Thiopropazate Hydrochloride in Persistent Dyskinesia

Abstract

One patient developed severe haematemesis needing inpatient therapy and had to be withdrawn from the trial. In retrospect it was clear that he should not have been admitted to the trial because he had a history of peptic ulceration. DiscussionControlled trials of treatment in Bell's palsy are difficult to perform because of delay in starting therapy which is likely to prejudice the result. For this reason the patients were subdivided into early and late groups. Sixty-six started treatment on the first or second day of paralysis and 120 on the third or fourth days. The results of earlier treatment were indeed better, though both groups showed benefit. However, in very severe attacks the major damage may be done within the first few hours and treatment should be started at once.It has previously been shown that the outcome in untreated Bell's palsy becomes worse with increasing age (Langworth and Taverner, 1963) so the patients were further subdivided into young and older groups. There were 104 patients in the young group and 82 in the older group. The expected difference was observed, but in the whole series the mean age of the patients who developed denervation was 44-6 years for the corticotrophin group and 43 9 years for the prednisolone group.Assessment of the result of treatment is a difficult problem even if very elaborate methods are used. The presence or absence of denervation can be determined by the appearance of associated movements (Langworth and Taverner, 1963), and this is the strictest criterion available. The results now reported are based almost entirely on this finding. We are well aware of the unreliability of subjective estimates of the difference in movement of the two sides of the face, but the statistically significant differences reported here are considerable and it is unlikely that observer error is responsible. The actual assessments of recovery in the severely denervated patients receiving corticotrophin mentioned above were 10%, 15%, 10%, 10%, 15%, and 15%, while all who took prednisolone were assessed at 50% recovery or above.We had hoped to show that corticotrophin injections gave better results than oral prednisolone if only because a previous trial of cortisone for Bell's palsy gave a negative result (Tavemer, 1954). In retrospect it is clear that the 1954 trial was intadequately planned to produce a reliable result. The treatment was started far too late to be effective, the dose of cortisone was too low, and the number of patients tested was too small.At present we believe that oral prednisolone is the treatment of choice in Bell's palsy and should be given in full doses from the day of onset. The small risk of serious side effects is acceptable in view of the significant reduction in the incidence of severe denervation. ReferencesJonsson, B., Reis, G. von, and Sahlgren, E. (1951 Journal, 1971, 4, 22-25 Summary Thiopropazate (Dartalan) was found to be significantly more effective than a placebo in relieving dyskinesia in 23 patients with functional psychosis and persisten...

Six month evaluation of thiopropazate hydrochloride in tardive dyskinesia.

“…In view of its unsatisfactory antipsychotic activity at this dosage and the considerable risk of Parkinsonism with higher doses (Singer and Cheng, 1971), we suggest that its main value is as an adjunctive agent in patients who need to continue other antipsychotic medication. Gerlach et al (1977) reported that the anticholinergic antiparkinsonism drug biperidin aggravated the dyskinesia in all seven patients studied, the changes in the mean dyskinesia score being statistically significant.…”

“…The effectiveness of three weeks of treatment with the drug has been demonstrated in two doubleblind cross-over placebo controlled studies, 23 patients in one study (Singer and Cheng, 1971) and two in the other (Roxburgh, 1970).…”

Clinical Use of Psychotherapeutic Drugs2 I

“…This rationale has led to its successful management by the addition of more of the drug which seems to have caused it, or by adding other antipsychotic drugs, such as thiopropazate, tetrabenazine or reserpine (Singer and Cheng, 1971) . The puzzling cases of acute dystonic reactions, resembling spastic torticollis, are now generally recognised as a drug-induced extrapyramidal reaction and are managed by acute doses of antiparkinsonian drugs.…”