PubMed · 15860145
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Christina M Whitney. 2005. Benign essential blepharospasm.. https://doi.org/10.1097/01.nrl.0000161996.06364.dc
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BACKGROUND: Tardive dyskinesia (TD) is a disabling movement disorder associated with the prolonged use of neuroleptic medication. Several strategies have been examined in the treatment of TD. Currently, however, there is no clear evidence of the effectiveness of these drugs in TD and they have been associated with many side effects. One particular strategy would be to use pharmaceutical agents which are known to influence the catecholaminergic system at various junctures. OBJECTIVES: To determine whether catecholaminergic drugs for people with schizophrenia or other chronic mental illnesses are associated with a reduction in neuroleptic-induced tardive dyskinesia. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group's Register (January 1996), Biological Abstracts (1982-1995), EMBASE (1980-1995), LILACS (1982-1996), MEDLINE (1966-1995) and PsycLIT (1974-1995). We searched the Cochrane Schizophrenia Group's Register again in December 2002 and September 2005. We also searched references of all relevant studies for further trial citations and contacted principal authors of trials. SELECTION CRITERIA: We selected studies if they were randomised controlled trials focusing on people with schizophrenia or other chronic mental illnesses who also suffered from neuroleptic-induced tardive dyskinesia. We compared the use of catecholaminergic interventions versus placebo or no intervention. DATA COLLECTION AND ANALYSIS: We independently extracted data. For homogenous dichotomous data, we calculated the random effects, relative risk (RR), and 95% confidence interval (CI) and, where appropriate, the numbers needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). MAIN RESULTS: We excluded 20 studies, mainly due to an inability to extract data from the first arm of the study crossover. One included study has shown that patients on placebo were no more likely to leave the study early than those on tiapride (n=24). The other included study (n=35) also reported equivocal data (RR 5.28 CI 0.3 to 102.6) for leaving the study early when participants were randomised to either celiprolol or placebo. However, in both studies, sample size was limited. AUTHORS' CONCLUSIONS: Although there has been a large amount of research in this area, most studies were excluded due to inherent problems in the nature of their crossover designs. Usually data are not reported before the crossover and the nature of TD and its likely response to treatments makes it imprudent to use this data. The review provides little usable information for service users or providers and more well designed and reported studies are indicated.
STUDY DESIGN: A case report. OBJECTIVES: To describe an interesting patient who underwent a three-level corpectomy of the cervical spine complicated by cervical dystonia and eventually treated successfully with botulinum toxin injections. SUMMARY OF BACKGROUND DATA: Cervical dystonia is a relatively rare disease and unfamiliar to many clinicians. Various types of peripheral trauma or peripheral lesion have been reported to induce cervical dystonia. However, to the best of our knowledge, there have been no reports about cervical dystonia following cervical spine surgery. METHODS: We present a case of a 45-year-old man who developed severe axial neck pain after cervical anterior corpectomy and fibula strut grafting due to cervical myelopathy. His neck pain gradually worsened, and involuntary spasmodic neck movement developed 6 weeks after operation when his halo-vest was removed. Initially, we considered his complaint to be transient or psychogenic, and diagnosis of cervical dystonia was delayed until 14 weeks after operation. RESULTS: Pharmacologic treatment was unsuccessful, but he was successfully treated with local intramuscular injections of botulinum toxin. CONCLUSIONS: It must be kept in mind that cervical spine surgery is not an exceptional precipitator of cervical dystonia, despite the fact that it is extremely rare.
The neurotoxins produced by various species of Clostridia are the causative agents of botulism and tetanus. The ability of the toxins, specifically those of the botulinum neurotoxin family, to disrupt neurotransmission has been exploited for use in several medical indications and now represents the therapeutic option of choice in a number of cases. Clostridial neurotoxins have been discovered to have a multi-domain structure that is shared between the various proteins of the family, and it has also been determined that each domain contributes a specific role to the holotoxin. The extensive use of recombinant expression approaches, along with solution of multiple crystallographic structures of individual domains, has enabled researchers to explore structurefunction relationships of the toxin domains more closely. These advances have facilitated a greater understanding of the potential use of individual domains for a wide variety of purposes, including the development of new therapeutics.