scholarly journals Effect of Trihexiphenidyl and Procyclidine for the management of resting tremor

2016 ◽  
Vol 44 (2) ◽  
pp. 72-75
Author(s):  
Md Ahsan Habib ◽  
ASM Alamgir ◽  
Subash Kanti Dey ◽  
Afroja Alam ◽  
Ahmed Asafuddoula ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Rating Scale ◽  
Anticholinergic Agent ◽  
Interventional Study ◽  
Resting Tremor ◽  
Associated Symptoms ◽  
Disease Rating ◽  
The Difference ◽  
Medical University ◽  
To Receive

Parkinson’s disease is the main etiology of resting tremor but may also rarely occur in Essential Tremor, Multiple System Atrophy & Progressive Suprneuclear Palsy. Levodopa improves bradykinesia, rigidity and other commonly associated symptoms. When resting tremor is the predominant presenting symptom of Parkinson's disease or when tremor persists despite adequate control of other parkinsonian symptoms with low dosages of levodopa, an anticholinergic agent such as trihexyphenidyl or Procyclidine may be the treatment of choice. This prospective interventional study was carried out in the department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka from March, 2014 to June, 2014 with the intention to outline effectiveness, similarities and differences between Trihexyphenidyl and Procyclidine in alleviating resting tremor. For Parkinson’s disease, patients presenting with predominant tremor but minimal bradykinesia and rigidity were purposively selected for the study. Resting tremor was assessed by united parkinson’s disease rating scale (UPDRS). A total of 30 consecutive patients, both male and female, having resting tremor due to different etiology & attending both indoor and outpatient department of Neurology, BSMMU were randomized to receive either Trihexyphenidyl or Procyclidine for two weeks. For most of the patients (93%) resting tremor were due to Parkinson’s disease and only 7% were due to Essential tremor. In case of Trihexiphenidyl, constancy and amplitude of resting tremor were improved in 60% and 80% respectively. In case of Procyclidine, constancy and amplitude of resting tremor were imoroved 87% and 67% respectively. The difference of improvement between Trihexiphenidyl group and Procyclidine group was not statistically significant.Bangladesh Med J. 2015 May; 44 (2): 72-75

scholarly journals Role of magnesium sulphate in ischemic stroke

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Nabeel Ahmed Aman ◽  
Zafar Niaz ◽  
Anjum Razzaq ◽  
Ssain Shah Z Hussain ◽  
Aziz B ◽  
...  
Keyword(s):  
Placebo Group ◽  
Ischaemic Stroke ◽  
Magnesium Sulphate ◽  
Control Group ◽  
Interventional Study ◽  
Barthel Score ◽  
Experimental Type ◽  
The Difference ◽  
To Receive

Objective: To evaluate the role of magnesium sulphate in patients presenting with ischaemic stroke. Methods: This experimental type of interventional study was carried out at Mayo Hospital, Lahore. Within 24 hours of onset of clinically diagnosed stroke, which was later confirmed by CT scan, patients were randomized to receive either magnesium sulphate (16mmol IV over 15 minutes and 65mmol over 24 hours) or placebo. Their disability was measured by Barthel score at presentation and outcome measured after three months by death and disability and the results were compared between the two groups. Those patients who had a Barthel score of = 12 at three months were considered independent and those with a score of < 12 were considered disabled. The results were analyzed by SPSS. Results: Fifty patients were recruited in the study. 25 patients were randomized to receive MgSO4 and 25 received placebo. The Barthel score improved from 5.13.3 at presentation to 13.53.4 after three months in all the patients so the re was improvement whether MgSO4 was given or not. Patients who were randomized to receive MgSO4 had a lower Barthel score of 4.22.9 as compared to controls 5.9 3.5, but after three months they improved more than the controls gaining a score of 15.71.9 versus 11.33.2 (p=0.000). The mortality rate was not statistically different in the two groups. 88% patients had a Barthel score of > 12 at three months in the MgSO4 and 30% in the control/placebo group. Combined death and disability was 8% in MgSO4 group and 60% in the control group. Moreover MgSO4 was well tolerated. Conclusion: Magnesium sulphate therapy was safe in patients presenting with ischaemic stroke irrespective of the site of infarct. It improves prognosis regarding Barthel score at three months as well as the difference in the Barthel score at presentation and at three months. A greater percentage of magnesium treated patients led independent lives after three months.

Dopamine-responsive and dopamine-resistant resting tremor in Parkinson disease

Neurology ◽  
2020 ◽  
Vol 95 (11) ◽  
pp. e1461-e1470
Author(s):  
Heidemarie Zach ◽  
Michiel F. Dirkx ◽  
Dominik Roth ◽  
Jaco W. Pasman ◽  
Bastiaan R. Bloem ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Exploratory Study ◽  
Rating Scale ◽  
Interindividual Differences ◽  
Dopaminergic Medication ◽  
Resting Tremor ◽  
Disease Rating ◽  
Tremor Intensity ◽  
Double Blinded ◽  
Pathophysiologic Mechanisms

ObjectiveWe tested the hypothesis that there are 2 distinct phenotypes of Parkinson tremor, based on interindividual differences in the response of resting tremor to dopaminergic medication. We also investigated whether this pattern is specific to tremor by comparing interindividual differences in the dopamine response of tremor to that of bradykinesia.MethodsIn this exploratory study, we performed a levodopa challenge in 76 tremulous patients with Parkinson tremor. Clinical scores (Movement Disorders Society–sponsored version of the Unified Parkinson’s Disease Rating Scale part III) were collected “off” and “on” a standardized dopaminergic challenge (200/50 mg dispersible levodopa-benserazide). In both sessions, resting tremor intensity was quantified using accelerometry, both during rest and during cognitive coactivation. Bradykinesia was quantified using a speeded keyboard test. We calculated the distribution of dopamine-responsiveness for resting tremor and bradykinesia. In 41 patients, a double-blinded, placebo-controlled dopaminergic challenge was repeated after approximately 6 months.ResultsThe dopamine response of resting tremor, but not bradykinesia, significantly departed from a normal distribution. A cluster analysis on 3 clinical and electrophysiologic markers of tremor dopamine-responsiveness revealed 3 clusters: dopamine-responsive, intermediate, and dopamine-resistant tremor. A repeated levodopa challenge after 6 months confirmed this classification. Patients with dopamine-responsive tremor had greater disease severity and tended to have a higher prevalence of dyskinesia.ConclusionParkinson resting tremor can be divided into 3 partially overlapping phenotypes, based on the dopamine response. These tremor phenotypes may be associated with different underlying pathophysiologic mechanisms, requiring a different therapeutic approach.

The Effects of a Caffeine Placebo and Experimenter Expectation on Blood Pressure, Heart Rate, Well-Being, and Cognitive Performance

2001 ◽  
Vol 6 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Harald Walach ◽  
Stefan Schmidt ◽  
Yvonne-Michelle Bihr ◽  
Susanne Wiesch
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cognitive Task ◽  
Well Being ◽  
Control Group ◽  
Double Blind ◽  
Main Effect ◽  
The Difference ◽  
Being There ◽  
To Receive

We studied the effect of experimenter expectations and different instructions in a balanced placebo design. 157 subjects were randomized into a 2 × 4 factorial design. Two experimenters were led to expect placebos either to produce physiological effects or not (pro- vs. antiplacebo). All subjects except a control group received a caffeine placebo. They were either made to expect coffee, no coffee, or were in a double-blind condition. Dependent measures were blood pressure, heart rate, well-being, and a cognitive task. There was one main effect on the instruction factor (p = 0.03) with the group “told no caffeine” reporting significantly better well-being. There was one main effect on the experimenter factor with subjects instructed by experimenter “proplacebo” having higher systolic blood pressure (p = 0.008). There was one interaction with subjects instructed by experimenter “proplacebo” to receive coffee doing worse in the cognitive task than the rest. Subjects instructed by experimenter “antiplacebo” were significantly less likely to believe the experimental instruction, and that mostly if they had been instructed to receive coffee. Contrary to the literature we could not show an effect of instruction, but there was an effect of experimenters. It is likely, however, that these experimenter effects were not due to experimental manipulations, but to the difference in personalities.

D-test: A New Test for Analyzing Scale Invariance Using Symbolic Dynamics and Symbolic Entropy

Methodology ◽  
2011 ◽  
Vol 7 (3) ◽  
pp. 88-95 ◽  
Author(s):  
Jose A. Martínez ◽  
Manuel Ruiz Marín
Keyword(s):  
Symbolic Dynamics ◽  
Scale Invariance ◽  
Rating Scales ◽  
Rating Scale ◽  
Marketing Research ◽  
Response Patterns ◽  
Measurement Scales ◽  
Improve Measurement ◽  
Entropy Measures ◽  
The Difference

The aim of this study is to improve measurement in marketing research by constructing a new, simple, nonparametric, consistent, and powerful test to study scale invariance. The test is called D-test. D-test is constructed using symbolic dynamics and symbolic entropy as a measure of the difference between the response patterns which comes from two measurement scales. We also give a standard asymptotic distribution of our statistic. Given that the test is based on entropy measures, it avoids smoothed nonparametric estimation. We applied D-test to a real marketing research to study if scale invariance holds when measuring service quality in a sports service. We considered a free-scale as a reference scale and then we compared it with three widely used rating scales: Likert-type scale from 1 to 5 and from 1 to 7, and semantic-differential scale from −3 to +3. Scale invariance holds for the two latter scales. This test overcomes the shortcomings of other procedures for analyzing scale invariance; and it provides researchers a tool to decide the appropriate rating scale to study specific marketing problems, and how the results of prior studies can be questioned.

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

scholarly journals Salivary caffeine in Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giorgio Leodori ◽  
Maria Ilenia De Bartolo ◽  
Daniele Belvisi ◽  
Alessia Ciogli ◽  
Andrea Fabbrini ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
De Novo ◽  
Oral Intake ◽  
Caffeine Intake ◽  
Motor Complications ◽  
Disease Rating ◽  
Caffeine Metabolism ◽  
Movement Disorder Society

AbstractWe aimed to investigate salivary caffeine content, caffeine absorption and metabolism in Parkinson’s disease (PD) and verify whether salivary caffeine can be used as a biomarker of PD. We enrolled 98 PD patients and 92 healthy subjects. Caffeine and its major metabolite, paraxanthine, were measured in saliva samples collected before and 4 h after the oral intake of caffeine (100 mg). We measured caffeine absorption as the normalized increase in caffeine levels, and caffeine metabolism as the paraxanthine/caffeine ratio. The Movement Disorder Society Unified Parkinson's Disease Rating Scale part III, the Hoehn & Yahr, the presence of motor complications, and levodopa equivalent dose (LED) were assessed and correlated with caffeine levels, absorption, and metabolism. The effects of demographic and environmental features possibly influencing caffeine levels were also investigated. Caffeine levels were decreased in patients with moderate/advanced PD, while caffeine levels were normal in patients with early and de-novo PD, unrelated to caffeine intake. Caffeine absorption and metabolism were normal in PD. Decreased salivary caffeine levels in PD were associated with higher disease severity, longer duration, and the presence of motor complications, no significant association was found with LED. Salivary caffeine decrease correlates with PD progression.

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