Valproate-withdrawal induced migraine.
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Adult↗
Biomedical subjects
U Bonuccelli
Publications and source records attributed to U Bonuccelli.
Prolactin secretion in epileptic subjects treated with phenobarbital: sex differences and circadian periodicity.
Circulating basal prolactin (PRL) levels were evaluated in 126 subjects of both sexes with partial or generalized epilepsy, who were treated with phenobarbital (PB) alone or in combination with either phenytoin or benzodiazepines. A significant increase in PRL levels was observed in male, but not in female, patients compared with a sex- and age-matched healthy volunteer group. Circadian PRL secretion, studied in six male epileptic patients on PB monotherapy and in nine normal subjects, showed comparable 24-h PRL mean values and a preserved PRL surge during the night in both groups; however, a statistically significant additional peak was found in male epileptic subjects during the late afternoon. The cosinor analysis of the data, used to evaluate PRL rhythmicity, showed a disruption of the 24-h periodicity in epileptic subjects, while the 12-h periodicity was maintained. These results indicate that central and/or peripheral mechanisms involved in PRL secretion control are more sensitive to PB alone or in combination with other antiepileptic drugs in male than in female subjects. However, the changes of PRL secretion we found were small and unrelated to the different clinical conditions.
Adolescent↗
Descriptive epidemiologic study of epilepsy syndromes in a district of northwest Tuscany, Italy.
To evaluate the prevalence of epilepsy syndromes in a district in Northwest Tuscany (Vecchiano, 9,952 inhabitants) we identified all suspected cases (probable epilepsy) from several information sources: files of local doctors, prescriptions of antiepileptic drugs (AEDs), hospital files from the center for epilepsy at the University of Pisa, medical files from university and hospital departments in Pisa, and files of the school doctors and social workers in the district of Vecchiano. All persons suspected of having epilepsy were examined; 51 cases of epilepsy were found, i.e., a prevalence rate of 5.1 in 1,000. During a previous study performed in the same district with the "house-to-house" method, a lower rate was found. Our study confirms that use of different epidemiologic investigational methods can produce different results.
Adolescent↗
[Sleep disturbances in a case of Morvan's chorea (author's transl)].
Six nocturnal polygraphic recordings were carried out in a young man with fibrillary chorea of Morvan, during the acute period of the disease. Sleep was remarkably fragmented by numerous and brief awakenings but the total sleep time fluctuated between 157 and 312 mins.; the sleep structure was altered by the almost total absence of stages 3,4 and REM. During the day, the subject had one or two periods of sleep (1-2 hours) and complained of being tired. The nocturnal awakenings were correlated by the patient with pain and burning dysaesthesiae of distal distribution that were more severe than those occurring during the day. The patient improved gradually, and five month later both sleep disturbances and other signs of disease had disappeared.
Adult↗
Late whiplash syndrome: a clinical and magnetic resonance imaging study.
Cervical hyperextension injuries are common and are associated with significant morbidity. Clinically two syndromes are described: "acute" whiplash syndrome and "late" whiplash syndrome (in which the patients are still symptomatic after six months despite normal physical and radiological examination). In order to clarify the pathology of the persistent pain in late whiplash syndrome we performed a cervical spine magnetic resonance imaging (MRI) in 33 consecutive patients suffering from this condition. Twenty-six patients (78.8%) showed MRI abnormalities, the most common MRI finding (57.6%) was pre-existent spondylosis. Indeed, the group of patients with spondylosis and other MRI changes had higher clinical scores than those without MRI abnormalities as measured by a three-point grading system based upon the symptoms and signs shown. Several MRI changes, most of them already demonstrable by standard X-ray were seen among 33 patients suffering from late whiplash syndrome. Although no one of these findings appears to be specific and certainly related to the previous neck injury, they could represent a risk factor for a longer pain duration.
Adult↗
Apomorphine test in de novo Parkinson's disease.
We administered apomorphine, a powerful dopaminergic agonist, subcutaneously to 25 untreated patients with parkinsonian features and evaluated motor response with the aim of discriminating idiopathic Parkinson's disease (IPD) from multiple system atrophy and progressive supranuclear palsy. The response to apomorphine was strongly predictive of responsiveness to subsequent levodopa follow-up and of the final diagnosis, made on the basis of both clinical and instrumental evaluation. Our data confirm that the apomorphine test is helpful in the differential diagnosis of IPD.
Apomorphine↗
[Diurnal worsening in Parkinson patients treated with levodopa].
Parkinson's disease (PD) patients show a good response to levodopa in the morning, and reduced duration or complete failure of response later in the day, but the pathophysiology of this phenomenon remains unclear. We evaluated motor performance hourly over a twelve-hour period in patients treated with levodopa/carbidopa (group A), with bromocriptine (group B), and in "de novo" patients (group C). At 8 am, 12 and 4 pm, group A patients received standard doses of levodopa/carbidopa, whereas patients of group B and C took, respectively, 5 mg bromocriptine and placebo. In "de novo" patients and in patients under bromocriptine we did not observe significant diurnal changes in motor score, whereas in patients under levodopa a progressive daytime worsening, which significantly correlated with progressive increase in 3-O-methyldopa plasma levels, was visible. These data seem to indicate a contributory role of pharmacokinetic or pharmacodynamic factors related to levodopa assumption, rather than to the underlying disease, in the afternoon worsening in PD.
Bromocriptine↗
[Dexamethasone therapy in Huntington chorea: preliminary results].
Neuroleptic drugs represent the current therapy for Huntington's chorea (HC). However neuroleptics can improve involuntary movements, but not functional performance and disease progression. Several clinical and experimental data suggest the existence of functional relationship between corticosteroids and extrapyramidal system. We administered dexamethasone to six choreics, all female. Dexamethasone was given i.m. at dose of 4 mg/die for 20 days and 8 mg/die for 20 days more. Dexamethasone at both the doses used, determined significant improvement (p less than 0.05) of dyskinesia, evaluated by AIMS, and manual dexterity, evaluated by Tapping test. Although at present it is not clear which mechanism are responsible for this of dexamethasone favourable effect, it might open new perspectives in HC therapy.
Adult↗
[The prevalence of active epilepsy in the Commune of Vecchiano, Tuscany].
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Adolescent↗
Familial occurrence of hypothyroidism and cerebellar ataxia.
Several cases of association between cerebellar ataxia and hypothyroidism have been reported, in which cerebellar symptoms regressed after euthyroid state was obtained, suggesting an etiologic relationship between hypothyroidism and ataxia. We present a further case of hypothyroidism and ataxia, with a peculiar positive family history for both thyroid and cerebellar disorders. Long-term replacement therapy with L-thyroxine determined the regression of hypothyroidism; however, no improvement in cerebellar symptoms was observed. The lack of response of the neurologic symptoms to L-thyroxine treatment suggests the absence of an etiological relationship between thyroid disease and cerebellar disease in this case.
Adult↗
[Amyotrophic lateral sclerosis with multiple myeloma].
Motor neuron diseases (MND) associations with paraproteinemia, lymphoma, hexosaminidase A deficiency and heavy-metal intoxication are of great interest. A case of amyotrophic lateral sclerosis (SLA) associated with multiple myeloma (monoclonal IgG paraproteinemia and K light chains) is reported. The detection of abnormal protein in 1988 and the increase of its serum level during 1989 were strictly correlated with the beginning and the worsening of the neurological disease. Shy and coll. in 1986 affirmed that association of paraproteins with MND is probably not merely the fortuitous association of a common laboratory abnormality and an uncommon disease. The reported case provides elements for a causal association between paraproteinemia and MND.
Amyotrophic Lateral Sclerosis↗
[The apomorphine test for diagnosis of parkinsonian syndrome].
Apomorphine is a powerful dopaminergic drug, able to improve cardinal symptoms of Parkinson's disease in few minutes, when injected subcutaneously. We administered different doses of apomorphine s.c. against placebo in 25 patients with a Parkinsonian syndrome, with the aim of discriminating Parkinson's disease from other Parkinsonism. A positive response to apomorphine was predictive (88%) of good responsiveness to levodopa therapy. Our data, together with those of other groups, indicate that apomorphine test is a useful tool in the diagnosis of Parkinsonian syndromes.
Aged↗
Pattern of plasma opioids in menstrually-related migraine and epilepsy.
Plasma estradiol (E2), progesterone (P), beta-endorphin (beta-EP) and beta-lipotropin (beta-LPH) were measured in the luteal phase of 8 patients affected by menstrually-related migraine (M) and in 3 cases of catamenial epilepsy (CE). Plasma P and E2 of the M patients were lower than in the CE group. Both beta-LPH and beta-EP showed a reduction in M patients near menses, while the opposite pattern was found in CE. These data demonstrate that premenstrual syndrome is sustained by different, neurobiological dysfunction even if endogenous opioids could be involved in both migraine and epilepsy.
Endorphins↗
Neuroendocrine evaluation in catamenial epilepsy.
The hypothesis that catamenial epilepsy depends on abnormal rhythmic hormone activity in the hypothalamus-pituitary-gonadal axis has never been critically tested. No significant modifications in the secretory pattern of pituitary hormones, both basally and in response to stimulatory tests, were found in a group of catamenial epileptic women. On the contrary, our data showed a reduction of luteal phase progesterone secretion. These findings indicate that an imbalanced secretion of ovarian steroids plays a role in the catamenial exacerbation of epilepsy.
Adult↗
Clinical usefulness of creatine kinase BB determination by a RIA method in serum of patients with cerebrovascular accidents.
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Aged↗
[Sleep in progressive supranuclear palsy].
Nocturnal sleep was poligraphycally recorded in three male patients aged 54-67, with progressive supranuclear palsy (PSP). All patients suffered from insomnia. In case 1 REM sleep was markedly reduced and spindles were less numerous than in normal subjects. In cases 2 and 3, EEG patterns were not distinguishable from those observed when the patients were awake. Sleep, therefore, was recognized only by constant observation of the patients. As seen in the literature EEG changes during sleep can be correlated to the severity of the clinical picture and the stage of evolution of the disease. EEG patterns of sleep in PSP are similar to those reported in patients with presenile dementia.
Aged↗
[EEG findings in hemophilia].
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Adolescent↗