Clinical and experimental neurology
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Results of 3 tests, intravenous edrophonium chloride, EMG, and acetylcholine receptor antibody testing, were compared in patients with generalised and ocular myasthenia gravis. None of the 3 tests was positive in any patient with a diagnosis other than myasthenia. ⋯ Edrophonium testing was superior in ocular myasthenia gravis. Although the yields from each test varied, all 3 tests were needed for the evaluation of some myasthenia gravis patients as each test may provide additional information.
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A family incorporating 2 interesting variants of trigeminal and glossopharyngeal neuralgia is presented. The familial occurrence of these cranial neuralgias spanning 3 generations is very unusual. ⋯ Furthermore, the coincidence of trigeminal and glossopharyngeal neuralgia in the same person is quite exceptional, despite the anatomical contiguity of the sensory territories of the fifth and ninth cranial nerves. These features suggest firstly that there must be an important constitutional factor in the aetiology of the cranial neuralgia, and secondly that in many cases there is a centronuclear rather than cranial nerve ganglionic pathogenesis of the pain.
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Clinical Trial Controlled Clinical Trial
An evaluation of bromocriptine in the treatment of Parkinson's disease.
22 patients entered a double-blind trial to test the efficacy of bromocriptine therapy in patients with Parkinson's disease already established on conventional levodopa therapy. 3 patients on placebo withdrew when no improvement occurred and control became complicated. 4 patients on active drug withdrew because of various symptoms, but in only 1 case were these (nausea and vomiting) thought to be a real drug effect. Of the 15 patients who completed the trial, 9 were on active drug and 6 were on placebo. ⋯ Side effects encountered included nausea, dyskinesiae and hallucinations. It is concluded that bromocriptine does not offer any additional benefit in most patients with Parkinson's disease who are well stabilised on levodopa therapy, but may have a place in those patients who encounter side effects due to fluctuations in serum and tissue levels of levodopa.
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Two patients with signs of alcoholic brain disease of the Wernicke-Korsakoff type were found to have an unusual movement disorder manifested basically as a resting tremor. Electrographic recording showed that the tremor wave comprised multiple elements, though the rate of the basic tremor was stable. Though the tremor was qualitatively similar to documented rubral tremor, a mesencephalic lesion could be defined in only 1 patient.