Preliminary remarks on the L‐dopa therapy of dystonia

Coleman, Mary

doi:10.1212/wnl.20.11_part_2.114

Cited by 31 publications

(6 citation statements)

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“…To our knowledge, there is no systematic investigation whether any other form of dystonia other than DRD may at least partially respond to L-dopa therapy. The effect of levodopa on dystonia was studied in the early era of levodopa therapy [36,37]. However, these studies were performed before functional imaging methods investigating the integrity of the dopaminergic system in vivo had been developed.…”

Section: Discussionmentioning

confidence: 99%

The role of 123I-FP-CIT-SPECT in the differential diagnosis of Parkinson and tremor syndromes: a critical assessment of 125 cases

et al. 2011

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(123)I-FP-CIT-SPECT is useful in the differential diagnosis of Parkinson's disease (PD) and tremor syndromes. Recently, there have been reports on normal nigrostriatal uptake of radio ligands in PD patients, referred to as scans without evidence of dopaminergic deficit (SWEDDs). Furthermore, a dopaminergic deficit has been described in some cases of different tremor types. We sought to clarify the occurrence of SWEDDs in PD and a possible association of various tremor types with PD. We performed a retrospective case analysis of 125 patients with diagnostically uncertain Parkinsonian or non-Parkinsonian tremor syndromes with clinical assessments and (123)I-FP-CIT-SPECT. A total of 36/40 (90%) patients with the predominant clinical feature of a postural and/or kinetic tremor showed normal DAT SPECT; 73/85 (86%) with predominant clinical symptoms of PD showed abnormal DAT SPECT with lower overall radio ligand uptake and a significant asymmetry contralateral to the clinically more affected side. In all, 4/40 (10%) of non-Parkinsonian tremor patients had abnormal DAT SPECT, but no corresponding asymmetry of radio ligand uptake. Probable essential tremor was considered clinically in follow-up assessments although final diagnosis of these four tremor cases remains inconclusive. A total of 12/85 (14%) clinically suspected PD patients had normal DAT SPECT (SWEDDs). Clinical reassessment identified two patients with dystonic tremor. Five patients with a positive response to levodopa remained unclear. In four cases of suspected PD with normal DAT SPECT, non-neurologic diseases were identified. One case showed a complete and spontaneous remission of symptoms. DAT SPECT offers an objective method to confirm or exclude a dopaminergic deficit in tremor predominant parkinsonism for clinically inconclusive cases. There was no evidence of a decrease in DAT binding in the majority of patients with postural and/or kinetic tremor. The striatal asymmetry index is a further helpful tool for differentiating PD from non-PD tremor syndromes.

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Section: Discussionmentioning

confidence: 99%

The role of 123I-FP-CIT-SPECT in the differential diagnosis of Parkinson and tremor syndromes: a critical assessment of 125 cases

et al. 2011

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“…Some reported improvement [22,24] while others reported worsening [23,25]. Other dopaminergic agents including bromocriptine, apomorphine, and lisuride have been studied, with inconclusive results [26,27].…”

Section: Oral Medicationsmentioning

confidence: 99%

Treatment strategies for dystonia

Cloud

Jinnah

2009

Expert Opinion on Pharmacotherapy

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Importance of the field Dystonia is a neurological syndrome characterized by involuntary twisting movements and unnatural postures. It has many different manifestations and causes, and many different treatment options are available. These options include physical and occupational therapy, oral medications, intramuscular injection of botulinum toxins, and neurosurgical interventions. Areas covered in this review In this review, we first summarize the treatment options available, then we provide suggestions from our own experience for how these can be applied in different types of dystonia. In preparing this review article, an extensive literature search was undertaken using PubMed. Only selected references from 1970 to 2008 are cited. What the reader will gain This review is intended to provide the clinician with a practical guide to the treatment of dystonia. Take home message Treatment of dystonia begins with proper diagnosis and classification, followed by an appropriate search for underlying etiology, and an assessment of the functional impairment associated with the dystonia. The therapeutic approach, which is usually limited to symptomatic therapy, must then be tailored to the individual needs of the patient.

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“…L-DOPA is already being shown to be of benefit in neurological diseases other than Parkinsonism (chronic manganese poisoning (Mena, Court, Fuenzalida, Papavasiliou & Cotzias, 1970); progressive nuclear palsy (Chase, 1970a); and certain dystonias (Coleman, 1970;Chase, 1970b) ) and it is to be hoped that better understanding of the functional metabolism of dopamine in the brain may permit a rational approach to therapy in neurological diseases in which dopaminergic neurones are involved.…”

Section: Discussionmentioning

confidence: 99%

Interaction in the cerebral metabolism of the biogenic amines. Effect of phenelzine on this interaction

Moir

Yates

1972

British J Pharmacology

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Summary1. Chronic administration of phenelzine to dogs caused the concentrations of homovanillic acid (HVA) in c.s.f. from both the lateral ventricle and cisterna magna to fall to new low levels at which they were maintained. 2. After 10-12 days treatment with phenelzine the caudate nucleus had elevated concentrations of dopamine and 3-methoxytyramine and lowered concentrations of 3,4-dihydroxyphenylacetic acid and HVA. 3. Intravenous administration of tryptophan to dogs pretreated with phenelzine caused in c.s.f. an increase in the concentrations of HVA and in the caudate nucleus a decrease in dopamine concentration and an increase in the concentrations of its metabolites, 3-methoxytyramine, 3,4-dihydroxyphenylacetic acid and HVA. 4. A model is proposed for the cerebral metabolism of dopamine and some of the points at which tryptophan and its metabolites may interact with dopamine metabolism are discussed.

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Preliminary remarks on the L‐dopa therapy of dystonia

Cited by 31 publications

References 0 publications

The role of 123I-FP-CIT-SPECT in the differential diagnosis of Parkinson and tremor syndromes: a critical assessment of 125 cases

The role of 123I-FP-CIT-SPECT in the differential diagnosis of Parkinson and tremor syndromes: a critical assessment of 125 cases

Treatment strategies for dystonia

Interaction in the cerebral metabolism of the biogenic amines. Effect of phenelzine on this interaction

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