Francisco Cabrera-Valdivia

Parkinsonism exacerbated by paroxetine

with surrounding edema. Four-vessel angiography showed occlusion of the right anterior cerebral and middle cerebral arteries. Discussion. This young man developed a cerebral infarct in association with use of shortterm, high-dosage anabolic steroids. Experimental evidence suggests that testosterone stimulates thrombus formation by suppressing prostacyclin production in arterial smooth muscle cells in rats.’ Nagelberg et aI3 reported another young man receiving testosterone for hypogonadism who developed a cerebral infarct. Shiozawa et a14 described three patients who developed superior sagittal sinus thrombosis after receiving androgen therapy for hypoplastic anemia. I t is unclear whether migraine added to the risk in these patients. With the more common use of anabolic steroids in the young, both users and their physicians should clearly be aware of this possible complication.

Tau protein concentrations in cerebrospinal fluid of patients with amyotrophic lateral sclerosis

Objective – To elucidate whether cerebrospinal fluid (CSF) concentrations of the microtubule‐associated tau protein are related to the risk for sporadic amyotrophic lateral sclerosis (SALS).

Serum levels of ascorbic acid (vitamin C) in patients with Parkinson's disease

To elucidate the possible role of vitamin C in the risk for developing Parkinsons disease (PD), we compared serum levels of ascorbic acid (vitamin C), measured by a fluorometric method, of 63 PD patients using their spouses as the control group. The serum levels of vitamin C did not differ significantly between the groups (47.13 +/- 0.89 micrograms/ml for PD and 47.60 +/- 0.60 micrograms/ml for controls). There was no influence of antiparkinsonian therapy on vitamin C. Serum levels of vitamin C did not correlate with age, age at onset and duration of the disease, scores of the Unified PD Rating Scale or the Hoehn and Yahr staging in the PD group. These results suggest that serum vitamin C concentrations are apparently unrelated to the risk of developing PD.

Serum levels of β-carotene and other carotenoids in Parkinson's disease

Abstract To elucidate the possible role of carotenoids in the risk for developing Parkinsons disease (PD), we compared serum levels of β-carotene, α-carotene and lycopene, measured by high performance liquid chromatography, of 61 PD patients using their spouses as the control group. The serum levels of these 3 carotenoids did not differ significantly between PD patients and control groups. There was no influence of antiparkinsonian therapy on serum carotenoids levels, and these did not correlate with age, age at onset, scores of the Unified Parkinson Disease Rating Scale or the Hoehn and Yahr staging in the PD group. These results show that serum carotenoids concentrations are apparently unrelated to the risk for developing PD.

Clinical features of essential tremor seen in neurology practice: a study of 357 patients

To assess the clinical features of essential tremor (ET), we studied 357 patients with diagnostic criteria for this disease who were referred to the Neurology departments of three urban hospitals. This is not a true epidemiological study, and can be biased in favour of patients with functional disability. There was a predominance of affectation of females and a peak of age at onset in the sixth and seventh decades. Family history of tremor was positive in 46.8% of patients. Females showed a a significantly higher frequency of inheritance through maternal than through paternal line, and had a higher frequency of head and voice tremor, than males. When compared with patients without family history, those with family history of tremor had lower age at onset of tremor, and lower frequency of jaw and trunk tremor in non-familial cases.

Drug-induced parkinsonism in a movement disorders unit: A four-year survey

UNLABELLED To establish the frequency of drug-induced parkinsonism (DIP) and the drugs responsible for this side-effect we reviewed the database of our Movement Disorders Unit during the first 4 years of its use. The diagnostic criteria for DIP included: (1) the presence of two or more cardinal symptoms of parkinsonism, (2) an absence of parkinsonian symptoms before the exposure to the offending drug, (3) a disappearance or significant improvement in parkinsonism after withdrawal of the offending drug, (4) no better explanation for the parkinsonism. One-hundred and five patients fulfilled the diagnostic criteria for DIP (16.3% of total patients referred and 33.8% of patients with parkinsonian syndromes). Drug-induced parkinsonism was related to 1, 2, 3, 4, 5 and 7 drugs in 62, 30, 9, 1, 2 and 1 patients, respectively. The most frequently offending drugs were: calcium-channel blockers (61 cases), antipsychotic drugs (29 cases), thiethylperazine (18 cases), clebopride (14 cases), and sulpiride (10 cases). When compared with idiopathic Parkinsons disease patients, DIP patients were predominantly female and showed an older age at the onset of parkinsonian signs. Parkinsonian signs only disappeared completely in 41 patients (39.0%). IN CONCLUSION (1) DIP was a frequent cause of parkinsonism in our Movement Disorder Unit, (2) calcium-channel blockers, and/or orthopramides and substituted benzamides were a frequent cause of DIP in our series, (3) old age and the female gender were frequent among DIP patients, (4) DIP is not always reversible.

Cerebrospinal fluid carnitine levels in patients with Alzheimer's disease.

We assessed free carnitine (FC) and acylcarnitine esters (AC) in both cerebrospinal fluid (CSF) and plasma from 24 patients with diagnostic criteria for Alzheimers disease (AD), and from 28 healthy matched-controls. We found no significant correlation between FC and AC levels in CSF. FC and AC levels in CSF did not differ significantly between AD patients and controls, but plasma FC levels were significantly lower in AD patients. CSF and plasma FC and AC levels did not correlate with age, age at onset of AD, duration of AD, and scores of the Minimental State Examination of Folstein. Although these results suggest that CSF carnitine levels are apparently unrelated with the risk for AD, the trend of the FC/AC ratio to be higher in AD patients might suggest the possibility of a lower carnitine acetyltransferase activity in AD, as previously reported in some brain areas.

Cerebrospinal fluid nitrate levels in patients with Alzheimer's disease

It has been suggested that nitric oxide could be implicated in the pathogenesis of Alzheimers disease (AD). Recently Kuiper et al. reported decreased CSF nitrate levels (oxidation product that provides an indirect estimation of nitric oxide) in AD patients, assessed with a colorimetric method. However other group, using a microplate version of the Griess reaction, did not confirm these findings. We studied the CSF and plasma levels of nitrate with a kinetic cadmium‐reduction method in 32 AD patients and 36 matched controls. The CSF and plasma nitrate levels did not differ significantly between the two study groups. CSF and plasma nitrate levels did not correlate with age at onset and duration in the patient group. These data suggest that CSF and plasma levels of nitrate are apparently unrelated with the risk for AD.

Serum and urinary manganese levels in patients with Parkinson's disease

To elucidate the possible role of manganese in the risk of developing Parkinsons disease (PD), we compared serum levels of manganese, and 24‐h manganese excretion by urine in 29 PD patients and in 27 matched controls. We also measured chromium and cobalt in the same samples. All these values did not differ significantly between the groups, they were not influenced by antiparkinsonian drugs, and they did not correlate with age, age at onset and duration of the PD, scores of the Unified PD Rating Scale or the Hoehn & Yahr staging in the PD group. These results might suggest that serum levels and urinary excretion of manganese are apparently unrelated to the risk of developing PD.

Parkinsonism unmasked by verapamil.

We report the case of a 55-year-old man who had a parkinsonian syndrome unresponsive to levodopa for 5 years and had been taking verapamil during the past 8 years. Parkinsonian signs improved markedly after withdrawal of verapamil, suggesting its role in unmasking the parkinsonism. To our knowledge, this side effect of verapamil has not been described previously.