Lege Artis Medicinae

[CONTINUOUS DOPAMINERG STIMULATION IN THE TREATMENT OF PARKINSON’S DISEASE]

TAKÁTS Annamária

SEPTEMBER 19, 2008

Lege Artis Medicinae - 2008;18(08-09)

[The greatest challenge in the treatment of Parkinson's disease is to delay or stop dyskinesias and motor fluctuations. The development of the so-called late levodopa failure is supposed to be due to the pulsatile dopaminergic stimulation. Growing evidence suggests that continuous stimulation that approaches the physiologic state decreases dyskinesias and prevents motor fluctuations. Continuous striatal stimulation can be achieved in several ways, including COMT inhibition, the use of prolonged release dopamine agonists, a new delivery system in patch form, intrajejunal levodopa infusion and deep brain stimulation.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[The History of Prosthetics from the Beginning until Today]

MAYER Ágnes

Lege Artis Medicinae

[A single-step colonoscopic screening method of colorectal cancer - A methodological guideline of the College of Gastroenterology]

RÁCZ István

Lege Artis Medicinae

[THE IMPORTANCE OF THE RECOGNITION AND TREATMENT OF LIPID METABOLISM DISORDERS IN THE SECONDARY PREVENTION OF CEREBROVASCULAR DISEASES]

FOLYOVICH András, HORVÁTH Eszter

[The high world prevalence of cerebrovascular diseases, and the particularly bad morbidity rates of Hungary are well known. The physiological properties of the brain make stroke prevention outstandingly important. Effective prevention will be reflected in the reduction of the late complications that are otherwise common and expensive to treat. Because of the common simultaneous development of stroke, cardiovascular and peripheral vascular diseases, overall vascular disease prevention is preferred, even if the various vascular diseases manifest in different degrees in a patient. Hungarian data also indicate the high risk of recurrence of cerebrovascular diseases, therefore, the importance of secondary prevention is obvious. Large international studies have proven the strokepreventing effect, and, by a pleiotropic drug action, additional benefits, of the efficient treatment of blood lipid disorders. Consensus conferences in recent years defined clear and even stricter lipid-lowering target values, mostly to be reached by “double inhibition”, bile acid binding resins, fibrates and nicotinic acid derivatives, beside the most common statin treatment. Neurological and stroke departments and clinics play a pivotal role in vascular prevention.]

Lege Artis Medicinae

[THE ADENOMATOID TUMOUR OF THE UTERUS]

HIDVÉGI Judit, BAJTAI Attila, VERECZKEY Attila, FÜLÖP István

[INTRODUCTION - The occurrence of an adenomatoid tumour is rare in the uterus; in the female genitals it is more common in the Fallopian tube, whereas in men it mainly arises from the epididymis. Though there are controversies, its mesothelial origin seems to be confirmed. Apart from their different sites of occurrence, the mesothelioma and the adenomatoid tumour are distinguished by the fact that the latter is always circumscribed and never turns malignant. CASE REPORT - Two cases of adenomatoid tumour of the uterus are reported which had clinically been thought to be leiomyomata. Both of them were adenoid in type, and stained positive for cytokeratin and vimentin as well as for a mesothelial marker, but were negative for CD-34, whereas some cells of the adenoid epithelium showed positivity with ethidiummonoazide staining. CONCLUSION - The poor and non-specific clinical symptoms and course of this tumour warrants the reporting of such cases.]

Lege Artis Medicinae

[PSORIATIC ARTHRITIS AND ITS PHARMACOLOGICAL TREATMENT MODALITIES]

KOÓ Éva

[Psoriatic arthritis is a destructive form of inflammatory arthritis that occurs in 10-30% of patients with psoriasis. Its prevalence is about 10.000 to 20.000 in Hungary. The pathogenesis includes both genetic and immunological factors. Average disease progression based on functional status is, on average, 0.05 HAQ score/year. The traditional disease-modifying antirheumatic drugs (DMARDs) are not always successful in controlling the disease and preventing joint damage. Based on the pathogenesis of psoriatic arthritis, several new drugs (anti-tumour necrosis factor alfa, or anti-TNF-α) have been introduced in the therapy, which have been found to be effective both in psoriasis and psoriatic arthritis. The development of the Biological Response Modifying Drugs (BRMDs) makes treatment possible for patients with the most serious, high activity disease, who are refractory to other therapy. There is no significant difference in efficacy among the different biological agents (etanercept, infliximab, adalimumab). The review presents the traditional DMARDs, as well as the indications, effectiveness, side effects and the national prescription regulations of the anti- TNF-alfa agents. Both DMARDs and TNF-α inhibitors can be safely used in psoriatic arthritis under strict specialist control.]

All articles in the issue

Related contents

Clinical Neuroscience

[Validation of the Hungarian Unified Dyskinesia Rating Scale]

HORVÁTH Krisztina, ASCHERMANN Zsuzsanna, ÁCS Péter, BOSNYÁK Edit, DELI Gabriella, PÁL Endre, KÉSMÁRKI Ildikó, HORVÁTH Réka, TAKÁCS Katalin, BALÁZS Éva, KOMOLY Sámuel, BOKOR Magdolna, RIGÓ Eszter, LAJTOS Júl

[Background - The Unified Dyskinesia Rating Scale (UDysRS) was published in 2008. It was designed to be simultaneous valid, reliable and sensitive to therapeutic changes. The Movement Disorder Society organizing team developed guidelines for the development of official non- English translations consisting of four steps: translation/back-translation, cognitive pretesting, large field testing, and clinimetric analysis. The aim of this paper was to introduce the new UDysRS and its validation process into Hungarian. Methods - After the translation of UDysRS into Hungarian and back-translated into English, it was reviewed by the UDysRS translation administration team. Subsequent cognitive pretesting was conducted with ten patients. For the large field testing phase, the Hungarian official working draft version of UDysRS was tested with 256 patients with Parkinson’s disease having dyskinesia. Confirmatory factor analyses (CFA) determined whether the factor structure for the valid Spanish UDysRS could be confirmed in data collected using the Hungarian Official Draft Version. To become an official translation, the Comparative Fit Index (CFI) had to be ≥0.90 compared to the Spanish-language version. Results - For the Hungarian UDysRS the CFI was 0.98. Conclusion - The overall factor structure of the Hungarian version was consistent with that of the Spanish version based on the high CFIs for the UDysRS in the CFA; therefore, this version was designated as the Official Hungarian Version Of The UDysRS.]

Clinical Neuroscience

[Analysis of antiparkinsonian drug reduction after bilateral subthalamic deep brain stimulation]

FEHÉR Georgina, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, BALÁZS Éva, NAGY Ferenc, KOVÁCS Norbert

[Background - Bilateral deep brain stimulation of the subthalamic nuclei (STN) is a well-established and cost-effective treatment in advanced PD. Objectives - To quantitatively analyze the change in use of antiparkinsonian drugs one year after subthalamic deep brain stimulator (DBS) implantation in patients with idiopathic Parkinson’s disease (PD). Patients and methods - Eighteen consecutive patients with advanced PD underwent bilateral STN DBS implantation were involved in the study. The stimulation achieved a stable and clear clinical benefit in all of the cases. One year after the implantation, drug usage of patients was analyzed and correlated with the postoperative symptomatic improvement measured by the modified Hoehn-Yahr, Schwab and England, and Unified Parkinson’s Disease Rating Scales. Because none of the investigated variables followed the normal distribution, non-parametric Wilcoxon signed-rank, McNemar and Kendell’s τ tests were applied. Results - Preoperatively, the patients used 12.05±4.57 tablets a day out of 3.19±0.97 different antiparkinsonian drugs, which was significantly reduced by deep brain stimulation to the application of 7.00±2.96 tablets out of 1-3 (1.84±0.76) drugs (p<0.001). Meanwhile, the usage of amantadine, MAO-B and COMT inhibitors was also significantly decreased (p<0.05). The dosage of dopaminerg medication was significantly lowered from 1136 mg to 706 mg expressed in levodopa equivalent dosage (p<0.001) whereas the UPDRS-III also improved by 48.6%. Conclusion - Our study is in accordance with previously published international findings that antiparkinsonian medication can be significantly lowered after bilateral STN DBS. Because not only the dosage, but also the applied number of tablets were decreased, it may have resulted in a better compliance and quality of life.]

Hungarian Radiology

[Functional disorders of the pharynx associated with gastroesophageal reflux disease]

SZÁNTÓ Dezső

[The reduced tone of the lower esophageal sphincter, hypomotility of esophagus and dilatory evacuation of stomach are causes of gastroesophageal reflux disease (GERD). Primary damages of esophageal motility lead to regurgitation of gastric content. The evolution of various disorders of esophagus, pharyngoesophageal junction and hypopharynx depend on regurgitant volume gastric and bile acids. The barium swallow well detects mucosal abnormalities and uncordinated contractions of pharyngeal constrictor and levator muscles moreover dyskinesia of upper and lower esophageal sphincters. According to the database of evidence-based medicine (Cochrane Library), sensitivity of barium pharyngo-esophagograms is in mild grade cases 72-74%, in moderate and in severe ones 88-93% and 100%, respectively. Till now laryngeal stasis, penetration and aspiration, dysmyotonia of lateral wall, cricopharyngeal bar, waterfall, vallecular balloon, besides double anterior wall signs of pharyngeal malfunctions were reviewed. We have to also consieder respiratory, cardiovascular and neurological manifestations.]

Lege Artis Medicinae

[The complexity of hyper-lipidaemia’s follow-up in a polymorbid patient diagnosed with newfound Parkinson’s disease]

HANG Dóra

[The 73-year-old polymorbid man has been examined because of above normal blood pressure and increased serum lipid levels. From his already known diseases subclinic hypothyreosis should be highlighted. Because of increased serum cholesterol (6.7 mmol/l) and LDL levels (4.91 mmol/l) 40 mg atorvastatin has been adjusted besides 10 mg amlodipine against his high blood pressure. Subsequently selegiline and levodopa/benserazid therapy have been adjusted caused by newly diagnosed Parkinson’s disease. Parallel in time decreased dosage of atorvastatin (20 milli- gramms) has been enabled to adjust as well, the pill taken by the patient is combinated with 10 milligramms of amlodipine and called Amlator®. The improvement of lipid levels might be due to the trasformation of subclinic hypothyroidism to euthyroid state of the thyroid gland. Levodopa might plays role in this improvement resulting in an inhibition of TSH release because of demonstrated dopamine-receptors in the pituitary gland.]

Clinical Neuroscience

[A rare paroxysmal movement disorder: Mixed type of paroxysmal dyskinesia]

AYSU Sen, DILEK Atakli, BAHAR Guresci, BAKI Arpaci

[Paroxysmal dyskinesias are rare, heterogeneous group of disorders characterised by recurrent attacks of involuntary movements. The four classic categories of paroxysmal dyskinesias are kinesigenic, nonkinesigenic, exercise-induced and hypnogenic. There are some patients that do not fit in these four groups of paroxysmal dyskinesia and are termed as “mixed type”. We describe a 13-year-old girl who had features of both paroxysmal kinesigenic dyskinesia and paroxysmal nonkinesigenic dyskinesia that was misdiagnosed as refractory epilepsy. She improved substantially with a combination of carbamazepine and clonazepame. It is important to recognize the clinical presentation of paroxysmal dyskinesias and distinguish these movement disorders from other disorders, such as psychogenic disorders and epilepsia, for deciding the treatment and prognosis of the patients. This case highlights the importance of the recognition of a rare paroxysmal movement disorders.]