.

Adolescent↗
PubMed1982

Management of motor side effects of chronic levodopa therapy.

The enthusiasm generated by the dramatic clinical response of parkinsonism to levodopa therapy has been blunted by the emergence of side effects related to chronic use of the drug. Levodopa-induced dyskinesias are thought to be due to striatal dopamine-receptor hypersensitivity as a result of chronic and excessive dopamine agonism. The daily dose of levodopa should be as low as possible and when dyskinesias develop, the dosage of both levodopa and anticholinergic agents should be reduced. Clinical oscillations, due to a variety of factors, are more difficult to control. More frequent and smaller doses of levodopa, drug holidays, and the use of amantadine or dopamine agonists may be helpful.

Circadian Rhythm↗
PubMed1982

Severe dystonia and myoglobinuria.

Myoglobinuria may follow extreme muscular exertion or disorders that cause muscle necrosis. Dystonia has not been implicated previously. We studied an 8-year-old boy of non-Jewish, Mexican-American descent with autosomal-dominant dystonia musculorum deformans who developed rapidly progressive and severe generalized dystonia, hyperpyrexia, myoglobinuria, and renal failure. Curarization was required. Transient improvement was achieved with tetrabenazine and baclofen, but bilateral thalamotomy was then performed. Patients with severe dystonia should be observed for evidence of myoglobinuria.

Child↗
PubMed1982

Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs.

It is not widely recognized that antipsychotic drugs can cause late-onset and persistent dystonia. This dystonia, which we call tardive dystonia, is to be distinguished from acute dystonic reactions, which are transient, and from classic tardive dyskinesia, which is a choreic disorder that predominantly affects the oral region. We present 42 patients with tardive dystonia. The age of onset of dystonia was 13 to 60 years. Symptoms began after 3 days to 11 years of antipsychotic therapy. Younger patients tended to have more generalized dystonia. In a few patients, spontaneous remission occurred, but dystonia persisted for years in most. Therapy was rarely a complete success. The most frequently helpful medications were tetrabenazine (68% of patients improved) and anticholinergics (39% improved).

Adolescent↗
PubMed1981

Benign coital cephalalgia. Differential diagnosis and treatment.

Benign coital cephalalgia is an acute headache that is time related to sexual intercourse. It is often confused with more serious conditions such as subarachnoid hemorrhage due to ruptured intracranial aneurysm. We describe eight patients with benign coital cephalalgia who were successfully treated with propranolol hydrochloride. We suggest that these patients have a variant of migraine.

Acute Disease↗
PubMed1981

Quantitative assessment of parkinsonian and essential tremor: clinical application of triaxial accelerometry.

Triaxial accelerometry was used to study various motion characteristics in 10 patients with Parkinson disease and 11 patients with essential tremor. The smoothness of motion factor (SPMEF) and the acceleration waveform factor (TIPAR) were frequently and consistently abnormal. When both factors were analyzed together and compared with a control population, 100% of the left arm and 88% of the right arm values were abnormal in the Parkinson disease group, and 82% of the left arm and 91% of the right arm values were abnormal in the essential tremor patients. Repeat evaluation revealed consistent intrapatient results. Therefore, this technique may provide an objective assessment of movement disorders.

Aged↗
PubMed1981

Drug-induced and other orofacial-cervical dyskinesias.

Tardive dyskinesia is one of the most prevalent and disabling of the iatrogenic disorders. Characterized by involuntary movements of the orofacial-cervical musculature that develop after prolonged use of neuroleptic drugs, it is sometimes confused with other involuntary movements involving predominantly the head and neck region. In this review the differential diagnosis of the orofacial-cervical dyskinesias is discussed. A therapeutic approach is presented in view of our recent understanding of the possible biochemical mechanisms of tardive dyskinesia.

Chorea↗
PubMed1980

Meige's syndrome.

We present two women with Meige's syndrome, a condition in which the clinical presentation differs from tardive dyskinesia by the lack of exposure to neuroleptic drgus, greater severity of blepharospasms, and more prolonged dystonic contractions of oromandibular muscles. In this condition we used triaxial accelerometry to detect dystonia, which may also appear in limb and respiratory muscles. Although psychologic factors may affect the symptoms, the basic pathogenesis of this syndrome does not seem to be psychogenic. We think that biochemical abnormalities in the basal ganglia are responsible for the dyskinesias and submit data suggesting a reduction of dopamine turnover in the central nervous system of one patient. Both patients have evidence of autoimmune diseases, and one patient's dystonic movements responded to immunosuppressive therapy, suggesting that autoimmune processes contribute to the pathogenic mechanism of Meige's syndrome in some instances.

Aged↗
PubMed1980

Haemorrhagic complications of multiple sclerosis.

Neurological exacerbations in multiple sclerosis patients are usually attributed to relapses of the disease. This report emphasises that other conditions, such as spontaneous CNS haemorrhage, may be responsible for the clinical deterioration. We describe two patients appropriately diagnosed as having multiple sclerosis who developed spontaneous CNS haemorrhage.

Adult↗
PubMed1980

Physiologic and pathologic tremors. Diagnosis, mechanism, and management.

Tremor, the commonest of the involuntary movement disorders, is characterized by rhythmical oscillatory movement that occurs at rest or during activity; all tremors cease during sleep. Physiologic tremor is present in normal persons and is asymptomatic. Tremor is considered pathologic when it impairs a patient's function. Clinically, the pathologic tremors may be classified as accentuated physiologic, parkinsonian, essential, and cerebellar. We review here the basic mechanisms and clinical features of various tremors and emphasize recent advances in pathophysiology and management.

Alcoholic Beverages↗
PubMed1979

Hereditary myoclonus and progressive distal muscular atrophy.

Myoclonus occurs in a variety of pathological conditions, some inherited. We recently evaluated 3 members of a Louisiana-Texas family with an autosomal dominant disorder manifested by adult-onset, generalized, stimulus-sensitive myoclonus and slowly progressive distal muscle weakness and wasting. The analyses of cerebrospinal fluid homovanillic acid and 5-hydroxyindoleacetic acid before and after probenecid provided some evidence of impaired turnover of central dopamine and serotonin. Treatment with clonazepam resulted in complete and lasting improvement of the myoclonus. A postmortem examination in 1 member of the family revealed chiefly neuronal degeneration of the anterior horn cells, Clark's nucleus, and the lower cranial nerve nuclei. A similar syndrome has not previously been reported.

Adult↗
PubMedDate not supplied

Drug-induced dystonia in neuronal ceroid-lipofuscinosis.

Neuroleptic-induced tardive dystonia is frequently refractory to therapy. We describe a 13-year-old girl with neuronal ceroid-lipofuscinosis who developed dystonia after beginning treatment with thioridazine for acute psychosis. Although anticholinergic drugs and benzodiazepines were ineffective, the patient improved with baclofen. Patients with certain degenerative diseases of the central nervous system may be at increased risk for the development of drug-induced dystonia, and we caution against the use of neuroleptics in these patients.

Adolescent↗
PubMedDate not supplied

Efficacy and tolerability of a novel sublingual apomorphine preparation in patients with fluctuating Parkinson's disease.

We tested a novel preparation of sublingual apomorphine hydrochloride (APO) in 10 patients with advanced Parkinson's disease complicated by motor fluctuations and dyskinesias. After dose titration, patients underwent a blinded comparison of APO versus placebo, and an unblinded comparison of APO versus optimally dosed carbidopa/levodopa using timed tapping and walking paradigms. APO was significantly better than placebo in both measures: Tapping speed was 30.8% faster than with placebo (p < .0005), and ambulation speed was 45.2% faster than with placebo (p < .05). Ambulation speed with APO was also 15.9% faster than that with optimal doses of carbidopa/levodopa (p < .05). The latency to onset of clinical improvement with each APO dose was 10 to 40 minutes, and the duration of effect was 60 to 130 minutes. Adverse events included nausea, orthostatic hypotension, and disagreeable taste in the patient's mouth. Aside from the bitter taste, all other side effects resolved with continued use and did not limit dosing in any case. We feel that the good short-term efficacy and tolerability demonstrated in this study warrant further study of this new preparation, as there are several potential advantages of sublingual administration compared with traditional APO preparations.

Adult↗