L-Dopa and the treatment of extrapyramidal disease

Treatment of Parkinson's disease with agents other than levodopa and dopamine agonists: controversies and new approaches

Parkinson's disease is associated with a variety of neurotransmitter disturbances which may be further altered by its treatment with dopamine agonists. Based on this information a wide range of pharmacological approaches have been used in search of newer treatment alternatives and in hopes of reducing complications of long-term levodopa use. This paper reviews the various therapies which have had some success in the management of Parkinson's disease, other than levodopa and dopamine agonists. Special emphasis is placed on the many unresolved questions and controversies that exist in this area of neuropharmacology.

Spinocerebellar degeneration with parkinsonian features: a clinical and pathological report

A 20-year-old patient had spinocerebellar degeneration and parkinsonian tremor that improved with L-dopa treatment. Postmortem examination revealed posterior column atrophy in the spinal cord and severe degeneration in the substantia nigra. Atrophic changes were noted in deep cerebellar nuclei and superior cerebellar peduncles. This study confirms the relationships between clinical parkinsonism, substantia nigra atrophy, and the therapeutic effect of L-dopa.

A new distinction between the euphoric and the anti-depressant effects of methylamphetamine

The psychological effects of an injection of methylamphetamine have been measured in 22 drug-free patients with endogenous depressive illness and in 9 patients with other psychiatric illness. A new distinction between the time course of the euphoric and anti-depressant effects is described. The euphoric effects were seen in the first hour after the injection, but the anti-depressant effects were delayed for 1--3 hours and then lasted for as long as 36 hours. These findings are at variance with the noradrenaline depletion hypothesis of depressive illness which (in its simplest form) predicts an immediate alleviation of depression as a result of an immediate rise in the concentration of noradrenaline at central receptor sites.

The synaptic significance of metoclopramide induced dyskinetic-dystonic head and neck movements in pregnancy

Two young, pregnant women presenting dyskinetic-dystonic crises limited to head and neck (HNDD) due to metoclopramide (MP) were observed. Evidence has been brought for the specific extrapyramidal effect of dyskinetic-dystonic head and neck movements induced by MP in young females. The synaptic action of MP differs from that of the generally accepted dopamine receptor blocking neuroleptics such as the phenothiazines. Concomittant quasi opposing neuroleptic and nonneuroleptic like effects of this drug can not support the mechanism of dopamine receptor blockade as the explanation of the synaptic effect. The concept of "dopamine receptor imbalance" may explain the synaptic action of the metoclopramide.