P. De Domenico

Prevalence of Parkinson's disease and other types of parkinsonism A door‐to‐door survey in three Sicilian municipalities

We investigated the prevalence of Parkinsons disease and other types of parkinsonism in a Sicilian population using a door-to-door two-phase approach. This design called for the administration of a brief screening instrument to all subjects who, on November 1, 1987, were residents of Terrasini (Palermo Province), Santa Teresa di Riva (Messina Province), and Riposto (Catania Province), Sicily (N = 24,496). Study neurologists using specified diagnostic criteria extensively investigated those subjects who screened positive. We found 63 subjects affected by Parkinsons disease, 21 with secondary parkinsonism, and seven with unspecified parkinsonism. The crude prevalence per 100,000 population was 371.5 for all types of parkinsonism and 257.2 for Parkinsons disease; for both entities, prevalence increased steeply with age and showed an inconsistent sex pattern. Our prevalence figures for Parkinsons disease are higher than those previously reported in Italy or elsewhere, which may be due, in part, to more complete case-ascertainment.

Adjunctive fluoxetine in the treatment of negative symptoms in chronic schizophrenic patients

The effect of adjunctive fluoxetine on negative schizophrenic symptoms was evaluated in 34 chronic schizophrenic in-patients on maintenance therapy with neuroleptics. They received randomly, on a double-blind basis, fluoxetine (20 mg/day) or placebo for 12 weeks. In the fluoxetine group, three patients dropped out because of side effects. Negative symptoms, as measured by change on the Scale for Assessment of Negative Symptoms at the end point compared to baseline values, were significantly improved in fluoxetine-treated patients (p < 0.001), but not in the placebo group. Fluoxetine treatment did not influence positive schizophrenic symptoms, while it induced a slight, but statistically significant, decrease (p < 0.05) in depressive symptoms, as measured by the Hamilton Rating Scale for Depression. Unwanted effects were more common among patients receiving fluoxetine. These data suggest that the addition of fluoxetine to neuroleptic treatment may be beneficial in some schizophrenic patients with negative symptoms.

Sleep features in Tourette's syndrome, neuroacanthocytosis and Huntington's chorea

Twenty-one patients affected by extrapyramidal disorders were polygraphically recorded during spontaneous nocturnal sleep for two consecutive nights to assess their sleep and movement patterns. The patients (pts) sample included: Gilles de La Tourette syndrome (TS, nine pts), neuroacanthocytosis (NA, six pts) and Hungtingtons chorea (HC, six pts). Sleep recording included C3/A2, 01/A2, ROC/LOC, submental EMG, EKG, nasal airflow thoracoabdominal respirogram, bilateral anterior tibialis and other EMGs, in relation to the individual distribution of the abnormal movements. According to our observations, abnormal movements always decreased but never ceased completely during sleep. Sleep efficiency (SE) was nearly always poor with a high percentage of wakefulness after sleep onset (WASO) and increased number of arousals. REM sleep was often reduced and in some cases (3 TS pts) incompletely defined as far as its microstructural aspects. Slow wave sleep (SWS) was reduced in HC, normal in NA, and increased in all TS patients with the exception of the two adult subjects more severely affected, while the percentage of stage 2 was not affected. Spindling was increased in NA, HC and in the two most severely affected adult TS patients.

Epileptic seizures in subjects previously affected by disorders of arousal

Six patients (3M, 3F, mean age 17.3 yrs) presenting different types of evolution from disorders of arousal to epilepsy are described. All subjects during their childhood had been diagnosed in a sleep center as affected by sleep-walking (three cases) and night terrors (the other three). Successively they developed nocturnal events different from those previously exhibited and consisting of clear epileptic seizures, generalized tonic-clonic in one case and complex partial in five cases. Nocturnal monitoring allowed recognition of clear interictal paroxysmal activity in three patients, while ictal events were recorded in the remaining three. Anticonvulsant treatment (carbamazepine in five patients, phenytoin in one patient) led to the resolution of the ictal events in all cases. The fact that both disorders of arousal and epilepsy are strictly related to sleep and often share common features such as age range of onset and precipitating factors, suggests the existence of common functional substrates identifiable in constitutional maturative and biologic factors. The possible occurrence of seizures in subjects exhibiting parasomnia during their childhood has to be considered in patients with familial history of epilepsy and in all doubtful cases.

Synergistic Anticonvulsant Effect of Valproic Acid and Ethosuximide on Pentylenetetrazole-induced Epileptic Phenomena in Rats

The possible synergistic effect of valproic acid and ethosuximide in combination on pentylenetetrazole-induced epilepsy was investigated in rats. Valproic acid and ethosuximide administered intraperitoneally both showed dose-dependent anti-epileptic activity towards pentylenetetrazole-induced myoclonias and tonic – clonic seizures. The valproic acid – ethosuximide combination had a synergistic pharmacological effect. Against myoclonias combined valproic acid – ethosuximide produced a non-significant decrease in the effective dose of both drugs compared with treatment with either drug alone. In the case of tonic – clonic seizures the protective effect against the seizures was significantly increased by combined treatment compared with treatment with either drug alone. Neither plasma concentrations nor any other pharmacokinetic parameters were significantly changed when the same doses of valproic acid and ethosuximide were given, singly or in combination.

Indole-3-Pyruvic Acid as a Possible Hypnotic Agent in Insomniac Subjects:

In a single-blind study six male patients (mean age 39.5 years) with moderate insomnia were treated with placebo for three nights, 100 mg indole-3-pyruvic acid (IPA) for three nights, 200 mg IPA for three nights, 100 mg IPA for two nights and placebo for two nights. Polygraphic recordings were made and total sleep time, sleep efficiency, sleep latency, slow wave sleep latency, rapid eye movement (REM) sleep latency, number of arousals (> 1 min), percentage and duration of wakefulness after sleep onset, percentage and duration of wakefulness after sleep onset, percentage and duration of sleep stages 1, 2, 3, 4 and REM were recorded. At the end of 13 days, total sleep time, duration of stage 2 sleep and total non-REM were significantly increased when compared with baseline. Total sleep time and duration of stage 2 and total non-REM sleep on completion were significantly decreased when compared with after 200 mg IPA (night 9). Results suggest an action of IPA on human sleep similar to that of exogenous melatonin and l-tryptophan, thus confirming that IPA could be used to increase serotonin and melatonin turnover.

Paroxysmal Electroencephalographic Abnormalities Genetically Transmitted: One Family Description

A 10-year-old girl came to our observation since a general rule-out electroencephalogram (EEG) had showed, in absence of any clinical manifestation, generalized and symmetrical 3 c/s spike-and-wave bursts, whose duration was longer than 3 s. The subject, only daughter born from her mothers first marriage, had no family history of neurological diseases; her physical and neuropsychological examinations were normal. A polysomnographic recording showed, during sleep, the same abnormalities observed during wakefulness. Also on this occasion, there were no related clinical manifestations. Subsequent recordings were performed on her 33-year-old mother and on two siblings, 3 and 2 years old, respectively, born from their mothers second marriage, all normal by physical and neuropsychological examinations, with no referral about clinical seizures. Among them, the 3-year-old sister showed asymptomatic left rolandic spikes, while the 2-year-old boy, whose EEG was firstly normal, displayed, 1 year later, a burst of generalized 3 c/s spike-and-wave paroxysmal activity on a 4-7 c/s background activity. The possible unitary genetic transmission of paroxysmal EEG abnormalities is discussed.

Generalized EEG abnormalities in cluster headache

Sir, A strict temporal association between cluster headache (CH) attacks and sleep has been described [1], but very few polysomnographic studies of CH patients during their active period have been undertaken. For this reason, we performed polysomnography in thirteen unmedicated patients (9 males, 4 females; mean age 41.38 years) affected by episodic CH (IHS criteria, 2) and with ocular autonomic signs ipsilateral to the side of pain. Cluster attacks occurred during the night recording in only three patients (2 males, 1 female); three females, none of whom experienced attacks during the night, presented generalized EEG abnormalities. Of these latter patients, patient 1, aged 29 years, has suffered from photosensitive GM seizures, well controlled by phenobarbital, since the age of 22; her CH started when she was 24. Baseline EEG showed generalized photoparoxysmal discharges whereas, during NREM sleep, EEG activity was characterized by brief trains of generalized spike and polyspike and wave complexes (3 c/sec). Patient 2, aged 37 years, has a positive familial history of idiopathic epilepsy and suffered a head injury at the age of 24. Clinical, EEG and neuroradiological findings had always been normal. CH started at the age of 28. The nocturnal recording revealed frequent trains of generalized rapid spike and polyspike and wave complexes (3-4 c/sec), strongly activated by all NREM sleep stages. Patient 3, aged 41 years, with no familial or personal history of neurological disorders, has experienced CH since the age of 20. Her NREM sleep EEG showed dispersed generalized rapid (4-5 c/sec) polyspike and wave complexes bilaterally predominant on the anterior leads. In patient 1, the EEG findings may be explained by her known generalized epileptic seizures; an association between CH and epilepsy has recently been reported [3]. The ipsilateral association of pain attacks with head injur,

Cerebral Atrophy in Long-Term Haemodialyzed Patients

(case 2) has also been reported [4]. However, the third patient had no antecedents to explain her LEG pattern. Our findings might be an element in favour of the central hypothesis of CH and the already described possibility of a gender relationship [5]; studies of a larger sample of patients, with a careful follow-up that includes the remission phase of CH, would be advisable to confirm observation.

Nocturnal paroxysmal dystonia with atypical short-lasting attacks.

In adult young patients on long-term regular haemodialytic treatment cerebral computed tomography (CT) scans have often revealed a high incidence of cerebral atrophy (CA), even in the absence of clear neurologic or psychiatric symptoms (1). On this basis we performed a CT investigation on a group of asymptomatic selected haemodialyzed outpatients, distinguishing between geriatric and adult subjects, in order to detect the possible incidence and severity of CA.