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Gallardo MJ, Cabello JP, Pastor C, Muñoz-Torrero JJ, Carrasco S, Ibañez R, Vaamonde J. Patients with advanced Parkinson's disease with and without freezing of gait: a comparative analysis of vascular lesions using brain MRI. Neurologia 2013; 29:218-23. [PMID: 24090496 DOI: 10.1016/j.nrl.2013.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/18/2013] [Accepted: 02/27/2013] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Freezing of gait (FOG) is one of the most disabling and enigmatic symptoms in Parkinson's disease. Vascular lesions, observed in magnetic resonance imaging (MRI) scans, may produce or exacerbate this symptom. PATIENTS AND METHODS The study includes 22 patients with Parkinson's disease subjects, 12 with freezing of gait and 10 without. All patients underwent an MRI scan and any vascular lesions were analysed using the modified Fazekas scale. RESULTS Patients with FOG scored higher on the modified Fazekas scale than the rest of the group. Although the two groups contained the same percentage of patients with vascular lesions (50% in both groups), lesion load was higher in the group of patients with FOG. Vascular lesions in the periventricular area and deep white matter seem to be the most involved in the development of FOG. DISCUSSION Vascular lesions may contribute to the onset or worsening of FOG in patients with PD. This study suggests that cerebral vascular disease should be considered in patients with FOG.
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Affiliation(s)
- M J Gallardo
- Servicio de Neurología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - J P Cabello
- Servicio de Neurología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - C Pastor
- Servicio de Neurología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - J J Muñoz-Torrero
- Servicio de Neurología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - S Carrasco
- Servicio de Neurología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - R Ibañez
- Servicio de Neurología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - J Vaamonde
- Servicio de Neurología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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Linazasoro G, Sesar A, Valldeoriola F, Compta Y, Herrero MT, Martínez Castrillo JC, López Lozano JJ, Bergaretxe A, Vela L, Fernández JM, Castro A, Kulisevski J, Lezcano E, Vaamonde J, López Del Val J, Chacón J, Vivancos F, Luquin R, Aguilar M, Burguera JA, Salvador C, Menéndez Guisasola L, Catalán MJ, Mir P, Campos V, Grandas F, Mínguez A, Balaguer E, Yáñez R, Leiva C, García Ruiz P, Cubo E. [Neuroprotection in Parkinson's disease: analysis though group of experts' methodology]. Neurologia 2009; 24:113-124. [PMID: 19322690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Currently used antiparkinsonian drugs neither stop nor slow-down the progressive nature of the disease. The final phase of PD is characterized by the presence of symptoms and signs resistant to dopaminergic agents, such as depression, dementia, freezing and falls. Therefore, it is urgent to develop therapies able to positively modify this outcome. Despite neuroprotection is a research priority in PD, no effective strategies have been found so far. METHOD A key informants study was conducted. A group of experts in PD fulfilled a questionnaire of 10 questions to explore the most important topics related to neuroprotection. Afterwards a consensus about the current situation of neuroprotection in PD was established and future directions of development were suggested. RESULTS Most of the answers emphasized the need of new concepts, the limitations of animal models and the difficulties in the difficulties in demonstrating a neuroprotective effects in humans owing to a lack of biomarkers. Some of the experts believe that we are already exerting a disease modifying effect. CONCLUSIONS The concept of neuroprotection should be widened. Animal models should be improved. A reliable biomarker to start neuroprotective therapies long before the appearance of motor symptoms and to evaluate the neuroprotective effect of any therapy should be urgently developed.
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Affiliation(s)
- G Linazasoro
- Centro de Investigación Parkinson, Policlínica Guipuzkoa, San Sebastián.
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Vaamonde J, Flores JM, Gallardo MJ, Ibáñez R. Subacute hemicorporal parkinsonism in 5 patients with infarcts of the basal ganglia. J Neural Transm (Vienna) 2007; 114:1463-7. [PMID: 17705041 DOI: 10.1007/s00702-007-0774-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Accepted: 05/23/2007] [Indexed: 10/22/2022]
Abstract
In 1929, Critchley introduced the term "vascular parkinsonism" (VP), which has been the subject of considerable controversy in neurology. Parkinsonism does not appear to be a frequent consequence of striatal infarcts, although unilateral parkinsonism has been reported as an acute or subacute onset syndrome following strategic infarcts in the striatum. Previous 123-I ioflupane SPECT (DaTSCAN) studies involving radioisotope labeling of the dopamine transporter protein at presynaptic level in patients with IPD (idiopathic Parkinson's disease) have found this technique to be highly sensitive in exploring the nigrostriatal pathway. Previous studies of VP with DatSCAN have been inconclusive. The present study correlates clinical data (unilateral parkinsonism following contralateral lenticular infarction), and radiological (CT/MRI) and functional neuroimaging findings (DatSCAN) in 5 patients with CT/MRI criteria for striatal infarcts. Finally, in 2 of these patients a diagnosis of IPD was made because of the follow-up of clinical signs and pathological DaTSCAN findings not concordant with the size and location of the vascular lesion.
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Affiliation(s)
- J Vaamonde
- Department of Neurology, Hospital General, Ciudad Real, Spain.
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Vaamonde J, García A, Flores JM, Ibáñez R, Gargallo L. [Study of presynaptic nigrostriatal pathway by 123-I-FD-CIT-SPECT (DatSCAN SPECT) in primary orthostatic tremor]. Neurologia 2006; 21:37-9. [PMID: 16525925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION Primary orthostatic tremor (OT) is defined as a clinical syndrome with high frequency (13-18 Hz) tremor when standing predominantly involving legs and trunk. OT is thought to be driven by an unique supraspinal tremor generator. Previous studies suggest that the nigrostriatal dopaminergic transmission is impaired in patients with OT. CLINICAL CASE All three patients at an age of 56, 45 and 72 years fulfilled the diagnosis criteria of primary OT. The duration of illness amounted to 4, 3 and 1 year, respectively. The three patients had single-photon emission computed tomography (SPECT) using 123-I-FP-CIT as dopamine transporter tracer (DatSCAN). RESULTS DatSCAN was normal in every patient. CONCLUSIONS OT is considered to be caused by a central oscillator because high-frequency tremor bursts are time locked in arm, leg, trunk, and even facial muscles and peripheral stimulation does not reset the tremor. Some reports suggest that the central generator may be located in the posterior fossa. In our patients presynaptic nigrostriatal pathway was normal.
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Affiliation(s)
- J Vaamonde
- Sección de Neurología, Complejo Hospitalario de Ciudad Real, Ciudad Real.
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Poblete García V, García Vicente A, Ruíz Solís S, Martínez Delgado C, Vaamonde J, Rodado Marina S, Cortés Romera M, Talavera Rubio M, Ibáñez R, Soriano Castrejón A. [SPECT with 123I-IBZM: utility in differential diagnosis of degenerative Parkinsonisms and establishment of quantification method]. ACTA ACUST UNITED AC 2005; 24:234-43. [PMID: 16122407 DOI: 10.1157/13076641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess utility of SPECT with 123I-Iolopride ( 123I-IBZM) in the differential diagnosis of patients with Parkinsonian symptoms and try to establish an adequate quantification method. MATERIAL AND METHOD We analyzed a total of 34 patients who underwent a study with 123I-IBZM SPECT. Studies were analyzed qualitatively (visually) and quantitatively, using different quantification methods. We used different sums of slices (2, 3, 4, and 7 slices) with different cortical regions as a reference (frontal and occipital regions). Results were analyzed statistically. The final diagnosis of patients was established by two neurologists, specialized in movement disorders. RESULTS Studies were visually assessed as normal in 24 cases and as pathologic in the other 10 cases. Scintigraphic studies had an adequate diagnostic correlation in 33 of the 34 patients. Four of the 8 methods used in the quantification were statistically significant in the differentation between normal and pathological. The use of different cortical brain regions as reference did not improve differentation between normal and pathologic studies. Global quantitative assessment of the studies showed that normal studies had higher values than pathological ones, with important overlapping between both categories. CONCLUSIONS 123I-IBZM SPECT is an effective diagnostic tool in the establishment of the differential diagnosis in patients with Parkinson's disease and Parkinson-Plus. Quantification of these studies had limited utility since the overlapping of index values between normal and pathological restricts their use in individual cases.
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Affiliation(s)
- Vm Poblete García
- Servicio de Medicina Nuclear, Hospital Ntra, Sra. de Alarcos, Ciudad Real, Spain
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Castro A, Valldeoriola F, Linazasoro G, Rodriguez-Oroz MC, Stochi F, Marin C, Rodriguez M, Vaamonde J, Jenner P, Alvarez L, Pavon N, Macias R, Luquin MR, Hernandez B, Grandas F, Gimenez-Roldan S, Tolosa E, Obeso JA. [Optimization of use of levodopa in Parkinson's disease: role of levodopa-carbidopa-entacapone combination]. Neurologia 2005; 20:180-8. [PMID: 15891947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Levodopa remains the mainstay treatment for Parkinson's disease (PD). Chronic treatment is associated with motor complications (MC) that marred the clinical benefit of levodopa. These problems and experimental data in cell cultures indicating a neurotoxic effect of levodopa have led to the idea of delaying the introduction of levodopa treatment for as long as possible. We here review recent data regarding the mechanism of action of levodopa and its application in clinical practice on the light of the marketing of the combination levodopa-carbidopa- entacapone. Accumulated evidence indicates that MC are mainly the consequence of disease severity governing the degree of dopaminergic depletion and the "pulsatile" dopaminergic stimulation provided by levodopa short plasma half-life. There is no in vivo or clinical evidence of a relevant neurotoxic effect of levodopa. In fact, the recent ELLDOPA study may suggest a neuroprotective effect. Entacapone reduces homocysteine plasma levels which could provide a mechanism to reduce cell death in PD. Currently, the combination levodopa-carbidopa-entacapone is particularly indicated for the treatment of "wearing off" fluctuations. Experimental evidence suggests that early treatment with levodopa-carbidopa-entacapone may substantially ameliorate the incidence of MC. Such a clinical study in "de novo" patients is underway. At present, the combination levodopa-carbidopa-entacapone is indicated when levodopa is judged necessary.
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Affiliation(s)
- A Castro
- Servicio de Neurología, Hospital Xeral de Galicia, Santiago de Compostela
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Vaamonde J, Ibáñez R, García AM, Poblete V. [Study of the pre and post-synaptic dopaminergic system by DaTSCAN/IBZM SPECT in the differential diagnosis of parkinsonism in 75 patients]. Neurologia 2004; 19:292-300. [PMID: 15199417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Essential tremor (ET) may be misdiagnosed as idiopathic Parkinson's disease (PD). In neurodegenerative diseases, structural imaging, such as CT or MRI, is of limited value for differentiating parkinsonian syndromes since structural changes are often only evident by the time the disease is far advanced. Most cases of symptomatic parkinsonism are vascular parkinsonism, but PD may coexist. The differential diagnosis between Alzheimer's disease (AD) and dementia with Lewy bodies (LBD) is often difficult. OBJECTIVE To define the utility of functional neuroimaging test to establish differential diagnosis between PD and ET, drug induced parkinsonism, multiple system atrophy and vascular parkinsonism, and between AD and LBD, when clinical presentation, evolution or treatment response are atypical. PATIENTS AND METHODS A group of 75 patients with parkinsonism was examined by clinical assessment and DaTSCAN (123I-FP-CTI, dopamine transporter protein marker) and/or IBZM SPECT (D2 receptor marker). The patients were recruited from our outpatient clinic. RESULTS Correlation between initial clinical diagnosis and functional imaging studies (DaTSCAN and/or IBZM SPECT) in our patients did not reach that described (more than 90 %) for these techniques in previously published studies. Conclusions. According to sensitivity and sensibility reported in previous imaging studies of the pre and/or postsynaptic dopaminergic system using DaTSCAN and/ or IBZM, SPECT may be a new tool in the diagnosis of parkinsonian patients with difficult clinical diagnosis.
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Affiliation(s)
- J Vaamonde
- Servicio de Neurología, Complejo Hospitalario de Ciudad Real, Ciudad Real.
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Vaamonde J, Ibañez R, Villanueva J. [Pneumoencephaly as a late complication of cranioencephalic trauma]. Neurologia 2003; 18:269. [PMID: 12768513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- J Vaamonde
- Servicio de Neurologia, Complejo Hospitalario de Ciudad Real, Ciudad Real, Spain.
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Vaamonde J, Ibáñez R, Gudín M, Hernández A. [Fluctuations and dyskinesias as early L-dopa-induced motor complications in severe Parkinsonian's patients]. Neurologia 2003; 18:162-5. [PMID: 12677484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Daily fluctuations of motor performance and dyskinesias in patients with Parkinson's disease (PD) treated with levodopa represent a difficult challenge to our understanding. We report 10 patients diagnosed of severe PD (Hoehn and Yahr: III-IV/V) treated with levodopa (range of dose: 750-900 mg/day) in single drug therapy since their diagnosis (mean time of levodopatherapy: 4.8 2.4 months, range: 3-6 months). All patients developed motor complications within weeks to months after initiating L-dopatherapy. Two patients received an intravenous apomorphine infusion (mean dose: 8.5 mg/day) during a mean time of 7.5 hours, but motor complications persisted during the infusion in spite of continuous dopaminergic stimulus. The degree of nigrostriatal damage (disease severity) seems to be a very important risk factor for the development of treatment-related motor complications.
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Affiliation(s)
- J Vaamonde
- Servicio de Neurología, Complejo Hospitalario de Ciudad Real, Spain.
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Cano J, Catalán B, Ibáñez R, Gudín M, Hernández A, Vaamonde J. [Primary orthostatic tremor: slow harmonic component as responsible of inestability]. Neurologia 2001; 16:325-8. [PMID: 11485726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Orthostatic tremor (OT) is clinically defined as a tremor of the lower limbs and trunk on walking. It bears a significant functional impairement. Although the term orthostatic tremor was first used by Heilman in 1984, Pazzaglia et al had previously described some cases in 1970. Despite the fact that the pathophysiology of this entity is not fully known, the presence of a central oscillator is generally accepted as being responsible. A high frecuency tremor, between 13 and 18 Hz, constitutes an almost patognomonic finding, and treatment with clonazepam usually improves the symptoms. PATIENT AND METHOD We present a patient who described his symptoms as "cramps" in lower limbs and trunk on standing up, which were relieved on walking or resting. RESULT This clinical presentation together with a neurophysiological recording of the tremor showing an activity of lower frequency (8 Hz) combined with the usual higher frequency (16 Hz) and above all the clear amelioration of symptoms when treated with gabapentin, i.e. resolution of the low frequency tremor without changes in the 16 Hz tremor, were the peculiar features of this case which merits discussion. CONCLUSIONS The slow component of the orthostatic tremor is crucial in this case. The improvement with gabapentin is explained by the disappearance of this slow c
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Affiliation(s)
- J Cano
- Neurofisiología. Hospital de Alarcos. Ciudad Real
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Vaamonde J, Ibáñez R, Hernández A, Gudín M, de Luis P, del Real MA. [Motor impairment, in patients with severe Parkinson's disease, associated with dopaminergic hyperstimulation (entacapone)]. Neurologia 2001; 16:81-4. [PMID: 11257935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE [corrected] Entacapone was given to try to improve the motor complications in eight patients with Parkinson's disease (PD) treated chronically with levodopa, with daily severe motor fluctuations and dyskinesias. PATIENTS AND METHODS We introduced entacapone (200 mg added to every dose of levodopa) to 8 parkinsonian patients (mean age: 68.25 +/- 2.3; range: 68-72; mean PD duration: 10.4 +/- 2.7 years) treated with oral levodopa, plus a dopa-decarboxylase inhibitor (mean dose: 706.25 +/- 2.3 mg/day; mean period of levodopa-treatment; 9 +/- 2.3 years). Dyskinesias were present in all patients (chorea: 8 patients; "off"--dystonia: 4; byphasic dyskinesias: 3). The type and duration (time "on" and "off") of fluctuations was categorized on the "on-off" charts drawn up by the patients or their relatives, and observation by the investigators after the introduction of entacapone. One patient, with severe impairment with entacapone, was evaluated (motor response) during i.v. apomorphine infusion (40 mg, during 3 hours). RESULTS The combination of levodopa and entacapone was associated with a net increase in "off" time in all patients (from 5.8 +/- 1.2 h to 12.4 +/- 4.4 h) without change in the URPD. In the patient studied with i.v. apomorphine, "off" periods appeared during the infusion. CONCLUSION These findings suggest that increased daily levodopa consumption may reduce striatal responsiveness to dopaminergic stimulation in severe parkinsonian patients. These data should be considered when planning the treatment strategy of complex parkinsonian patients.
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Affiliation(s)
- J Vaamonde
- Servicio de Neurología, Complejo Hospitalario de Ciudad Real
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Vaamonde J, Ibáñez R, Gudín M, Hernández A, de Luis P, del Real MA. [Falling backward: atypical sign of iodiopathic Parkison's disease. Use of intravenous apomorphine as a diagnostic test]. Rev Neurol 2000; 31:1147-51. [PMID: 11205547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION The differential diagnosis of a parkinsonian syndrome is extensive and complex. In most cases, however, a detailed clinical examination will help to differentiate between idiopathic Parkinson's disease (IPD) and other causes of parkinsonism. PATIENTS AND METHODS 10 patients with an average age of 65.1 years (range 60-70), of whom 6 were men and 4 women were referred to our department with a diagnosis of IPD and history of backwards falls. The average duration of disease was 4.7 years (range 4-7). All 10 patients had at presentation a severe akinetic-rigid syndrome with no other symptoms of IPD. I.v. apomorphine (APO) was administered to each of them at a rate of 8.9 mg/hr (range 15.3 mg/hr) for an average time of 5.4 hours (range: 3-10 hours). RESULTS The improvement of the akinetic-rigid state in six of the patients during the i.v. infusion with APO helped to elicit signs that are atypical of IPD (ataxia and postural instability). Three of the patients did not respond to i.v. APO and one of them could not be evaluated, as he did not tolerate the infusion. Oral Dopa challenge or s/c APO bolus has not been as successful in helping to differentiate IPD from other parkinsonian syndromes. CONCLUSIONS The prompt detection of postural instability or retropopulsion is necessary in order to diagnose atypical parkinsonian syndromes. In difficult cases, continuous i.v. APO will improve the akinetic-rigid state and facilitate the detection of atypical signs. The pharmacokinetic characteristics of APO, and the advantage of it being possible to administer the drug i.v. in a few hours increases the viability of this test.
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Affiliation(s)
- J Vaamonde
- Servicio de Neurología, Complejo Hospitalario de Ciudad Real, Ciudad Real, España
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Hernandez A, Aguirre M, Vaamonde J, Gudin M, Ibanez R. Pituitary apoplexy: a transient benign presentation mimicking mild subarachnoid hemorrhage with negative angiography. Eur J Neurol 1998; 5:499-501. [PMID: 10210880 DOI: 10.1046/j.1468-1331.1998.550499.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report on a patient who presented with isolated transient headache as the only manifestation of pituitary apoplexy. A high index of suspicion and MRI led to the diagnosis. Copyright 1998 Lippincott Williams & Wilkins
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Affiliation(s)
- A Hernandez
- Unit of Neurology, Alarcos Hospital, Ciudad Real, Spain
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Gargallo L, Vaamonde J, Ibáñez R, Del Real M, Hernandez A, Gudín M. 3-09-04 Early focal cerebral injury: Brain plasticity. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vaamonde J, Ibáñez R, del Real MA, Hernández A. [Trigeminal neuralgia: new therapeutic possibilities]. Neurologia 1997; 12:272. [PMID: 9303602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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del Real MA, Hernández A, Vaamonde J, Ibáñez R. [Neuroborreliosis: diagnostic controversy]. Neurologia 1997; 12:268-9. [PMID: 9303600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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del Real MA, Hernández A, Vaamonde J, Gudín M. [Exacerbation of spasticity induced by serotonin reuptake inhibitors. Letter]. Neurologia 1996; 11:272. [PMID: 8974431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Vaamonde J, del Real MA, Ibáñez R, Gudín M. [Acute dystonia induced by fluoxetine]. Neurologia 1996; 11:197. [PMID: 8845186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Marchán E, Rodríguez S, Ortega J, Vaamonde J. [Heat stroke and arterial hypertension]. Med Clin (Barc) 1996; 106:479. [PMID: 8656738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Campos Y, Martín MA, Vaamonde J, Cabello A, Esteban J, Arenas J. Clinical variability associated with the mutation at nucleotide position 8344 of the mitochondrial DNA. J Inherit Metab Dis 1996; 19:119-22. [PMID: 8739944 DOI: 10.1007/bf01799408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Y Campos
- Centro de Investigación, Hospital 12 de Octubre, Madrid, Spain
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Abstract
On rare occasions, torsion dystonia can rapidly worsen and produce life-threatening symptoms. We present reports on two children who had generalized dystonia and who demonstrate the management difficulties of "dystonic storms."
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Affiliation(s)
- J Vaamonde
- Department of Neurology, Clinica Universitaria University of Navarra, Pamplona, Spain
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Abstract
The motor responses of 14 patients with Parkinson's disease (six previously untreated and eight chronically receiving levodopa) with pronounced asymmetry in the severity of motor signs between the left and right sides of the body were studied. The effects of a short (60 minutes) and a long (16-22 hours) intravenous levodopa infusion as well as of subcutaneous apomorphine (1-6 mg bolus) were assessed. Four different tapping tests were used to measure motor function. For all pharmacological tests, the more affected side showed a shorter response duration, increased latency, and greater response magnitude than the less affected side. These differences were more pronounced in those patients receiving chronic levodopa treatment. As apomorphine is not dependent on dopamine storage capacity, these findings suggest that postsynaptic mechanisms play an important part in the origin of motor fluctuations in Parkinson's disease.
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Affiliation(s)
- M Rodriguez
- Department of Neurology, University of Navarra, Pamplona, Spain
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Abstract
We treated 36 patients with motor fluctuations and dyskinesias on chronic levodopa therapy with cabergoline (CBG) once a day for a mean period of 14.2 +/- 5.8 months. There was a significant increase in the "on" hours and a reduction in "off-period" dystonia. Ten patients continued to show a marked improvement after 28.3 months of treatment (mean dose, 11.3 +/- 4.5 mg). In 23 patients, increased dyskinesias (daily CBG dose, 11 +/- 4.3 mg) had complicated the positive effect after 17.2 +/- 4.8 months. Three patients (daily CBG dose, 14.3 mg) were therapeutic failures, and administration of CBG was stopped. Side effects leading to CBG discontinuation were visual hallucinations (n = 5), heart failure (n = 5), and nausea and vomiting (n = 1). Plasma CBG levels, measured in seven patients taking 3, 5, or 7 mg daily (po), showed fairly stable concentrations throughout the 24 hours. We concluded that CBG is an efficient dopamine agonist that can provide continuous dopaminergic stimulation when taken orally once a day.
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Affiliation(s)
- G Lera
- Department of Neurology, University of Navarra, Pamplona, Spain
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25
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Alvarez-Gomez MJ, Vaamonde J, Narbona J, Barao M, Barona P, Brannan T, Gudin M, Ibañez R. Parkinsonian syndrome in childhood after sodium valproate administration. Clin Neuropharmacol 1993; 16:451-5. [PMID: 8221706 DOI: 10.1097/00002826-199310000-00009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Among the side effects attributed to sodium valproate administration, the production of a parkinsonian syndrome is very uncommon, particularly in children. We report a 12-year-old girl with secondary epilepsy; 7 days after the initiation of valproate therapy she developed parkinsonism that disappeared completely when valproate was replaced by carbamazepine. We discuss the possible role of alterations in GABAergic neurotransmission in the extrapyramidal syndrome that developed.
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26
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Vaamonde J, Legarda I, Jimenez-Jimenez J, Zubieta JL, Obeso JA. Levodopa-responsive parkinsonism associated with basal ganglia calcification and primary hypoparathyroidism. Mov Disord 1993; 8:398-400. [PMID: 8341314 DOI: 10.1002/mds.870080332] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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27
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Abstract
A patient with a bilateral striatal lesion secondary to anoxia presented reflex blepharospasm associated with parkinsonism and dystonia in the limbs. The blink reflex excitability curve was enhanced and the R-2 response prolonged as in patients with essential blepharospasm. The findings in this patient support the notion that blepharospasm may be secondary to basal ganglia dysfunction through abnormal facilitation of reticular formation neurons controlling facial nucleus motoneuron excitability.
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Affiliation(s)
- R Larumbe
- Department of Neurology, University of Navarra Medical School, Pamplona, Spain
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28
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29
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Abstract
The myoclonus of two patients with Ramsay Hunt syndrome was only partially controlled under treatment with clonazepam, sodium valproate, primidone, and piracetam. Acetazolamide (200 mg daily) was added to these drugs, resulting in a dramatic improvement. Placebo substitution (one patient) and withdrawal of acetazolamide in the other patient resulted in marked aggravation of the myoclonus. The mechanism of action of acetazolamide in myoclonus is unknown. Acetazolamide may be an additional therapeutic possibility for patients with severe action myoclonus.
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Affiliation(s)
- J Vaamonde
- Department of Neurology, Clinica Universitaria, Madrid, Spain
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30
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Grandas F, Luquin MR, Rodríguez M, Vaamonde J, Lera G, Obeso JA. [Motor fluctuations in Parkinson disease: risk factors]. Neurologia 1992; 7:89-93. [PMID: 1389297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We studied the histories of 173 patients with Parkinson's disease (1985-1987) chronically treated with levodopa + dopa decarboxylase inhibitor. Ninety four patients had daily motor fluctuations and 79 showed stable motor response. The most significant differences between fluctuating and stable patients were given by age at disease onset and duration of levodopa therapy. Patient with disease onset before 60 had a greater risk (p less than 0.001) of developing fluctuations. Delaying the initiation of levodopa treatment was not associated with a smaller incidence of fluctuations.
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Affiliation(s)
- F Grandas
- Departamento de Neurología, Clínica Universitaria de Navarra, Pamplona
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31
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Abstract
Recent studies giving subcutaneous apomorphine or intravenous levodopa boluses have not found clear evidence of behavioral hyposensitivity to repeated dopaminergic stimulation in Parkinson's disease (PD). Here we analyze that data, and review experimental findings in animal models and our previous experience with parkinsonian patients. We conclude that acute tolerance to pulsatile stimulation is likely to play a role in the pathophysiology of motor fluctuations in PD.
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Affiliation(s)
- J A Obeso
- Department of Neurology, Clinica Universitaria, Medical School, Pamplona, Spain
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32
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Vaamonde J, Muruzabal J, Tuñón T, Perez N, Artieda J, Rodriguez M, Obeso JA. Abnormal muscle and skin mitochondria in family with myoclonus, ataxia, and deafness (May and White syndrome). J Neurol Neurosurg Psychiatry 1992; 55:128-32. [PMID: 1538218 PMCID: PMC488976 DOI: 10.1136/jnnp.55.2.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A mother and two of her daughters had deafness and cortical reflex myoclonus; the mother also had mild truncal ataxia. Muscle and skin biopsy specimens revealed abundant ragged-red fibres and abnormal mitochondria. The son of one of the daughters had sensorineural deafness. Three other grandchildren were asymptomatic. The two daughters also had diabetes mellitus, hypertension and cardiomyopathy. Another daughter died of renal failure. The mother lost her hearing in her 70s, one daughter in her 30s, and the other daughter and the grandson in their 20s. The mother has had transient episodes (24-48 hours) of temporal disorientation, severe action myoclonus, and ataxia for about eight years. This is the first reported family with inherited deafness, myoclonus, and ataxia with mitochondrial pathology.
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Affiliation(s)
- J Vaamonde
- Clinica Universitaria, University of Navarra, Pamplona, Spain
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33
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Luquin MR, Scipioni O, Vaamonde J, Gershanik O, Obeso JA. Levodopa-induced dyskinesias in Parkinson's disease: Clinical and pharmacological classification. Mov Disord 1992; 7:117-24. [PMID: 1350058 DOI: 10.1002/mds.870070204] [Citation(s) in RCA: 146] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Levodopa-induced dyskinesias (LID) in Parkinson's disease (PD) may be classified into three main categories: "On" dyskinesias, diphasic dyskinesias (DD), and "off" periods. The study of 168 parkinsonian patients showed that about half (n = 84) showed one pattern of LID only. A combination of two was present in 68, and 16 had the three presentation patterns. A fairly good correlation between type of dyskinesia and presentation pattern was established. Chorea, myoclonus, and dystonic movements occurred during the "on" period. Dystonic postures, particularly affecting the feet, were mainly present in the "off" period, but a few patients had a diphasic presentation. Repetitive stereotyped movements of the lower limbs always corresponded to DD. Acute pharmacological tests using dopamine agonists (subcutaneous apomorphine 3-8 mg; intravenous lisuride 0.1-0.15 mg) and dopamine antagonists (intravenous sulpiride 200-400 mg and intravenous chlorpromazine 25 mg) were performed in 40 patients. Dopamine agonists enhanced "on" dyskinesias and markedly reduced or abolished "off" period dystonia and DD. Dopamine antagonists reduced all types of LID but usually aggravated parkinsonism. These clinical and pharmacological results indicate that LID in PD are a heterogeneous phenomenon difficult to explain on the basis of a single pathophysiological mechanism.
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Affiliation(s)
- M R Luquin
- Department of Neurology, Clinica Universitaria, University of Navarra, Pamplona-Spain
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34
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Vaamonde J, Narbona J, Obeso JA. [Evaluation and diagnosis of torsion dystonia]. Rev Med Univ Navarra 1991; 36:29-34. [PMID: 1820591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J Vaamonde
- Facultad de Medicina, Universidad de Navarra
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35
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Vaamonde J, Luquin MR, Obeso JA. Subcutaneous lisuride infusion in Parkinson's disease. Response to chronic administration in 34 patients. Brain 1991; 114 ( Pt 1B):601-17. [PMID: 2004258 DOI: 10.1093/brain/114.1.601] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Thirty-eight parkinsonian patients with motor fluctuations and dyskinesias on chronic levodopa therapy were treated with subcutaneous lisuride infusion (SLI). Thirty-six were discharged from hospital on combined treatment with 24 h lisuride infusion (111.3 +/- 29.5 micrograms/h) and oral levodopa plus a decarboxylase inhibitor (729.6 +/- 452 mg/day); all obtained a marked initial improvement in mobility (mean reduction 'off' hours 87.5%); 34 were followed for a mean of 20.85 (range 6-45) months. Most patients continued to show improvement with respect to baseline assessment during chronic treatment but 23 developed dyskinesias, 'off' periods or both, which were difficult to control by changing the levodopa schedule, lisuride dose or both. In only 5 patients was lisuride treatment stopped because of inefficacy. The high incidence of psychiatric side-effects (18/38) was the major limiting factor for continuing lisuride infusion in this population of severe parkinsonian patients. Many complained about the inconvenience of the pump's technical requirements for long-term utilization, but only 4 patients abandoned SLI for this reason. These results indicate that motor function may be substantially improved in severe parkinsonian patients treated with SLI but increased dyskinesia or psychiatric adverse effects limited the long-term usefulness of this approach. It is suggested that continuous dopaminergic stimulation may be a particularly useful therapeutic strategy when applied in earlier stages of the disease.
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Affiliation(s)
- J Vaamonde
- Department of Neurology, Clinica Universitaria, University of Navarra, Pamplona, Spain
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36
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Abstract
The clinical manifestations of a patient with hereditary paroxysmal ataxia and neuromyotonia are described. Generalized tremor, triggered by sudden movements, and spasms of hand and foot muscles were the main clinical findings. Electromyogram (EMG) and nerve blocking studies led to the diagnosis of neuromyotonia. Treatment with acetozolamide was of no therapeutic value, confirming previous observations about the difference in response of paroxysmal ataxia with and without neuromyotonia.
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Affiliation(s)
- J Vaamonde
- Department of Neurology, Clinica Universitaria, Pamplona, Spain
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37
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38
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Artieda J, Luquin MR, Vaamonde J, Laguna J, Obeso JA. Generalized reflex myoclonus in a patient with alcohol-sensitive spontaneous myoclonus and an abnormal gait. Mov Disord 1990; 5:85-8. [PMID: 2296265 DOI: 10.1002/mds.870050120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A patient with alcohol-sensitive spontaneous, action- and stimulus-sensitive generalized reflex myoclonus is reported. Gait was abnormal but could not be clearly classified as dystonic. No other neurological abnormality was present. The possible relationship between alcohol-sensitive myoclonic dystonia and this case is discussed. Reflex myoclonus may serve as an additional clinical marker in the study of families with alcohol-sensitive myoclonus, dystonia, or both.
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Affiliation(s)
- J Artieda
- Department of Neurology, Clinica Universitaria, Pamplona, Spain
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39
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Vaamonde J, Luquin MR, Obeso JA. Dopaminergic responsiveness to apomorphine after chronic treatment with subcutaneous lisuride infusion in Parkinson's disease. Mov Disord 1990; 5:260-2. [PMID: 2388647 DOI: 10.1002/mds.870050316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to assess whether or not continuous infusion of lisuride in combination with intermittent levodopa-carbidopa administration was associated with tolerance. Intravenous apomorphine was given to four patients before initiation of chronic treatment with subcutaneous lisuride infusion and oral levodopa. The study was repeated under identical conditions after a mean of 18 months of treatment. In no case was the motor response induced by apomorphine infusion reduced as compared to baseline assessment. Choreic dyskinesias accompanying the "on" state were enhanced in all patients. These findings suggest that chronic continuous infusion of a dopamine agonist like lisuride, associated with oral levodopa, is not accompanied by tolerance or down-regulation of striatal dopaminergic receptors.
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Affiliation(s)
- J Vaamonde
- Department of Neurology, University of Navarra, Pamplona, Spain
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40
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Obeso JA, Grandas F, Vaamonde J, Luquin MR, Artieda J, Lera G, Rodriguez ME, Martinez-Lage JM. Motor complications associated with chronic levodopa therapy in Parkinson's disease. Neurology 1989; 39:11-9. [PMID: 2685647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Fluctuations and dyskinesias are the 2 main motor complications associated with chronic levodopa therapy. Striatal denervation following degeneration of the substantia nigra dopaminergic projections is probably the major pathophysiologic mechanism underlying motor fluctuations. In addition, pathologic modification of striatal receptors, partially related to the nonphysiologic delivery of levodopa in a discontinuous pulsatile mode, may be responsible for the various types of dyskinesias and sudden "off" episodes. Drugs capable of providing a stable dopaminergic stimulation should be particularly useful for preventing the development of motor complications in patients not yet treated. At the other end of the clinical spectrum, patients with complex fluctuations are the least likely to improve with slow-release levodopa preparations.
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Affiliation(s)
- J A Obeso
- Department of Neurology, Clinica Universitaria, Pamplona, Spain
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41
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Obeso JA, Luquin MR, Vaamonde J, Herrero T, Guridi J, Martínez-Lage JM. [Cerebral implants in Parkinson's disease]. Neurologia 1989; 4:302-3. [PMID: 2641998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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42
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Luquín MR, Obeso JA, Vaamonde J, Martínez Lage JM. [Orally administered lisuride in the treatment of complex fluctuations of motion in Parkinson disease]. Neurologia 1989; 4:229-32. [PMID: 2638588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Oral lisuride associated with the previous therapy (levodopa plus inhibitor) was given to 15 patients with complex fluctuations of mobility that were not controlled with usual therapy. In contrast with previous studies using this drug, in the present trial several lisuride doses (5-10 administrations) were distributed throughout the day. This therapeutic strategy permitted a greater control of the fluctuations, a significant reduction of the block hours and the disappearance or attenuation of biphasic dyskinesia and off dystonia. It is considered that the use of multiple doses of lisuride permits better therapeutic results than its usual administration schedule (3-4 times a day). Oral lisuride associated with levodopa may provide a definite improvement in motor function in patients with significant functional impairment. The general tolerance was very good using concomitant domperidone therapy.
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43
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Abstract
In seven patients with Parkinson's disease with daily motor fluctuations, we found that the same subcutaneous apomorphine dose that improved motor function when given in the morning after a normal night without taking levodopa failed to turn patients "on" during afternoon and evening "off" periods, and on a different morning after receiving levodopa during the night. No significant changes in levodopa or 3-O-methyldopa plasma levels that could explain these variations were detected. These findings suggest that increased daily levodopa consumption may reduce striatal responsiveness to dopaminergic stimulation.
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Affiliation(s)
- J Vaamonde
- Department of Neurology, University of Navarra, Pamplona, Spain
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44
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Abstract
Many parkinsonian patients with motor fluctuations in response to levodopa show a good response to initial morning doses but fail to respond in the afternoon and evening. We have studied levodopa and 3-O-methyldopa (3-OM-dopa) plasma profiles in 21 patients with fluctuations and eight patients with stable motor function throughout the day. Levodopa plasma peaks and valleys were similar for both group of patients. No significant difference for levodopa absorption index [defined as levodopa plasma levels after each dose divided by the quantity (mg) of ingested levodopa] was found between the first and the second levodopa-carbidopa dose in either group of patients. Even in patients who failed to improve after the second levodopa-carbidopa tablet (p.o.) on the day of the study, no significant variation in levodopa absorption index was observed. 3-OM-dopa values depended mainly upon levodopa consumption and were not different for patients with fluctuating or stable motor response. These findings provide further evidence of the prime role of central pharmacokinetic and pharmacodynamic factors in the pathogenesis of motor fluctuations in Parkinson's disease.
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Affiliation(s)
- M R Luquin
- Department of Neurology, Clinica Universitaria, University of Navarro, Pamplona, Spain
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45
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Obeso JA, Vaamonde J, Grandas F, Luquin MR, Rodriguez M, Lera G, Martínez-Lage JM. Overcoming pharmacokinetic problems in the treatment of Parkinson's disease. Mov Disord 1989; 4 Suppl 1:S70-85. [PMID: 2657410 DOI: 10.1002/mds.870040510] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- J A Obeso
- Department of Neurology, Clinica Universitaria-Medical School, University of Navarra, Pamplona, Spain
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46
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Abstract
Forty patients with different clinical and electrophysiological types of myoclonus were treated with piracetam (18-24 g per day, p.o.) alone, or with other drugs (clonazepam, sodium valproate, and primidone) in different combinations. Piracetam in monotherapy improved the electrophysiological abnormalities in patients with cortical reflex myoclonus, but had no useful clinical effect. Sixteen patients obtained benefit from piracetam when given in combination with other antimyoclonic drugs; improvement was dramatic in two patients, moderate in seven and mild in seven. All patients showing some response to piracetam had myoclonus of cortical origin; however, five other patients with similar cortical myoclonus failed to improve when piracetam was added. Tolerance was excellent and side effects were minimal and transient. It is concluded that piracetam probably has an antimyoclonic action, but its potential value as a therapeutic tool for disabling myoclonus requires further study.
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Affiliation(s)
- J A Obeso
- Department of Neurology, Clinica Universitaria, Pamplona, Spain
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47
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Obeso JA, Luquin MR, Grandas F, Vaamonde J, Martínez Lage JM. Levodopa therapy and motor fluctuations in Parkinson's disease. Ann Neurol 1988; 24:696-7. [PMID: 3202620 DOI: 10.1002/ana.410240523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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48
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Obeso JA, Grandas F, Vaamonde J, Luquin MR, Martinez-Lage JM. Continuous dopaminergic stimulation for Parkinson's disease: facts and fancy. Funct Neurol 1988; 3:413-27. [PMID: 3072277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J A Obeso
- Department of Neurology, Universidad de Navarra, Pamplona, Spain
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49
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Obeso JA, Luquin MR, Vaamonde J, Grandas F, Pastor MA, Artieda J, Martínez-Lage JM. [Continuous dopaminergic stimulation in Parkinson disease]. Neurologia 1987; 2:227-34. [PMID: 2908545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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50
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Abstract
Complex motor fluctuations and dyskinesias ("on-off" phenomenon) in Parkinson's disease can be corrected by parenteral administration of levodopa, levodopa-methyl-ester, lisuride and apomorphine. Levodopa and levodopa-methyl-ester may only be administered intravenously because of their low solubility. Lisuride and apomorphine are readily absorbed after subcutaneous administration. Repeated or continuous intravenous infusions of levodopa have been given for a few days, using a wearable "jacket-like" pump, with good results. So far, lisuride is the only dopamine agonist used for chronic treatment by continuous infusion. The "on-off" effect is adequately controlled in most patients by subcutaneous lisuride administration (plus oral levodopa). However, adverse effects, particularly psychiatric complications, constitute a major limiting factor for routine applications of this form of treatment. Subcutaneous apomorphine infusion is unlikely to become a standard therapeutic procedure in Parkinson's disease, but it is a very valuable research method to gain further insight into the pathophysiology of motor fluctuations in Parkinson's disease.
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Affiliation(s)
- J A Obeso
- Department of Neurology, University of Navarra, Medical School, Pamploma, Spain
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