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Biomedical subjects

F Girotti

Publications and source records attributed to F Girotti.

At least 73 records · Page 4Linked to original sources

Problems arising during chronic treatment with L-dopa for Parkinson's disease: changes in response to treatment.

Some aspects of the problems of long-term L-dopa treatment syndrome are reviewed, with special attention to the changes in response to treatment with dopaminergic agents, specifically end-of-dose deterioration, the on-off phenomenon and hyperkinesia. The various hypotheses for interpreting these are presented, with particular stress on changes in the function of DA-ergic receptors. It is concluded that the on-off phenomenon is probably related to changes in plasma L-dopa levels and to decreased stores of intraneural dopamine.

Corpus Striatum↗

Neuropsychological evaluation in transient ischaemic attack and minor stroke.

Two groups of patients with transient ischaemic attack and minor stroke without detectable haemodynamic stenotic lesions were evaluated by neuropsychological tests and compared with a control group. The mean values of the scores adjusted for age and educational background demonstrated that the patients with transient ischaemic attack did not have a worse performance than normal subjects in any of the tests, the patients with minor stroke had a worse performance than normals, particularly in Rey's figure-copying test (P less than 0.025), and the latter test was not affected by educational background or age of the subjects. The results are discussed with reference to other case series, and the importance of age and cerebral damage in causing intellectual impairment evaluated by neurophysiological tests is stressed.

Adult↗

Giant cell arteritis and normal pressure hydrocephalus. A case report.

The first known case of association of giant cell arteritis and normal pressure hydrocephalus is described. The arteritis was cured with corticosteroid therapy while hydrocephalus required ventriculo-peritoneal shunt. The high protein content of cerebrospinal fluid of this patient is probably the pathogenetic mechanism of cerebrospinal fluid block, leading to occult obstructive hydrocephalus.

Aged↗

Effect of neuroleptic treatment on involuntary movements and motor performances in Huntington's disease.

Eighteen patients with Huntington's chorea were examined before and after neuroleptic treatment (haloperidol, pimozide, tiapride) to study the effect of such treatment on hyperkinesia and motor performance. Pimozide and haloperidol improved hyperkinesia; none of the drugs significantly affected motor performance. No correlation was found between the severity of hyperkinesia and motor performance scores, or between hyperkinesia and intelligence score, before and after therapy.

Adult↗

Gamma-vinyl GABA treatment of Huntington's disease.

In a double-blind, crossover study gamma-vinyl GABA, 2 g/day, and placebo were administered orally for 2 weeks each to six patients with Huntington's disease. Five patients were treated concomitantly with a neuroleptic maintained at constant dose. No consistent beneficial effects on the hyperkinetic movements, abnormal motor function, or ability to carry out normal activities were evident with gamma-vinyl GABA treatment. Treatment was tolerated without clinically significant alterations in the physiologic or biochemical tests used for monitoring. These results suggest that increasing CNS GABAergic function is unlikely to ameliorate Huntington's disease.

Aminocaproates↗

Diffuse arachnoiditis following epidural analgesia.

Four cases of spinal arachnoiditis are reported, which occurred as a delayed complication of epidural anaesthesia. Different causes are considered: the most convincing hypothesis is that there was a subarachnoid hyperergic reaction to the drugs injected during epidural anaesthesia.

Adolescent↗

Oculomotor disorders in cortical lesions in man: the role of unilateral neglect.

The saccades of 22 patients with lesions of the left (6) and right (16) hemisphere were analysed. Seven patients with a right hemispheric lesion presented a left unilateral neglect (UN) syndrome. In the first test session the saccades were performed in response to a predicted sequence of targets; in the second session the luminous stimuli were unpredicted and randomized. In patients with UN we observed the absence of saccadic response to 25% of the targets a lengthening of the reaction time and a staircase pattern in the left hemifield. In the predicted stimulus sequence the oculomotor performance was not significantly better. Hemianopia, a defect of arousal and an altered visuospatial orientation are the most important elements that account for the alterations of oculomotor strategy in the UN syndrome.

Brain Damage, Chronic↗

L-dopa long-term treatment in Parkinson's disease: age-related side effects.

One hundred ninety L-dopa-treated parkinsonian patients have been studied according to the age at onset and to age at last examination. The frequency of major mental disturbances was significantly higher in patients older than 60 years, whereas abnormal involuntary movements and on-off phenomenon were more frequent in patients with onset before age 60. The association of normal aging and of Parkinson's disease may be responsible for the prevalence of mental disease in older patients.

Adult↗

Idiopathic dystonia: neuropharmacological study.

A total of 15 patients affected by idiopathic dystonia (7 with generalized and 8 with focal or segmental dystonia) were subjected to therapy with bromocriptine at low doses, pimozide and trihexyphenidyl. The symptoms were evaluated by giving a progressive score in relation to the intensity of the dystonic symptom to each of the body segments involved by the dystonia. Bromocriptine did not significantly modify the dystonia. Pimozide showed a slight nonsignificant improvement of the dystonic symptoms. Trihexyphenidyl was effective in the generalized dystonias, in agreement with previous reports in the literature. The variation in the pharmacological results could be due to the diversity of the dystonic syndromes, which comprise cases that are different in age at onset, site of dystonic symptoms, and evolution.

Adolescent↗

Oculomotor disturbances in Balint's syndrome: anatomoclinical findings and electrooculographic analysis in a case.

A 67-year-old man had repeated cerebral ischemic attacks, which resulted in a clinical picture combining paralysis of visual fixation, optic ataxia and impairment of visuospatial orientation, consistent with the definition of Balint's syndrome. Postmortem examination showed multiple lesions involving the occipital cortex of both sides and the white matter underlying the right insular cortex. EOG recording demonstrated a marked impairment of refixation saccades and saccades on verbal command. Smooth pursuit movements were completely abolished. Visual fixation was randomly achieved after many erratic exploratory movements and steadily maintained on the target (spasmodic fixation). During spasmodic fixation, EOG recording detected an ocular flicker resulting in a continuous instability of eye position. It is suggested that these findings may all be accounted for by the loss of panoramic vision due to a bilateral impairment of cortical areas 18 and 19.

Aged↗

Intrauterine growth retardation. A report of two cases with bird-headed appearance, skeletal changes and peripheral GH resistance.

Two cases of severe intrauterine growth retardation, a boy and a girl studied for 7 and 10 years respectively, are reported. Both patients showed peculiar cranio-facial abnormalities as observed in the so-called Seckel's syndrome, an appearance of premature aging, peripheral GH resistance which was probably due to deficiency in Somatomedin A production, sella areas and volumes consistently at the upper limits of normal when related to the patients' height, and dysharmonic skeletal maturation ivory cone-shaped epiphyses of the tubular bones of the hands.

Bone Development↗

"Long term evaluation of combined treatment of Parkinson disease with L-dopa, peripheral decarboxylase inhibitors and bromocreptine".

In this study the author's experience of Parkinson Disease treatment with long-term Bromocriptine (Br) administration, is summarized. Br, which acts directly on dopaminergic receptors, was introduced in combination with L-Dopa and peripheral decarboxylase inhibitors (PDI). The reasons for this association were: 1) the reduced effectiveness of the current treatment (L-Dopa + PDI) 2) onset of AIM (abnormal involuntary movements). 3) patient's desire to try new drugs. Only the patients who had been on the triple association for at least a year, were considered. Therefore of 50 patients originally considered only 19 were included in this study. The addition of Br allowed a reduction of the mean daily dose of L-Dopa(30%) and the therapeutic efficacy of the drug remained unchanged even after more than 4 years treatment. The "on-off" effect and AIM, are reduced by Br especially in the first months of treatment. The triple association is regarded at present as the best treatment for Parkinson disease.

Aged↗

Oculomotor abnormalities in patients with lesions involving the tectal region.

An analysis of ocular movements was performed in four patients with retraction nystagmus and paralysis of the upward gaze. The clinical and radiological data indicate that the lesion were relatively limited to the most rostral and dorsal portion of the mesencephalon. The electrooculographic examination disclosed not otherwise obvious abnormalities of horizontal ocular movements. The most prominent defect was a tendency to perform hypometric saccades followed by multiple corrective movements. This tendency was particularly evident in saccadic movements toward a light spot unexpectedly displaced in the visual field of the subject. It is suggested that lesions responsible for retraction nystagmus can also affect the visuomotor integration mechanisms; the foveation of the target is then obtained through a typical modification of the motor strategy.

Adult↗

Effects of DA agonist in Huntington disease hyperkinesia.

Apomorphine, bromocryptine, lysuride, diazepam and cyproheptadine were administered to 11 patients with Huntington's disease (HD). The evaluation of the pharmacologic activity of different drugs on abnormal involuntary movements (AIM) was determined by means of an arbitrary clinical method. Apomorphine, diazepam and cyproheptadine succeeded in improving the AIM, while bromocryptine and lysuride did not modify the clinical pattern or provoked (bromocryptine) a worsening in some patients. The growth hormone (GH) responses to apomorphine and bromocryptine were determined in 6 patients. The relationship between clinical, endocrine results and pharmacologic action of apomorphine is discussed, suggesting that the reducing effect of apomorphine on AIM of HD may be due to its sedative action.

Adult↗

Failure of MIF-I to affect behavioral responses in patients with Parkinson's diseases under L-dopa therapy.

In eight subjects with Parkinson's disease under an optimal daily dose of L-dopa, acute administration of MIF-I (200 mg i.v.) did not ameliorate either the total disability score or the intellectual test PM 38 when evaluated in comparison with the effect induced by acute administration of a placebo. Also concomitant evaluation of the effect of MIF-I on the secretion of anterior pituitary hormones which are under dopaminergic control i.e., growth hormone and prolactin, did not reveal any potentiation of the L-dopa-induced stimulus.

Aged↗

Alterations of ocular motility in cerebellar pathology. An electro-oculographic study.

Saccadic as well as smooth pursuit movements were studied by means of electro-oculograms in a group of 14 patients affected by cerebellar diseases. Ten patients had cerebellar atrophies, and four had undergone surgery for cerebellar tumors. Loss of gain of the pursuit system and metric alteration of saccades were the most striking abnormalities observed. Dysmetria was shown to be related to the amplitude of the movement and to the sector of the perimeter within which the movement occurs (movements occurring in the more eccentric sector were more disturbed). A tendency to produce saccades slower than normal was noted in patients affected by olivopontocerebellar atrophy. The clinical and pathophysiological significance of this finding is discussed with particular reference to Wadia-Swaami hereditary ataxia.

Adult↗

Oculomotor disorders in Huntington's chorea.

Electro-oculographic recordings were obtained from 11 patients with Huntington's disease. Significant reduction of saccadic velocity was constantly found. In all the patients vertical saccades were much more impaired than horizontal. When present, vertical saccades showed long latency, low amplitude, low velocity, and disturbances related to blinking. Following movements were jerky, and ability to perform repeated rhythmic movements was impaired. These results are in agreement with previous observations and underline the selective defect of rapid movements as a characteristic feature of Huntington's disease. Further, they suggest a possible correlation between the difficulty in performing repeated ocular movements and the impaired execution of gestural sequences involving a succession of different fundamental movements.

Adult↗