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Biomedical subjects

W Birkmayer

Publications and source records attributed to W Birkmayer.

At least 37 records · Page 2Linked to original sources

DL-3,4-threo-DOPS in Parkinson's disease: effects on orthostatic hypotension and dizziness.

Parkinsonian patients with orthostatic hypotension and dizziness due to usual antiparkinson therapy have been treated with the precursor amino-acid of noradrenaline, DL-3,4-threo-dihydroxyphenylserine (DL-3,4-threo-DOPS). Oral and intravenous administration improved these side effects significantly. A combined treatment of L-dopa, peripheral decarboxylase inhibitor and DL-3,4-threo-DOPS seems to be of benefit with respect to akinesia and orthostatic hypotension.

Aged↗

Deprenyl (selegiline) in the treatment of Parkinson's disease.

Deprenyl combined with levodopa and a peripheral decarboxylase inhibitor is of therapeutic value in the treatment of Parkinson's disease. This conclusion is substantiated by the improvement of akinesia, on-off phases, fluctuations of disability and rigidity. Levodopa doses can be reduced. The onset of adverse reactions is later and side-effects are even milder when compared to those with combined levodopa treatment. The most significant effect of deprenyl, however, is its ability to prolong the life expectancy of parkinsonian patients.

Dopamine↗

Symptoms and side effects in the course of Parkinson's disease.

From our investigations, we are tempted to assume that all types of akinesia, including "freezing", off-phases, Yo-Yoing and akinetic crises, are primarily symptoms of PD, while hyperkinesia, stretch spasms and pharmacotoxic psychosis are "side-effects". Therefore side-effects can be triggered by antiparkinsonian therapy while they will disappear after withdrawal of the drugs inducing them. Antiparkinson drugs alleviate major symptoms like akinesia and rigidity but sometimes and especially as reflection of advanced parkinsonism, might amplify minor symptoms (freezing, off-phases, Yo-Yoing), which then predominantly at high drug doses occur earlier and more intensively. Therefore, minor symptoms can be observed more frequently in the advanced stages of PD. Depressed phases belong to the symptom complex as is bradyphrenia and dizziness. Bradyphrenia is the psychic correlate to akinesia. Dementia, if at all is a symptom, but more likely this disease occurs occasionally in combination with parkinsonism.

Autonomic Nervous System Diseases↗

[Senile Parkinsonism: its motor and psychological defects].

25% of patients with Parkinson's disease demonstrate the first symptoms with 70 years. The deficiency of Tyrosinhydroxylase is the trigger of the decreased level of Dopamin in the basal ganglia. The implications are the typical symptoms (tremor, rigor and akinesia) and the psychopathological decompensations as depression, delirs and bradyphrenie.

Aged↗

[The combined treatment of Parkinson's disease with L-dopa plus decarboxylase inhibitors (carbidopa, benserazide) (author's transl)].

An open cross-over study of 20 patients with Parkinson's disease performed with two drugs containing L-dopa and a peripheral aromatic amino acid decarboxylase inhibitor (benserazide, carbidopa) confirmed the conclusions reached in other clinical trials that this combined treatment of Parkinson's disease is the most effective form of drug therapy available at present. With both drugs, Madopar or Sinemet, an optimum therapeutic result was obtained with relatively small doses of L-dopa (the reduction in L-dopa dosage amounting to about 80%). A loss of efficacy with both drugs, which has observed during long-term treatment of patients with Parkinson's disease, could be avoided by switching the patients from Sinemet to Madopar and vice versa. Determination of L-dopa in the plasma demonstrated that with either drug similar plasma levels of L-dopa were achieved during clinically effective treatment.

Aged↗

Distinction between benign and malignant type of Parkinson's disease.

Clinical data demonstrate that there is a significant difference between at least two types of idiopathic Parkinsonian patients; a benign type of Parkinson's disease and a malignant type. They can be distinguished by the time course of a disability-score, independent of the duration of the disease. The benign cases respond very well to L-Dopa (Madopar) treatment and show a long lasting (7 years) drop in the disability, whereas the improvement of disability in the malignant cases is much smaller and lasts for about one year, followed by an increase of disability. The duration of the disease is 12,5 +/- 0,4 years in the benign type but only 4,0 +/- 0,3 years in the malignant type. Akinetic crises, off-phases, hyperkinetic crises and toxic deliria after Madopar treatment can be observed later in the benign than in the malignant cases. These results suggest that the degeneration of the dopaminergic nigrostriatal system occurs much more rapidly in malignant cases than in benign cases of Parkinson's disease.

Dose-Response Relationship, Drug↗

[Psychological problems of incurable patients in old age (author's transl)].

Biological functions are regulated by feedback mechanisms. In old age disorders occur in this regulation by insufficiency of biochemical transmitters. The synthesizing enzymes of Tyrosine Hydroxylase, Tryptophan Hydroxylase, Dopa Decarboxylase and 5-Hydroxytryptophan Decarboxylase are diminished in old age. Minus symptoms as depression, or exhaustion and disorders of circulation occur. A substitution by biogenic transmitters is not possible, because these don't pass the blood-brain-barriere. Therefore a medication of psychopharmacological drugs is necessary. For instance Anxiety--tranquilizer, exhaustion--anti depressive drugs.

Aged↗

Dopamine-sensitive adenylate cyclase activity in the caudate nucleus and adrenal medulla in Parkinson's disease and in liver cirrhosis.

In human caudate nucleus and adrenal medulla dopamine-stimulated adenylate cyclase was measured. At a concentration of 100 microM dopamine, liver cirrhosis, carcinoma and therapy resistent parkinsonian patients showed decreased stimulation or even a reduction compared to controls. Therapy responding parkinsonian patients showed a decreased stimulation compared to controls, but this stimulation was significantly higher than in drug resistent patients.

Adenylyl Cyclases↗

Toxic delirium after L-dopa medication.

L-DOPA-psychosis is a frequent side effect of the combined treatment of Parkinson's disease with L-DOPA and peripherally active decarboxylase inhibitors. Regional human post-mortem brain studies showed a significant increase of noradrenaline and serotonin particularly in extrastriatal areas, whereas the lenticular nuclei were not involved. The significance of extrastriatal neurotransmitter dysfunctions for psychiatric disorders is discussed.

Autopsy↗

CNS Modulation of adrenal tyrosine hydroxylase in Parkinson's disease and metabolic encephalopathies.

Tyrosine hydroxylase (TH) activity was assayed radioenzymatically in various regions of post-mortem brains of human individuals without neurologic disorders (controls), with Parkinson's disease, senile dementia, hypertensive encephalopathy, hepatic and diabetic coma, liver cirrhosis without coma, and hepatic coma treated with parenteral administration of L-valine. In addition TH activity of the post-mortem adrenal medulla was assayed in controls, in Parkinson's disease, senile dementia and hypertensive encephalopathy. In Parkinson's disease TH activity was significantly decreased in the nigrostriatal system, and less severe in other brainstem areas, while the raphé-reticular formation and limbic system showed normal values. In addition, there was significant decrease in the TH activity of the adrenal medulla, suggesting that Parkinson's disease is a generalized disorder not limited to distinct CNS areas, and that impairment of the dopaminergic niggro-striatal system may involve the TH activity in the adrenal medulla, thus inducing disorders of the peripheral sympathetic system. Senile brain atrophy showed no definite changes in brain, except the striatum, and adrenomedullary TH, while in one case of hypertensive encephalopathy due to long-term corticosteroid treatment normal TH activity in the adrenal medulla was opposed by decreased striatal TH activity, probably due to cerebral ischemia. TH activity in the caudate nucleus of individuals with both hepatic and diabetic coma were within normal ranges, suggesting a sufficient energy supply of the brain during such metabolic catastrophes, while reduced brain TH activity in patients with hepatic coma who died of acute gastrointestinal bleeding is probably due to severe final cerebral ischemia. No correlative data on brain and adrenomedullary TH activities in metabolic encephalopathies are available so far.

Aged↗