[Neurosurgical treatment of Parkinson disease].
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Electric Stimulation Therapy↗
Biomedical subjects
L Regeur
Publications and source records attributed to L Regeur.
Increasing loss of brain tissue with increasing dementia: a stereological study of post-mortem brains from elderly females.
Neocortical volumes, cortical thickness and volumes of archicortex, the ventricular system, the central grey matter and white matter were estimated using stereological methods on the brains from 28 elderly females (mean age 81.8 years) with increasing degree of senile dementia and brains from 13 (mean age 82.7 years) female controls who did not suffer from dementia. The estimator of pial surface area, as opposed to the other stereological techniques used in this study, was not strictly unbiased. Brains from patients with dementia (14 Alzheimer cases and 14 non-Alzheimer cases) had decreased cortex volume, and neocortical thickness was significantly reduced in the patients with dementia, with the highest degree of reduction in those whose dementia was most severe, as were the volumes of archicortex. No statistically significant difference was found in the volumes of cortex, white matter, central grey structures, ventricular volume or archicortex between the cases with Alzheimer's dementia (N = 14) compared with those with non-Alzheimer dementia (N = 14). The ventricular volume increased with increasing degree of dementia, but did not reach statistical significance in the dementia group compared with the control group. Surface area did not change in those patients with dementia, and no significant reductions were found in the volumes of white matter or central grey structures in the patients with dementia compared with controls.
Aged↗
Long-term botulinum toxin treatment of cervical dystonia--EMG changes in injected and noninjected muscles.
OBJECTIVE: To evaluate changes in quantitative EMG of injected and noninjected sternocleidomastoid muscles following long-term unilateral botulinum toxin treatment of cervical dystonia. METHODS: We investigated 27 patients with cervical dystonia, who received repeated unilateral botulinum toxin injections of the sternocleidomastoid muscle, with quantitative EMG at rest and at maximal voluntary contraction. The patients had on the average 7.1 botulinum toxin treatments and the follow-up period was on the average 31 months (SD 16). RESULTS: After the first treatment, the injected sternocleidomastoid muscles showed a significant decrease in turns/s (mean 45%) and amplitude (mean 52%) at rest, and in amplitude at maximal flexion (mean 24%) and rotation (mean 39%). Except for a reduction in turns/s at rotation (mean 19%) no further reductions in EMG parameters were seen after long-term treatment. The contralateral noninjected sternocleidomastoid muscles showed no significant change in EMG activity after the first BT treatment, but after long-term treatment a significant reduction in turns/s and amplitude at both maximal flexion (turns: mean 28%; amplitude: mean 25%) and rotation (turns/s: mean 32%; amplitude: mean 25%) were seen as compared to pretreatment values. CONCLUSION: The results indicate that there seems to be no cumulative chemodenervation by repeated botulinum toxin injections of sternocleidomastoid muscles measured by quantitative EMG. Contralateral noninjected sternocleidomastoid muscles however, seem to be affected following long-term treatment. The mechanism behind this finding is unknown.
Adolescent↗
[The normal brain: a new knowledge in different fields].
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Brain↗
A clinical trial of dextromethorphan in amyotrophic lateral sclerosis.
INTRODUCTION: Although the cause of amyotrophic lateral sclerosis (ALS) is unknown, excitotoxicity mediated by glutamate has been implicated. Dextromethorphan is a NMDA-glutamate receptor antagonist with neuroprotective properties. MATERIAL AND METHODS: The effect of treatment with dextromethorphan (150 mg daily) in ALS patients was evaluated in a randomized, double-blind, placebo-controlled study. Forty-five patients were included in the analysis. RESULTS: At the end of the treatment period, 12 months after randomization, 15 patients (65%) in the placebo group and 12 patients (55 %) in the dextromethorphan group were still alive (log rank test, P=0.49). Rates of disease progression, as expressed by rates of decline in pulmonary function and in functional disability, were similar in both groups except for a significantly less pronounced rate of decline in the ability scores for the lower extremities in the dextromethorphan group. CONCLUSION: Treatment with a relatively low dose of dextromethorphan did not result in an improvement in 12-month survival in ALS.
Adult↗
Clinical evaluation and pharmacological treatment of Gilles de la Tourette's syndrome and other hyperkinesias.
The clinical evaluation and pharmacological treatment of Gilles de la Tourette's syndrome (TS) and other hyperkinesias in Hvidovre Hospital is reviewed. Pimozide still seems to be the most effective single drug in the treatment of Tourette symptoms. Anticholinergics most often in combination with one or two other drugs are still the most effective drug in the treatment of dystonia. Clozapine is an effective alternative in the treatment of tremor.
Adrenergic beta-Antagonists↗
Optimizing sampling designs for volume measurements of components of human brain using a stereological method.
Measurements of the cerebral cortical volume used to be very laborious, due to the 3-D complexity of the gyral pattern. Using stereological methods, which allow the quantification of 3-D structures from measurements on 2-D cross-sections, the difficulties have been overcome. In thirty formalin-fixed normal human brains the total volumes were measured by saline displacement. The brains were serially sliced in coronal sections and the fractional areas of the cortex, white matter, central grey structures and ventricles were determined by point-counting. Using Cavaliéri's principle the volumes of these structures were calculated. The average cortical fixed volume was 549 ml (SD +/- 107) corresponding to 54% of the total volume of the hemispheres. The coefficient of error of the cortical volume determinations was 2.6%. The efficiency of the design and the possibilities for optimizing the design are discussed. This point-counting method was preferred to the use of an automatic image analyser, being precise, easy to handle and not interfering with further tissue processing for histological preparation.
Aged↗
Clinical features and long-term treatment with pimozide in 65 patients with Gilles de la Tourette's syndrome.
During the last seven years 65 patients with Gilles de la Tourette's syndrome have been treated. Pimozide was used as the preferred drug because of our experience of treating other hyperkinesias which indicated fewer side-effects than with haloperidol. Of the 65 patients with Gilles de la Tourette's syndrome, 59 were treated with pimozide alone or in combination with tetrabenazine or clonidine. The dose ranges of pimozide were 0.5-9 mg per day. Eighty-one percent experienced a good clinical response without side-effects. The side-effects seen in our patients were sedation, gain in weight, depression, pseudoparkinsonism and akathisia; acute dystonic reactions, blurred vision, slurred speech and xerostomia did not occur. No cases of tardive dyskinesia were seen.
Adolescent↗
Neuropharmacology of tics.
In pharmacological treatment of Gilles de la Tourette's syndrome neuroleptic (antipsychotic) drugs have been the most effective. This has led to the hypothesis of a relative dopaminergic overactivity in the brain. Animal studies with neuroleptic drugs different in their affinity to different dopamine areas as well as studies with drugs different in their selectivity to different receptors have, however, not shown direct correlations to the clinical response in the treatment of hyperkinetic syndromes. There is a trend that drugs with high affinity to striatal D2-receptors might be the most potent. Other attempts to change brain dopamine in different ways using cholinergic, GABAergic, and peptidergic drugs have given rather poor clinical results. The apparent importance of brain dopamine in a whole range of neuropsychiatric diseases may be due to the central role of basal dopaminergic areas as a relay station for a lot of neuronal pathways.
Antipsychotic Agents↗
The effect of insulin deprivation on fasting levels of 5000 dalton gastric inhibitory polypeptide in type 1 (insulin-dependent) diabetics.
To investigate whether metabolic decompensation has an effect on gastric inhibitory polypeptide (GIP), 8 fasting male type 1 diabetics were deprived of insulin for 12 h. An overnight insulin infusion aiming at normoglycaemia was stopped at 08.00 h. During the following 12 h blood glucose increased from 7.0 +/- 0.4 to 14.9 +/- 1.0 mmol/l, P less than 0.01, 3-hydroxy-butyrate from 0.18 +/- 0.07 to 4.00 +/- 0.74 nmol/1, P less than 0.01, and immunoreactive GIP (IR-GIP) from 16.7 +/- 2.6 to 21.9 +/- 2.9 pmol/1, P less than 0.05. The antiserum employed, R65, only measures 5000 dalton IR-GIP. The final IR-GIP concentrations were not significantly different from fasting IR-GIP concentrations in 13 normal male subjects (17.4 +/- 1.5 pmol/1). Short term insulin deprivation therefore is associated with a slight increase in fasting IR-GIP concentrations. Whether this modest increase in IR-GIP significantly enhances insulin secretion is unknown.
3-Hydroxybutyric Acid↗
Relation of immunoreactive gastric inhibitory polypeptide to changes in glycaemic control and B cell function in type 1 (insulin-dependent) diabetes mellitus.
The effect of strict glycaemic control on plasma immunoreactive gastric inhibitory polypeptide (IR-GIP) concentrations and pancreatic B cell function as estimated by plasma C-peptide was evaluated in 14 Type 1 (insulin-dependent) diabetics. The effect was estimated by giving a test meal before (test 1) and after (test 2) 1 week with near normal blood glucose control (mean blood glucose 6.7 +/- 0.2 mmol/l) and again 3 weeks later (test 3) in the outpatient clinic. The glycaemic control was significantly improved at test 2 and test 3 compared with that of test 1. The IR-GIP concentrations before and after the meals were similar at all three tests and not different from those found in 21 normal controls. In 8 patients with a significant B cell response at test 1, B cell function was significantly improved both at test 2 and test 3 but no change in fasting or post-prandial IR-GIP concentrations was found and no correlation between B cell function and IR-GIP existed. We conclude that strict glycaemic control improves B cell function but does not modulate plasma IR-GIP concentrations. Factors other than GIP seem to be of greater importance in determining the magnitude of B cell function in Type 1 diabetes.
Adolescent↗
Diminished immunoreactive gastric inhibitory polypeptide response to a meal in newly diagnosed type I (insulin-dependent) diabetics.
The release of immunoreactive gastric inhibitory polypeptide (IR-GIP) in response to a standard meal was examined in 10 normal subjects and 15 type I (insulin-dependent) diabetics 7 days (test I), 14 days (test II), and 3 months (test III) after time of diagnosis. During all three tests, the diabetics had significantly lower plasma IR-GIP concentrations than the controls from 15-90 min after the standard meal. The IR-GIP response in the diabetics measured as the integrated area under the response curve corresponded to 70% of that of normal subjects. beta-cell function evaluated from the C-peptide response to the meal increased significantly from test I to test III whereas the IR-GIP response was similar during all three tests. As GIP is known to potentiate glucose-induced insulin secretion and possibly the biosynthesis of insulin, the low IR-GIP responses in subjects with type I diabetes may significantly influence insulin levels and hyperglycemia.
Adolescent↗
[Gilles de la Tourette's syndrome. Experiences with 18 patients].
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Adolescent↗
The transient effect of strict glycaemic control on B cell function in newly diagnosed type 1 (insulin-dependent) diabetic patients.
Within 24h of diagnosis, 15 consecutive Type 1 (insulin-dependent) diabetic patients were allocated at random to one of two treatment groups: group A (n = 9, mean age: 28 years, range: 17-35 years) was treated conventionally with one or two daily doses of insulin; group B (n = 6, mean age: 27 years, range: 21-37 years) was treated with nine daily injections of fast-acting insulin for ten days and there-after conventionally as for group A. The mean diurnal blood glucose concentration during the initial ten days of insulin treatment was 11.7 +/- 0.5 mmol/l (mean +/- SEM) in group A and 6.4 +/- 0.3 mmol/l in group B (p less than 0.01). Pancreatic B cell function was evaluated 1, 7, 14, 90, and 180 days after the start of insulin treatment from the C-peptide response to a standard meal. At one and seven days after diagnosis, no difference was found in B cell function between the two groups. After 14 days, the amount of C-peptide secreted during the test meal was 18.0 +/- 2.6 nmol (mean +/- SEM) in group A compared with 29.0 +/- 3.6 nmol in group B (p less than 0.05). After 90 and 180 days, no difference was demonstrated in B cell function. The maximal B cell function observed was similar in the two groups, but occurred earlier in group B (at 14 days) than in group A (at 90 days) (p less than 0.05). This study indicates that strict initial glycaemic control may lead to an earlier improvement in B cell function, but that this improvement is of short duration.
Adolescent↗
The significance of the portal insulin secretion in insulin dependent patients with residual beta-cell function: a safeguard against hormonal and metabolic derangement.
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3-Hydroxybutyric Acid↗
"Tardive" Tourette syndrome in relation to long-term neuroleptic treatment of multiple tics.
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Adult↗
Very early changes in circulating T3 and rT3 during development of metabolic derangement in diabetic patients.
Alterations in circulating iodothyronines were studied in 15 juvenile type diabetic patients during the development of metabolic derangement after withdrawal of insulin. By means of measurements of circulating C peptide, one group of patients with and one without residual beta-cell function had been selected. In both groups there was a gradual decrease in serum T3 during the 12-hour period studied after withdrawal of insulin, while an increase in serum rT3 was observed after 4-6 hours. The alterations in serum T3 and the metabolic derangement were significantly more pronounced in patients without than with residual beta-cell function.
C-Peptide↗
Insulin secretory reserve in insulin dependent patients at time of diagnosis and the first 180 days of insulin treatment.
Eleven newly diagnosed insulin dependent patients were studied before and during the first 16 h after start of insulin treatment. All the patients were found to have significant amounts of C-peptide in plasma indicating residual insulin secretion. The fall in blood glucose after start of insulin therapy was followed by a parallel decrease in C-peptide (R = 0.99, P < 0.01) suggesting that the beta-cells may respond to variation in blood glucose. Eight of the patients were studied 1, 4, 7, 14, 90 and 180 days after start of insulin therapy. During the first 90 days of treatment an increasing maximal C-peptide concentration was found after a standard breakfast test meal. Two thirds of this improvement i beta-cell function was found after the initial 14 days with an average increase in maximal C-peptide of 260 per cent. The sensitivity to glucose improved.
Adolescent↗