Acute Parkinsonism Research Articles

Klassifikation OG Prævalens Af Ekstrapyramidale Syndromer Hos Psykiatriske Patienter I Neuroleptisk Langtidsbehandling

Neuroleptic-induced neurological side effects have usually been classified as acute dystonia, Parkinsonism, akathisia and tardive dyskinesia (TD). Recent observations in monkeys and man have revealed that classification in this way is over-simplified because nearly identical extrapyramidal syndromes may appear as a result of 1) neuroleptic treatment, 2) withdrawal of neuroleptic treatment and initiation of anticholinergic treatment, or 3) age and/or the psychotic process. The aim of the present study was to determine the prevalence of the these first two syndromes.Two hundred and two long-term neuroleptically treated psychiatric inpatients were evaluated 1) during treatment with their usual neuroleptic medication, but without anticholinergics for 2 days, and 2) after treatment with anticholinergics for 14 days, the last two of which the neuroleptic treatment was stopped. Patients with extrapyramidal symptoms were divided into subgroups depending on response to this pharmacological manipulation: those who ...

The "neuroleptic" antipsychotic drugs. 2. Neurologic side effects.

The specific neurologic side effects of the antipsychotic agents include acute dystonias, parkinsonism, motor restlessness, and late choretoathetosis. Treatment of the acute reactions is usually effected by the use of anticholinergic agents; treatment of the later dyskinesias is unsatisfactory, and these reactions are to be avoided by judicious use of antipsychotic drugs for long-term treatment.

Persistent dyskinesia after long-term treatment with neuroleptics in Japan: its present status and clinical problems.

The studies on drug-induced persistent dyskinesia in Japan began only in the late nineteen-sixties, while the first historical description of the symptom by French authors was published in 1959. Then, at first, the literatures re-ported by Japanese workers were briefly reviewed and the prevalences, char-acteristics of the patients and correlations between the manifestation of the symptoms and characteristics of psychotropic drugs were summarized.Secondly, two clinically important problems were discussed from the findings of 19 dyskinetic patients in Minakawa Mental Hospital. The first problem was concerned with the reversibility of persistent dyskinesia and the second with the relationship between persistent dyskinesia and other types of extrapyramidal reactions.In conclusion, it was stressed that the earlier diagnosis and earlier re-moval of the drug were important for the prophylaxis of irreversible persistent dyskinesia and that close relationship of persistent dyskinesia with the other types of extrapyramidal reaction (acute dyskinesia, akathisia and parkin-sonism) should be taken into consideration for the prediction of the symptom.

Extrapyramidal reactions and amine metabolites in cerebrospinal fluid during haloperidol and clozapine treatment of schizophrenic patients

8 male schizophrenic patients participated in a double-blind, cross over study of the extrapyramidal side-effects of haloperidol and clozapine (acute dystonis, Parkinsonism and tardive dyskinesia), together with their effect on homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF). Haloperidol (9 mg/day) caused Parkinsonism, reduced tardive dyskinesias and increased the HVA concentration in the CSF. Clozapine (225 mg/day) had no effect on the neurological phenomena but reduced HVA and 5-HIAA concentrations in the CSF. During the discontinuation phase following the administration of haloperidol, tardive dyskinesia occurred or was aggravated; this did not occur after administration of clozapine. Accordingly, it is suggested that clozapine does not induce dopaminergic hypersensibility and, therefore, will not induce tardive dyskinesias.

Neurological Syndromes Associated With Antipsychotic Drug Use

Acute dystonias, akathisia, and parkinsonism have long been recognized as extrapyramidal side effects which occur in susceptible individuals who are taking neuroleptic (antipsychotic) drugs. These side effects often occur early in treatment and they usually respond to dosage reduction and/or the addition of corrective medication. More recently a quite different syndrome, tardive dyskinesia has been found to be associated with antipsychotic drug use. Many aspects of the characteristics, etiology, prevention, and treatment of this variegated set of symptom complexes are very unclear at this time. However, patients who clearly show this syndrome are not uncommon and the condition sometimes persists with little improvement for periods of one to two years or indefinitely. The condition does not respond to antiparkinsonian medication. The Neuropharmacology Division of the Bureau of Drugs, the Food and Drug Administration (FDA), and the American College of Neuropsychopharmacology have recognized the seriousness of these complications and established a

Subakute sklerosierende leukoencephalitis unter dem initialbild einer akuten epidemischen encephalitis (akute parkinsonistische encephalitis) mit ausgeprägter entwicklung von Maulbeerzellen und Russell-Körperchen

During a minor epidemic of influenzal infections with slight accompanying meningitic and encephalitic symptoms, a 23-year-old patient, after a 2- to 3-month initial stage, showed a rapidly evolving Parkinsonian syndrome with generalized myoclonia. With rising temperature, loss of consciousness, focal cramps and pareses and signs of decortication with akinetic mutism developed. The original clinical picture of “acute encephalitic Parkinsonism” had given rise to the false diagnosis of epidemic lethargic encephalitis (Von Economo's disease). The neuropathological findings showed subacute, sclerosing leukoencephalitis with only very discrete demyelinization as well as perivascular and diffuse interstitial lymphoplasmocellular infiltrations with morular-cells and Russell's bodies. These findings apparently correspond to a very specific stage of the disease characterized by special immunological defensive mechanisms. This could be related to the conspicuous transformation of the clinical symptoms with rise of temperature and an increasing protein, especially globulin, content of the cerebrospinal fluid. The assumption is suggested that the “delayed” appearance of electroencephalographic findings with the periodically-occurring complexes of sharp and slow waves typical of SSLE are connected with peculiarities in the clinical course of the disease.