M. Streifler

Clomipramine and Amitriptyline in the Treatment of Severe Pain

Clomipramine is the most potent 5-HT reuptake blockade agent among the antidepressants. A comparison between the effect of clomipramine and a less powerful 5-HT reuptake blockade agent (amitriptyline) could test the hypothesis that brain 5-HT is a mediator of pain sensation. Groups of patients of either sex, with pain indication of trigeminal neuralgia, tension headache or postherpatic neuralgia, received doses of clomipramine or amitriptyline in a single blind clinical experiment. The results after three months of treatment showed that clomipramine: (1) was better than amitriptyline in treating trigeminal neuralgia; (2) tended to be better in the treatment of tension headache; and (3) amitriptyline is better in treating postherpatic neuralgia. Clomipramine was better tolerated. The results support the hypothesis that in certain pain situations, clomipramine exerts a beneficial effect, not only because of its effect on the depression and anxiety level of the patient, but also via its effects on the 5-HT brain system.

Motor Lesions in Herpes Zoster

In the review of 117 patients hospitalized for herpes zoster (HZ) during the 10-year-period of 1960–1969, six patients with motor paralysis of the limbs were found. The incidence of motor paralysis in

Painful Ophthalmoplegia: the Tolosa-Hunt Syndrome

Painful ophthalmoplegia is characterized by unilateral involvement of the IIIrd, IVth and VIth cranial nerves, as well as supra- and retro-orbital pain, i.e. participation of the Vth cranial nerve. The pain is relieved within 48-72 h with steroid therapy. The paresis of the eye muscles in various combinations usually subsides gradually from within a few weeks to several months. The etiology is unknown. The few pathological examinations reported in the literature showed an unspecific inflammatory granulation tissue around the intracavernous portion of the carotid artery and on the dura mater in the vicinity of the cavernous sinus. Carotid arteriography may show stationary waves of this artery and narrowing of its intracavernous portion. With orbital phlebography the occlusion of the supraorbital vein and obstruction of the cavernous sinus are sometimes demonstrable. The syndrome is well defined and its etiology still unknown.

Detrusor Hyperreflexia in Multiple Sclerosis

16 patients with multiple sclerosis, complaining of urgency, frequency and urge incontinence were studied urologically. They all suffered from detrusor hyperreflexia. We managed to improve this distur

L-Dopa and the Secretion of Sebum in Parkinsonian Patients

Sebum secretion was studied in 14 parkinsonian patients before and after 3 months of treatment with L-dopa. An abnormality of sebum secretion was shown to exist in parkinsonism. In 7 patients, successfully treated with L-dopa, sebum secretion diminished and its pattern improved. In all patients, in whom L-dopa treatment did not result in noticeable clinical changes, there was no significant modification in sebum secretion. No change was observed in the secretion of sebum of 5 normal control subjects, who were given L-dopa for 1 week.

Skeletal Findings in Human Neurolathyrism

In a review of the roentgenological files of 22 patients suffering from spastic paraplegia due to neurolathyrism, 3 patients were found to present abnormal skeletal findings. 2 patients showed absence of union of the secondary ossification centres of the iliac crests, the ischial tuberosities and the vertebral bodies. Their age at the time of ingestion of poisonous Lathyrus sativus plants was 19 and 20 years. The 3rd patient had bowing and thickening of his right femoral shaft. He was 22 years old at the time of poisoning. These findings which are similar to those found in experimental osteolathyrism have never been described in clinical neurolathyrism. They are of a nature to throw some doubt on the correctness of the currently prevailing concept of sharp distinction between these two pathological entities.

Liver Function and Gastric Acid Secretion in Parkinsonian Patients Under Prolonged Treatment with L-Dopa and a Peripheral Decarboxylase Inhibitor

Twelve patients with long-standing Parkinsons disease, treated successfully with a combination of l-dopa and an inhibitor of aromatic l-amino acid decarboxylase (Ro 4-4602), in the ratio 4:1, were screened for damage to various organ systems, in particular liver and skeleton. Among other tests, liver biopsies were obtained before and after 6 months of treatment. One patient discontinued therapy becuase of an accentuation of pre-existent liver damage, another because of psychomental manifestations. The remaining ten patients were followed for 8-15 months and longer. The liver biopsies remained practically unaltered. Elevation of alkaline phosphatase was found in 10 out of 12 subjects. In five patients this rise fluctuated around the upper limit of normal. In two patients, who discontinued the treatment, the raised alkaline phosphatase values soon returned to normal. Analysis of isozymes proved this phosphatase to be of liver origin. All other liver function tests remained unchanged, except for an increased retention of bromsulphalein in two patients. In the one patient with the initially damaged liver, all tests became normal soon after discontinuation of therapy. No changes could be found in gastric acid secretion. All other parameters studied remained within normal limits, including urinary excretion of calcium and phosphate.