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PubMed2003

[Neuroleptic malignant syndrome].

Neuroleptic malignant syndrome (NMS) is the most dangerous side effect of phenothiazines therapy. In the period of time from 1995 to 2002 in the Intensive Toxicological Unit there were five patients, 3 men and 2 women, aged from 25 to 62 (average 44.2) years-old, admitted from the regional inpatients psychiatric units with the diagnosis of pneumonia and/or sepsis. The patients about 48-72 hours before admittance were given some phenotiazine derivatives (promazine, perphenazine, clozapine, pipamperon) and/or buthyrophenone (haloperidol) because of psychotic state. Altered consciousness, muscle rigidity, hyperpyrexia (39.0-41.0 degrees C), sweating, tachycardia (120-150/min.), tachypnoea (respiratory rate more than 25/min.) and high level of creatine kinase activity (23,751-112,288 U/l) dominated. Only one patient had clinical picture of pneumonia. Because of the rapid development of acute respiratory failure, respirathorotherapy was initiated and continued for 8 and 10 days in two patients respectively. Transient thrombocytopenia (26,000/microliter) in one subject was observed. The neuroleptic drug was withdrawn and intensive supportive care with administration of bromocriptine (15-20 mg/24 h) was provided. None one of the doctors told the patients about the possibility of NMS during phenothiazines therapy.

Adult↗
PubMed2003

[3 cases of sedation and analgesia using propofol and remifentanil for labor].

Three women in labor for whom epidural analgesia was contraindicated--2 with sepsis (pylonephritis and chorioamnionitis) and 1 with sacral agenesia--were provided intravenous analgesia with propofol (0.4-1.2 mg/kg/h) and remifentanil (0.033-0.1 microgram/kg/min plus boluses of 20 micrograms controlled by the patient) with oxygen supplementation. Heart rate, noninvasive blood pressure, maternal oxygen saturation and fetal heart rate were monitored. Maternal satisfaction, quality of analgesia, maternal side effects (sedation, depression, breathing, muscle rigidity, nausea, and vomiting) and fetal side effects (heart rate variability and Apgar score) were evaluated. We conclude that in cases where epidural analgesia is contraindicated, intravenous perfusion of low doses of propofol and remifentanil can provide a valid alternative for analgesia during labor.

Adult↗
PubMed2003

[Perospirone therapy in elderly patients with schizophrenia].

Perospirone is a novel serotonin-2 and dopamine-2 receptor antagonist (SDA) developed in Japan. Premarketing trials suggested that this agent was effective in reducing positive and negative symptoms of schizophrenia and had a favorable side-effect profile. However, these trials included only a few elderly patients, so the usefulness of perospirone in this population remains unknown. In this report we describe the treatment of 2 elderly patients with schizophrenia for whom perospirone therapy was efficacious. Case 1 was a patient with acute exacerbation of schizophrenic symptoms after discontinuance of medication. He was treated with 12 mg of perospirone daily and his symptoms reduced markedly from the 4th day of perospirone therapy. Efficacy was assessed by the positive and negative symptom scale (PANSS); all subscales of PANSS (positive symptom, negative symptom, and general psychopathology) reduced and the total score reduced from 78 to 38 by the end of the 6th week of treatment. No side effects such as extrapyramidal symptoms were noted. Thus, perospirone may be a useful antipsychotic for elderly patients with acute schizophrenia. Case 2 was a patient who had severe negative symptoms and extrapyramidal symptoms such as tardive dyskinesia, tardive dystonia, and sialorrhea. She had been hospitalized for more than 7 years. In this patient 12 mg of perospirone was administered daily after 3 mg of risperidone had been tapered off. The negative symptom subscale and general psychopathology subscale in PANSS were gradually reduced after perospirone therapy was started. Extrapyramidal symptoms were assessed by the drug-induced extrapyramidal symptoms scale (DIEPSS), which consists of eight individual parameters and one global assessment, and each parameter is graded on a 5-point (0 = none to 4 = severe) scale. Sialorrhea, muscle rigidity, tremor, dystonia and overall sererity were improved more than 2 points by the end of the 6th week. The clinical course of this patient suggests that the clinical characteristics of perospirone and risperidone may be different, even though these agents are categorized into the same class of antipsychotics, SDA. Because this is a case report, evaluations are limited the clinical properties of perospirone. Further examination is necessary to evaluate the efficacy and safety of perospirone for elderly patients with schizophrenia, who are more vulnerable to the side effect of antipsychotics than the younger population.

Aged↗
PubMedDate not supplied

Role of metabotropic glutamate receptors in animal models of Parkinson's disease.

The efficacy of the majority of drugs currently used for treatment of Parkinson's disease is insufficient. Moreover, such therapeutics are not devoid of serious side effects. Multiple studies on animal models of parkinsonism have shown that new class of drugs, acting selectively on metabotropic glutamate receptors (mGluRs) might be very promising for the future therapy of Parkinson's disease. This review briefly describes changes in glutamatergic transmission in the neuronal circuitry of the extrapyramidal system that occur in parkinsonian patients, contains background information on structure, function and distribution of mGluRs throughout the basal ganglia and concentrates on discussion of the results obtained from numerous animal model studies aimed to establish potential antiparkinsonian properties of various mGluR ligands. The reviewed literature data indicate that among these compounds group I mGluR antagonists and group II mGluR agonists might be beneficial to the treatment of parkinsonian akinesia and muscle rigidity.

Animals↗
PubMedDate not supplied

Progressive supranuclear palsy with widespread cerebral lesions.

A 51-year-old woman with no history of any familial neurological diseases initially presented with numbness in her extremities, slowing of movements, comprehension deficit, memory disturbance, dyscalculia, muscle rigidity, hyperreflexia, Parkinsonian gait, increasing disorientation, left-right disturbance, finger agnosia, alexia, acalculia, apraxia, aspontaneity, euphoria, gait disturbance, aphasia, echolalia, and in the terminal stage, mutism, contracture of lower extremities and cachexia. She died of bronchopneumonia at the age of 55. The brain showed widespread cerebral lesions, consisting of nerve cell loss and neurofibrillary tangles in the frontal, parietal and occipital cortex, demyelination and gliosis in the frontal, parietal and occipital subcortical white matter in addition to the typical pathological findings of progressive supranuclear palsy (PSP): severe neuronal loss with gliosis and neurofibrillary tangles (NFTs) in the subthalamic nucleus, globus pallidus and substantia nigra. In conclusion, we present a case of PSP with unusual clinical features (extrapyramidal signs, frontal and parietal lobe syndromes without ophthalmoplegia) and neuropathologically widespread cerebral lesions in addition to the typical pathological findings of PSP. The differential diagnosis of PSP and Alzheimer's disease and other degenerative disorders is discussed.

Alzheimer Disease↗
PubMedDate not supplied

Analgesic transition after remifentanil-based anesthesia in neurosurgery. A comparison of sufentanil and tramadol.

AIM: Transition from the end of remifentanil infusion and postoperative analgesia must be planned carefully owing to remifentanil's (R) rapid offset. Intraoperative morphine has been used for the transition to postoperative analgesia following remifentanil-based anesthesia. Sufentanil (S) is a very potent opioid with high micro-receptor affinity, a much wider therapeutic index and a lower fractional receptor occupancy. These pharmacological and dynamics features make sufentanil an interesting alternative to morphine for immediate postoperative analgesia. METHODS EXPERIMENTAL DESIGN: perspective, randomized, single blinded and comparative study. Institution: neurosurgical operating theatre at University. PATIENTS: 96 patients, aging from 25 to 67 years, ASA class I-III, undergoing neurosurgical operations, were studied. INTERVENTIONS AND MEASUREMENTS: the anesthetic management was: premedication: atropine 0.01 microg kg(-1) + remifentanil 0.20 microg kg(-1) min(-1); induction: propofol 2.0 microg kg(-1) + cisatracurium 0.15 microg kg(-1); maintenance: sevoflurane 0.8% + remifentanil (titrated infusion) cisatracurium. All patients received ketorolac 30 mg i.v. 1 hour before the end of surgery and ketorolac (60-90 mg) + tramadol (200-300 mg) by elastomeric pump; patients were divided into 2 groups: group T receiving tramadol 100 mg and group S receiving a bolus dose of sufentanil 0.10 microg kg(-1), 30 and 15 minutes before the end of surgery respectively. Recovery time, postoperative analgesia evaluated by VAS, cardiocirculatory parameters and side effects like nausea, vomiting, shivering, muscle rigidity, sedation and respiratory depression were recorded. RESULTS: VAS was significantly lower in Group S. Recovery time was shorter in Group T than in Group S (8.8 +/- 3.6 vs 11.6 +/- 4.6 min), no statistically significant differences between groups as regards nausea, vomiting and shivering. Short-lasting respiratory depression was detected in 3 cases in Group S. CONCLUSION: At the emergence much better control of the transition phase in patients treated with sufentanil: smooth recovery with better tolerability of the endotracheal tube; efficacious analgesia along with cardiocirculatory stability.

Adult↗
PubMed2004

[Regional anesthesia for a patient with stiff-person syndrome].

We report a case of stiff-person syndrome (SPS). A 65-year-old male underwent an emergency pacemaker implantation for syncope. With lidocaine infiltration under fentanyl and propofol sedation, the operation was completed without complications. Muscle rigidity and spasms are exacerbated by sensory and emotional stimuli in SPS. However, the present case suggests that regional anesthesia is also acceptable under adequate sedation.

Aged↗
PubMed2004

[Anesthetic management of a child with Schwartz-Jampel syndrome].

A 6-year-old child with Schwartz-Jampel syndrome (SJS) underwent tenotomy of bilateral lower limbs under general anesthesia. Patient with SJS has problems such as difficulty of intubation owing to microstomia and jaw muscle rigidity, and is susceptible to malignant hyperthermia by using volatile inhalation anesthetics. In this case, we used a laryngeal mask for airway management and anesthesia was maintained with inhalation of nitrous oxide and continuous i.v. infusion of propofol with caudal block, and his clinical course was uneventful.

Anesthesia, General↗
PubMed1992

Neuroleptic malignant syndrome among acute psychiatric admissions in Barbados.

The main features of the Neuroleptic Malignant Syndrome (NMS), a complication of neuroleptic therapy, are fever, muscle rigidity, autonomic dysfunction, and an alteration in consciousness level. We describe five cases of NMS comprising 0.6% of acute neuroleptically-treated admissions to a psychiatric hospital over a one-year period. All patients, four females aged 26 to 63 years, and one male, aged 65 years, were of African origin and received multiple neuroleptic drugs, at least one of which was a depot preparation. Four were being treated for functional psychiatric disorders while one had dementia. All patients had fever and depressed consciousness level while four had rigidity and autonomic dysfunction. Serum creatine phosphokinase was elevated in 4 cases, and there was indirect evidence of myoglobinuria in 3 cases suggested by a positive urine dipstick test for blood despite the absence of red cells on microscopy. Rhabdomyolysis was associated with renal failure in one case. Both bromocriptine mesylate and dantrolene sodium were given in two cases. Three patients died in hospital, one with persistent rigidity and progressive decubitus ulceration, one from peritonitis following peritoneal dialysis, and another suddenly. Early recognition of NMS is important; it should be considered in any patient on neuroleptic therapy who develops fever, rigidity or alteration in consciousness level.

Adult↗
PubMed1992

[A case of parkinsonism induced by an oral contraceptive].

We report a case of parkinsonism induced by long term administration of an oral contraceptive. A 38-year-old woman complained of easily stumbling, démarche à petit pas and fatiguability in her lower extremities since January, 1991. When examined on April 5, 1991, she explained taking an oral contraceptive for 7 years on her doctor's recommendation after two times artificial abortions. Her facial expression was mask-like and body was bent forward with knee joints flexed and arms flexed at elbow joints. She had frozen gait with inactive pendulousness of the arms. We could find her muscle rigidity in both upper and lower extremities, especially in her right side extremities. A brain MRI finding was lacunar infarction which proton density weighted and T2-weighted MR images showed small patches of high-signal intensities in white matter of the bilateral frontal lobes and in left periventricular white matter. Her symptoms improved after stopping administration of the oral contraceptive and starting combination therapy with nicergoline and bromocriptine. She had some leg fatiguability at the onset of her next menstruation in May, but it was much less than her previous condition. When her menstruation terminated, those symptoms disappeared and it was possible to stop the administration of bromocriptine and nicergoline, and her symptoms have improved.

Adult↗
PubMed2000

Neurochemical and extra pyramidal effects of atypical neuroleptic clozapine in rats.

In view of a possible role of serotonin (5-hydroxytryptamine, 5-HT) and dopamine (DA) in neuroleptic-induced muscle rigidity and catalepsy, the present study is designed to investigate the neurochemical and extrapyramidal effects of atypical antipsychotic/neuroleptic drug i.e., Clozapine (CZP) on the metabolism of serotonin and dopamine particularly in the caudate (a region of the brain involved in the control of movement), accumbens and rest of the rat brain. Interaperitoneal (i.p) injections of CZP at doses of 5.0 & 10 mg/kg decreased significantly (p<0.01) locomotor activity in familiar (home cage) environment. CZP produced a significant (P<0.01) cataleptic response only at doses of 10 mg/kg used. Maximal cataleptic effects in rats occurred at high doses of CZP. Acute administration of CZP significantly (p<0.01) decreased levels of NA in accumbens at all the doses used. Significant increases (p<0.01) in the levels of NA observed in rest of the brain only at moderate dose (5 mg/kg) of CZP. Results showed significant (p<0.01) increases in the levels of caudate DA following the administration of CZP at 10 mg/kg. However administration of CZP at all the doses produced similar significant (p<0.01) increases in the levels of HVA in all the regions of the rat brain. Overall insignificant effects of CZP occurred on brain regional TRP. However, plasma TRP significantly (p<0.01) increased at 2.5 mg/kg dose of CZP. Administration of CZP at doses of 2.5 and 10 mg/kg significantly (p<0.01) decreased 5-HT levels in the rest of the brain. Administration of CZP produced insignificant (p>0.05) effects on 5-HIAA levels in the caudate and accumbens regions but CZP at doses of 2.5 and 5 mg/kg significantly (p<0.01) decreased 5-HIAA levels in the rest of the brain. Neurochemical and extrapyramidal effects of atypical antipsychotic (clozapine) are discussed in relation to a potential therapeutic profile in rats.

Journal Article↗
PubMed2005

[The application of electroconvulsive therapy in neuroleptic malignant syndrome treatment in patient with catatonic schizophrenia].

The above article presents a case report of a 28-year-old patient, primarily treated with a diagnosis of catatonic schizophrenia, in who in the course of hospitalization developed neuroleptic malignant syndrome (NMS). The patient presented unawareness, hyperthermia, respiratory insufficiency, muscle rigidity, CK increased activity. The patient required tracheotomy and oxygen therapy and then was subjected to a series of electroconvulsive therapy (ECT). Since the fifth ECT treatment we noted a gradual recovery to a completely normal mental status. We did not make an attempt to introduce neuroleptic maintenance treatment.

Adult↗
PubMed2006

[Remifentanil].

Remifentanil is a potent mu-opioid receptor agonist and has some unique pharmacokinetic characteristics compared to other anilidopiperidine opioids (e.g. fentanyl, alfentanil, and sufentanil). As remifentanil is metabolised rapidly by nonspecific esterases that are widespread throughout the plasma and tissuses, its duration of action is very short. It is cleared very rapidly, and its clearance is not affected by renal and hepatic function. The context-sensitive half-time of remifentanil remains consistently short, even after administration for a long time. Consequently, emergence is quick even after anesthesia of long duration. As other piperidine opioids, remifentnil has some adverse effects such as respiratory depression, muscle rigidity, bradycardia, and nausea as well as vomiting. Because of the rapid dissipation of analgesic effect following remifentanil discontinuation, postoperative analgesia should be provided before or soon after anesthesia using longer-acting opioid analgesics, non-opioid analgesics, or local as well as regional anesthesia.

Analgesics, Opioid↗