Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. The etiology and pathophysiology of this disorder are poorly known, and treatment options are limited. However, some options to improve symptoms are available, including endoscopic injection of botulinum toxin. Nevertheless, few reports have described the effects of endoscopic injection of botulinum toxin in patients with symptomatic diffuse esophageal spasm with clear endoscopic and high-resolution manometry images. Here, we report a case of diffuse esophageal spasm diagnosed with high-resolution manometry and treated by endoscopic injection of botulinum toxin with good results at the 7-month follow-up.
Aged ; Anti-Dyskinesia Agents/*therapeutic use ; Botulinum Toxins/*therapeutic use ; Endoscopy, Digestive System ; Esophageal Spasm, Diffuse/radiography/*therapy ; Female ; Humans ; Manometry ; Tomography, X-Ray Computed

Dopamine (DA), as a catecholamine neurotransmitter widely distributed in the central nervous system and the peripheral tissues, has attracted a lot of attention. Especially in recent years, DA has been found to regulate the function of the immune system, and the involvement of DA in the intestinal mucosal inflammation-related diseases has become a hot research topic. The digestive tract is an important source of peripheral DA, and DA is not only produced in the enteric nervous system and gastrointestinal epithelium, but also produced by intestinal microorganisms. In addition to the synthetases of DA, the DA contents in body tissues are also affected by the two kinds of metabolic enzymes, monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT). This article reviewed the sources, metabolism, and functions of DA in digestive tract, especially focusing on the distribution and function of MAO and COMT, the enzymes degrading DA.
Catechol O-Methyltransferase ; Catechol O-Methyltransferase Inhibitors ; Dopamine ; Gastrointestinal Tract ; Monoamine Oxidase ; Monoamine Oxidase Inhibitors

The patient was a 44-yr-old man with end-stage renal disease who had developed chorea as a result of hypoglycemic injury to the basal ganglia and thalamus and who was subsequently diagnosed with depression and restless legs syndrome (RLS). For proper management, the presence of a complex medical condition including two contrasting diseases, chorea and RLS, had to be considered. Tramadol improved the pain and dysesthetic restlessness in his feet and legs, and this was gradually followed by improvements in his depressed mood, insomnia, lethargy, and feelings of hopelessness. This case suggests that the dopaminergic system participates intricately with the opioid, serotoninergic, and noradrenergic systems in the pathophysiology of RLS and pain and indirectly of depression and insomnia.
Adult ; Analgesics, Opioid/therapeutic use ; Anti-Dyskinesia Agents/therapeutic use ; Chorea/*complications/pathology ; Citalopram/therapeutic use ; Drug Therapy, Combination ; Haloperidol/therapeutic use ; Humans ; Kidney Failure, Chronic/*complications ; Magnetic Resonance Imaging ; Male ; Restless Legs Syndrome/*complications/drug therapy/pathology ; Serotonin Uptake Inhibitors/therapeutic use ; Tramadol/therapeutic use

OBJECTIVE[corrected] To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disorders such as sialorrhea and hyperhidrosis.

METHODSA retrospective study of BTX-B injections in treatment of 58 patients with various neurological disorders was performed. The mean follow-up time was 0.9 +/- 0.8 years. Results of the first and last treatment of patients with at least 3 injection sessions were compared.

RESULTSThe response of 58 patients to a total of 157 BTX-B treatment sessions was analyzed. Of the 157 treatment sessions, 120 sessions (76.4%) resulted in moderate or marked improvement while 17 sessions (10.8%) had no response. The clinical benefits after BTX-B treatment lasted an average of 14 weeks. Of the 41 patients with at least 3 injection sessions (mean 10 +/- 8.6), most patients needed increased dosage upon the last session compared to the first session. Nineteen patients (32.8%) with 27 sessions (17.2%) reported adverse effects with BTX-B treatment.

CONCLUSIONSThough most patients require increased dosage to maintain effective response after repeated injections, BTX-B is an effective and safe treatment drug for a variety of movement disorders, as well as drooling and hyperhidrosis.

Anti-Dyskinesia Agents ; administration & dosage ; therapeutic use ; Blepharospasm ; drug therapy ; Botulinum Toxins ; administration & dosage ; therapeutic use ; Botulinum Toxins, Type A ; Follow-Up Studies ; Humans ; Hyperhidrosis ; drug therapy ; Injections ; Meige Syndrome ; drug therapy ; Movement Disorders ; drug therapy ; Retrospective Studies ; Sialorrhea ; drug therapy ; Torticollis ; drug therapy

OBJECTIVETo investigate the associations between the drug responses to obsessive -pulsive disorder (OCD) and six functional genes related with serotonin and dopamine.

METHODSOne hundred and thirteen OCD nuclear families were collected. The OCD patients were treated with serotonin reuptake inhibitors (SRIs) for 8 weeks and the drug responses were assessed using the Yale-Brown obsessive-compulsive scale (Y-BOCS). The patients were divided into drug responders group and non-responders group according to the reducing rate of Y-BOCS score. The genotypes of six genes were determined with the Amp-FLP and Amp-RFLP techniques and analyzed by transmission disequilibrium test (TDT). The six genes are serotonin 2A receptor (5-HT2A), serotonin transporter (5-HTT), dopamine D2 receptor ( DRD2), dopamine D4 receptor (DRD4), catechol-O- methyltransferase (COMT) and monoamine oxidase A (MAOA).

RESULTSNo association was found between the six genes and different drug responses groups. However, there was significant difference between the drug responders and non-responders in homozygosity at the 5-HT2A -1438G/A locus (chi(2)=4.69, P=0.03).

CONCLUSIONThe results suggested that the 5-HT2A may play some roles in the effects of drug treatment on OCD.

Adolescent ; Adult ; Catechol O-Methyltransferase ; genetics ; Female ; Humans ; Male ; Monoamine Oxidase ; genetics ; Obsessive-Compulsive Disorder ; drug therapy ; genetics ; Pharmacogenetics ; methods ; Receptor, Serotonin, 5-HT2A ; genetics ; Receptors, Dopamine D2 ; genetics ; Receptors, Dopamine D4 ; genetics ; Serotonin Plasma Membrane Transport Proteins ; genetics ; Serotonin Uptake Inhibitors ; therapeutic use ; Treatment Outcome ; Young Adult

BACKGROUND: The development of dyskinesia in patients with Parkinson's Disease (PD) has been associated with several risk factors, including the use of Levodopa.
OBJECTIVES: To determine the prevalence of dyskinesia among Filipino patients with Parkinson's Disease given Levodopa versus Dopamine Agonist. To determine the time to development of dyskinesia among Filipino PD patients given Levodopa versus Dopamine Agonists, and to determine the risk factors for the development of dyskinesia among patients on Levodopa.
METHODS: In this retrospective case-control study, the occurrence of dyskinesia was evaluated in 367 PD patiems given Levodopa or Dopamine Agonists.
RESULTS: The prevalence of dyskinesia was significand higher in patients on Levodopa compared to those on DopamineAgonist (36.11% vs 0.86%, p 0.005). Kaplan Meier survival curve showed that at 9 years of treatment, a greater proportion of patients in the dopamine agonist group remained free of dyskinesia compared to the levodopa group (87 vs 3-5%) Patients in the Dopamine agonist group had a longer time to dyskinesia at 7 years compared to those in the Levodopa group at 6.25 years (CI 2 - 20 years). Among patients on Levodopa younger at onset of PD (53.29 vs. 62.37, p < 0.05), female sex (60.44 vs. 39.56%, p 0.006), and longer duration of treatment (6.25 vs. 3.73, p < 0.05) were significant risk factors for the occurrence of dyskinesia.
CONCLUSION: Among Filipino PD patients, the prevalence of dyskinesia is significantly higher in patients on Levodopa compared to those on Dopamine Agonists (36.11% vs 0.8%). At 9 years of treatment, a greater proportion of patients in the DA group remained free of dyskinesia compared to the L-dopa group (87% vs 37.5%). Patients on DAs also had a longer time to the onset dyskinesia at 7 years of treatment compared to those in the L-dopa group at 6.25 years (range at 2 - 20 years of treatment). Among patients on L-dopa, the significant risk factors that predispose patients to the development of dyskinesia are: younger age, female sex, and longer duration of treatment.

Human ; Female ; Antiparkinson Agents ; Disease Susceptibility ; Dopamine Agonists ; Dyskinesias ; Kaplan-meier Estimate ; Levodopa ; Parkinson Disease ; Prevalence

Parkinson's disease (PD) is a neurodegenerative disorder with a complex, multifactorial aetiology. The brains of patients affected with PD are characterized by a loss of neurons in dopamine neurons in the substantia nigra, decreasing of dopamine secretion, and the deposition of Lewy bodies (LBs) in the cytoplasm of remaining neurons. In China the data show that the incidence of Parkinson's disease increases at least 20 times in recent 20 years, and it makes things worse for the aging society. Developing good anti-PD drugs to improve the patient's quality of life is particularly important. The treatment of PD using traditional Chinese medicine (TCM) has made remarkable effect, while the the molecular mechanisms of it is still not known, while elucidating the molecular mechanism of TCM is the base of better understanding its function. Using genetically modified PD model of Caenorhabditis elegans, which is suitable for molecular mechanism study, to explore the interference mechanism of TCM to PD might be an effective way. This review briefly introduces the research progress on molecular mechanism of PD, and then discusses the idea of using C. elegans to study molecular mechanism of TCM intervention to PD.
Animals ; Antiparkinson Agents ; pharmacology ; Caenorhabditis elegans ; drug effects ; Disease Models, Animal ; Humans ; Medicine, Chinese Traditional ; Parkinson Disease ; etiology

OBJECTIVE: To explore the association of VEGFR2 gene polymorphisms (rs2305948 and rs1870377) with the effect of levodopa (L-dopa) and dyskinesia in Chinese population and to provide theoretical basis for clinical treatment.
 METHODS: By using Taqman MGB analysis and gene sequencing, the rs2305948 and rs1870377 polymorphisms of 69 enrolled Parkinson's disease (PD) patients were detected. Among them, 32 cases developed dyskinesia during 5 years and 37 cases did not develop dyskinesia during 8 years (as the control).
 RESULTS: There was no significant association between the occurrence of dyskinesia and VEGFR2 polymorphisms at rs2305948 and rs1870377. However, rs1870377 polymorphism of AA showed greater maximum L-dopa dose [(565.00±163.55) mg/d vs (396.88±200.39) mg/d, (300.00±80.18) mg/d, P=0.038] and higher value of Modified Abnormal Involuntary Movement Scale (mAIMS) compared with that with polymorphisms of AT and TT [17.00±5.24 vs 8.94±6.53, 7.86±4.45, P=0.026]. 
 CONCLUSION VEGFR2 genes polymorphism (rs1870377) is associated with maximum L-dopa dose and mAIMS value in PD patients.
Antiparkinson Agents ; pharmacology ; Humans ; Levodopa ; pharmacology ; Parkinson Disease ; drug therapy ; genetics ; Polymorphism, Genetic ; Vascular Endothelial Growth Factor Receptor-2 ; genetics

In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.
Antiparkinson Agents ; Anxiety* ; Bipolar Disorder* ; Brain ; Dementia ; Diagnosis, Differential ; Dihydroergotamine ; Drainage ; Female ; Gait* ; Humans ; Hydrocephalus, Normal Pressure* ; Hypokinesia* ; Mood Disorders ; Negotiating ; Neuroimaging ; Psychomotor Agitation ; Urinary Incontinence

Aged, 80 and over ; Antiparkinson Agents ; pharmacology ; therapeutic use ; Female ; Humans ; Lewy Body Disease ; drug therapy ; psychology ; Memantine ; adverse effects ; pharmacology ; therapeutic use ; United States