Biomedical subjects
Publications and source records attributed to S Nagaswami.
A 64-year-old male with glossopharyngeal neuralgia, cardiac asystole and grand mal seizures has been relieved of his attacks by intake of 400 mg of Carbamazepine per day over a 4-year period. Simultaneous EEG-EKG recordings before and after drinking water document the diagnosis.
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The twenty-four hour urinary excretion of vanillyl mandelic acid was determined in a group of eleven psychiatric patients prior to and during the day of the fifth unilateral electroconvulsive treatment. The patients were all determined by their treating psychiatrists and by psychological testing to be psychotically depressed. In ten of the eleven patients a marked decrease in excreted vanillyl mandelic acid was apparent from the pretreatment level to the fifth treatment level. In one of the eleven patients there was a slight rise from the pretreatment level to the excreted level during the fifth day of treatment. The mean pretreatment determination of vanillyl mandelic acid was 4.2 mg per twenty-four hours; the mean determination made on the fifth treatment was 2.8 mg per twenty-four hours.
The late manifestation of neuroleptic-induced dyskinesia (persistent dyskinesia) is an irreversible complication of long-term treatment that is poorly understood and difficult to treat. Recently, a theory of dopamine receptor hypersensitivity in the dopaminergic-cholinergic system has suggested an explanation of choreiform movements and, thus, an implication for the management of persistent dyskinesia. The case presented is that of bulbar persistent dyskinesia in a patient who had been prescribed a phenothiazine derivative for eleven years; his symptoms improved with the use of deanol, which probably converts to acetylcholine after crossing the blood brain barrier. This improvement suggests that deanol may shift the neuroleptic-induced dopaminergic-cholinergic system unbalance toward equilibrium by matching predominant dopaminergic effect or by enhancing deficient cholinergic action in the dopaminergic-cholinergic system. This isolated finding needs to be confirmed by more research in neuropharmacology.
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This paper describes a case of limbic dysfunction in a 28-year-old female veteran who presented with psychoses and sexual promiscuity. She had EEG abnormalities and showed dramaic improvement with anti-convulsant medication. Limbic system dysfunction in general may present as "functional psychoses." The literature is briefly reviewed.