OBJECTIVE: To determine the effect of topiramate on patients with essential tremors in the randomized clinical trials
BACKGROUND: Essential tremor is characterized by an action tremor that occurs upon voluntary muscle contraction such as postural or kinetic tremor. Essential Tremor is a common movement disorder that interferes with the performance motor tasks and social activities. As a consequence, patients experience a reduction in quality of life. Topiramate is a broad spectrum antiepileptic drug with a good safety profile in humans. Topiramate has been reported to be effective in the management of essential tremors.
METHODS: Meta-analysis of two randomized trials searched from PUBMED/MEDLINE, Google and Cochrane Library (2001 up to present). Comparisons were performed according to intent-to-treat principle. Data were run through the RevMan 5 statistical software. Heterogeneity of Tremor Rating Scale outcome was assessed using Chi-square test statistics. The z-test statistic used to test the overall effect of the mean final TRS difference and mean change TRS difference between two treatments.
RESULTS: A total of 270 patients were included. Overall, the results showed that topiramate is effective in decreasing the Tremor Rating Scale score compared with placebo (CI 95%).
CONCLUSIONS: In summary, topiramate is better than the , placebo in reducing the Tremor Rating Scale score in this two randomized controlled trials. It showed that topiramate (n = 140) was significantly (p < 0.00001) more effective than placebo in improving TRS scores in patients with essential tremor.

Human ; Male ; Female ; Anticonvulsants ; Essential Tremor ; Fructose ; Medline ; Muscle Contraction ; Pubmed ; Quality Of Life ; Tremor

OBJECTIVE: To compare the scores of patients with idiopathic Parkinson's Disease using the Montreal Cognitive Assessment and Mini-Mental State Examination in a tertiary hospital
BACKGROUND: Parkinson's Disease (PD) is a neurodegenerative disorder diagnosed clinically based on the signs of resting tremor bradykinesia, rigidity and loss of postural reflexes. According to Bassett et al, 20% to 40% of PD patients ultimately become demented with an incidence of 10% per year. Cognitive decline is an impotant predictor of dementia in PD. Almost all patients with PD suffer from selective cognitive impairments including difficulties with attention, concentration, planning, sequencing, concept formation, problem solving, set-shifting and memory which are thought ro reflect dysfunction of cortical circuits subserving frontal brain regions. Identification of cognitive impairment in PD is crucial. It predicts future cognitive decline and may eventually be a target for pharmacologic intervention to prevent or delay the development of dementia.
METHODS: A descriptive study. A convenience sampling of 95 patients with idiopathic Patkinson's disease were screened for cognitive impairment.
RESULTS: Mean MMSE and MoCA scores were 26.1 (SD 2.9) and 19.8 (SD 4.28). Based on the published cutoff scores for cognitive impairment for Parkinson's Disease, 72% of the participants scored 26/30 and below on MoCA whereas only 42% scored 26/30 and below on the MMSE. Impairments were seen in numerous cognitive domains including executive function, language, recent semantic memory, visuo-spatial processing and constructional praxis. Predictors of cognitive impairment on the MoCA include low level of education and older age.
CONCLUSIONS: MoCA was able to detect more cognitive impairments in patients with Parkinson's disease than MMSE. Therefore, MoCA is a better screening tool to detect cognitive impairments in PD patients.

Human ; Male ; Female ; Attention ; Brain ; Cognition ; Cognition Disorders ; Cognitive Dysfunction ; Dementia ; Hypokinesia ; Muscle Rigidity ; Neuropsychological Tests ; Parkinson Disease ; Tremor

There is a paucity of published literature on the different oral medications tried for X-linked dystonia parkinsonism (XDP). In practice, most XDP patients are tired on medication typically used for patients with generalized dystonia. These drugs include anticholinergic agents, baclofen, clonazepam and other ben-zodiazepines, tetrabenazine, and clozapine. Although several articles have shown that these classess of drugs are beneficial for patients with generalized dystonia, none been systematically studied specifically for XDP patients. We are currently conducting the first randomized, placebo-controlled trial on the medications that have been used in XDP.

Human ; Baclofen ; Cholinergic Antagonists ; Clonazepam ; Clozapine ; Dystonia ; Dystonic Disorders ; Genetic Diseases, X-linked ; Parkinsonian Disorders ; Tetrabenazine ; Levodopa

X-linked dystonia-parkinsonism (XDP) is a rare, adult-onset, progressive, hereditary neurological movement disorder primarily affecting Filipino men with maternal families from Panay province of the Philippines. Medical treatment modalities currently being used have offered temporary symptomatic relief. Surgical management in the form of bilateral globus pallidi internae (Gpi) deep brain stimulation (DBS) has shown promising results and is increasingly being performed in advanced centers, as reported in international literature. Presented herein is the local experience of seven (7) retrospectively reviewed cases from February 2018 to February 2019 in a tertiary center in the Philippines with a particular focus on anesthetic management. All patients were male, from Panay, and presented with progressive dystonia and parkinsonism. All patients underwent planned bilateral, simultaneous DBS electrode, and implantable pulse generator (IPG) placement performed by a multidisciplinary team. Anesthetic management consisted of Bispectral Index (BIS) guided conscious sedation with low dose propofol and remifentanil infusions with a complete scalp nerve block (SB) at the start of the procedure then shifted to awake monitored anesthesia care during electrode placement, microelectrode recording (MER) and macro stimulation testing. All were put under general anesthesia with a supraglottic airway device during the placement of the internal pulse generator (IPG) in the infraclavicular area. All seven patients had successful localization, and insertion of the DBS electrode and discharged improved. The anesthetic management of the DBS used in these cases warrants further investigation and may lead to standardization of future practice.
Deep Brain Stimulation