Fourteen diabetic patients (13 males, 1 female, 7 IDDM and 7 NIDDM) were tested during wakefulness with a battery of tests examining parasympathetic and sympathetic control of the cardiovascular system. Subsequently sleep recordings including EEG, EOG, submental, left and right anterior tibialis EMGs, ECG, nasal airflow, thoracic and abdominal respirograms, nocturnal penile tumescence, were performed in each subject. The assessment of cardiovascular functions during sleep was based on the following parameters: Rbm, R-wake, apnea index, adequate penile tumescence during phase REM. Parasympathetic and sympathetic control of cardiovascular system were both impaired during wakefulness in only one patient, who also showed a low Rbm index indicative of ascertained autonomic neuropathy. Indices Rbm sufficiently low to be considered an evidence of probable autonomic neuropathy were found in 5 patients (3 IDDM and 2 NIDDM); all but one with normal cardiovascular tests during wakefulness. Five patients showed gross deficiency upon nocturnal penile tumescence monitoring. In comparison with a control group the patients showed a significantly lower overall Rbm index (p less than 0.001). IDDM patients showed an increased plasma GH response to insulin-induced hypoglycemia compared to NIDDM and normal subjects. Increased GH secretion was furthermore confirmed by GH values obtained in blood samples drawn during the first REM stage of the night in IDDM patients. The evaluation of the variables taken into consideration during sleep appears to be crucial for the assessment and prevention of autonomic neuropathies and neuroendocrine dysregulation in diabetic patients.

Adolescent↗

PubMedDate not supplied

Prevalence of cervical spondylotic radiculopathy: a door-to-door survey in a Sicilian municipality.

INTRODUCTION: Because of the limited information on cervical spondylotic radiculopathy, we conducted a door-to-door two-phase survey in a Sicilian municipality. MATERIAL AND METHODS: We first screened for cervical spondylotic radiculopathy among the inhabitants of the municipality: (N = 7653, as of the prevalence day, November 1, 1987). Study neurologists then investigated those subjects suspected to have had a cervical spondylotic radiculopathy. Diagnoses were bases on specified criteria. RESULTS: We found 27 subjects affected by CSR (17 definite, 10 possible). Prevalence (cases per 1000 population) was 3.5 in the total population; it increased to a peak at age 50-59 years, and decreased thereafter. The age-specific prevalence was consistently higher in women. CONCLUSIONS: Comparison with other prevalence studies shows similar age-specific patterns, but different magnitudes, which may partly reflect methodologic differences across studies.

Adolescent↗

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Clinically relevant anti-epileptic drug interactions.

Anti-epileptic drugs frequently interact due to pharmacokinetic features (induction or inhibition of metabolism, production of active metabolites, low therapeutic indices) and the need for prolonged treatment with possible addition of other drugs to treat concomitant diseases. The most important pharmacokinetic interactions are those that inhibit phenytoin, carbamazepine and phenobarbitone metabolism and thus increase their toxicity. Drugs inhibiting metabolism include antibiotic macrolides, chloramphenicol, isoniazide, some sulphonamides, propoxyphene, cimetidine, valproic acid and sulthiame. Anti-epileptic drugs can induce hepatic microsomal enzymes and, therefore, may increase metabolism of corticosteroids, oral contraceptives, oral anticoagulants, cardiovascular agents, antibiotics, chemotherapeutic agents, psychotropic drugs and non-opiate analgesics, thereby reducing their efficacy. Advantageous pharmacodynamic interactions include synergism of ethosuximide plus valproic acid and of carbamazepine plus valproic acid. A pharmacodynamic mechanism may be responsible for the reduced sensitivity of chronically treated epileptics to some neuromuscular blockers.

Anticonvulsants↗

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Synergistic anticonvulsant effect of valproic acid and ethosuximide on pentylenetetrazole-induced epileptic phenomena in rats.

The possible synergistic effect of valproic acid and ethosuximide in combination on pentylenetetrazole-induced epilepsy was investigated in rats. Valproic acid and ethosuximide administered intraperitoneally both showed dose-dependent anti-epileptic activity towards pentylenetetrazole-induced myoclonias and tonic-clonic seizures. The valproic acid-ethosuximide combination had a synergistic pharmacological effect. Against myoclonias combined valproic acid-ethosuximide produced a non-significant decrease in the effective dose of both drugs compared with treatment with either drug alone. In the case of tonic-clonic seizures the protective effect against the seizures was significantly increased by combined treatment compared with treatment with either drug alone. Neither plasma concentrations nor any other pharmacokinetic parameters were significantly changed when the same doses of valproic acid and ethosuximide were given, singly or in combination.

Animals↗

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A multicentre trial to evaluate the efficacy and tolerability of alpha-glycerylphosphorylcholine versus cytosine diphosphocholine in patients with vascular dementia.

An open clinical trial was carried out to compare the efficacy and the tolerability of 1 g/day alpha-glycerylphosphorylcholine (alpha-GPC) with 1 g/day cytosine diphosphocholine (CDP) both given intramuscularly for 90 days in 120 patients with mild to moderate vascular dementia. The clinical evaluation, carried out at the start as well as halfway through (45 days) and at the end of treatment (90 days), was expressed by psychometric tests (modified Parkside behaviour rating scale, Sandoz clinical assessment geriatric scale, word fluency test, Hamilton's rating scale of depression, narration subtest of Wechsler memory scale). Both treatments produced a definite symptomatic improvement and showed a very good tolerability. The results suggest that in most tests alpha-GPC possessed a statistical higher efficacy and an overall more satisfactory activity assessed by both patients and investigators compared with CDP.

Aged↗

PubMedDate not supplied

Indole-3-pyruvic acid as a possible hypnotic agent in insomniac subjects.

In a single-blind study six male patients (mean age 39.5 years) with moderate insomnia were treated with placebo for three nights, 100 mg indole-3-pyruvic acid (IPA) for three nights, 200 mg IPA for three nights, 100 mg IPA for two nights and placebo for two nights. Polygraphic recordings were made and total sleep time, sleep efficiency, sleep latency, slow wave sleep latency, rapid eye movement (REM) sleep latency, number of arousals (greater than 1 min), percentage and duration of wakefulness after sleep onset, percentage and duration of wakefulness after sleep onset, percentage and duration of sleep stages 1, 2, 3, 4 and REM were recorded. At the end of 13 days, total sleep time, duration of stage 2 sleep and total non-REM were significantly increased when compared with baseline. Total sleep time and duration of stage 2 and total non-REM sleep on completion were significantly decreased when compared with after 200 mg IPA (night 9). Results suggest an action of IPA on human sleep similar to that of exogenous melatonin and L-tryptophan, thus confirming that IPA could be used to increase serotonin and melatonin turnover.

Adult↗

PubMedDate not supplied

Neuroleptic malignant syndrome: description of two cases with prolonged clinical course.

Two cases of neuroleptic malignant syndrome presenting an unusual clinical course are reported. The first patient was untreated for the syndrome and recovered completely only after four months, while the other one was given dopaminergic and myorelaxing drugs only 10 days after the onset of the symptoms and died about six months later with an unmodified clinical picture. In both cases the treatment seemed to influence the clinical course, a delay or lack of drug intake worsening the prognosis.

Adult↗

PubMedDate not supplied

[Analysis of rapid eye movements in sleep in insomnic patients treated with flurazepam and phenobarbital].

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Adult↗

PubMedDate not supplied

[Gilles de la Tourette disease: review of the literature].

The authors reviewed recent literature reports on Gilles de la Tourette syndrome. Clinical aspects, etiopathogenetic theories and therapeutic trials were taken into account, to better define the disease and its rational therapeutic approach.

Adolescent↗

PubMedDate not supplied

[Behavior of facial paraspasm during various phases of physiological nocturnal sleep].

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Adult↗

PubMedDate not supplied

Hormonal disregulation and catamenial epilepsy.

Six epileptic women, showing a clear increase in seizure frequency in the perimenstrual period, were studied during three consecutive menstrual cycles. At each control seizure occurrence, EEG recordings, endocrine profile and antiepileptic drug plasma levels were evaluated. The only pathological finding was the progesterone deficiency with a relative hyperestrogenism during the late luteal phase. Our data agree with other reports suggesting that catamenial epilepsy may result from a sex hormone disregulation.

Adolescent↗

PubMedDate not supplied

[Relationship between periodic movements in sleep and vigilance: analysis of the role of circadian rhythms].

Periodic movements during sleep (PMS) are discussed in relation to several hypotheses concerning their etiology and their possible nosographic classification. In particular the role of central and peripheral events able to determine PMS is emphasized. The possible existence of space-intensity-time (SIT) patterns responsible for the vigilance profiles and the state of activity of central and peripheral effectors is also discussed. Finally the authors examine the modulating role of GABA on the circadian system and a possible metabolic instability of the GABAergic neurons responsible for PMS. This hypothesis is confirmed by the usefulness of clonazepam to treat such disorders.

Circadian Rhythm↗

PubMedDate not supplied

[Lennox-Gestaut syndrome: therapeutic aspects].

The Lennox-Gastaut Syndrome is one of the most refractory form of epilepsy and a variety of compounds, such as traditional antiepileptics, "new anticonvulsants" and non-anticonvulsant drugs has been tested. ACTH and, among the traditional antiepileptics. Clonazepam and Sodium Valproate showed the most favorable effects. The immediate (within 6 months) therapeutic response to ACTH and Clonazepam is satisfactory, with a more than 50% reduction of seizures in about one half of patients; after one year, however, only a small percentage of cases (7-10%), rather close to that with spontaneous remission, shows some therapeutic benefit. Valproate, when used as a single drug, produces a decrease in seizures (greater than 50%) in 25-30% of pts. A list of compounds, such as amphetamine, taurine, amantadine, allopurinol and, among the new putative antiepileptics, cinromide and gamma-vinyl-GABA, has been tested with some occasionally observed improvement in seizure control. None of these compounds, however, is of really proven efficacy. An acquired general rule of treatment is to avoid complex polypharmacy and overdose; there is in fact good evidence that making the child drowsy will greatly increase the number of fits.

Anticonvulsants↗

PubMedDate not supplied

Wakefulness and sleep autonomic dysfunction in diabetics.

Parasympathetic and sympathetic controls on cardiovascular systems were studied during wakefulness and sleep in 8 diabetic patients (3 IDDM and 5 NIDDM), in order to detect the presence of autonomic dysfunction. In particular, cardiovascular assessment during sleep allowed to detect minimal autonomic abnormalities in the absence of a documented pathology during wakefulness.

Adolescent↗