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PubMed2005

The role of dimethylaminoethanol in cosmetic dermatology.

Skincare formulations for the improvement of aging skin are increasingly important consumer products. Here, we review available data on one such agent - 2-dimethylaminoethanol (DMAE) or deanol - that has recently been evaluated in a placebo-controlled trial. DMAE is an analog of the B vitamin choline and is a precursor of acetylcholine. Although the role of acetylcholine as a neurotransmitter is well known, growing evidence points to acetylcholine as a ubiquitous cytokine-like molecule that regulates basic cellular processes such as proliferation, differentiation, locomotion, and secretion in a paracrine and autocrine fashion. Indeed, this modulatory role may contribute to the cutaneous activity of DMAE. In a randomized clinical study, 3% DMAE facial gel applied daily for 16 weeks has been shown to be safe and efficacious (p < 0.05) in the mitigation of forehead lines and periorbital fine wrinkles, and in improving lip shape and fullness and the overall appearance of aging skin. These effects did not regress during a 2-week cessation of application. Beneficial trends (p > 0.05 but </= 0.1) were noted in the appearance of coarse wrinkles, under-eye dark circles, nasolabial folds, sagging neck skin, and neck firmness. Application was found to be well tolerated, with no differences in the incidence of erythema, peeling, dryness, itching, burning, or stinging between the DMAE and placebo groups. An open-label extension of the trial showed that the long-term application of DMAE gel for up to 1 year was associated with a good safety profile. The acute skin-firming effects of DMAE have been confirmed by quantitative measures of cutaneous tensile strength. In vitro studies in peripheral blood lymphocytes indicate that DMAE is a moderately active anti-inflammatory agent. Although its mechanisms of action in the skin remain to be elucidated, evidence suggests that the skin is an active site of acetylcholine synthesis, storage, secretion, metabolism, and receptivity. Muscarinic acetylcholine receptors have been localized to keratinocytes, melanocytes and dermal fibroblasts, whereas nicotinic acetylcholine receptors have been found in keratinocytes. The role of acetylcholine and the role of DMAE as a modulator of acetylcholine-mediated functions in the skin remain to be elucidated.Thus, the benefits of DMAE in dermatology include a potential anti-inflammatory effect and a documented increase in skin firmness with possible improvement in underlying facial muscle tone. Studies are needed to evaluate the relative efficacy of DMAE compared with other skin-care regimens (e.g., topical antioxidant creams, alpha-hydroxy acids).

Cosmetics↗
PubMed2001

Treatment of typical absence seizures and related epileptic syndromes.

Typical absences are brief (seconds) generalised seizures of sudden onset and termination. They have 2 essential components: clinically, the impairment of consciousness (absence) and, generalised 3 to 4Hz spike/polyspike and slow wave discharges on electroencephalogram (EEG). They differ fundamentally from other seizures and are pharmacologically unique. Their clinical and EEG manifestations are syndrome-related. Impairment of consciousness may be severe, moderate, mild or inconspicuous. This is often associated with motor manifestations, automatisms and autonomic disturbances. Clonic, tonic and atonic components alone or in combination are motor symptoms; myoclonia, mainly of facial muscles, is the most common. The ictal EEG discharge may be consistently brief (2 to 5 seconds) or long (15 to 30 seconds), continuous or fragmented, with single or multiple spikes associated with the slow wave. The intradischarge frequency may be constant or may vary (2.5 to 5Hz). Typical absences are easily precipitated by hyperventilation in about 90% of untreated patients. They are usually spontaneous, but can be triggered by photic, pattern, video games stimuli, and mental or emotional factors. Typical absences usually start in childhood or adolescence. They occur in around 10 to 15% of adults with epilepsies, often combined with other generalised seizures. They may remit with age or be lifelong. Syndromic diagnosis is important for treatment strategies and prognosis. Absences may be severe and the only seizure type, as in childhood absence epilepsy. They may predominate in other syndromes or be mild and nonpredominant in syndromes such as juvenile myoclonic epilepsy where myoclonic jerks and generalised tonic clonic seizures are the main concern. Typical absence status epilepticus occurs in about 30% of patients and is more common in certain syndromes, e.g. idiopathic generalised epilepsy with perioral myoclonia or phantom absences. Typical absence seizures are often easy to diagnose and treat. Valproic acid, ethosuximide and lamotrigine, alone or in combination, are first-line therapy. Valproic acid controls absences in 75% of patients and also GTCS (70%) and myoclonic jerks (75%); however, it may be undesirable for some women. Similarly, lamotrigine may control absences and GTCS in possibly 50 to 60% of patients, but may worsen myoclonic jerks; skin rashes are common. Ethosuximide controls 70% of absences, but it is unsuitable as monotherapy if other generalised seizures coexist. A combination of any of these 3 drugs may be needed for resistant cases. Low dosages of lamotrigine added to valproic acid may have a dramatic beneficial effect. Clonazepam, particularly in absences with myoclonic components, and acetazolamide may be useful adjunctive drugs.

Anticonvulsants↗
PubMed1990

New method of MVD using a vascular tape for neurovascular compression involving the vertebrobasilar artery--report of two cases.

In the treatment of hemifacial spasm and trigeminal neuralgia by microvascular decompression (MVD), lack of improvement or recurrence may occur because of the difficulties in positioning prostheses and the involvement of the large vertebrobasilar arteries, even with use of fenestrated aneurysm clips or adhesives. We have developed a new method of MVD, in which a vascular tape is anchored to the dura mater to transpose the responsible large artery. This method achieved successful results in our two patients with nerve compression involving the vertebrobasilar arteries.

Aged↗
PubMed1995

Hemifacial spasm in Albright's hereditary osteodystrophy with pseudopseudohypoparathyroidism and nephrogenic diabetes insipidus--case report.

A 30-year-old male with Albright's hereditary osteodystrophy, pseudopseudohypoparathyroidism, and nephrogenic diabetes insipidus presented with hemifacial spasm persisting for 2 years. This association is extremely unusual. Angiography revealed markedly tortuous carotid and vertebral arteries inconsistent with his age. Neurovascular decompression of the left vertebral artery achieved only partial resolution of the spasm.

Adult↗
PubMed1996

Turbo spin-echo magnetic resonance imaging depiction of facial nerve compression by a vertebral artery in a patient with hemifacial spasm--technical note.

Turbo spin-echo magnetic resonance (MR) imaging of a patient with hemifacial spasm clearly demonstrated vascular compression of the facial nerve by the vertebral artery. The high resolution images of this method may be an appropriate alternative to preoperative cerebral angiography. Turbo spin-echo MR imaging is a diagnostic procedure of choice for patients with hemifacial spasm and possibly trigeminal neuralgia.

Adult↗
PubMedDate not supplied

New techniques for optimum reconstruction of the facial nerve in its extemporal course.

Microsurgery of the facial nerve has resulted in a great progress by regaining, thanks to its various techniques, not only the voluntary movements of the face but in addition also the emotional expressive motility. It has become evident, however, that one disadvantage is always unavoidable even in the most subtle reconstructive measures: the development of mass-movements. It is the aim of our work to reduce these mass-movements, or even better to prevent their occurrence right from the beginning. We have therefore developed the diversification method. The human face is divided into two functional spheres: the upper face and the lower face. Reinnervation of both facial regions is achieved by two nerves: the upper face by means of the original facial nerve (with intercalation of a free nerve transplant), and the lower face by means of a hypoglossofacial anastomosis. The advantages of this combined operation technique and its neurophysiologic basis are described in detail.

Facial Expression↗
PubMed1988

Nationwide investigation on diagnostic methods for facial palsy.

We investigated the present status concerning the performance of examinations of facial nerve function for facial palsy, based on statistics obtained from the project supported by a Grant-in-Aid for Co-operative Research (A) from the Ministry of Education. The project is called An Epidemiological and Clinical Study on the Idiopathic Facial Palsy. In an analysis of the questionnaire "individual investigation card for idiopathic facial palsy" obtained from 28 medical facilities throughout Japan between 1984 and 1986, the outline of the examinations performed for peripheral facial palsy was examined.

Electrodiagnosis↗
PubMed1988

Occurrence of sequelae in Bell's palsy.

The occurrence of sequelae in 330 patients with Bell's palsy followed up for more than 6 months was investigated. At least one of five kinds of sequelae (synkinesis, crocodile tears syndrome, spasm, contracture, tinnitus and/or hearing loss during facial movement) was observed in 30 of the 330 cases (9.1%). Sequelae occurred at 23.9-39.0 weeks (mean) after onset of palsy and at scores of 30-34 points (mean; full score 40 points). The incidence of sequelae was correlated to the degree of facial nerve dysfunction.

Facial Muscles↗
PubMed1988

Results of facial nerve decompression.

To evaluate the benefit of facial nerve decompression for Bell's palsy and Hunt's syndrome, prognoses of patients who underwent surgery were compared with those of patients treated conservatively. Facial nerve decompression was slightly effective only in the Bell's palsy patients having 95-100% maximal nerve degeneration, when it was performed at a very early stage of the palsy. No significant difference in the incidence of sequelae was observed between surgically and conservatively treated groups. In Hunt's syndrome, the prognosis for the surgical group was poorer than that of the conservatively treated group.

Electrodiagnosis↗
PubMed1988

Effects of Aciclovir in Ramsay Hunt syndrome.

Nine patients with Ramsay Hunt syndrome were treated with Aciclovir and the effects of this treatment were observed for 6 months. The results were excellent in 5 cases, fair in 3, and poor in one case. Otalgia and auricular herpes was improved rapidly after the administration of Aciclovir. No severe side effect was observed in this study.

Acyclovir↗
PubMed1993

MR imaging of vascular compression in hemifacial spasm.

Hemifacial spasm is related to vascular compression of the root entry zone of the facial nerve at the brainstem by elongated tortuous vessels of the vertebrobasilar arterial system. In this study, we performed MR imaging in 16 patients with hemifacial spasm and investigated the vascular structures in bilateral-cerebellopontine angles and the relationship of each vessel to the root entry zone of the facial nerve. MR examination was performed with a 0.5 tesla MRI system, and MR angiography (3D time-of-flight) was obtained. Of 15 patients in whom both the nerve and vessels were clearly visible and could be observed to contact each other at the root entry zone, in 11 the tortuous artery could be identified by name. In only 1 patient was the contact between the nerve and vessel indeterminate, due to nonvisualization of the vessel around the facial nerve at its root entry zone. These findings suggest that MRI is a useful screening method in the preoperative assessment of hemifacial spasm.

Adult↗