15 patients with this disorder showed considerable decrease in rigidity, tremor, or both, after the administration of this hypoglycemic agent.1 Improvement of mask-like facies and speech was also noted in several patients. The authors found that the effect was not related to hypoglycemia and was present whether or not antispasmodic medicaments were given. This paper will report a double-blind study of 39 patients with Parkinsonism who were given both tolbutamide and a placebo, either alone or in combination with other antispasmodic or antihistaminic drugs. The series was composed of 20 males and 19 females. No diabetic patients were included. Twenty-one patients had idiopathic Parkinsonism, 7 were arteriosclerotic, and 11 had the postencephalitic form of the disorder. Random numbers were assigned to bottles containing either tolbutamide or the placebo. This numbering system avoided the possibility of breaking the double-blind study by the occurrence of a hypoglycémie reaction, which could have happened if all the tolbutamide were given one number and the placebo another. The numbers were assigned by an individual who otherwise did not participate in the study and were arranged so that some patients would receive tolbutamide first, others the placebo first. The patients were instructed regarding the nature of a possible hypoglycémie reaction, and between-meal and bedtime snacks were advised during the study. The patients were told to take medicament from the bottle with a given number for 3 to 4 weeks (or longer if necessary to ascertain its effects) and then switch to the other medicament for a similar period. Because of side reactions, certain patients could not continue the medication for this long a period; they were then advised to proceed to the next bottle as soon as it became obvious that they could not continue the first medicament. When severe reactions occurred with both medicaments, dosage was reduced or the study on that patient was terminated. The daily dosage of both tolbutamide and the placebo was 1.5 to 3 gm. per day given in 0.5 gm. tablets in divided doses 3 times daily before meals. The majority of patients tested the preparations without other anti-Parkinson drugs, but in some patients with severe Parkinsonism, it was thought to be inadvisable to withdraw the antispasmodic medicament and the study was conducted by adding the test drugs to the existing therapeutic program. The patients were evaluated both subjectively and objectively regarding the effect of tolbutamide as compared with the placebo, and the effect of both was
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