Postural deformities like dropped head, camptocormia, and Pisa syndrome are seen in both Parkinson’s disease and multiple-system atrophy (MSA). However, these features are relatively more common in MSA. These deformities may worsen during treatment and cause the patient distress. We report here two MSA patients. The first patient was a 53-year-old woman with severe bradykinesia, rigidity, and orthostatic hypotension developed dropped head after increasing her levodopa dose from 400 to 600 mg/day. This symptom improved when we reduced the levodopa dose back to 400 mg/day. The second was a 59-year-old woman with severe bradykinesia, rigidity, and urinary incontinence who showed putaminal atrophy on magnetic resonance imaging. After Pisa syndrome was observed at her last follow-up visit, we decreased the pramipexole dose from 4.5 to 3 mg, and she improved. In conclusion, postural deformities in MSA patients may worsen with higher doses of dopaminergic treatment, and decreasing the dose may be the treatment of choice in these patients.

The present study was designed to evaluate the possible beneficial effects of biofeedback-assisted relaxation to pharmacotherapy on blood pressure and heart rate in patients with essential hypertension. Twenty patients with essential hypertension and without any complications or end-organ damage participated in the study. All the patients were using anti-hypertensive drugs. The study protocol consisted of an interview, 10 days baseline, 10 biofeedback-assisted relaxation sessions and a 10-day post-treatment period. Interview blood pressure (BP) and heart rate (HR) measurements, baseline mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR recorded during the 1st, 10th and 20th minutes of each session and the post-treatment mean values were evaluated. Significant differences were found between the mean values of SBP, DBP and HR after the whole treatment protocol (Wilcoxon signed-ranks test). The mean values of SBP, DBP and HR measurements recorded during the 1st, 10th and 20th minutes of the biofeedback-assisted relaxation sessions, which were evaluated by repeated measures of ANOVA on ranks test, showed a significant decrease only for the 10th minute values at the end of the whole treatment program. Despite a short follow-up, it was suggested that these results were encouraging considering the fact that once the patients are thoroughly instructed in home practice of relaxation and encouraged to develop their own strategies for relaxation, the long term outcome may also be promising.
Adult ; Aged ; Biofeedback (Psychology)* ; Blood Pressure/drug effects* ; Female ; Follow-Up Studies ; Heart Rate/drug effects* ; Human ; Hypertension/therapy* ; Male ; Middle Age ; Relaxation Techniques*

PURPOSE: This study aimed to determine the impaired glucose tolerance and diabetes prevalence in patients with essential hypertension (HT) and to compare the developed microvascular complications of these groups. MATERIALS AND METHODS: An oral glucose tolerance test (OGTT) was performed on 338 essential hypertensive cases and glucose tolerances were classified according to ADA-2002 criteria. RESULTS: Of the 338 cases, 32 people had diabetes (DM, 9.46%), 78 people had glucose intolerance (IGT, 23.1%), and 228 people had only hypertension but not IGT and DM (67.4%). Both the mean ages of the DM group (56.9 +/- 6.7 years, p = 0.002) and IGT group (56.3 +/- 8.4 years, p = 0.003) were older than the mean age of the control group (51.1 +/- 6.4 years). The risk of IGT development was found to be four times greater in male cases than female cases when compared to the control group (p = 0.004, add ratio = 4.194). There were no significant differences in the body mass indexes (BMI's), hypertension durations, and microvascular complications between the groups. CONCLUSION: In conclusion, the risk of IGT and DM development in hypertensive cases increases with aging and longer hypertension duration. The risk of IGT development in hypertensive cases is four times more in males.
Aged ; Blood Glucose ; Diabetes Mellitus, Type 2/pathology/physiopathology ; Female ; Glucose Intolerance/pathology/*physiopathology ; Humans ; Hypertension/pathology/*physiopathology ; Male ; Middle Aged