Movement disorders : official journal of the Movement Disorder Society
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Randomized Controlled Trial Clinical Trial
A pilot, double-blind, placebo-controlled trial of pregabalin (Lyrica) in the treatment of essential tremor.
We performed a pilot, double-blind, placebo-controlled, randomized trial to evaluate the efficacy and tolerability of pregabalin (PGB, Lyrica), an antiepileptic agent, in treating essential tremor (ET). Twenty two patients with ET were randomly assigned to receive PGB or placebo. PGB was initiated at 50 mg/day and was escalated by 75 mg/day every 4 days to a maximum dose of 600 mg/day. ⋯ PGB was fairly well tolerated, with about one-third of patients dropping out of the study because of adverse events. PGB provided significant improvements in accelerometry and in action tremor limb scores on the FTM. However, larger studies are needed to further evaluate the potential effect of PGB on ET.
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Letter Case Reports
Epileptic myoclonus as ciprofloxacin-associated adverse effect.
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Repetitive transcranial magnetic stimulation (rTMS) delivered at 5 Hz frequency and suprathreshold (RMT) intensity produces a progressive facilitation of motor-evoked potential (MEP) amplitude that outlasts the end of stimulation. This phenomenon is related to a short-term enhancement of cortical excitatory interneurones. In this study, we investigated whether 5 Hz-rTMS elicits similar MEP facilitation during stimulation and similar facilitatory after-effects in patients with upper limb dystonia and healthy subjects. ⋯ MEP amplitudes during and after 1 Hz-rTMS remained unchanged. Ulnar nerve stimulation did not change the test MEP amplitude. We conclude that in patients with upper limb dystonia there is an abnormal recovery from MEP facilitation after suprathreshold 5 Hz-rTMS suggesting an abnormal pattern of short-term cortical plasticity.
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Patients with Parkinson's disease (PD) have difficulty performing tasks relying on inhibitory control and working memory, functions of the prefrontal cortex. Eye movement paradigms can be used to investigate basic sensorimotor functions and higher order cognitive aspects of motor control. This study investigated inhibitory control and spatial working memory in the saccadic system of 13 individuals with mild-moderate PD and 13 age-matched controls. ⋯ Results for the PD group indicated an increased percentage of response selection errors during an oddball task, reduced suppression of inappropriate reflexive saccades during memory-guided tasks (but not during fixation or saccade-engagement tasks), and an increased percentage of express and anticipatory saccades. Spatial working memory was preserved in the PD group during single and two-step memory-guided tasks. These findings are consistent with dysfunction within fronto-striatal and prefrontal-collicular pathways influencing suppression and selection of eye movements.
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Depression is a common comorbid condition in Parkinson's disease (PD) and a major contributor to poor quality of life and disability. However, depression can be difficult to assess in patients with PD due to overlapping symptoms and difficulties in the assessment of depression in cognitively impaired patients. As several rating scales have been used to assess depression in PD (dPD), the Movement Disorder Society commissioned a task force to assess their clinimetric properties and make clinical recommendations regarding their use. ⋯ To account for overlapping motor and nonmotor symptoms of depression, adjusted instrument cutoff scores may be needed for dPD, and scales to assess severity of motor symptoms (e.g., UPDRS) should also be included to help adjust for confounding factors. The HADS and the GDS include limited motor symptom assessment and may, therefore, be most useful in rating depression severity across a range of PD severity; however, these scales appear insensitive in severe depression. The complex and time-consuming task of developing a new scale to measure depression specifically for patients with PD is currently not warranted.