The successful treatment of disinhibition due to a possible case of non-human immunodeficiency virus neurosyphilis: a proposed pathophysiological explanation of the symptoms and treatment

Spiegel, David R.; Qureshi, Nabeel

doi:10.1016/j.genhosppsych.2009.01.002

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…The information about the history of the patients' therapy was scarce as well. In particular, only six patients (2%) reported a certain previous treatment for syphilis, but for two of them it was unclear whether such therapy was completed and even if it was a standard one . A total of 171 patients, that is, 60%, denied the occurrence of previous skin or mucous lesions; so we must assume that they have not received any therapy for early syphilis.…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, the suggestion that a standard therapy with penicillin G benzathine (BPG) in early syphilis may not be sufficient to prevent NS, has been already advanced and supported by cases of BPG failures and by late complications in immunocompetent patients adequately treated for early disease . In a recent study, 17 patients progressed to NS despite appropriate treatments and serological response understood as of a fourfold decrease in their RPR titres within 6 months from therapy .…”

Section: Discussionmentioning

confidence: 99%

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Changes in neurosyphilis presentation: a survey on 286 patients

Drago

Merlo

Ciccarese

et al. 2016

Acad Dermatol Venereol

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Although neurosyphilis (NS) keeps plaguing worldwide, often with oligosymptomatic and atypical manifestations, the most recent reports fail to provide useful information, like details of the clinical history and even of the previous early therapy. We conducted a survey of the literature of the last 5 years on the clinical presentation of NS, recording the aforementioned inaccuracies. One hundred and thirty-seven articles were collected, reporting on 286 patients. General paresis was the commonest form (49%), often manifesting with cognitive impairment and psychiatric symptoms. Syphilitic meningitis was found in 63 patients (22%), mainly with ocular or auditory involvement. Meningovascular and tabetic form were both found in 12% of cases. Gummatous and epileptic manifestations were rare. Perusal of the literature confirms that NS prevalence is increasing, often with manifestations that are atypical for timing and type of lesions. Unfortunately, many articles are lacking of critical information, like an accurate clinical history and timing of the therapy making difficult to assess the effectiveness of penicillin in preventing NS.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in neurosyphilis presentation: a survey on 286 patients

Drago

Merlo

Ciccarese

et al. 2016

Acad Dermatol Venereol

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“…It is well known that T. pallidum is sensitive to the treatment only when it is in replication (every 33 h); therefore, when its replication is slower/absent, as in the late syphilis stages, penicillin may be ineffective [ 64 ]. Although it is still considered the treatment of choice for syphilis [ 8 ], several reports found that penicillin may be inadequate in preventing all syphilis late complications such as neurosyphilis [ 3 , 65 , 66 , 67 , 68 , 69 ]. In addition, allergic reactions and poor drug tolerance represent challenging problems for the use of this antibiotic; therefore, the search for new therapeutic strategies has attracted the attention of many researchers [ 69 , 70 ].…”

Section: Discussionmentioning

confidence: 99%

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

Ciccarese,

Facciorusso,

Mastrolonardo

et al. 2024

JCM

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Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.

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“…It is important for the transmission of impulses between the prefrontal and limbic areas of the brain. Dysregulation of this system can cause disorders of dopamine regulation in several brain areas (37,38). One of several mechanisms of action of carbamazepine is augmentation of the GABA system, hence a pathophysiological explanation for its benefi cial effects in the treatment of disinhibition (39).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of conduct disorder related to frontal lobe syndrome in a 16-year-old girl

et al. 2010

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Conduct disorders are the most frequent psychiatric diagnosis in the pediatric and adolescent population, with different etiology and difficult to treat. Delinquent, aggressive, and impulsive behavior, lack of empathy and inability to predict possible consequences of the behavior lead to significant desadaptation and danger for these patients. In clinical practice, focus is usually given on social and psychological causes of conduct disorders ignoring possible biological factors in etiology and pathophysiology. A clinical case described in this article shows the linkage between frontal brain dysfunction and behavioral symptoms. The first clues of organic brain disorder were multiple and severe symptoms of disinhibition resistant to treatment with dopaminergic drugs and the results of neuropsychological testing. Computed tomography, magnetic resonance imagining, and single-photon emission computed tomography findings were minor and not supported by associated neurological symptoms. However, the location of alterations of brain structure and perfusion significantly correlated with psychopathology. Clarification of the organic cause of the conduct disorder allowed choosing an effective strategy of psychopharmacologic treatment. A positive clinical effect was achieved after switching the treatment from dopaminergic antipsychotic drugs to carbamazepine, which modulates the GABAergic system. Presenting this clinical case, we intended to emphasize the importance of careful attention to the findings of neurovisual and neuropsychological testing diagnosing conduct disorders and individually choosing the most effective psychopharmacologic treatment.

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The successful treatment of disinhibition due to a possible case of non-human immunodeficiency virus neurosyphilis: a proposed pathophysiological explanation of the symptoms and treatment

Cited by 5 publications

References 12 publications

Changes in neurosyphilis presentation: a survey on 286 patients

Changes in neurosyphilis presentation: a survey on 286 patients

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

Diagnosis and treatment of conduct disorder related to frontal lobe syndrome in a 16-year-old girl

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