Decreased serum selenium concentrations in patients with Parkinson's disease

Selenium is an essential component of the antioxidant enzyme glutathione peroxidase. The activity of this enzyme is reduced in the substantia nigra of patients with Parkinson's disease (PD), but the results of studies on erythrocytes are controversial. We compared the serum levels of selenium and the 24 h urinary selenium excretion (measured by hydride generation atomic absorption spectrophotometry) in 29 PD patients and 30 matched controls. Serum selenium levels were significantly lower in PD patients than in controls (34.6 ± 2.35 and 45.2 ± 3.83 μg/l, p < 0.05) while urinary excretion was similar for both groups (47.1 ± 6.25 and 45.5 ± 5.38 μg/24 h). These values were not influenced by antiparkinsonian drugs, and they did not correlate with age, age at onset and duration of the PD, scores of the Unified PD Rating Scale or the Hoehn and Yahr staging in the PD group. These results might suggest a possible role of low serum selenium levels in the risk for, or a consequence of the oxidative stress in PD.

Peripheral iron metabolism in patients with focal cerebral ischemia

To ascertain the possible role of iron as a risk factor for cerebral ischemia, we studied the serum levels of iron, transferrin and ferritin in 42 patients between the third and seventh days after a cerebral ischemic event (transient ischemic attack, reversible ischemic neurological deficit or cerebral infarction) and in 62 matched controls. The serum levels of iron did not differ significantly between cerebral ischemic patient and control groups. Serum transferrin levels were lower and ferritin higher in stroke patients than in controls. These values were not influenced by age, blood pressure, or smoking and alcohol drinking habits. These results suggest that iron stores could be related to the risk for cerebral ischemia.

Tau protein concentrations in cerebrospinal fluid of patients with amyotrophic lateral sclerosis

OBJECTIVE

To elucidate whether cerebrospinal fluid (CSF) concentrations of the microtubule-associated tau protein are related to the risk for sporadic amyotrophic lateral sclerosis (SALS).

PATIENTS/METHODS

We measured tau concentrations in the CSF of 18 patients with SALS and 75 age- and sex-matched controls, using a specific ELISA method.

RESULTS

The mean CSF concentrations of tau protein did not differ significantly between SALS patient and control groups, were not influenced by the clinical form (spinal vs bulbar) of ALS, and were not correlated with age, age at onset, and duration of the disease.

CONCLUSIONS

CSF tau concentrations are not a biochemical marker of ALS.

[Bilateral hand dystonia secondary to a bilateral opercular syndrome or Foix-Chavany-Marie syndrome]

INTRODUCTION

The main clinical feature of the opercular syndrome (Foix Chavany Marie) is the automatic voluntary dissociation of the facio glosso pharyngeal movements (that is, the alteration of voluntary motility with preservation of authomatic movements). Less frequently, it is presented with movement disorders as dystonia.

CASE REPORT

We report a male patient aged 40 years who developed a biopercular syndrome of vascular etiology (confirmed by neuroimaging), in the context or a clinical picture of global hipoxemia, for which the most outstanding clinical manifestation was the presence of dystonic posturing.

CONCLUSION

Although dystonia is usually related with damage or dysfunction of the basal ganglia or thalamus, in some case it can be caused by lesions in other locations, such as in some patients with biopercular syndrome as in the present case

[Do antioxidants in the diet affect the risk of developing Parkinson disease?]

OBJECTIVE

A number of studies suggest the existence of 'oxidative stress' in the substantia nigra from parkinsonian patients. If 'oxidative stress' should be relevant in the pathogenesis of Parkinson's disease (PD), the consumption of antioxidant or prooxidant substances in the diet could theoretically influence the risk for this disease.

DEVELOPMENT

A critical up to date review of the literature regarding premorbid consumption of antioxidants or prooxidants by PD patients and controls has been done. Most studies have been retrospective, they have been performed following different designs, and disclosed contradictory results.

CONCLUSION

From the current literature, it is unlikely that dietetic consumption of prooxidants and antioxidant, specially vitamin E (the most frequently studied antioxidant) have any influence on the risk for PD.

[Brown-Séquard syndrome as the initial clinical manifestation ofmultiple sclerosis]

Multiple sclerosis is a disorder with different forms of clinical presentation. The Brown-Séquard syndrome has occasionally been described in association with multiple sclerosis. We present the case of a patient whose initial clinical presentation of multiple sclerosis was the Brown-Séquard syndrome.

Bilateral primary writing tremor

Primary writing tremor is a task-specific tremor that is considered to be unilateral. We report a 59-year-old man with a 5-year history of a typical primary writing tremor in the right hand who developed similar symptoms in the left hand. Copyright 1998 Lippincott Williams & Wilkins

Cerebrospinal fluid carnitine levels in patients with Alzheimer's disease

We assessed free carnitine (FC) and acylcarnitine esters (AC) in both cerebrospinal fluid (CSF) and plasma from 24 patients with diagnostic criteria for Alzheimer's disease (AD), and from 28 healthy matched-controls. We found no significant correlation between FC and AC levels in CSF. FC and AC levels in CSF did not differ significantly between AD patients and controls, but plasma FC levels were significantly lower in AD patients. CSF and plasma FC and AC levels did not correlate with age, age at onset of AD, duration of AD, and scores of the Minimental State Examination of Folstein. Although these results suggest that CSF carnitine levels are apparently unrelated with the risk for AD, the trend of the FC/AC ratio to be higher in AD patients might suggest the possibility of a lower carnitine acetyltransferase activity in AD, as previously reported in some brain areas.

Cerebrospinal fluid nitrate levels in patients with Alzheimer's disease

It has been suggested that nitric oxide could be implicated in the pathogenesis of Alzheimer's disease (AD). Recently Kuiper et al. reported decreased CSF nitrate levels (oxidation product that provides an indirect estimation of nitric oxide) in AD patients, assessed with a colorimetric method. However other group, using a microplate version of the Griess reaction, did not confirm these findings. We studied the CSF and plasma levels of nitrate with kinetic cadmium-reduction method in 32 AD patients and 36 matched controls. The CSF and plasma nitrate levels did not differ significantly between the two study groups. CSF and plasma nitrate levels did not correlate with age at onset and duration in the patient group. These data suggest that CSF and plasma levels of nitrate are apparently unrelated with the risk for AD.

Plasma levels of inorganic sulfates in patients with Parkinson's disease

Some investigators reported pharmacogenetic differences in the metabolism of sulfur-containing drugs and lower plasma sulfate levels in patients with Parkinson's disease (PD) compared with controls. However, other group did not confirm these findings. We studied the plasma levels of sulfate by indirect atomic absorption spectrophotometry in 55 PD patients and 57 age and sex-matched controls. The plasma sulfate levels did not differ significantly between PD patients and control groups (mean +/- SEM 73 +/- 8 and 75 +/- 7 mg/l, respectively). They were not influenced by antiparkinsonian drugs and they did not correlate with age at onset, duration, Hoehn & Yahr staging or activities of daily living subscale of the Unified Parkinson's disease rating scale. There was a low but significant correlation of plasma sulfate levels with motor examination (r = -0.39, p < 0.05) and total score (r = -0.33, p < 0.05) of this scale in the PD group. These data suggest that plasma sulfate levels are apparently unrelated with the risk for PD.

[Dysfunction of the upper respiratory airways in patients with essential tremor]

OBJECTIVES

To investigate pulmonary function abnormalities in essential tremor.

METHODS

We obtained maximal inspiratory and expiratory flow-volume curves in 41 unselected patients with essential tremor (14 males, 27 females, age 61.7 +/- 2.14 years). Severity of essential tremor was evaluated using the Fahn, Tolosa and Marin clinical scale.

RESULTS

Sixteen patients (39.0%) had flow oscillations on the flow-volume curves (8 only during inspiration, 7 during inspiration and expiration, and 1 with flow oscillations during inspiration and obstructive pattern). The duration and severity of the essential tremor did not influence the pattern of the curve, but abnormal curves were more frequent in patients with voice tremor. Although there were a number of significant correlations between essential tremor scales and spirographic parameters, they were of very low range. Four patients (9.8%) fulfilled criteria for physiological upper airway obstruction: 2 had smooth flow-volume loop contour and 2 had flow oscillations in inspiration and expiration.

CONCLUSION

Abnormalities in flow-volume loop contour are a usual finding in essential tremor. This probably reflects involvement of the upper airway musculature, that in some patients can produce clinical upper airway obstruction.

Serum and urinary manganese levels in patients with Parkinson's disease

To elucidate the possible role of manganese in the risk of developing Parkinson's disease (PD), we compared serum levels of manganese, and 24-h manganese excretion by urine in 29 PD patients and in 27 matched controls. We also measured chromium and cobalt in the same samples. All these values did not differ significantly between the groups, they were not influenced by antiparkinsonian drugs, and they did not correlate with age, age at onset and duration of the PD, scores of the Unified PD Rating Scale or the Hoehn & Yahr staging in the PD group. These results might suggest that serum levels and urinary excretion of manganese are apparently unrelated to the risk of developing PD.

Plasma levels of nitrates in patients with Parkinson's disease

It has been suggested that nitric oxide (NO) could be implicated in the neuronal degeneration of substantia nigra compacta in patients with Parkinson's disease (PD). To ascertain the possible role of NO as risk factor for PD, we studied the plasma levels of nitrate (oxidation product that provides an indirect estimation of NO), in 68 PD patients and 68 matched-controls. The plasma levels of nitrate did not differ significantly between PD patient and control groups (44.5 +/- 2.46 and 44.8 +/- 2.67 mumol/l, respectively). They were not influenced by antiparkinsonian drug and they did not correlate with age at onset, duration, scores of the Unified Parkinson's Disease Rating scales and Hoehn and Yahr staging in the PD group. These data suggest that plasma levels of nitrate are apparently unrelated to the risk for PD.

Chronic paraparesis associated with human T-lymphotropic virus type I beginning after dental extraction

We report a patient with a chronic paraparesis associated with human T-lymphotropic virus I infection (HTLV-I antibodies were present in blood and CSF), which began after a dental extraction. We suggest the possible relation of the dental procedure with the triggering of the disease.

Peripheral iron metabolism in patients with Parkinson's disease

To elucidate the possible role of peripheral metabolism of iron in the risk for developing Parkinson's disease (PD), we compared serum levels of iron, transferrin and ferritin, and 24-h iron excretion in urine after a single intramuscular dose of 1 mg/kg desferrioxamine, in 68 PD patients and their spouses as the control group. All these values did not differ significantly between the groups, they were not influenced by antiparkinsonian therapy, and they did not correlate with age, age at onset and duration of the disease, scores of the Unified PD Rating Scale or the Hoehn and Yahr staging in the PD group, with the exception of the 24-h urinary iron excretion with the duration of the disease (r = 0.32, p < 0.05). These results suggest that peripheral metabolism of iron is apparently unrelated to the risk of developing PD.

Nicardipine versus propranolol in essential tumor

To evaluate effect of the calcium-channel blocker nicardipine in essential tremor (ET), 14 patients with ET affecting upper limbs underwent a cross-over study with nicardipine (1 mg/Kg/day) and propranolol (160 mg/day). Evaluation (baseline and 1 month after each drug) was done by using the Fahn-Tolosa-Marin scale. Two patients withdrawed nicardipine (pretibial edema and palpitations) and other 2 propranolol (dyspnea and hypotension). Both drugs improved ET, with a non-significantly higher efficacy of propranolol. These results suggest that nicardipine might be efficacious for ET.

Progressive multifocal leukoencephalopathy in HIV infection presenting as Balint's syndrome

We report a patient with AIDS presenting with Balint's syndrome. CT and MRI showed the characteristic lesions of a progressive multifocal leukoencephalopathy, which was confirmed by histologic examination.

Airway dysfunction in patients with Parkinson's disease

To investigate pulmonary function abnormalities in Parkinson's disease (PD), we obtained maximal inspiratory and expiratory flow-volume curves in 63 patients (59 under treatment) with different stages of the disease, not filtered for respiratory symptoms. PD severity was evaluated by the Unified PD Rating Scale, the Webster's scale, and Hoehn and Yahr staging. Patients with more severe PD had lower percentage forced vital capacity (FVC%), and peak inspiratory and expiratory flows. Those with fluctuations and/or dyskinesias had lower FVC% and percentage forced expiratory flow volume in 1 sec (FEV1%). There were a number of weak but significant correlations between PD scales and spirographic parameters. Thirty one patients (49.2%) had pathological flow-volume curves. The clinical profile and the duration of the disease did not influence the pattern of the curve. Physiologic evidence of upper airway obstruction was observed in 3 cases. A spirometric restrictive ventilatory defect (FEV1/FVC higher than or equal to 80%) was observed in 54 patients (85%), while generalized airway obstruction was present only in one nonsmoker. We conclude that abnormal flow-volume loop contour is a frequent finding in PD. This probably reflects involvement of the upper airway musculature, that in some patients can produce upper airway obstruction. Generalized airflow limitation is not an important characteristic of PD. By contrast, a restrictive spirometric defect, probably due to incoordinated expiratory effort or abnormally low chest wall compliance, is the main spirometric finding in these patients.

Serum levels of ascorbic acid (vitamin C) in patients with Parkinson's disease

To elucidate the possible role of vitamin C in the risk for developing Parkinson's disease (PD), we compared serum levels of ascorbic acid (vitamin C), measured by a fluorometric method, of 63 PD patients using their spouses as the control group. The serum levels of vitamin C did not differ significantly between the groups (47.13 +/- 0.89 micrograms/ml for PD and 47.60 +/- 0.60 micrograms/ml for controls). There was no influence of antiparkinsonian therapy on vitamin C. Serum levels of vitamin C did not correlate with age, age at onset and duration of the disease, scores of the Unified PD Rating Scale or the Hoehn and Yahr staging in the PD group. These results suggest that serum vitamin C concentrations are apparently unrelated to the risk of developing PD.

Serum levels of beta-carotene and other carotenoids in Parkinson's disease

To elucidate the possible role of carotenoids in the risk for developing Parkinson's disease (PD), we compared serum levels of beta-carotene, alpha-carotene and lycopene, measured by high performance liquid chromatography, of 61 PD patients using their spouses as the control group. The serum levels of these 3 carotenoids did not differ significantly between PD patients and control groups. There was no influence of antiparkinsonian therapy on serum carotenoids levels, and these did not correlate with age, age at onset, scores of the Unified Parkinson Disease Rating Scale or the Hoehn and Yahr staging in the PD group. These results show that serum carotenoids concentrations are apparently unrelated to the risk for developing PD.

Parkinsonism unmasked by verapamil

We report the case of a 55-year-old man who had a parkinsonian syndrome unresponsive to levodopa for 5 years and had been taking verapamil during the past 8 years. Parkinsonian signs improved markedly after withdrawal of verapamil, suggesting its role in unmasking the parkinsonism. To our knowledge, this side effect of verapamil has not been described previously.

Orthostatic tremor: successful treatment with phenobarbital

This article describes two patients with orthostatic tremor. The tremor affected the legs while standing and had a frequency of 14-16 Hz. We remark on the success of therapy with phenobarbital.