Biomedical subjects
Publications and source records attributed to K Masmoudi.
A patient presented with facial diplegia, occulomotor paresis, ataxia, areflexia and albuminocytologic dissociation. Such clinical features mimicked Fisher's syndrome. In fact, these signs were due to two metastases, one in the pons, the other in the right frontal lobe.
Among the side-effects attributed to valproic acid (VPA), the occurrence of Parkinsonian syndromes and cognitive impairment is very uncommonly reported. We describe five cases of reversible associated Parkinsonism. These cases were observed in epileptic patients, 57 to 74 years old, two women and three men. Extrapyramidal disorders appeared after various durations of treatment (from 6 months to 10 years). Dementia characterized by an insidious onset was associated in three cases and bradypsychia in one case. Brain pseudoatrophy was present in three patients. In all cases the signs and symptoms improved some weeks or months after discontinuation of VPA. In the literature some cases, usually in young adults or children, have been reported. In a prospective study, Armon et al. found various abnormal symptoms and signs related to motor and cognitive function impairment in patients with long-term VPA therapy. These side-effects may be related to a disturbance in the gabaergic pathways in the basal ganglia system. It is of interest to consider that delta 2-valproic acid, a metabolite of VPA, is especially accumulated in selected areas of the brain: the substantia nigra, superior and inferior colliculus, hippocampus and medulla.
19 cases of acute dyskinetic reactions related to anti-emetic drugs have been retrospectively examined. In these cases, the diagnosis was not recognized and the patients were hospitalized. Metoclopramide was the most frequently involved drug (17 cases). In one case, domperidone was the drug responsible of the neurologic symptomatology. The doses used were not higher than recommended. In most of cases, the neurologic manifestations occurred within the first 24 hours and disappeared within a few hours after discontinuation of the treatment.
Central neurological diseases caused by beta-lactamins are usually associated with excessive dosages in patients with renal failure. Two case reports of convulsive encephalopathy in patients treated with ceftazidime, show the absolute necessity of adapted posology, in case of renal dysfunction. In one case, we could follow plasma levels of ceftazidime during hemodialysis, and calculated the pharmacokinetic parameters. We conclude that extra renal epuration is an efficient technique in case of acute ceftazidime intoxication.
Veralipride is a substituted benzamide which is used for the treatment of menopausal hot flushes. We report five cases with extrapyramidal disorders associated to a treatment with this drug for which the neuroleptic activity resulting from an interaction with D2 receptors is not always known by prescribers. One case consisted of acute dyskinesias and four of parkinsonian syndromes, one of these being associated with tardive dyskinesia. In these four cases, dosing recommendations were not respected.
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