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Assessing Paediatric Development in Psychiatry
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
The neurones that inter-connect the nuclei are either excitatory (glutaminergic) or inhibitory (GABAergic) in nature, and signals are facilitated by different neurotransmitters, as indicated in the parentheses. A third set of neurones, thought to have both excitatory and inhibitory functions, depending on circumstances, originate in the substantia nigra and utilise dopamine as a chemical messenger. It is these neurones that degrade in Parkinson’s disease and lead to the gradual onset of paucity of movement seen in these patients. L-DOPA, one of the drugs used to treat Parkinson’s, is one of the breakdown products of dopamine that is metabolically active, i.e. binds to the receptors on the postsynaptic membrane of dopaminergic synapses and so exerts the same effects as dopamine.
Propionic acidemia
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
An infant who presented with a pure hyperammonemia picture without ketoacidosis is shown in Figure 2.7. MRI of the brain revealed extensive atrophy (Figure 2.8). An unusual patient [22] was diagnosed at 31 years of age after admission to a psychiatric hospital where he was admitted for bizarre behavior and studied further because of involuntary movements. We have observed MRI evidence of hypodense myelin, along with areas of increased signal in the basal ganglia [20]. We have also encountered a metabolic stroke in an eight-year-old patient with propionic acidemia in which there was virtually complete infarction of the basal ganglia followed by death [23, 24]. We have been informed about a similar patient who did not die, but remained in a vegetative state. A 15-year-old diagnosed neonatally suddenly developed a stroke of the basal ganglia from which he ultimately recovered [25]. Assessment of cerebral vessels showed no abnormality. Treatment with L-DOPA appeared to be beneficial.
The presentation and management of physical disease in older people
Published in David Beales, Michael Denham, Alistair Tulloch, Community Care of Older People, 2018
L-dopa commonly causes nausea, hallucinations, confusion, severe orthostatic hypotension and constipation. Nausea can be countered by giving small more frequent doses and adding the dopa antagonist domperidone (which only seems to penetrate the brain stem). Hallucinations may be controlled by small doses and by avoiding L-dopa soon before bedtime. It is wise to check a mental test score before and after initiating therapy in frail patients, and to check lying and standing blood pressure in all. When the equivalent of 600 mg of L-dopa per day (given in 62.5 mg increments or in a sustained release formulation) is not proving effective control, it is time for a specialist referral. Tremor is more likely to respond to an anti-cholinergic such as benzhexol 1 mg once or twice daily, but be on the look out for hallucinations and confusion. Nevertheless, some patients require and can be maintained on L-dopa and an anti-cholinergic to great benefit.
Real-world safety and effectiveness of rotigotine in patients with Parkinson’s disease: analysis of a post-marketing surveillance study in Japan
Published in International Journal of Neuroscience, 2022
Hidefumi Ito, Tomoyo Takayama, Hiroyuki Kondo, Yasuhiko Fukuta
Throughout the follow-up period, the dosage of l-dopa remained almost unchanged (approximately 450 mg/day). The overall LED increased by approximately 160 mg/day; however, rotigotine was of low dose. This finding could have been caused by (1) low, additional doses of rotigotine causing an improvement in symptoms by, (2) the slow progression of PD [30], and there was no necessity for immediate dose increase from a risk–benefit perspective based on the physicians from their observation of the symptoms and progression status of the patients, and (3) many elderly patients in the study population, and (4) possibility of the follow-up ending during the switching of drugs. If a certain degree of improvement in symptoms was achieved by a low dose of rotigotine and improvement in the Quality of Life were achieved, a careful determination of the DA dose increases according to the patient’s condition while maintaining a uniform l-dopa dose is considered. This would reflect the actual situation in clinical practice, which would leave the door open for further dose increases in cases of disease progression.
Manganese concentration in patients with encephalopathy following ephedrone use: a narrative review and analysis of case reports
Published in Clinical Toxicology, 2022
Michal Ordak, Natalia Sloniewicz, Tadeusz Nasierowski, Elzbieta Muszynska, Magdalena Bujalska-Zadrozny
Literature data indicate that people with advanced diseases are commonly admitted to clinics. The problem is that, according to patients, these disorders appear after a few or several weeks [17,19]. It is possible that patients with milder symptoms early in the course of the disease may have lower manganese concentrations. L-DOPA preparations, as well as other anti-Parkinsonian drugs, have proved to be ineffective. Drugs that speed up the excretion of manganese from the body have been found to reduce the likelihood of disease progression but do not contribute significantly to the regression of symptoms [37,38]. Future studies should include treatment in a larger group of patients, namely comparing the efficacy of intravenous ethylenediaminetetraacetic acid (EDTA) in these patients, para-aminosalicylic acid (PAS), or supplements of iron ions to test its manganese chelating properties [39,40].
The potential role of 2D-speckle tracking echocardiography for detecting left ventricular systolic dysfunction in patients with Parkinson’s disease: a case control study
Published in Acta Cardiologica, 2021
Mostafa Osama El Mokadem, Amr Hassan, Mona Hussein, Yousef Mohsen Mohamed
In our study 92.5% of PD patients were treated with L-dopa. 28 PD patients were treated with dopamine agonists (Pramipexole). There are multiple mechanisms that may explain the occurrence of myocardial dysfunction in patients with PD. One of these mechanisms is that Levodopa (L-dopa), the mainline of therapy in PD, was found to increase serum homocysteine levels [17]. Homocysteine is a well-known risk factor for cardiovascular disease [18]. This makes PD patients at increased risk of atherosclerosis and ischaemic heart disease. However, this assumption is not convincing in presence of homogenous peaks of regional systolic strain in addition to bull’s-eye analysis being not consistent with specific coronary artery territory. Our speculations were in agreement with Günaydın et al. They conducted a study to assess the effect of treatment with L-dopa on left ventricular global systolic function using speckle tracking technique compared with the control group. They found similar values of EF and GLS in both groups [19].