Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tardive dyskinesia can be suppressed by drugs that block dopaminergic receptors, but often at the cost of a concomitant increase in parkinsonism. Sulpiride (400 -- 2100 mg/day), a selective type-2 dopamine receptor antagonist, was evaluated in a blind, placebo-controlled trial in 11 patients with tardive dyskinesia. It significantly (P less than 0.01) reduced tardive dyskinesia without significantly affecting parkinsonism, although three patients had a increase in preexisting parkinsonian hypokinesia and tremor. During the placebo phase, the tardive dyskinesia and parkinsonian scores returned to the pretreatment values. There was no relationship between either tardive dyskinesia or parkinsonism and eye blinking rates. These results are consistent with the hypothesis that more than one population of dopamine receptors are involved in controlling extrapyramidal function. Sulpiride is an important tool for elucidating both the practical and heuristic aspects of subtypes of dopamine receptors and is a lead in the search for compounds that selectively affect dopaminergic mechanisms.
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PMID:Sulpiride in tardive dyskinesia. 4 75

Bromocriptine, a dopamine receptor agonist, was administered to 20 patients with idiopathic parkinsonism taking levodopa (L-dopa) or "Sinemet" (levodopa combined with carbidopa in a 10/1 ratio) at optimum doses. In a double-blind randomised cross-over study lasting 6 months, the addition of bromocriptine (mean daily dose 79 mg) led to a significant (P less than 0.01) 74% reduction in the dose of sinemet and levodopa. "Total disability score" showed a significant (P less than 0.01) improvement at both low and high doses of bromocriptine. Tremor improved 50% (P less than 0.01), with significant improvements in gait, posture, writing, balance, rigidity, finger dexterity, and drooling. Adverse reactions were similar to those observed with sinemet and levodopa. Although both the cause and the cure of idiopathic parkinsonism remain elusive, bromocriptine appears to represent a therapeutic advance.
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PMID:Bromocriptine and levodopa (with or without carbidopa) in parkinsonism. 5 50

Single unit activity in primary spindle afferent nerve fibres from finger and foot flexors was recorded with tungsten microelectrodes inserted into the median and peroneal nerves of healthy subjects. During voluntary fast alternating finger and foot movements, simulating the tremor of Parkinsonism, two types of discharges were seen in the Ia afferent fibres: (1) stretch responses occurring during the flexor relaxation phases, and (2) discharges occurring during the flexor contraction phases. Contrary to the stretch responses the spindle contraction discharges could be eliminated by a partial lidocaine block of the muscle nerve proximal to the recording site, indicating that they resulted from fusimotor activation of intrafusal fibres. On the basis of the temporal relations between the beginning and end of individual EMG-bursts, the start of the spindle contraction discharges and the latency of the stretch reflex in the muscles concerned, the following conclusions were drawn: the recurrent extrafusal contractions in movements of this type are initiated by the fast direct alpha route, but individual contraction phases generally last long enough to be influenced subsequently by the coactivated fusimotor loop through the spindles. It is postulated that this gamma loop influence during alternating movements helps to keep flexor and extensor muscles working in a regular reciprocal fashion with contractions adjusted in strength to the external loads.
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PMID:Muscle spindle activity in man during voluntary fast alternating movements. 12 82

Single unit activity in spindle afferent nerve fibres from the finger flexors, the anterior tibial muscle, and the calf muscles was recorded intraneurally with tungsten microelectrodes in patients with Parkinsonism with resting tremor and in spastic patients with clonus. During tremor of Parkinsonism, involving the receptor bearing muscles, the Ia afferent fibre discharge patterns were similar to those seen previously in healthy subjects during voluntary fast alternating finger or foot movements: besides the stretch discharges occurring during the relaxation phases, discharges also occurred during the contraction phases. Such contraction discharges, presumed to originate from intrafusal muscle fibre contractions, were not seen in the spastic patients during clonus. During the clonic oscillations each afferent stretch discharge was regularly followed by a stretch reflex contraction which on its falling phase elicited a new volley of impulses in the Ia afferent fibres. The findings are considered to support the notion that, like the contractions in normal voluntary alternating movements, the contractions in tremor of Parkinsonism are organized according to the principle of alpha-gamma coactivation, whereas the contractions in clonus are stretch reflexes causing pure alpha contractions.
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PMID:Muscle spindle activity in alternating tremor of Parkinsonism and in clonus. 12 83

Eight hundred and eight subjects participated in three surveys of random samples of people aged 65 years or more living in their own homes. Neurological history and examination showed the prevalence of completed stroke to be 73 per 1000. Eighty-seven subjects per 1000 gave a history of transient cerebral ischaemic attacks. These prevalence rates were unaffected by age or sex. Senile dementia was diagnosed in 24 subjects per 1000 under 75 years and 109 per 1000 over that age. The prevalence of dementia of all types was 43 per 1000 under, and 140 per 1000, over 75 years of age. Parkinsonism was diagnosed in 16 subjects per 1000, and essential tremor in 17 per 1000. The prevalence of epilepsy was four subject per 1000. Other neurological disorders were diagnosed in 36 subjects, and a similar number had neurological abnormalities to which a definite diagnosis could not be given.
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PMID:Neurological disorders in the elderly at home. 18 Feb 57

The practical value of measuring plasma concentrations is to optimize treatment in order to attain the best balance in each particular patient between wanted clinical therapeutic effects and unwanted adverse and side-effects. This increase in treatment efficacy can be concurrent--that is, the treatment is monitored and the dosage changed as necessary--or predictive, where the results of a test dose can be used to calculate the appropriate dosage. Wanted effects include: (1) the attainment of adequate drug concentrations for the minimum period of time necessary, as in the use of antibiotics; (2) the suppression of symptoms, as in the use of the benzodiazepines in anxiety states; (3) the use of drugs to improve function, e.g. levodopa in Parkinsonism; (4) drugs are used to prevent episodes of illness; and (5) complex suppression of symptoms, as with the antidepressives and antipsychotics. The biological alternatives to plasma level monitoring depend on establishing an empirical relationship between the putative monitor and the clinical response. Such measures avoid the problem of estimation of drug concentration at the receptor. Examples include monoamine oxidase activity in platelets, the uptake of amines into platelets, neuroendocrine measures such as prolactin concentrations, the electroencephalogram, and peripheral measures such as pulse rate, pupil size and tremor.
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PMID:Drug concentrations in neuropsychiatry: alternative approaches. 26 86

Paralysis agitans may be mimicked by other disease processes and drugs which disturb the structural or functional integrity of the dopaminergic nigrostriatal system. In another group of patients, isolated symptoms or signs such as tremor or increased muscle tone are considered out of the context of the total clinical picture and may suggest parkinsonism.
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PMID:Differential diagnosis of paralysis agitans. 26 20

This review covers recent advances in a variety of dyskinesias. Introduction of new drugs for the treatment of myoclonus and sensory biofeedback therapy for focal dystonia are expanding our concepts of these types of movement disorders. Progress in the treatment of action myoclonus is especially noteworthy and has led to the implication of serotonin deficit in the pathophysiology of this syndrome. Knowledge of the biochemical pathology of Huntington's chorea has outpaced therapy for this disorder, but new forms of therapy have been proposed based on the chemical findings. Basic pharmacologic studies suggest pathophysiologic mechanisms for the syndrome known as tardive dyskinesia, but treatment is still far from ideal for this disorder. Other movement disorders with recent therapeutic advances include essential tremor and hemiballism. This review will cover only those dyskinesias in which new therapies have been advanced in the last few years. Aside from parkinsonism, which will not be discussed here, progress in the treatment of movement disorders has been slow, but steady. New drugs are being tested constantly, and the purpose of this review is to call attention to the ongoing evaluation in this field. Descriptions and etiologies for these dyskinesias are covered elsewhere (Fahn, 1976a) and therefore are not repeated here.
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PMID:New approaches in the management of hyperkinetic movement disorders. 30 60

1. The effect of nomifensine was compared with that of placebo in a double-blind crossover study in patients with parkinsonism. 2. Of the 29 patients who entered the study, three were previously untreated and 26 continued their L-DOPA or other antiparkinsonian therapy, or both, during the trial. 3. Clinical assessments were made at fortnightly intervals throughout the study. 4. The most noticeable improvement during active treatment--namely, tremor, facial expression and finger flexion were moderate in extent. 5. When placebo was substituted for active drug a significant deterioration of physical signs and functional disability occurred (P less than 0.001). 6. Elderly patients fared less well than younger patients, and the most common adverse effect was involuntary movements.
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PMID:Nomifensine in parkinsonism. 33 22

An experimental anticholinergic drug, elantrine, had shown significant improvement in tremor of parkinsonism in 89 patients not taking L-dopa. A double-blind study of 22 parkinsonian patients stabilized on L-dopa showed marked improvement in tremor and moderate improvement in rigidity and bradykinesia when elantrine was added to their treatment program. Nine of 15 patients taking L-dopa (or Sinemet) and elantrine had cessation of all tremor and have continued free of tremor to date, over two years.
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PMID:Evaluation of an experimental anticholinergic drug, elantrine, in treating the tremor of parkinsonism. 33 73


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