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Differential diagnosis of paralysis agitans.

Paralysis agitans may be mimicked by other disease processes and drugs which disturb the structural or functional integrity of the dopaminergic nigrostriatal system. In another group of patients, isolated symptoms or signs such as tremor or increased muscle tone are considered out of the context of the total clinical picture and may suggest parkinsonism.

Adult↗

Profound hypotension immediately following insertion of methyl methacrylate during bipolar endoprosthesis in a patient with long-term levodopa-treated paralysis agitans.

Insertion of methyl methacrylate polymer into newly reamed bony cavities has sometimes resulted in profound hypotension, cardiac arrest, or sudden death which are more common in patients with hemodynamic instability or hypovolemia. In paralysis agitans(Parkinson's disease), dramatic worsening of the disease often occurs when another illness or trauma accompanies it. And it is possible that chronic medication with levodopa can cause the loss of ability to support blood pressure. So, it involves some risk to use methyl methacrylate in chronic levodopa-treated paralysis agitans. We present a case of paralysis agitans who demonstrated profound hypotension immediately following insertion of methyl methacrylate polymer in spite of normovolemia and proper anesthetic management.

Aged↗

Paralysis agitans and levodopa in "Ayurveda": ancient Indian medical treatise.

Neurologic diseases (Vata rogas, Sanskrit) and the pharmacologic treatment of them were described in the ancient Indian medical system--Ayurveda. This article explores paralysis agitans, which was described under the name Kampavata. Mucuna pruriens (Atmagupta, Sanskrit), which contains levodopa, was used in the treatment of Kampavata. Existence of paralysis agitans prior to the industrial revolution is not just of historical interest, but would also suggest that under the hypothesis of exposure to environmental toxins as a possible cause of paralysis agitans, natural organic compounds with worldwide distribution should also be considered.

History, Ancient↗

Effect of CB 154 (2-bromo-alpha-ergocryptine) on paralysis agitans compared with Madopar in a double-blind, cross-over trial.

Twenty patients with paralysis agitans took part in a double-blind, cross-over investigation of CB 154 (2-bromo-alpha-ergocryptine) and Madopar (L-Dopa + benserazid (a peripheral decarboxylase inhibitor), dose ratio 4:1). Each treatment phase lasted for 8 weeks. Modapar was found to be significantly superior to CB 154 in the treatment of the Parkinson state as a whole (Webster total score) and the individual symptoms of hypokinesia, rigidity and tremor. Compared with pretreatment score, CB 154 had a weak, but significant effect on tremor, but not on the Webster total score, hypokinesia and rigidity. The effect of CB 154, however, varied: four patients preferred CB 154 to Madopar on account of its satisfactory therapeutic effect and fewer side-effects ("on-off" phenomena, hyperkinesia, psychiatric complications); other patients showed neither therapeutic effect nor side-effects of CB 154, which in some cases may be related to too low a dose-level of CB 154 (median 30 mg daily, range 20-60 mg). In the four cases first mentioned which showed a good effect of CB 154, the ratio between the dose of CB 154 and the dose of L-Dopa (in Madopar) was 3.5-10 mg/100 mg, i.e. in certain cases it must be assumed that the maximum dose of CB 154 lies around 120 mg daily.

Aged↗

Studies on the prevalence of paralysis agitans by tracer methodology.

The present study was motivated by the methodological issues revealed by a review of previous studies on Paralysis Agitans (PA) epidemiology. The study was given the following aims: To identify an easy available, inexpensive marker of PA frequency in populations; to develop, standardize and validate a model for measurement of PA prevalence by using that tracer; to study the geographical distribution of PA in Sweden, and to use the model in environmental risk analysis (ERA) for PA. Information on diagnoses and anti-parkinsonian drugs (APD) utilization from Swedish registers was analyzed, in order to select the group of APD which would best fulfill the prerequisites of specificity and preference of choice, and combined with prevalence data from direct surveys. Levodopa drugs were found to be the most suitable tracer for PA prevalence. A mathematical model was formulated to generate annual estimates for average age specific prevalences from total sales of levodopa, age specific population and figures for infant mortality rates. The following was required in order for the model to yield accurate estimates: high quality of the information to be used, good availability of levodopa drugs, a minimal size of the studied population of 100,000, an IMR lower than 28.8 per 1000 and that levodopa diffusion had reached the late adoption phase. Underdiagnosis was found to constitute an important cause of bias in classical surveys. Standardization for age and health services effectiveness by using infant mortality rates was shown to improve comparability of prevalence figures. The model was validated and showed internal consistency for age specific data on levodopa sales and on prevalence from Sweden and six Chinese towns, respectively. Estimates for prevalence for Iceland and Sardinia fitted historical data from direct surveys. The results of the ERA study showed that a high latitude and a low population density in 1900-20 were correlated with an increase in PA prevalence as measured by surveys or estimated by the use of the tracer method. Further analysis indicated that several so-called risk factors or concomitant diseases are associated with low population density. The geographical distribution of standardized PA prevalences in Swedish counties was studied for the period 1977-84. The findings were in accordance with the figures expected from the natural characteristics of the disease as determined by latitude and population density except in the county of Gävleborg which showed a significantly higher, and continuously increasing prevalence.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Loss of neurons in the nucleus basalis of Meynert in Alzheimer's disease, paralysis agitans and Korsakoff's Disease.

The nucleus basalis of Meynert, the major source of cholinergic innervation of the cerebral cortex, was morphometrically investigated in 58 cases of neuropsychiatric disorders and compared to 14 controls. The results demonstrate a loss of neurons in the nucleus basalis of Meynert in Alzheimer's disease (70%), paralysis agitans (77%), and Korsakoff's disease (47%) but no marked reduction of neurons in postencephalitic parkinsonism, Huntington's disease, chronic alcoholism without dementia, schizophrenia and infantile brain damage. Neurons of the three subdivisions of the nucleus basalis of Meynert (the nucleus septi medialis, the nucleus of the diagonal band of Broca and the nucleus basalis Meynert neurons in the substantia innominata) may be affected in a different manner in different patients within a single group homogeneous with respect to the usual clinical and neuropathological diagnostic criteria. Cell loss in the basal forebrain is restricted to the large neurons of the nucleus basalis, the immediately adjacent neurons of the globus pallidus externus not being affected. The selective degeneration of these neurons provides the morphological correlate of the cortical cholinergic deficiency in these neuropathological conditions. The degeneration of this discrete cholinergic neuronal population in several disorders of higher cortical function is probably directly related to the progressive deterioration of memory and cognitive processes in affected patients.

Alcohol Amnestic Disorder↗

Paralysis agitans.

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Parkinson Disease↗