344 results on '"Merello M"'
Search Results
302. Comparison of 1-year follow-up evaluations of patients with indication for pallidotomy who did not undergo surgery versus patients with Parkinson's disease who did undergo pallidotomy: a case control study.
- Author
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Merello M, Nouzeilles MI, Cammarota A, Betti O, and Leiguarda R
- Subjects
- Aged, Case-Control Studies, Disease Progression, Follow-Up Studies, Humans, Middle Aged, Movement Disorders diagnosis, Muscle Rigidity diagnosis, Postoperative Complications diagnosis, Severity of Illness Index, Tremor diagnosis, Globus Pallidus surgery, Parkinson Disease diagnosis, Parkinson Disease surgery
- Abstract
Unlabelled: Many reports published during the past 5 years have shown evidence of the beneficial effect of posteroventral pallidotomy (PVP) in large groups of patients for up to 3 years, but none of them have compared patients who underwent surgery with a control group., Objective: To compare the evolution of Parkinson's disease symptoms at 1-year follow-up between patients who underwent surgery and those who did not., Material and Methods: Ten patients with idiopathic Parkinson's disease refractory to treatment who were included in the Core Assessment for Intracerebral Transplantation program for PVP did not undergo surgery because financial support was lacking. These patients were followed up for 1 year as if they had been operated on and were finally compared with 10 patients having similar characteristics in whom PVP had been performed during the same period of time., Results: There were no significant differences at basal evaluation in the motor section scores of the Unified Parkinson's Disease Rating Scale between those patients who underwent surgery and those who did not, but a significant reduction in Unified Parkinson's Disease Rating Scale motor score in the group who underwent surgery at 1-year evaluation was found (P < 0.006). Dyskinesias, which was nonsignificantly different at basal evaluation, showed, at the 1-year follow-up, a significant reduction in the group who underwent surgery (P < 0.04). Scores from the subsets of the Unified Parkinson's Disease Rating Scale addressing rigidity, tremor, and bradykinesia also proved significantly different at the 1-year follow-up. The slope of the line generated by the two evaluations for each group showed a negative value in the group who underwent surgery (value of -0.21) and a positive value in the group who did not (value of 0.148)., Conclusion: At the 1-year follow-up, microelectrode-guided PVP produced significant changes in patient motor status and disease progression versus a comparable group of patients who did not undergo surgery during the same period of time.
- Published
- 1999
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303. Apomorphine induces changes in GPi spontaneous outflow in patients with Parkinson's disease.
- Author
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Merello M, Balej J, Delfino M, Cammarota A, Betti O, and Leiguarda R
- Subjects
- Antiparkinson Agents adverse effects, Apomorphine adverse effects, Electroencephalography drug effects, Evoked Potentials drug effects, Female, Globus Pallidus physiopathology, Globus Pallidus surgery, Humans, Male, Microelectrodes, Middle Aged, Neurologic Examination drug effects, Neurons drug effects, Neurons physiology, Parkinson Disease physiopathology, Parkinson Disease surgery, Signal Processing, Computer-Assisted, Synaptic Transmission physiology, Antiparkinson Agents administration & dosage, Apomorphine administration & dosage, Globus Pallidus drug effects, Parkinson Disease drug therapy, Synaptic Transmission drug effects
- Abstract
Objective: To determine the effect of a single dose of apomorphine on internal globus pallidus (GPi) neuronal discharge in patients with Parkinson's disease (PD)., Patients and Methods: Nine PD patients who underwent microelectrode-guided posteroventral pallidotomy (PVP) were studied. After identification of a single GPi unit discharge with sufficient spike S/N ratio to allow reliable thresholding, basal recording was followed by a single 3-mg subcutaneous injection. One-minute samples were recorded 10', 30', and 60' after apomorphine., Results: In four patients, recording was lost after 5-10 minutes. In two, changes were observed at peak-of-dose but recording was then lost, whereas three completed recording and returned to baseline, all five showing significant reduction in GPi firing rate (mean +/- standard deviation for basal and post-apomorphine were 143+/-55.6 and 52+/-19.2, respectively; p <0.002)., Conclusion: In patients with PD, apomorphine induces changes in GPi spontaneous discharge and modifies firing rates resembling recordings in normal primates. These findings show that clinical improvement as well as induction of dyskinesias following DA administration could be mediated by reduction of GPi outflow.
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- 1999
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304. Unilateral radiofrequency lesion versus electrostimulation of posteroventral pallidum: a prospective randomized comparison.
- Author
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Merello M, Nouzeilles MI, Kuzis G, Cammarota A, Sabe L, Betti O, Starkstein S, and Leiguarda R
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- Aged, Female, Globus Pallidus physiopathology, Humans, Male, Middle Aged, Neurologic Examination, Neuropsychological Tests, Parkinson Disease physiopathology, Postoperative Complications diagnosis, Prospective Studies, Treatment Outcome, Dominance, Cerebral physiology, Electric Stimulation Therapy instrumentation, Electrosurgery, Globus Pallidus surgery, Microelectrodes, Parkinson Disease surgery, Psychosurgery
- Abstract
Microelectrode-guided posteroventral pallidotomy (PVP) has shown to be an effective method in the treatment of a group of patients with advanced Parkinson's disease. A nonlesioning approach by means of deep brain electrodes connected to a programmable neuropacemaker has also been used to inhibit the internal segment of globus pallidus (posteroventral stimulation [PVS]) reporting comparable clinical efficacy to the one obtained with the ablative method. Nevertheless, no controlled studies have been performed to compare the efficacy of both procedures. A prospective series of 13 patients with a clinical indication for globus pallidus surgery was randomized either to a pallidotomy or stimulator implantation, and comparisons on motor and neuropsychologic measurements were made on a 3-month follow-up basis. Primary measurements of efficacy showed a comparable effect on Unified Parkinson's Disease Rating Scale and activities of daily living score after both procedures. Secondary measurements of efficacy showed that although both techniques improve hand tapping score and dyskinesia score, the bilateral improvement in the former was greater after PVS whereas the latter improved more significantly after PVP. No significant changes in neuropsychologic parameters were observed after either PVP or PVS. Side effects and surgery complications occurred in six of 13 patients (three after PVP and three after PVS): they were mild, transient, and unrelated to optic tract injury. In conclusion, the short-time effect and safety of both procedures is comparable.
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- 1999
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305. Movement quality of repetitive self-paced single joint rapid arm movements on Parkinson's disease: acute effect of 1-dopa.
- Author
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Merello M, Balej J, Starkstein S, and Leiguarda R
- Abstract
Most studies on single-joint ballistic movements in PD have reported smaller differences between ON and OFF states than those exhibited when PD patients are compared with normal controls. We developed a mathematical model (quality of movement coefficient, QMC), which represents a combination of the diverse kinematic variables applicable to repetitive ballistic movements and depicting the differences between normal subjects and PD patients as well as disclosing changes induced by 1-dopa. Seven patients were evaluated in ON and OFF states. An optoelectronic system (SELSPOT II) was used to digitize movement trajectories. Patients were instructed to repetitively flex and extend the forearms maximizing speed during 20 s. Seven normal controls were also evaluated. Significant differences were found in the QMC between ON and OFF states (ANOVA p < 0.0 1) and between patients and normal controls (ANOVA p < 0.04). Moreover, QMC significantly correlated with UPDRS motor score in both ON and OFF states [R2 F(1,5) = 12.06; p < 0.01]. In conclusion, we found that QMC seems to be a sensitive indicator of Parkinsonian disabilities as well as of 1-dopa effect.
- Published
- 1998
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306. [Clarification of "DRG and PRG in infarction"].
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Bezante GP, Brunelli C, Pasdera A, Spallarossa P, Merello MR, Rossettin P, Zorzet F, and Caponnetto S
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- Humans, Diagnosis-Related Groups, Myocardial Infarction
- Published
- 1998
307. Confirmation of the antidyskinetic effect of posteroventral pallidotomy by means of an intraoperative apomorphine test.
- Author
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Merello M, Cammarota A, Nouzeilles MI, Betti O, and Leiguarda R
- Subjects
- Aged, Dyskinesia, Drug-Induced physiopathology, Female, Follow-Up Studies, Globus Pallidus physiopathology, Humans, Intraoperative Complications physiopathology, Male, Middle Aged, Neurologic Examination, Parkinson Disease physiopathology, Sensitivity and Specificity, Treatment Outcome, Antiparkinson Agents, Apomorphine, Dyskinesia, Drug-Induced diagnosis, Globus Pallidus surgery, Intraoperative Complications diagnosis, Parkinson Disease surgery
- Abstract
We present a series of six consecutive Parkinson's disease patients undergoing posteroventral pallidotomy (PVP), who received an apomorphine injection after thermolesioning the posteroventral region of the internal globus pallidus (GPi) to evaluate the effect of the lesion on drug-induced dykinesias and therefore to proceed with further lesions or to conclude the surgery. Five of six patients failed to present dykinesias or did so to a significantly lesser degree (F [2,10] 42.6; p < 0.0001) so that surgery was concluded. One patient continued having contralateral dyskinesia despite an improvement in rigidity and bradykinesia, therefore, a new track was performed followed by a new lesion. No differences were found between intrasurgical and 1-month postoperative apomorphine test values. This report indicates that the use of an apomorphine test after thermolesioning may provide a reliable tool to check lesion efficacy on dyskinesia. The development of techniques that provide additional clinical information to the electrophysiological recording could help improve the outcome of patients undergoing pallidotomy.
- Published
- 1998
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308. Changes in the motor response to acute L-dopa challenge after unilateral microelectrode-guided posteroventral pallidotomy.
- Author
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Merello M, Nouzeilles MI, Cammarotta A, Pikielny R, and Leiguarda R
- Subjects
- Adult, Analysis of Variance, Antiparkinson Agents pharmacology, Combined Modality Therapy, Dose-Response Relationship, Drug, Female, Humans, Levodopa therapeutic use, Male, Microelectrodes, Middle Aged, Neurologic Examination, Prospective Studies, Antiparkinson Agents therapeutic use, Globus Pallidus surgery, Levodopa pharmacology, Motor Activity drug effects, Parkinson Disease drug therapy, Parkinson Disease surgery
- Abstract
To determine the effect of unilateral posteroventral pallidotomy (PVP) on latency and duration of response to L-dopa ipsilateral and contralateral to the side of the lesion, six severe fluctuating Hoehn-Yahr IV patients with Parkinson's disease were evaluated 2 days before and after unilateral PVP. After an overnight drug holiday in a fasting state, patients were challenged with a single dose of 200/50 mg of L-dopa/ carbidopa. Sequential tapping tests every 5 minutes in both hands were used to measure changes in motor status. Duration of L-dopa effect was significantly longer after PVP (p < 0.03). Mean latency of the effect improved by 50% without reaching statistical significance. Despite a clear, asymmetric improvement of cardinal Parkinson's disease symptoms after unilateral PVP, changes in the dose-response L-dopa profile occurred symmetrically, suggesting that mechanisms underlying the two effects are distinct.
- Published
- 1998
309. Apomorphine responses in Parkinson's disease and the pathogenesis of motor complications.
- Author
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Colosimo C, Merello M, Hughes AJ, Sieradzan K, and Lees AJ
- Subjects
- Disease Progression, Humans, Levodopa therapeutic use, Parkinson Disease physiopathology, Antiparkinson Agents therapeutic use, Apomorphine therapeutic use, Motor Activity drug effects, Parkinson Disease drug therapy
- Published
- 1998
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310. Depression in classic versus akinetic-rigid Parkinson's disease.
- Author
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Starkstein SE, Petracca G, Chemerinski E, Tesón A, Sabe L, Merello M, and Leiguarda R
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- Aged, Chi-Square Distribution, Comorbidity, Cross-Sectional Studies, Female, Humans, Hypokinesia epidemiology, Male, Middle Aged, Muscle Rigidity epidemiology, Parkinson Disease classification, Prevalence, Tremor epidemiology, Depression epidemiology, Depressive Disorder epidemiology, Parkinson Disease epidemiology
- Abstract
We examined the prevalence of major depression and dysthymia in 78 patients with the classic variant of Parkinson's disease (PD) (that is, tremor plus rigidity and/or bradykinesia), and in 34 patients with the akinetic-rigid variant. Although the prevalence of dysthymia was similar in both groups (classic PD, 31%; and akinetic-rigid PD, 32%), patients with akinetic-rigid PD had a significantly higher prevalence of major depression (38% versus 15%, respectively; p < 0.01). A stepwise regression analysis demonstrated that bradykinesia was the extrapyramidal sign with the highest correlation with Hamilton depression scale scores. Our findings demonstrate a significant association between major depression and the akinetic-rigid type of PD.
- Published
- 1998
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311. [Cost analysis for DRG and PRG in the treatment of acute myocardial infarction in hospitalized patients].
- Author
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Bezante GP, Brunelli C, Pasdera A, Spallarossa P, Merello MR, Rossettin P, Zorzet F, and Caponnetto S
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- Budgets, Costs and Cost Analysis, Humans, Diagnosis-Related Groups, Inpatients, Myocardial Infarction economics, Myocardial Infarction therapy
- Abstract
The cost of diagnostic and therapeutic procedures in patients with acute myocardial infarction (AMI) during hospitalization was determined using both the Diagnosis Related Group (DRG) and Process Related Group (PRG) systems. This cost-analysis system was planned and performed to estimate the cost of medical and non-medical staff involved in patient care, as well as commensurate costs. Over a three-month period, 45 patients discharged with a diagnosis of AMI, equivalent to 410 code ICD-9-CM, were enrolled in the study. The collected data were then processed and the cost for each DRG was derived. The mean cost borne for each patient with AMI was 5,864,345 Italian lire with a maximum of 17,138,300 lire for DRG 112 and a minimum of 3,332,329 lire for DRG 123. Our data suggest that in patients with AMI, there is profound discrepancy between the current DRG reimbursements and "real" cost, for example in DRG 112 (a discrepancy equivalent to 166%). The cost difference is essentially related to different procedures involved in medical care and, therefore, it follows that the overall cost of patient with AMI is primarily related to PRG cost and is largely independent of other components. These results prove that therapeutic strategies are very important in determining the cost for each DRG and that the cost for each DRG can change in relation to the PRG performed and to the progression of illness. The utilization of DRG and PRG systems appears to be an essential tool that can be used to build a system in which not only efficiency but also quality of care are evaluated.
- Published
- 1997
312. Involuntary movements during thermolesion predict a better outcome after microelectrode guided posteroventral pallidotomy.
- Author
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Merello M, Cammarota A, Betti O, Nouzeilles MI, Cerquetti D, Garcia H, Pikielny R, and Leiguarda R
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Stereotaxic Techniques, Electric Stimulation, Globus Pallidus physiopathology, Globus Pallidus surgery, Movement Disorders physiopathology, Parkinson Disease physiopathology, Parkinson Disease surgery
- Abstract
Eight of the first 15 patients with advanced Parkinson's disease who underwent microelectrode guided posteroventral pallidotomy developed transient abnormal involuntary movements during thermolesion, four of whom also did so during high frequency macrostimulation. Abnormal involuntary movements found before thermolesion were choreic, ballistic, or choreoathetoid in nature, usually persisted less than 60 minutes, and were contralateral to the site of thermolesion in six and bilateral in two of them. The appearance of abnormal involuntary movements during macrostimulation or thermolesion of the internal globus pallidus correlated with better surgical outcome as measured by UPDRS motor items and CAPIT timed test, so that they seem to be of prognostic value.
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- 1997
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313. Sleep benefit in Parkinson's disease.
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Merello M, Hughes A, Colosimo C, Hoffman M, Starkstein S, and Leiguarda R
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- Aged, Female, Humans, Levodopa pharmacology, Male, Middle Aged, Parkinson Disease drug therapy, Prospective Studies, Surveys and Questionnaires, Time Factors, Antiparkinson Agents pharmacology, Circadian Rhythm drug effects, Motor Activity drug effects, Parkinson Disease physiopathology, Sleep drug effects
- Abstract
Sleep benefit (SB) In Parkinson's disease (PD) is not well characterized. To determine SB frequency, as well as to characterize and correlate it with other disease variables, we evaluated prospectively a consecutive series of 312 PD patients by means of a structured questionnaire: 55% reported having SB and 35% reported that awakening was their best time of the day. Because of SB, 21% of the entire population were able to skip or delay medication. The mean duration of the phenomenon was 85.4 +/- 67 min. Patients with SB were significantly older (p < 0.0002), had disease longer (p < 0.05), and were often men (chi 2 = 3.5, df 1, p = 0.05). Patients with SB took sleep medication with similar frequency as those without SB. There were no differences in hours of sleep or sleep latency. Sleep problems such as nightmares or somnambulism, but not the number of sleep awakenings, were similar in both groups. In conclusion, SB is a frequent phenomenon, especially in men, elderly patients, and patients with longer disease duration. SB enables the morning L-dopa dose to be postponed in approximately 50% of patients.
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- 1997
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314. Correlation between results of motor section of UPDRS and Webster Scale.
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Nouzeilles MI and Merello M
- Subjects
- Aged, Antiparkinson Agents, Apomorphine, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Neurologic Examination methods, Parkinson Disease physiopathology, Predictive Value of Tests, Retrospective Studies, Severity of Illness Index, Motor Activity drug effects, Neurologic Examination standards, Parkinson Disease diagnosis
- Published
- 1997
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315. [Contrast echocardiography: current trends and future prospects].
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Bezante GP, Merello MR, and Caponnetto S
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- Humans, Echocardiography instrumentation, Echocardiography trends
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- 1997
316. Comparison of subcutaneous apomorphine versus dispersible madopar latency and effect duration in Parkinson's disease patients: a double-blind single-dose study.
- Author
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Merello M, Pikielny R, Cammarota A, and Leiguarda R
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- Administration, Oral, Double-Blind Method, Drug Combinations, Enzyme Inhibitors therapeutic use, Female, Humans, Injections, Subcutaneous, Male, Middle Aged, Parkinson Disease physiopathology, Antiparkinson Agents therapeutic use, Apomorphine therapeutic use, Aromatic Amino Acid Decarboxylase Inhibitors, Benserazide therapeutic use, Levodopa therapeutic use, Parkinson Disease drug therapy
- Abstract
Twelve parkinsonian patients with severely fluctuating symptoms were given a single dose of apomorphine or Dispersible Madopar on 2 consecutive days, to confirm the latter drug's usefulness in "off" period rescue. According to our results, apomorphine proved faster in reverting "off" periods and should still be regarded as the drug of choice for this treatment modality.
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- 1997
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317. Apraxia in Parkinson's disease, progressive supranuclear palsy, multiple system atrophy and neuroleptic-induced parkinsonism.
- Author
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Leiguarda RC, Pramstaller PP, Merello M, Starkstein S, Lees AJ, and Marsden CD
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- Adult, Aged, Antipsychotic Agents adverse effects, Apraxias physiopathology, Female, Frontal Lobe physiopathology, Humans, Male, Middle Aged, Movement, Neuropsychological Tests, Olivopontocerebellar Atrophies psychology, Parkinson Disease, Secondary psychology, Psychomotor Performance, Supranuclear Palsy, Progressive physiopathology, Supranuclear Palsy, Progressive psychology, Apraxias complications, Olivopontocerebellar Atrophies complications, Parkinson Disease, Secondary complications, Supranuclear Palsy, Progressive complications
- Abstract
We studied 45 non-demented patients with Parkinson's disease (PD), 12 with progressive supranuclear palsy (PSP), 10 with multiple system atrophy (MSA) and 12 with neuroleptic-induced parkinsonism (NIP) for the presence of apraxia. Our aim was to determine whether a standard comprehensive assessment of different praxic functions would demonstrate specific types of errors not attributable to bradykinesia, rigidity, tremor or any other abnormal elementary motor deficit. PD patients on chronic levodopa treatment were examined in the 'on' and 'off' (treatment) states. Based on apraxia assessment scores, bilateral ideomotor apraxia for transitive movements was found in eight (75%) and 12 (27%) of PSP and PD patients, respectively. Ideomotor apraxia was mainly characterized by spatial errors (i.e., external and internal configuration, body-part-as-object and trajectory). Four PSP but no PD patients exhibited ideomotor apraxia for intransitive movements. PSP as well as PD patients with ideomotor apraxia also had difficulties in imitating hand and finger postures, but none of them failed on pantomime comprehension and pantomime recognition/discrimination. Some PSP patients exhibited, in addition, a limbkinetic type of apraxia and a minority of them displayed deficits on tasks involving multiple steps. Neither MSA nor NIP patients showed any disturbance of praxic functions. There were no differences in age, disease duration, Mini Mental State Examination (MMSE), Unified Parkinson's disease Rating Scale and Hoehn-Yahr scores between apraxic and non-apraxic PD patients, and ideomotor apraxia scores were similar in the 'on' and 'off' states. A correlation was found between ideomotor apraxia scores in PD patients and deficits in frontal lobe-related neuropsychological tasks such as the Tower of Hanoi, verbal fluency and the Trail Making Test. Furthermore, PD patients with apraxia showed higher Hamilton depression scores than non-apraxic PD patients. In PSP patients, ideomotor apraxia scores correlated significantly with cognitive deficit as measured with MMSE. The presence or absence of cortical involvement, and its severity and distribution might determine the presence and type of apraxia in PD and PSP. Apraxia in these conditions would therefore reflect combined cortico-striatal dysfunction.
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- 1997
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318. SPECT findings in Alzheimer's disease and Parkinson's disease with dementia.
- Author
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Starkstein SE, Vázquez S, Petracca G, Sabe L, Merello M, and Leiguarda R
- Abstract
We examined, with single photon emission tomography (SPECT) and (99mTc)-HMPAO, 18 patients with idiopathic Parkinson's disease and no dementia (PD), 12 patients with PD and dementia, 24 patients with probable Alzheimer's disease (AD), and 14 controls. While the three patient groups showed significantly lower perfusion in frontal inferior and temporal inferior areas as compared to controls, both demented groups showed significantly more severe bilateral hypoperfusion in superior frontal, superior temporal and parietal areas as compared to non-demented PD patients and controls. On the other hand, no significant differences in cerebral perfusion were found between patients with AD and patients with PD and dementia. In conclusion, our findings demonstrated specific but similar cerebral perfusion deficits in demented patients with either AD or PD.
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- 1997
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319. Drug-induced parkinsonism in schizophrenic patients: motor response and psychiatric changes after acute challenge with L-Dopa and apomorphine.
- Author
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Merello M, Starkstein S, Petracca G, Cataneo EA, Manes F, and Leiguarda R
- Subjects
- Adult, Analysis of Variance, Antipsychotic Agents adverse effects, Cross-Over Studies, Double-Blind Method, Female, Humans, Parkinson Disease, Secondary physiopathology, Psychiatric Status Rating Scales, Schizophrenia physiopathology, Antiparkinson Agents therapeutic use, Apomorphine therapeutic use, Levodopa therapeutic use, Motor Activity drug effects, Parkinson Disease, Secondary drug therapy, Parkinson Disease, Secondary etiology, Schizophrenia chemically induced, Schizophrenia drug therapy
- Abstract
Acute single-dose response of drug-induced parkinsonism (DIP) to L-Dopa and apomorphine challenge was evaluated in a double-blind crossover study in 12 schizophrenic patients. There were two noteworthy negative findings. First, neither L-Dopa nor apomorphine produced significant improvements in DIP and second, no changes (neither improvement nor worsening) were found in patients' psychiatric status. Findings suggest that, for a stimulation dose reaching almost 90% of the responsive dose for idiopathic Parkinson's disease, no significant changes may reasonably be expected in the parkinsonism of schizophrenic patients treated with neuroleptic drugs.
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- 1996
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320. Neuropsychological and psychiatric differences between Alzheimer's disease and Parkinson's disease with dementia.
- Author
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Starkstein SE, Sabe L, Petracca G, Chemerinski E, Kuzis G, Merello M, and Leiguarda R
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- Aged, Alzheimer Disease complications, Cognition Disorders complications, Cognition Disorders diagnosis, Female, Humans, Infant, Newborn, Male, Parkinson Disease complications, Alzheimer Disease diagnosis, Alzheimer Disease psychology, Neuropsychological Tests, Parkinson Disease diagnosis, Parkinson Disease psychology, Psychiatric Status Rating Scales
- Abstract
Objective: To examine neuropsychological and neuropsychiatric differences between patients with probable Alzheimer's disease and patients with Parkinson's disease and dementia., Methods: Thirty three patients with probable Alzheimer's disease and 33 patients with Parkinson's disease and dementia were matched for age, sex, and mini mental state examination scores and given a battery of neuropsychological and neuropsychiatric tests., Results: Patients with Parkinson's disease with dementia had a significantly higher prevalence of major depression than patients with Alzheimer's disease; patients with Alzheimer's disease showed more severe anosognosia and disinhibition than patients with Parkinson's disease. Whereas no significant between group differences were found on tests of memory and language, demented patients with Parkinson's disease had a significantly greater impairment on a test of visual reasoning than patients with Alzheimer's disease., Conclusion: There were significant psychiatric differences between patients with Alzheimer's disease and demented patients with Parkinson's disease, but neuropsychological differences were restricted to a single cognitive domain.
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- 1996
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321. Motor response to acute dopaminergic challenge with apomorphine and levodopa in Parkinson's disease: implications for the pathogenesis of the on-off phenomenon.
- Author
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Colosimo C, Merello M, Hughes AJ, Sieradzan K, and Lees AJ
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- Aged, Antiparkinson Agents administration & dosage, Apomorphine administration & dosage, Carbidopa administration & dosage, Drug Therapy, Combination, Female, Humans, Levodopa administration & dosage, Male, Middle Aged, Antiparkinson Agents pharmacology, Antiparkinson Agents therapeutic use, Apomorphine pharmacology, Apomorphine therapeutic use, Carbidopa pharmacology, Carbidopa therapeutic use, Dopamine metabolism, Levodopa pharmacology, Levodopa therapeutic use, Motor Activity drug effects, Parkinson Disease drug therapy
- Abstract
Objectives: To evaluate the contribution of postsynaptic changes to motor fluctuations, three groups of parkinsonian patients with differing responses to treatment were acutely challenged with two dopaminergic drugs-apomorphine and levodopa-having different mechanisms of action., Methods: Forty two patients with Parkinson's disease (14 untreated, eight with a stable response to levodopa, and 20 with levodopa induced motor fluctuations) were challenged on two consecutive days with apomorphine and levodopa. The latency, duration, and magnitude of motor response was measured., Results: A progressive shortening of mean latency after levodopa challenge was found passing from the untreated to the stable and fluctuating groups; the difference between untreated and fluctuating patients was statistically significant (P < 0.01). Response duration after levodopa challenge was similar in untreated and stable patients, whereas it showed a significant shortening in patients with motor fluctuations (P < 0.05 v both untreated and stable patients). When subcutaneous apomorphine was given, untreated patients had a longer response duration than those who had developed motor fluctuations (P < 0.05). Although baseline disability was significantly greater in the fluctuating patients than in the untreated and stable patients, the severity of residual parkinsonian signs after both apomorphine and levodopa challenge was similar for all three groups; as a result, the degree of improvement in parkinsonian signs after dopaminergic stimulation was substantially greater in more advanced than in early cases. Linear regression analysis also indicated that latency and duration after apomorphine challenge did not significantly correlate with those after levodopa challenge, whereas magnitude of response to apomorphine showed a strong positive correlation with that after levodopa challenge (r = 0.9, P < 0.001)., Conclusion: The progressive shortening of motor response after both apomorphine and levodopa suggests that pharmacodynamic factors play an important part in determining the duration of motor response and argue against altered central pharmacokinetics of levodopa being principally responsible for the on-off effect. The widening response amplitude and increasing off phase disability occurring during disease progression are also critical factors in determining the appearance of motor fluctuations.
- Published
- 1996
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322. Amantadine in parkinsonian patients unresponsive to levodopa: a pilot study.
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Colosimo C, Merello M, and Pontieri FE
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pilot Projects, Treatment Outcome, Amantadine therapeutic use, Antiparkinson Agents therapeutic use, Levodopa therapeutic use, Parkinson Disease drug therapy
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- 1996
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323. Catatonia in depression: prevalence, clinical correlates, and validation of a scale.
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Starkstein SE, Petracca G, Tesón A, Chemerinski E, Merello M, Migliorelli R, and Leiguarda R
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- Aged, Apomorphine therapeutic use, Case-Control Studies, Catatonia drug therapy, Dopamine Agents therapeutic use, Female, Humans, Interview, Psychological, Male, Middle Aged, Prevalence, Reproducibility of Results, Severity of Illness Index, Catatonia diagnosis, Catatonia etiology, Depressive Disorder complications, Psychiatric Status Rating Scales standards
- Abstract
Objectives: To examine the clinical correlates of catatonia in depression, to validate a scale for catatonia, and to assess the validity of the DSM-IV criteria of the catatonic features specifier for mood disorders., Methods: A series of 79 consecutive patients with depression and 41 patients with Parkinson's disease without depression were examined using the modified Rogers scale (MRS), the unified Parkinson's disease rating scale (UPDRS), and the structured clinical interview for DSM-III-R (SCID)., Results: Sixteen of the 79 depressed patients (20%) had catatonia. Depressed patients with catatonia had significantly higher scores on the MRS than non-catatonic depressed patients matched for severity of depression, or non-depressed patients with Parkinson's disease matched for severity of motor impairment. Depressed patients with catatonia were older, had a significantly higher frequency of major depression, more severe cognitive impairments, and more severe deficits in activities of daily living than depressed non-catatonic patients. The DSM-IV criteria of catatonia separated depressed catatonic patients from patients with Parkinson's disease matched for motor impairment, with a specificity of 100%. Catatonic signs did not improve after apomorphine., Conclusions: catatonia is most prevalent among elderly patients with severe depression. The study showed the validity of the MRS for the diagnosis of catatonia in depressed patients, as well as the specificity of the DSM-IV criteria of the catatonic features specifier.
- Published
- 1996
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324. Preclamol. A "designer drug" in the treatment of advanced Parkinson's disease.
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Pirtosek Z, Merello M, Carlsson A, and Stern G
- Subjects
- Humans, Antiparkinson Agents therapeutic use, Dopamine Agonists therapeutic use, Parkinson Disease drug therapy, Piperidines therapeutic use
- Published
- 1996
325. A SPECT study of parkinsonism in Alzheimer's disease.
- Author
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Starkstein SE, Vazquez S, Merello M, Tesón A, Petracchi M, and Leiguarda R
- Subjects
- Aged, Alzheimer Disease complications, Alzheimer Disease psychology, Cerebrovascular Circulation physiology, Female, Humans, Male, Movement Disorders diagnostic imaging, Movement Disorders etiology, Muscle Rigidity diagnostic imaging, Muscle Rigidity etiology, Neurologic Examination, Neuropsychological Tests, Parkinson Disease complications, Parkinson Disease physiopathology, Psychiatric Status Rating Scales, Tomography, Emission-Computed, Single-Photon, Alzheimer Disease diagnostic imaging, Brain diagnostic imaging, Parkinson Disease diagnostic imaging
- Abstract
The authors examined the presence of significant regional cerebral blood flow (rCBF) differences between Alzheimer's disease (AD) patients with and without extrapyramidal signs (EPS). Nine patients with probable AD and EPS (resting tremor or rigidity and bradykinesia) and 9 AD patients without EPS, comparable in age, duration of illness, and global cognitive decline, were studied with [99mTc]HMPAO SPECT. Patients with AD and EPS showed significantly lower rCBF in the superior frontal, superior temporal, and parietal regions of the left hemisphere than AD patients without EPS. Rigidity and bradykinesia independently accounted for the decreased rCBF in these areas. These findings suggest that the presence of EPS in AD may result from dysfunction in specific brain regions.
- Published
- 1995
- Full Text
- View/download PDF
326. [Treatment of motor fluctuations in Parkinson's disease with subcutaneous injections of apomorphine].
- Author
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Merello M and Leiguarda R
- Subjects
- Aged, Aged, 80 and over, Analysis of Variance, Apomorphine adverse effects, Apomorphine therapeutic use, Follow-Up Studies, Humans, Injections, Subcutaneous, Middle Aged, Movement, Prospective Studies, Time Factors, Apomorphine administration & dosage, Parkinson Disease drug therapy, Parkinson Disease physiopathology
- Abstract
Sixteen patients with Parkinson's disease and severe motor fluctuations were treated with subcutaneous injections of apomorphine and followed up prospectively for a year. The use of the drug improved the number of daily "off" hours by 52%, while treatment efficacy remained constant for a year without the appearance of tolerance (ANOVA with repeated measurements:p = 0.0002). No severe adverse effect or any justifying treatment discontinuance were recorded. Apomorphine proved a safe and reliable drug for the treatment of motor fluctuations.
- Published
- 1995
327. Extrapyramidalism in Alzheimer's disease: prevalence, psychiatric, and neuropsychological correlates.
- Author
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Merello M, Sabe L, Teson A, Migliorelli R, Petracchi M, Leiguarda R, and Starkstein S
- Subjects
- Aged, Alzheimer Disease physiopathology, Apomorphine, Case-Control Studies, Dementia diagnosis, Dementia epidemiology, Depressive Disorder diagnosis, Depressive Disorder epidemiology, Female, Humans, Interview, Psychological, Male, Neuropsychological Tests, Parkinson Disease, Secondary diagnosis, Parkinson Disease, Secondary epidemiology, Parkinson Disease, Secondary physiopathology, Prevalence, Severity of Illness Index, Alzheimer Disease complications, Alzheimer Disease psychology, Dementia etiology, Depressive Disorder etiology, Extrapyramidal Tracts physiopathology, Parkinson Disease, Secondary etiology
- Abstract
The prevalence and clinical correlates of extrapyramidal signs in a consecutive series of 78 patients with Alzheimer's disease attending a neurology clinic, and 20 age comparable normal controls, were examined. Based on the unified Parkinson's disease rating scale (UPDRS) findings, 18 patients (23%) met criteria for parkinsonism, 44 (56%) had isolated extrapyramidal signs, and 16 (21%) had no extrapyramidal signs. Whereas the control group showed a similar prevalence of isolated extrapyramidal signs (57%), none of them showed parkinsonism. No significant differences were found for age, sex, duration of illness, and severity of dementia among the three Alzheimer's disease groups. Patients with Alzheimer's disease-parkinsonism, however, showed a significantly higher frequency of major depression and dysthymia and significantly higher Hamilton depression scores than patients with isolated or no extrapyramidal signs. Patients with Alzheimer's disease-parkinsonism also showed significantly more deficits on frontal lobe related tasks such as the Wisconsin card sorting test, trail making test, and verbal fluency, as well as on tests of constructional praxis and abstract reasoning than patients with Alzheimer's disease but no extrapyramidal signs. In conclusion, the study showed a specific association between Alzheimer's disease and parkinsonism, as well as significant relations between parkinsonism, deficits in executive functions, and depression among patients with Alzheimer's disease.
- Published
- 1994
- Full Text
- View/download PDF
328. Clinical usefulness of apomorphine in movement disorders.
- Author
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Colosimo C, Merello M, and Albanese A
- Subjects
- Apomorphine administration & dosage, Dystonia drug therapy, Humans, Huntington Disease drug therapy, Neuroleptic Malignant Syndrome drug therapy, Parkinson Disease drug therapy, Antiparkinson Agents therapeutic use, Apomorphine therapeutic use, Dopamine Agonists therapeutic use, Movement Disorders drug therapy
- Abstract
Apomorphine, the first dopamine agonist to be synthesized, has received a renewed interest in the last few years. This compound acts powerfully on D1 and D2 dopamine receptors and has the most complete pharmacological profile of all clinically available dopamine agonists. When given subcutaneously, apomorphine consistently reverses levodopa-resistant "off" periods in parkinsonian subjects: thus, it is used in cases with severe motor fluctuations, either by continuous infusion with a portable pump or by multiple injections. Studies based on this approach have been highly encouraging, as they have shown a significant reduction in off time and a good drug tolerability. The main side effect has been the occurrence of nodular skin lesions, especially when continuous infusions were used. At variance with other dopamine agonists, a low incidence of psychiatric morbidity has been reported with apomorphine. The few available comparative reports have shown that this compound is more potent and better tolerated than lisuride. Parenteral apomorphine has been used in Parkinson's disease (PD) to replace levodopa after surgery or to treat the malignant syndrome brought about by sudden levodopa withdrawal. Acute challenge with apomorphine has been used to test dopaminergic responsiveness in parkinsonian syndromes and in dystonia. The clinical response to apomorphine may predict the effect of a chronic therapy with levodopa in approximately 90% of PD cases. Further studies are still necessary to evaluate the exact relationship between the acute response to apomorphine and a chronic therapy. In addition, apomorphine has been used to conduct clinical pharmacological studies in PD, for it is particularly well suited for research on the pharmacodynamics of central dopamine receptors. In summary, apomorphine appears to be an efficacious and safe drug for the treatment of advanced PD. It must still be considered under clinical evaluation as a test drug for acute challenge in PD and dystonia. Finally, in our opinion, the available data suggest apomorphine (in conjunction with domperidone) as a first-choice treatment for the neuroleptic malignant syndrome and the temporary replacement of levodopa (e.g., after gastrointestinal surgery).
- Published
- 1994
- Full Text
- View/download PDF
329. The nature of apraxia in corticobasal degeneration.
- Author
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Leiguarda R, Lees AJ, Merello M, Starkstein S, and Marsden CD
- Subjects
- Aged, Apraxias psychology, Basal Ganglia Diseases psychology, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Regression Analysis, Apraxias physiopathology, Basal Ganglia Diseases physiopathology, Cerebral Cortex physiopathology
- Abstract
Although apraxia is one of the most frequent signs in corticobasal degeneration, the phenomenology of this disorder has not been formally examined. Hence 10 patients with corticobasal degeneration were studied with a standardised evaluation for different types of apraxia. To minimise the confounding effects of the primary motor disorder, apraxia was assessed in the least affected limb. Whereas none of the patients showed buccofacial apraxia, seven showed deficits on tests of ideomotor apraxia and movement imitation, four on tests of sequential arm movements (all of whom had ideomotor apraxia), and three on tests of ideational apraxia (all of whom had ideomotor apraxia). Ideomotor apraxia significantly correlated with deficit in both the mini mental state examination and in a task sensitive to frontal lobe dysfunction (picture arrangement). Two of the three patients with ideomotor apraxia and ideational apraxia showed severe cognitive impairments. The alien limb behaviour was present only in patients with ideomotor apraxia. In conclusion, ideomotor apraxia is the most frequent type of apraxia in corticobasal degeneration, and may be due to dysfunction of the supplementary motor area. There is a subgroup of patients with corticobasal degeneration who have a severe apraxia (ideomotor and ideational apraxia), which correlates with global cognitive impairment, and may result from additional parietal or diffuse cortical damage.
- Published
- 1994
- Full Text
- View/download PDF
330. Effect of entacapone, a peripherally acting catechol-O-methyltransferase inhibitor, on the motor response to acute treatment with levodopa in patients with Parkinson's disease.
- Author
-
Merello M, Lees AJ, Webster R, Bovingdon M, and Gordin A
- Subjects
- Aged, Catechols therapeutic use, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Levodopa pharmacokinetics, Male, Middle Aged, Nitriles, Parkinson Disease metabolism, Parkinson Disease physiopathology, Treatment Outcome, Catechol O-Methyltransferase Inhibitors, Catechols pharmacology, Levodopa therapeutic use, Parkinson Disease drug therapy, Psychomotor Performance drug effects
- Abstract
Catechol-O-methyltransferase (COMT) inhibitors may be useful in the treatment of Parkinson's disease by improving the bioavailability of levodopa and by prolonging its effects. Entacapone (OR-611), a novel COMT inhibitor, which does not cross the blood brain barrier, was assessed in 12 patients with Parkinson's disease and motor fluctuations in a randomised, double-blind, cross-over, single dose study. The magnitude and duration of the therapeutic response to a single dose of 200 mg levodopa/50 mg carbidopa was evaluated after concomitant placebo, or 200 or 800 mg entacapone. A significant increase in the duration of the motor response to levodopa was seen when 200 mg entacapone was given with levodopa/carbidopa. Plasma levodopa concentrations were increased with both doses of the COMT inhibitor. The latency to onset of motor response did not differ significantly between active drug and placebo. Entacapone may prove useful in prolonging the duration of the benefit obtained from individual doses of levodopa.
- Published
- 1994
- Full Text
- View/download PDF
331. Masticatory muscle spasm in a non-Japanese patient with Satoyoshi syndrome successfully treated with botulinum toxin.
- Author
-
Merello M, García H, Nogués M, and Leiguarda R
- Subjects
- Dose-Response Relationship, Drug, Electromyography drug effects, Humans, Injections, Intramuscular, Male, Masticatory Muscles physiopathology, Middle Aged, Spasm physiopathology, Syndrome, Masticatory Muscles drug effects, Spasm drug therapy
- Abstract
A non-Japanese patient with Satoyoshi syndrome is presented. Severe masticatory muscle spasms interfered with feeding, but were successfully treated with botulinum toxin.
- Published
- 1994
- Full Text
- View/download PDF
332. Preclamol and parkinsonian fluctuations.
- Author
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Pirtosek Z, Merello M, Carlsson A, and Stern G
- Subjects
- Antiparkinson Agents administration & dosage, Apomorphine administration & dosage, Apomorphine pharmacology, Blood Pressure drug effects, Dopamine Agonists administration & dosage, Dopamine Agonists pharmacology, Female, Humans, Injections, Subcutaneous, Male, Middle Aged, Movement drug effects, Piperidines administration & dosage, Receptors, Dopamine D1 agonists, Receptors, Dopamine D2 agonists, Antiparkinson Agents therapeutic use, Parkinson Disease drug therapy, Piperidines therapeutic use
- Abstract
Preclamol, the (-)enantiomer of 3-PPP (= 3(3-hydroxyphenyl)-N-n-propyl piperidine), has a selective dopamine autoreceptor- and postsynaptic mixed agonist-antagonist profile. Its action on patients with disabling on-off parkinsonian fluctuations has been studied and compared with those of placebo and subcutaneous apomorphine. Preclamol had a mild but unequivocal antiakinetic effect, less than that caused by subcutaneous apomorphine, but it provoked less dyskinesia. Further studies to explore the therapeutic potential of preclamol seem justified.
- Published
- 1993
333. Bromocriptine-induced dystonia in patients with aphasia and hemiparesis.
- Author
-
Leiguarda R, Merello M, Sabe L, and Starkstein S
- Subjects
- Adult, Aged, Aphasia drug therapy, Brain diagnostic imaging, Dystonia diagnostic imaging, Female, Humans, Male, Middle Aged, Tomography, X-Ray Computed, Aphasia complications, Bromocriptine adverse effects, Dystonia chemically induced, Hemiplegia complications
- Abstract
Five of seven patients with chronic nonfluent aphasia and hemiparesis due to a focal ischemic infarction developed painful hemidystonia during treatment with a high dose of bromocriptine. All seven patients had cortical damage, but four also had basal ganglia and one thalamic involvement. While lesion location did not differ between dystonic and nondystonic patients, the dystonic patients had more weakness than those without dystonia.
- Published
- 1993
- Full Text
- View/download PDF
334. Inverse masticatory muscle activity due to syringobulbia.
- Author
-
Merello M, Lees AJ, Leiguarda R, Guevara J, and Nogués M
- Subjects
- Adult, Brain Stem physiopathology, Female, Humans, Magnetic Resonance Imaging, Mastication physiology, Masticatory Muscles innervation, Medulla Oblongata physiopathology, Muscle Contraction physiology, Neuromuscular Diseases etiology, Syndrome, Syringomyelia complications, Trigeminal Nerve physiopathology, Masticatory Muscles physiopathology, Neuromuscular Diseases physiopathology, Syringomyelia physiopathology
- Abstract
The clinical, radiological, and electrophysiological data of a 25-year-old woman with "inverse masticatory muscle activity" due to syringobulbia is presented. This uncommon brain stem syndrome may be due to a disturbance in central programming of mastication.
- Published
- 1993
- Full Text
- View/download PDF
335. Abnormal sympathetic skin response in patients with autoimmune vitiligo and primary autoimmune hypothyroidism.
- Author
-
Merello M, Nogues M, Leiguarda R, López Saubidet C, and Florin A
- Subjects
- Electromyography, Female, Humans, Male, Middle Aged, Reaction Time physiology, Autoimmune Diseases physiopathology, Galvanic Skin Response physiology, Hypothyroidism physiopathology, Vitiligo physiopathology
- Abstract
The sympathetic skin response was studied in 21 patients with autoimmune vitiligo or hypothyroidism or both. No response to stimulation was found in 6 patients, but 4 with both diseases showed abnormal results. Sympathetic skin response is useful in evaluating sudomotor activity of the autonomic nervous system, and it is concluded that patients with autoimmune vitiligo, autoimmune hypothyroidism and especially those with both diseases show evidence of sudomotor dysfunction.
- Published
- 1993
- Full Text
- View/download PDF
336. [Spinal arachnoiditis as a complication of peridural anesthesia].
- Author
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Torres D, Bauso Toselli L, Vecchi E, Leiguarda R, Doctorovich D, Merello M, Guevara J, and Nogues M
- Subjects
- Adolescent, Adult, Arachnoiditis diagnosis, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Anesthesia, Epidural adverse effects, Arachnoiditis etiology
- Abstract
Seven patients who received epidural anesthesia for gynecological (5 cases), cosmetic (1 case) or general surgery (1 case) developed spinal arachnoiditis leading to subarachnoid cyst in all 7 and cord cavitation in 5. MRI was useful to show the subarachnoid and intramedullary cysts, as well as to monitor lesion extent and progress. Associated MRI findings were a Chiari anomaly in one case, a tethered cord in another and spinal cord atrophy in a third. One patient refused surgery but improved spontaneously while the other six were treated by a shunting procedure, with a satisfactory outcome in three. Meningeal inflammation may have left scars which later induced ischemia and subsequent cavitation. Alternatively, CSF circulation blockade may have dilated the central spinal canal causing ischemia by compression, followed by myelomalacia and cavitation. Careful handling of this procedure is urged in order to avoid such severe complications.
- Published
- 1993
337. Beginning-of-dose motor deterioration following the acute administration of levodopa and apomorphine in Parkinson's disease.
- Author
-
Merello M and Lees AJ
- Subjects
- Adult, Apomorphine administration & dosage, Apomorphine adverse effects, Female, Humans, Injections, Subcutaneous, Levodopa administration & dosage, Levodopa adverse effects, Male, Middle Aged, Movement Disorders complications, Parkinson Disease complications, Parkinson Disease physiopathology, Apomorphine therapeutic use, Levodopa therapeutic use, Parkinson Disease drug therapy
- Abstract
Six Parkinsonian patients on long term levodopa therapy complained of short-lived deterioration of Parkinsonian symptoms immediately after levodopa intake. After withdrawal of the drug overnight, and following an oral challenge with levodopa/carbidopa (250/25) in all six cases, and with subcutaneous apomorphine (3 mg) in two, deterioration below base line levels of disability were observed which would not be explained by loss of sleep benefit. This occurred 10-20 minutes after levodopa challenge and lasted for 10-20 minutes. The latency and duration of this phenomenon were shorter with apomorphine but the characteristics were similar. This phenomenon may be due to an inhibitory effect of levodopa acting via presynaptic dopamine receptors.
- Published
- 1992
- Full Text
- View/download PDF
338. SEPs and CNS magnetic stimulation in syringomyelia.
- Author
-
Nogués MA, Pardal AM, Merello M, and Miguel MA
- Subjects
- Adult, Evoked Potentials physiology, Female, Humans, Magnetic Resonance Imaging, Magnetics, Male, Neural Conduction physiology, Syringomyelia diagnosis, Syringomyelia surgery, Central Nervous System physiopathology, Evoked Potentials, Somatosensory physiology, Motor Cortex physiology, Syringomyelia physiopathology
- Abstract
Somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) to transcranial and spinal stimulation from upper and lower limb muscles were elicited in 13 patients with syringomyelia. Seven had an associated Chiari type I anomaly. Diagnosis was confirmed by MRI. In 5 cases, SEPs and MEPs were performed before and after surgical treatment. Prolonged central motor conduction times or absent motor responses in upper or lower limbs were found in most patients. The greatest number of abnormalities was disclosed by measurement of CMCT followed by SEPs after tibial nerve stimulation. Two of 5 cases undergoing surgery improved clinically and showed reduction in CMCT after surgical treatment. Our study shows that MEPs were useful in the evaluation of neurophysiological status in syringomyelia patients, helping to estimate anterolateral spinal cord function.
- Published
- 1992
- Full Text
- View/download PDF
339. Cardiovascular reflexes in Parkinson's disease: effect of domperidone and apomorphine.
- Author
-
Merello M, Pirtosek Z, Bishop S, and Lees AJ
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Apomorphine adverse effects, Blood Pressure drug effects, Domperidone adverse effects, Heart Rate drug effects, Parkinson Disease drug therapy
- Abstract
Cardiovascular reflexes were evaluated in 18 patients with idiopathic Parkinson's disease who had a Hoehn & Yahr score of III-IV. The effect of apomorphine and domperidone on blood pressure, heart rate, R-R interval variation, and the Valsalva ratio were studied. Autonomic dysfunction was not found in the patients and there were no differences between subgroups of patients on different treatments. Apomorphine altered cardiovascular reflexes to a greater degree in patients who received the drug for the first time than in chronically treated patients. The changes were antagonized by domperidone, a peripheral dopamine receptor antagonist. Apomorphine treated patients who were receiving long-term domperidone had similar abnormalities of cardiovascular reflexes to those who had been able to withdraw it.
- Published
- 1992
- Full Text
- View/download PDF
340. Impaired levodopa response in Parkinson's disease during melanoma therapy.
- Author
-
Merello M, Esteguy M, Perazzo F, and Leiguarda R
- Subjects
- Adult, Dacarbazine therapeutic use, Dopamine blood, Drug Interactions, Humans, Male, Melanins urine, Melanoma drug therapy, Parkinson Disease complications, Skin Neoplasms drug therapy, Dacarbazine adverse effects, Levodopa therapeutic use, Melanoma complications, Parkinson Disease drug therapy, Skin Neoplasms complications
- Abstract
A patient with melanoma and sporadic positive melanuria developed Parkinson's disease. Treatment with levodopa failed to modify tumoral progress. However, during chemotherapy with dacarbazine, the patient experienced a significant impairment to levodopa response.
- Published
- 1992
- Full Text
- View/download PDF
341. Subarachnoid and intramedullary cysts secondary to epidural anesthesia for gynecological surgery.
- Author
-
Nogués MA, Merello M, Leiguarda R, Guevara J, and Figari A
- Subjects
- Adult, Arachnoid Cysts surgery, Female, Follow-Up Studies, Humans, Laminectomy, Magnetic Resonance Imaging, Middle Aged, Neurologic Examination, Postoperative Complications surgery, Pregnancy, Spinal Cord Compression surgery, Tomography, X-Ray Computed, Anesthesia, Epidural adverse effects, Anesthesia, Obstetrical adverse effects, Arachnoid Cysts diagnosis, Cesarean Section, Fibroma surgery, Genital Neoplasms, Female surgery, Postoperative Complications diagnosis, Spinal Cord Compression diagnosis
- Abstract
Three women who received epidural anesthesia for gynecological surgery developed spinal arachnoiditis leading to subarachnoid cysts and cord cavitation. MRI was useful to show the subarachnoid and intramedullary cysts, as well as to monitor lesion extent and progress. Associated MRI findings were a Chiari anomaly in 1 case and a tethered cord in another. Two cases underwent surgery: 1 improved, but the other suffered progressive neurological deterioration. Although the 3rd patient had no treatment, there was spontaneous reduction in cavity size and clinical improvement. Careful handling of this procedure is urged to avoid such severe complications in young mothers.
- Published
- 1992
- Full Text
- View/download PDF
342. [Convulsions induced ty OKT3?].
- Author
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Merello M, Nogués M, Leiguarda R, Dávalos M, and Jost L
- Subjects
- Adult, Female, Humans, Immunosuppressive Agents adverse effects, Muromonab-CD3 adverse effects, Seizures chemically induced
- Published
- 1991
343. Dystonia and reflex sympathetic dystrophy induced by ergotamine.
- Author
-
Merello MJ, Nogués MA, Leiguarda RC, and López Saubidet C
- Subjects
- Dystonia diagnosis, Dystonia physiopathology, Ergotamine administration & dosage, Foot physiopathology, Humans, Male, Middle Aged, Migraine Disorders drug therapy, Reflex Sympathetic Dystrophy diagnosis, Reflex Sympathetic Dystrophy physiopathology, Dystonia chemically induced, Ergotamine adverse effects, Reflex Sympathetic Dystrophy chemically induced
- Abstract
A 59-year-old man developed dystonia and reflex sympathetic dystrophy after receiving high doses of ergotamine for migraine treatment. Ischemia is suggested as the precipitating factor.
- Published
- 1991
- Full Text
- View/download PDF
344. [Significance of the presence of anti-heart antibodies in some cardiopathies].
- Author
-
Barabino A, Di Benedetto G, Indiveri F, Merello MA, Puppo F, and Soldà AM
- Subjects
- Arthritis, Rheumatoid immunology, Cardiomyopathies immunology, Coronary Disease immunology, Humans, Lupus Erythematosus, Systemic immunology, Myocardial Infarction immunology, Rheumatic Fever immunology, Scleroderma, Systemic immunology, Thyroid Diseases immunology, Thyroid Gland immunology, Autoantibodies analysis, Heart Diseases immunology, Myocardium immunology
- Published
- 1974
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