Parkinsonism--new drugs and new approaches.
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Biomedical subjects
Publications and source records attributed to T Eisler.
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The response of Parkinsonism to three ergot derivatives which modify dopaminergic transmission was studied. CF 25-397 behaved more as an antagonist than an agonist. Lergotrile was an agonist with therapeutic properties marred by prominent hepatotoxicity. Bromocriptine is an effective anti-Parkinsonian agent, particularly useful in patients with prominent dyskinesia or "on-off" reactions to levodopa; in most patients optimal results have been obtained by combining from 40 to 90 mg of bromocriptine daily with approximately 60% of the previous maximal dose of levodopa. Unfortunately, only some 50% of patients tolerate long-term bromocriptine therapy, but all adverse reactions have been dose dependent and reversible.
Animal experiments suggest that opiate peptides might play a role in extrapyramidal function. This hypothesis was tested by administering the opiate antagonist, naltrexone, in doses sufficient to antagonize exogenous opiates, to patients with parkinsonism and Huntington's disease. No improvement in the clinical features of either disorder was noted.
Two members of a family have slowly progressing proximal muscle weakness starting from ages 2 and 6 years. Muscle biopsy specimens from these patients, as well as two other asymptomatic members of the same family, demonstrate predominance of type I fibers (without fiber-type grouping) and minimally enlarged type II fibers. In all four cases there was an increase in serum creatine phosphokinase levels, but electromyographic studies were normal. To our knowledge, this family represents a previously undescribed syndrome of type I muscle fiber predominance without a history of "floppy" babies and includes asymptomatic members with similar pathologic changes.