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J Vaamonde

Publications and source records attributed to J Vaamonde.

52 records · Page 3Linked to original sources
PubMed1987

Continuous dopaminergic stimulation in Parkinson's disease.

Complex motor fluctuations and dyskinesias ("on-off" phenomenon) in Parkinson's disease can be corrected by parenteral administration of levodopa, levodopa-methyl-ester, lisuride and apomorphine. Levodopa and levodopa-methyl-ester may only be administered intravenously because of their low solubility. Lisuride and apomorphine are readily absorbed after subcutaneous administration. Repeated or continuous intravenous infusions of levodopa have been given for a few days, using a wearable "jacket-like" pump, with good results. So far, lisuride is the only dopamine agonist used for chronic treatment by continuous infusion. The "on-off" effect is adequately controlled in most patients by subcutaneous lisuride administration (plus oral levodopa). However, adverse effects, particularly psychiatric complications, constitute a major limiting factor for routine applications of this form of treatment. Subcutaneous apomorphine infusion is unlikely to become a standard therapeutic procedure in Parkinson's disease, but it is a very valuable research method to gain further insight into the pathophysiology of motor fluctuations in Parkinson's disease.

Antiparkinson Agents↗
PubMed1986

Antimyoclonic action of piracetam.

Five patients with myoclonus were treated with oral piracetam (8-9 g/day). All patients had action-sensitive and/or stimulus-sensitive myoclonus and enhanced amplitude of somatosensory evoked potentials. Piracetam produced a marked reduction of the myoclonus in the five subjects without side effects. In view of its excellent tolerance and synergism with other antimyoclonic drugs, we consider piracetam to be a very valuable drug for the treatment of patients with myoclonus of any origin.

Adolescent↗
PubMedDate not supplied

[SPECT with 123I-IBZM: utility in differential diagnosis of degenerative Parkinsonisms and establishment of quantification method].

OBJECTIVES: To assess utility of SPECT with 123I-Iolopride ( 123I-IBZM) in the differential diagnosis of patients with Parkinsonian symptoms and try to establish an adequate quantification method. MATERIAL AND METHOD: We analyzed a total of 34 patients who underwent a study with 123I-IBZM SPECT. Studies were analyzed qualitatively (visually) and quantitatively, using different quantification methods. We used different sums of slices (2, 3, 4, and 7 slices) with different cortical regions as a reference (frontal and occipital regions). Results were analyzed statistically. The final diagnosis of patients was established by two neurologists, specialized in movement disorders. RESULTS: Studies were visually assessed as normal in 24 cases and as pathologic in the other 10 cases. Scintigraphic studies had an adequate diagnostic correlation in 33 of the 34 patients. Four of the 8 methods used in the quantification were statistically significant in the differentation between normal and pathological. The use of different cortical brain regions as reference did not improve differentation between normal and pathologic studies. Global quantitative assessment of the studies showed that normal studies had higher values than pathological ones, with important overlapping between both categories. CONCLUSIONS: 123I-IBZM SPECT is an effective diagnostic tool in the establishment of the differential diagnosis in patients with Parkinson's disease and Parkinson-Plus. Quantification of these studies had limited utility since the overlapping of index values between normal and pathological restricts their use in individual cases.

Adult↗
PubMedDate not supplied

[Falling backward: atypical sign of iodiopathic Parkison's disease. Use of intravenous apomorphine as a diagnostic test].

INTRODUCTION: The differential diagnosis of a parkinsonian syndrome is extensive and complex. In most cases, however, a detailed clinical examination will help to differentiate between idiopathic Parkinson's disease (IPD) and other causes of parkinsonism. PATIENTS AND METHODS: 10 patients with an average age of 65.1 years (range 60-70), of whom 6 were men and 4 women were referred to our department with a diagnosis of IPD and history of backwards falls. The average duration of disease was 4.7 years (range 4-7). All 10 patients had at presentation a severe akinetic-rigid syndrome with no other symptoms of IPD. I.v. apomorphine (APO) was administered to each of them at a rate of 8.9 mg/hr (range 15.3 mg/hr) for an average time of 5.4 hours (range: 3-10 hours). RESULTS: The improvement of the akinetic-rigid state in six of the patients during the i.v. infusion with APO helped to elicit signs that are atypical of IPD (ataxia and postural instability). Three of the patients did not respond to i.v. APO and one of them could not be evaluated, as he did not tolerate the infusion. Oral Dopa challenge or s/c APO bolus has not been as successful in helping to differentiate IPD from other parkinsonian syndromes. CONCLUSIONS: The prompt detection of postural instability or retropopulsion is necessary in order to diagnose atypical parkinsonian syndromes. In difficult cases, continuous i.v. APO will improve the akinetic-rigid state and facilitate the detection of atypical signs. The pharmacokinetic characteristics of APO, and the advantage of it being possible to administer the drug i.v. in a few hours increases the viability of this test.

Accidental Falls↗
PubMedDate not supplied

[Primary orthostatic tremor: slow harmonic component as responsible of inestability].

BACKGROUND: Orthostatic tremor (OT) is clinically defined as a tremor of the lower limbs and trunk on walking. It bears a significant functional impairement. Although the term orthostatic tremor was first used by Heilman in 1984, Pazzaglia et al had previously described some cases in 1970. Despite the fact that the pathophysiology of this entity is not fully known, the presence of a central oscillator is generally accepted as being responsible. A high frecuency tremor, between 13 and 18 Hz, constitutes an almost patognomonic finding, and treatment with clonazepam usually improves the symptoms. PATIENT AND METHOD: We present a patient who described his symptoms as "cramps" in lower limbs and trunk on standing up, which were relieved on walking or resting. RESULT: This clinical presentation together with a neurophysiological recording of the tremor showing an activity of lower frequency (8 Hz) combined with the usual higher frequency (16 Hz) and above all the clear amelioration of symptoms when treated with gabapentin, i.e. resolution of the low frequency tremor without changes in the 16 Hz tremor, were the peculiar features of this case which merits discussion. CONCLUSIONS: The slow component of the orthostatic tremor is crucial in this case. The improvement with gabapentin is explained by the disappearance of this slow c

Acetates↗
PubMedDate not supplied

[Study of the pre and post-synaptic dopaminergic system by DaTSCAN/IBZM SPECT in the differential diagnosis of parkinsonism in 75 patients].

INTRODUCTION: Essential tremor (ET) may be misdiagnosed as idiopathic Parkinson's disease (PD). In neurodegenerative diseases, structural imaging, such as CT or MRI, is of limited value for differentiating parkinsonian syndromes since structural changes are often only evident by the time the disease is far advanced. Most cases of symptomatic parkinsonism are vascular parkinsonism, but PD may coexist. The differential diagnosis between Alzheimer's disease (AD) and dementia with Lewy bodies (LBD) is often difficult. OBJECTIVE: To define the utility of functional neuroimaging test to establish differential diagnosis between PD and ET, drug induced parkinsonism, multiple system atrophy and vascular parkinsonism, and between AD and LBD, when clinical presentation, evolution or treatment response are atypical. PATIENTS AND METHODS: A group of 75 patients with parkinsonism was examined by clinical assessment and DaTSCAN (123I-FP-CTI, dopamine transporter protein marker) and/or IBZM SPECT (D2 receptor marker). The patients were recruited from our outpatient clinic. RESULTS: Correlation between initial clinical diagnosis and functional imaging studies (DaTSCAN and/or IBZM SPECT) in our patients did not reach that described (more than 90 %) for these techniques in previously published studies. Conclusions. According to sensitivity and sensibility reported in previous imaging studies of the pre and/or postsynaptic dopaminergic system using DaTSCAN and/ or IBZM, SPECT may be a new tool in the diagnosis of parkinsonian patients with difficult clinical diagnosis.

Adult↗
PubMedDate not supplied

[Study of presynaptic nigrostriatal pathway by 123-I-FD-CIT-SPECT (DatSCAN SPECT) in primary orthostatic tremor].

INTRODUCTION: Primary orthostatic tremor (OT) is defined as a clinical syndrome with high frequency (13-18 Hz) tremor when standing predominantly involving legs and trunk. OT is thought to be driven by an unique supraspinal tremor generator. Previous studies suggest that the nigrostriatal dopaminergic transmission is impaired in patients with OT. CLINICAL CASE: All three patients at an age of 56, 45 and 72 years fulfilled the diagnosis criteria of primary OT. The duration of illness amounted to 4, 3 and 1 year, respectively. The three patients had single-photon emission computed tomography (SPECT) using 123-I-FP-CIT as dopamine transporter tracer (DatSCAN). RESULTS: DatSCAN was normal in every patient. CONCLUSIONS: OT is considered to be caused by a central oscillator because high-frequency tremor bursts are time locked in arm, leg, trunk, and even facial muscles and peripheral stimulation does not reset the tremor. Some reports suggest that the central generator may be located in the posterior fossa. In our patients presynaptic nigrostriatal pathway was normal.

Aged↗