acyclovir and Parkinson-Disease

We sought to investigate the effects of dopamine on motor cortical plasticity in Parkinson's disease (PD) using a novel interventional transcranial magnetic stimulation protocol that targets spike-timing-dependent plasticity (iTMS). Six patients (3F, mean age 62 years) with mild-moderate PD (mean disease duration 6 years, UPDRS-off 13, UPDRS-on 3, H&Y stage 2, daily levodopa dosage 450 mg) were studied off and on levodopa on separate days. Paired TMS pulses at resting motor threshold with an inter-stimulus interval of 1.5 ms were given over the hand area of the motor cortex for 20 min at 0.2 Hz. Single-pulse motor evoked potential (MEP) amplitude and visually cued simple reaction time (SRT) were measured before and after iTMS. When on levodopa, MEP amplitude increased to 278+/-36% of baseline (p<0.01), and when off levodopa to 157+/-13% of baseline (p=0.02). All patients showed a significantly greater increase in MEP amplitude when on levodopa than off levodopa (p=0.01). SRT was reduced to 95% baseline after iTMS off levodopa (p=0.02), but did not change on levodopa. These findings indicate that motor cortex plasticity to iTMS is preserved in mild-moderate PD. The effects of this spike-timing-related TMS protocol on cortical excitability were consistent and were enhanced by levodopa. The results support the important role of dopamine in regulating synaptic plasticity and justify a larger crossover study to assess the therapeutic effects of iTMS in PD.

Topics: Acyclovir; Aged; Analysis of Variance; Dopamine; Dopamine Agents; Electric Stimulation; Evoked Potentials, Motor; Female; Glutamic Acid; Humans; Levodopa; Male; Middle Aged; Motor Cortex; Parkinson Disease; Reaction Time; Transcranial Magnetic Stimulation

A 64 year-old female with Parkinson disease treated with amantadine for two years who suddenly suffered bilateral corneal oedema. It was initially treated as herpetic endotheliitis without improvement as we lacked information on her chronic treatment. The corneal oedema finally resolved after withdrawing the drug.. Amantadine hydrochloride may produce endothelial dysfunction. Once the amantadine treatment is stopped, the corneal oedema may be reversible but endothelial density remains low. An ophthalmologist examination should be performed before the initiation of amantadine treatment in order to establish a risk: benefit ratio, especially in those patients with low endothelial density or any endothelial anomaly.

Topics: Acyclovir; Amantadine; Antiparkinson Agents; Aqueous Humor; Cataract Extraction; Ceftazidime; Corneal Edema; Corneal Endothelial Cell Loss; Corneal Opacity; Diagnostic Errors; Female; Humans; Keratitis; Middle Aged; Parkinson Disease; Postoperative Complications; Prednisolone; Saline Solution, Hypertonic; Vancomycin

Herein, we present a case of a parkinsonism-hyperpyrexia syndrome (PHS) in a 58-year-old man with a 10-year history of Parkinson's disease. The patient presented with a 2-week history of fever and increasing confusion, in the context of a number of changes to his medication regimen. On presentation, he was noted to be febrile with autonomic instability, diaphoresis and marked rigidity. He was disoriented and responding to visual hallucinations. Investigations revealed an elevated creatine kinase and a provisional diagnosis of PHS was made. After the patient failed to respond during a 2-week period to supportive measures, electroconvulsive therapy (ECT) treatment was commenced. A good response to eight bilateral ECT treatments was achieved, with resolution of his confusional state and associated psychotic phenomena. We discuss the nosological and management issues associated with this case and discuss the role of ECT as a treatment modality in this condition.

Topics: Acetaminophen; Acyclovir; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Anxiety Agents; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiparkinson Agents; Antiviral Agents; Anxiety; Carbidopa; Ceftriaxone; Cervical Vertebrae; Depression; Dexamethasone; Diazepam; Doxepin; Electroconvulsive Therapy; Humans; Levodopa; Male; Middle Aged; Neuroleptic Malignant Syndrome; Oxycodone; Pain; Parkinson Disease; Selegiline; Spinal Injuries

Although the antiviral agent acyclovir is currently used for the treatment of Ramsay Hunt syndrome, its effects on facial nerve and hearing recovery remain controversial. We retrospectively analyzed the effects of acyclovir-prednisone treatment in 80 Ramsay Hunt patients. Of 28 patients for whom treatment was begun within 3 days of the onset of facial paralysis, the recovery from paralysis was complete in 21 (75%). By comparison, of 23 patients for whom treatment was begun more than 7 days after onset, recovery from facial paralysis was complete in only 7 (30%). A significant difference in facial nerve recovery was found between these groups. Early administration of acyclovir-prednisone was proved to reduce nerve degeneration by nerve excitability testing. Hearing recovery also tended to be better in patients with early treatment. There was no significant difference in facial nerve outcome between intravenous and oral acyclovir treatment.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Audiometry; Chi-Square Distribution; Drug Therapy, Combination; Facial Paralysis; Female; Humans; Injections, Intravenous; Male; Middle Aged; Parkinson Disease; Prednisone; Remission Induction; Retrospective Studies; Statistics, Nonparametric