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Biomedical subjects

C Chouza

Publications and source records attributed to C Chouza.

At least 19 recordsLinked to original sources
PubMed1990

Long-term treatment with Madopar HBS in parkinsonians with fluctuations.

1. Of 22 parkinsonians with fluctuations under long-dating dopatherapy in whom standard Madopar was substituted by the HBS form, 16 who performed the trial longer than 1 year were particularly studied to evaluate some parameters of this long-term follow-up (30-36 months). 2. The outstanding beneficial effects were an enhancement of the antiparkinsonian response, improvement or disappearance of motor oscillations, longer "on" periods, less severe "off" periods, and a more sustained nocturnal antiparkinsonian effect with a reduction of dystonias and pain at night and decreased or absent early morning parkinsonism. 3. The decrease or disappearance of dystonia was observed since the early stages of the trial and can be explained by the more sustained dopaminergic effect. 4. Surprisingly, dyskinesias also decreased in spite of the higher dopaminergic effect. The avoidance of sharp and repeated plasmatic peaks and the lower levels of L-dopa under HBS could explain this phenomenon. 5. The negative aspects of Madopar HBS are a lower bioavailability that means a dosage increase and a longer latency for the therapeutic response in the morning. 6. The dosage increase went up by 80% to 100% in relation to standard Madopar during the long-term treatment. 7. As Madopar HBS is a sustained release preparation, we had to increase the initially reduced the number of intakes, again in order to obtain better results. In the most severe cases with poor or absent response, benefits were achieved only when administering the HBS intake every hour.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Combination of selegiline and controlled release levodopa in the treatment of fluctuations of clinical disability in parkinsonian patients.

Thirteen parkinsonians with a long duration of the disease and long-term dopa therapy, seven of them showing severe on-off oscillations and 6 an "end-of-dose impairment", were treated with a controlled release (HBS) preparation of L-DOPA/benserazide for more than 3 years. Thereafter, selegiline was added in a progressively increasing dosage up to a maximum of 10 mg/day during 4 months, with the aim of a) further improving the long-term results and b) reducing the doses of the new formula of L-DOPA. A significant decrease of early morning parkinsonism and reduction of motor disability throughout the day were observed; "wearing-off" cases showed better results compared with those presenting "on-off" oscillations. A mean reduction of 20% in the doses of levodopa was achieved. Likewise, a mild reduction of dyskinesias and a mild-moderate enhancement of dystonias were recorded. Only one patient did not tolerate selegiline and two others received lower doses due to side-effects. Selegiline was capable of enhancing the antiparkinsonian effect of the new formula of L-DOPA, while allowing a reduction of the doses administered. It must also be emphasized that such improvement was achieved in complicated patients, most of whom showed some deterioration of response in the late stages of long-term sustained-release levodopa treatment.

Adult↗
PubMed1988

A combined regimen of subcutaneous lisuride and oral Madopar HBS in Parkinson's disease.

At the first stage of a pilot study involving 14 parkinsonians with motor fluctuations, treatment with standard Madopar was substituted by a sustained-release form, Madopar HBS, which attenuated fluctuations in patients with end-of-dose impairment, but achieved only moderate improvement in patients with on-off phenomena. In a second phase of the trial, 4 parkinsonians exhibiting the most severe fluctuations of mobility and the poorest response to Madopar HBS (Hydrodynamically Balanced System) were selected for treatment with a combined regimen utilizing subcutaneous lisuride infusions as the additional component. The sequence of the trial was as follows: 1. standard Madopar, 2. Madopar HBS, 3. standard Madopar combined with lisuride infusions and 4. Madopar HBS combined with lisuride infusions. Steady improvement was observed along the lines of this schedule, but the best results were obtained when Madopar HBS was combined with lisuride infusions. Subsequently motor fluctuations were less marked or disappeared, early-morning Parkinson symptoms decreased and dystonia was not recorded any longer. Even better results could be accomplished in an extended trial attempting to establish the best dosage ratio of the combination, possibly admitting increased dosage. The tolerance of the combined regimen was excellent, except in one patient who transiently exhibited delusions and postural hypotension. The combination of sustained-release Madopar and continuous infusions of the dopaminergic agonist lisuride seems to prove a more physiological and effective regimen for the treatment of severe motor fluctuations.

Administration, Oral↗
PubMed1987

Substitution of standard Madopar by Madopar HBS in parkinsonians with fluctuations.

Fourteen parkinsonian patients, 10 of them showing severe and long-standing 'on-off' effects and 4 'end-of-dose impairment', received Madopar HBS instead of standard Madopar. At the end of the dosage adaptation phase (9 weeks) most patients improved; in patients with 'on-off' phenomenon, parkinsonism became less severe, on periods were longer, and fluctuations decrease; end-of-dose impairment resolved in 4 patients. However, a longer delay in the onset of the therapeutic effect was observed after the first daily drug intake in those patients still showing severe early-morning parkinsonism. With Madopar HBS, L-dopa dosage was increased by 116%. In spite of a greater dopaminergic effect, dyskinesias were reduced, and dystonias became less marked or even disappeared.

Aged↗
PubMed1986

Parkinsonism, tardive dyskinesia, akathisia, and depression induced by flunarizine.

12 subjects, 8 women and 4 men, presented with extrapyramidal motor signs and psychic depression after treatment with flunarizine for between 3 weeks and 15 months. One woman presented with severe symptoms and 20 months after stopping flunarizine she still had dyskinesia and akathisia. The other patients showed partial or complete improvement after withdrawal of the drug.

Aged↗
PubMed1984

Visual evoked potentials and brain stem auditory potentials in Friedreich's ataxia--a longitudinal study.

Six patients with Friedreich's ataxia, 4 males and 2 females, their ages ranging from 13 to 33 years, were studied. The early manifestations started between age 7 and 13 with an evolution time between 6 and 20 years. Serial visual and brain stem auditory evoked potential recordings were made. A progressive increase in latency, reduction in amplitude and in latency inter-ocular difference of P100 were observed. The pattern of the reversal checker-board visual evoked potential was preserved. A disorganized BAEP pattern, a well defined potential I, a very small potential V and a delay in the interpeak latency were constant findings. The assumption is made of a progressive involvement of both visual and central auditory pathways. Pathophysiological mechanisms are discussed.

Adolescent↗
PubMed1984

Familial spastic ataxia associated with Ehlers-Danlos syndrome with platelet dysfunction.

Four members of a family with consanguineous relationships, the proband and his three children (2 sons and 1 daughter) are affected with Familial Spastic Ataxia and with Ehlers-Danlos' Syndrome with platelet aggregation dysfunction. In the four cases, this exceptional association appears remarkably homogeneous both in clinical and laboratory studies. The two syndromes are of dominant-autosomic transmission and probably originated in a new mutation which presumably maintained a genetic linkage. Spastic ataxia is characterized by a precocious onset and a slow evolution. The first-born son shows a dominant pyramidal syndrome with mild ataxia suggesting that it is a transitional form of familial spastic paraplegia. The Ehlers-Danlos syndrome pertains to form II or "mitis" with moderate skin hyperelasticity and joint hypermobility. The abnormal platelet aggregation curves have the same profile in all the patients. The first-born son also presents a mitral valve prolapsus as we may find either in Ehlers-Danlos syndrome or in spastic ataxia. The neurophysiological, tomographical, histological, ultrastructural and biochemical studies attempt to accomplish a better definition of these associated nosological entities.

Adolescent↗
PubMed1982

[Clinical trial of tiapride in patients with dyskinesia (author's transl)].

Twenty-five patients with various forms of dyskinesia were given tiapride for three months. Maximal dosage was 900 mg per day. A double-blind trial of tiapride versus placebo showed significantly better results in the group given tiapride. The forms of dyskinesia which responded best to tiapride were the following: iatrogenic dyskinesia, tics (Gilles de la Tourette syndrome), and chronic chorea (Huntington disease). Patients with complex dyskinesia resulting from neonatal encephalopathy or vascular disease were not improved. The protocol used in l-dopa-induced dyskinesia is described. Changes in dyskinesia and "on-off" effect following variations in tiapride and l-dopa dosage are detailed. An unequivocal, although minor, tiapride-induced parkinson syndrome was recorded in a few patients. No instances of tiapride-induced dyskinesia or akathisia were seen. The other side-effects were either psychic (depression, drowsiness, agitation) or endocrinologic (menstrual disorders, overeating, galactorrhea).

Adolescent↗
PubMed1982

Pilot study of threonine supplementation in human spasticity.

Threonine supplementation (500 mg/day) was given to 6 patients with genetic spasticity syndromes for a period of 12 months, followed by a 4-month observation period without medication. All 6 patients showed partial improvement of spasticity, intensity of knee jerks and muscle spasms without changes in true pyramidal tract signs. The improvement in motor performance, objectively measured, averaged 29% (19% in upper limbs and 42% in lower limbs). The range of overall improvement was 19--35% (7--30% for upper limbs; 25--67% for lower limbs). No toxic clinical or biochemical side effects were encountered. Thus threonine, a precursor of glycine, produced the same effect on spasticity than that previously observed with glycine. It is concluded that threonine supplementation is feasible and safe and that it deserves a controlled trial in well defined (preferably genetic) cases of spasticity.

Adult↗
PubMed1981

[Jugular chemodectoma with Garcin syndrome].

The authors present an exceptional case of chemodectoma jugulare with important invasion of the skull base involving all the cranial nerves on one side and conforming Garcin's syndrome. Practically all the possible ways of spreading were followed by the tumor, with involvement of the posterior, middle and anterior fossas of the skull base and also orbit, middle ear and neck. The clinical and histopathological difficulties in the diagnosis, especially when the chemodectoma has only neurological signs, are stressed. The association of otologic symptoms makes the diagnosis easier. The patient had an early onset of the symptoms and a rapid evolution considering this type of tumors. The appearance of goitre in this patient is a sign of endocrine disturbance, which is occasionally associated with these tumors. Apparently this chemodectoma was not a secreting tumor, since the blood pressure values were normal. No signs of multicentricity or metastatic growths were detected. The radiological studies, and especially computerized tomography scanning, gave precise information about the spreading of the tumor. The authors consider that the knowledge of this entity is important in order to arrive at a correct diagnosis.

Adult↗
PubMed1979

[Dysplastic gangliocytoma of the cerebellum or Lhermittee-Duclos disease].

Lhermitte-Duclós disease is an infrequent condition of which there are only 37 cases described in the literature. Although presently considered as a displasic process, its clinical presentation is of a typical posterior fossa tumour and should be treated as such. Even though it is a benign growth there are only 7 cases described with postoperative survival. The uniform pathological anatomy in all the cases presented makes the definitive diagnosis. The authors present a new case with postoperative survival and discuss its clinical presentation, treatment and origin of the disease.

Adult↗
PubMed1976

[5 years of experience in the treatment of parkinsonism with L-dopa and its combination with Ro4-4602].

Eighty-one Parkinsonic patients were treated with L-dopa alone and/or combined with Ro4-4602, during 27 to 60 months. The results are reported. 7.2% of the patients, who are still being treated, showed good, very good or excellent results. There was a relation between the duration of the illness and the degree of improvement, the most prolonged Parkinsonisms showed the least improvement. The 4:1 proportion of L-dopa and Ro4-4602 was more effective than the 3:2. Adding small amounts of L-dopa to the combinations improvement and secondary effects increased. No advantages were found using high combined dosages. The main secondary effects at the end of treatment were abnormal movements (45% of cases) and distonic attitudes (53%). Patients who stoped the medication showed less sustained improvement and a high degree of Parkinsonism. This reveals that Parkinson's disease continues to envolve in spite of the medication. The "long-term syndrome" includes the late decrease of effectiveness of the drugs and/or the increase of secondary effects.

Adult↗
PubMed1976

[Long-term syndrome in the treatment of parkinsonism with L-dopa and decarboxylase an inhibitor].

In 28% of patients treated for a long time with L-dopa, alone or combined with a decarboxilase inhibitor, the following "long-term syndrome" was observed: decrease in effectiveness, psychic disorders, intense abnormal movements, distonic attitudes, speech and gait disorders, orthostatic hypotension and/or general reprecussion. In 11% of the patients the "on-off" effect was studied (brisk alteranting Parkinsonic and improved states). Clinical observation during 14 hours a day was repeated with different dosages and different regimes of the drug; these modified the daily variations but did not eliminate the syndrome. The electromyographic studies also revealed the "on and off" phenomenon in different patients. When the "long-term syndrome" is severe, at times it is necessary to stop the drug; the secondary effects are thus decreased and, when the medication is given again, the therapeutic effectiveness is temporarily restored. When the drug is stopped the patients should be watched, since a "withdrawal syndrome" may appear.

Adult↗
PubMed1975

[Long-term syndrome in the treatment of parkinsonism with L-dopa].

A group of 71 patients with Parkinson's disease were treated with L-Dopa and benserazide during periods ranging from 27 to 60 months. In 28% of cases a decline in therapeutic effects and or delayed appearance or increase of secondary actions were observed constituting a long-term syndrome. Its most complex and dramatic expression, the on-off effect, was present in 11% of cases. Those patients with more severe symptoms were studied by means of continuous clinical observation enabling the design of daytime follow-up curves. Observations were repeated with varying dosage patterns, showing variations but no substantial changes or disappearance of the symptoms described. Electromyographic recordings and films were taken in certain cases defining the characteristics of on and off effects. Several procedures were implemented in an attempt to control Long-Term Syndrome manifestations: Change of dosage, variation of L-dopa/decarboxilase inhibitor ratio, association of anticholinergic agents with antidepressants, hypoprotein diets. Improvement was moderate and/or transient, with the exception of Nortriptilline which permitted total or partial control of certain symptoms, especially hypokinetic periods, bouts of tremor and dystonic attitudes. It was occasionally necessary to interrupt administration of L-Dopa, readministering it later with recovery of the therapeutic effect and/or avoidance of undesirable effects for varying periods of time. Loss than optimal doses proved beneficial in reducing or postponing Long-Term Syndrome manifestations. Although L-Dopa does not detain the course of the disease, the persistence of favourable results in most patients for prolonged periods of treatment confirms the long-term therapeutic value of this drug.

Benserazide↗