Chen-Hua Li

The efficacy of homemade tolcapone in the treatment of patients with Parkinson's disease

The aim of the study was to investigate the efficacy of homemade tolcapone in treatment of patients with Parkinsons disease (PD). Eighty patients with PD were subjected to randomized, double-blind, placebo-controlled and parallel-group study. PD patients were randomly divided into the tolcapone treatment group (41 cases) and placebo group (39 cases). Each patient received 1 pill of tolcapone or placebo, 3 times per day for 26 weeks. Efficacy was evaluated using the internationally used unified Parkinsons disease rating scale (UPDRS) scoring system for PD symptoms. After the treatment for 26 weeks, the cognitive function, tremor, muscle stiffness, voluntary movement and autonomic nerve symptoms were compared between the two groups using UPDRS scores. Compared with the placebo group, cognitive function, muscle stiffness and voluntary movement reduction were significantly improved in patients of the tolcapone group (P<0.05). However, no significant differences in UPDRS scores of autonomic nerve symptoms and tremor were found between two groups after treatment (P>0.05). Tolcapone, a catechol-O-methyl transferase (COMT) inhibitor, can improve the motor function of patients with PD, especially exercise and muscle stiffness. Tolcapone can also improve the cognitive function of patients.

Intravenous Thrombolytic Therapy for Acute Ischemic Stroke with Subclavian Arterial Steal Syndrome: A Case Report

This case study is of a patient who was a 71-year-old man, admitted to the emergency room due to ‘‘slurred speech and right limb weakness for 3.5 h’’. His symptoms started at 20:00 h, and the patient came to the hospital at 23:30 h on August 13, 2012. The patient had history of hypertension for 2 years, but no history of smoking/drinking or familial genetics. He experienced sudden slurred speech and right limb weakness at 20:00 h. The symptoms worsened quickly, and he was soon unable to express himself or understand words of others. Accompanying symptoms included poor mobility of the right limbs, and he was unable to lift or hold objects with the right upper limb, or could stand and walk with the right lower limb. There was no headache, dizziness, nausea, vomiting, unconsciousness, limb convulsion, or incontinence of urine and feces. As the patient’s symptoms persisted without relief, he visited the emergency room of our hospital immediately. Examination showed his blood pressure was 140/90 mmHg, heart rate 94 beats/min, irregular heart sound intensity with arrhythmia, and no pathological murmurs over all valve auscultation areas. The patient was alert with complete mixed aphasia. Both eye pupils were 3:3 mm, light reaction was positive, with eyes gazing to the left but no sign of nystagmus. Forehead wrinkles of the patient were symmetric. The patient could close the eyelids completely, but the right nasolabial fold was shallow. The tongue was in the midline, gag reflexes were positive, uvula centered in the midline, and the soft palate could lift naturally. The neck was soft, the myodynamia of left limb was achieved grade 5, and the myodynamia of right limb was achieved grade 1. The patient was uncooperative for other neurological examinations. National Institutes of Health Stroke Scale (NIHSS) of USA score was 15 points. Head CT scan suggested a widespread demyelination of bilateral cerebral hemispheres, as shown in Fig. 1. The relevant blood tests (including blood, coagulation, electrolytes, glucose, liver, and kidney function) did not show obvious abnormalities but ECG showed atrial fibrillation. Based on the guidelines of intravenous thrombolysis for acute ischemic cerebrovascular diseases, and the clinical and laboratory evaluations, the patient required intravenous rt-PA thrombolysis after admission. Therefore, rtPA thrombolytic therapy was administered 4 h after onset. The rt-PA dose was calculated at 0.9 mg/kg, 55 mg in total, which was first delivered with a 5.5 mg intravenous bolus for 1 min, and by intravenous infusion for the rest of 1 h. One hour after thrombolysis, the symptoms of speech disorders and the right limb weakness were slightly improved. Physical examinations showed that the patient was alert with complete motor aphasia and incomplete sensory aphasia. Pupils of both eyes were 3:3 mm, light reaction was positive; both eyes were gazing incompletely to the right, without nystagmus. Forehead wrinkles were symmetric. The patient could close the eyelids completely, but the right nasolabial fold was shallow. The tongue was in the midline, gag reflexes were positive, uvula centered in the midline, and the soft palate could lift naturally. The neck was soft, the myodynamia of left leg was achieved grade 5, the myodynamia of right upper limb was achieved grade 1, and the myodynamia of right lower limb was achieved grade 2. All limb muscle tensions were normal, tendon reflexes were positive, and right-side Babinski sign X.-G. Tong Y. Wang Y. Chen C. Zhang C.-H. Li Z. Dong X.-W. Zhang F.-F. Zhang H. Yin J.-H. Wang P.-L. Zhang (&) Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, No. 122, Qixiangtai Road, Tianjin 300060, China e-mail: peilanzhng@sina.com