Mabel Gatto

Bruxism secondary to chronic antidopaminergic drug exposure

Eight cases of diurnal bruxism (DB) secondary to long-term antidopaminergic drug exposure are reported. Five exhibited a grinding pattern, one a clenching form, and two a mixed type. An odontological etiology was absent throughout. EMG recordings disclosed two distinct patterns of muscle activity, one with brief rhythmic, forceful contractions and the other featuring sustained prolonged contractions. Surface EMG and EEG monitoring during a 24-h period confirmed the absence of bruxism during sleep. Several drug trials failed to provide relief. Our findings support DB as a focal tardive dystonia syndrome.

Treatment of Tourette's syndrome with calcium antagonists.

Six males and one female with chronic tic disorders, whose ages ranged from 12 to 31 years, were evaluated before treatment, after 1 month on placebo, after a single 10 mg nifedipine dose (three patients), and monthly while on flunarizine 10-15 mg (mean dose of 13 mg). None of the patients receiving nifedipine improved, but treatment with flunarizine significantly decreased both motor and phonic tic severity and frequency in all but one patient. Side effects included mild transient headaches in one patient, depression in one, and bradykinesia in two. Although a double-blind study is essential to validate our findings, results suggest that flunarizine is a useful drug in the treatment of Gilles de la Tourette syndrome.

Gilles de la Tourette syndrome: clinical features of 75 cases from Argentina.

A series of 75 cases of Gilles de la Tourette syndrome (GTS) from Argentina, whose ages ranged from 6 to 55 with a mean of 20.02, were evaluated to compare findings with those reported for other countries. Mean age at onset was 7.44 years and mean overall duration of symptoms was 12.58 years; 6.7% of cases were mild, 49% moderate and 44.3% severe. Most frequent presenting motor tics were excessive blinking in 41 followed by head jerking in 16 and eye winking in six, while phonic tics included coprolalia in 28.0%, echolalia in 17.5% and palilalia in 10.8%. Abnormal perinatal events were reported in 40.5%, while positive family history for tics was present in 26.66%. Obsessive-compulsive behaviour was evident in 66% and attention deficit disorder in 16% of cases. Self-injurious behaviour comprised onychophagia in 28 patients, lip-biting in seven and self-slapping in eight cases. Almost half of our patients were initially interpreted as having a psychogenic disorder indicating that GTS in Argentina is most likely underdiagnosed. It may be concluded that the overall pattern of GTS is not dissimilar to that described for European, Asian and American populations, thus highlighting the previously recognized cross-cultural uniformity.

L-dopa malabsorption in a Parkinsonian patient with Strongyloides stercoralis duodenitis

We report a parkinsonian patient initially responding to L-dopa who developed a severe loss of drug efficacy due to Strongyloides stercoralis duodenitis. The patient was put on mebendazole and metronidazole, and the parasitosis abated, allowing L-dopa reduction by 33%. Our patient illustrates the advisability of searching for Strongyloides stercoralis when L-dopa malabsorption is suspected in Parkinsons disease.

Asymmetrical Blepharospasm Associated with a Right Anterior Cerebral Infarct

A patient is described, who developed blepharospasm secondary to a cortical ischemic lesion in the region of the right anterior cerebral artery. Blepharospasm started as an increased blinking rate in the contralateral eye, and slowly progressed to sustained bilateral orbicularis oculi contractions, which were more severe on the contralateral side. Abnormal blink reflexes suggest a disinhibited excitatory drive to the facial nucleus. Our case warrants the inclusion of blepharospasm in the list of eyelid abnormalities secondary to cerebrovascular hemispheric lesions.

Blefaroespasmo. Distonía oromandibular

El blefaroespasmo es una distonia focal que compromete el orbicularis oculi, que en casos severos produce una ceguera funcional. Hemos evaluado las caracteristicas clinicas y perfil neurofarmacologico en 100 casos consecutivos estudiados en los ultimos 9 anos en el Hospital Universitario de Buenos Aires, Argentina. La poblacion estuvo compuesta por 69 mujeres y 39 hombres cuyas edades oscilaron entre 29 y 78 anos. El 61 por ciento presento blefaroespasmo mientras que el resto tenia una distonia oromandibular asociada. La gran mayoria comenzo en la 5ta. decada y el comienzo fue unilateral en el 12 por ciento pero en todos los casos evoluciono a una forma bilateral. Solo el 60 por ciento habia sido previamente diagnosticado en forma correcta, mientras que en el 40 por ciento restante el diagnostico se difirio hasta varios anos el tratamiento mas efectivo fue la infiltracion del orbicular de los parpados con toxina botulinica (88 por ciento) seguido por el lisuride en dosis bajas que beneficio al 56 por ciento y el trihexifenidilo en el 54.5 por ciento de los tratados. Nuestros resultados sugieren que el cuadro puede ser manejado con exito luego de hacer un correcto diagnostico. Las infiltraciones con toxina botulinica debieran ser efectuadas por neurologos con experiencia en movimientos anormales.

Treatment of Parkinson’s disease with subcutaneous lisuride infusions

Four patients with Parkinsons disease and severe fluctuating responses to levodopa and oral dopamine agonists were treated with continuous administration of lisuride infusions, administered by means of an externally worn pump. Levodopa dosage ranged from 300 to 687 mg/day and was kept stable throughout the study. In addition increasing doses of lisuride were injected subcutaneously in the abdomen. Lisuride doses ranged from 41 to 104 micrograms/h. A marked improvement in mobility was observed in every patient while severe biphasic dyskinesais almost remitted in one of them. The most common side-effect was the presence of subcutaneous nodules appearing at the injection site. Two cases had mild hemorrhagic complications and one initially had nausea. One patient developed acute psychiatric disturbances severe enough to be excluded from the study. Our findings suggest that lisuride subcutaneous infusions can be useful in severily handicapped parkinsonian patients, however local and psychiatric side-effects may be a serious threat in the long-term care.