A cross-over clinical and electromyographic assessment of treatment for parkinsonian tremor

BACKGROUND: Whether dopaminergic and anticholinergic drugs exert influence on parkinsonian rest and postural tremor is a subject of debate. Different types of tremor may be influenced differently by the drugs. The aim of this study was to reevaluate the differential effects of levodopa and anticholinergic drugs on parkinsonian tremor in different limb positions and on different types of postural tremor. METHODS: Thirty-eight patients with parkinsonian resting tremor and postural tremor were included in this study. Patients were divided into two groups according to the electromyographic pattern of the postural tremor. We found fast synchronous postural tremor (>7 Hz) in 16 patients, and slow alternating postural tremor in 22 patients. The tremor was scored clinically in each limb position using the Webster Tremor Scale. Surface electromyographic recordings from the most involved limb in all positions were also performed. The patients were randomly assigned to levodopa (one 250/50-mg tablet), or to biperiden (one 3-mg tablet). Tremor was assessed by clinical and electromyographic examinations at base line 1h following ingestion of the drug. The subjective tremor improvement was also assessed. RESULTS: We found that levodopa had a good effect on the amplitude of the resting tremor, while the effect of biperiden was weaker. Both levodopa and biperiden has less effect on postural tremor. However, levodopa's effect was better than that of biperiden. Levodopa and biperiden had better effect on slow alternating postural tremor than on fast synchronous postural tremor. They had no effect on kinetic and intention tremors. CONCLUSIONS: Levodopa and anticholinergic drugs have differing effects on both resting and postural tremor Also, the different categories of postural tremor respond differently to treatment. The mechanisms underlying resting parkinsonian tremor may be different from those underlying postural, kinetic and intention tremor. Moreover, the mechanisms underlying different types of postural tremor may be different.     

Autotransplantation of the greater omentum in patients with radiation injuries of the integumentary tissues

The treatment of radiation damages of the integumentary tissues is a complicated problem of reconstructive plastic surgery. The condition of the tissues in the irradiated zone do not allow wide application of the traditional methods. Microsurgical autotransplantation of the greater omentum provides the possibility for adequate closure of the radiation ulcers. Operations were conducted on 9 patients with such ulcers of various localization; the cosmetic and functional result was good in 7 of them.     

Mechanisms of tetrazepam action on spasticity.

This investigation assessed the mechanisms of Tetrazepam action on spasticity using a battery of electromyographic methods. Thirty patients with post-stroke spastic hemiparesis treated with Tetrazepam took part in the investigation. A questionnaire for assessment of subjective improvement after treatment used a 5-point scale. The 5-point scales were used to assess muscle tone, muscle strength and tendon reflexes. A battery of electromyographic methods was used to analyse different mechanisms of spasticity: for alpha-motoneuron activity--the F-wave parameters; for gamma-motoneuron activity--the TA/H amplitude ratio; for presynaptic inhibition--the ratio of H-reflex maximal amplitudes before and after vibration on the Achilles tendon (Hvibr/Hmax); for common interneuron activity--the flexor reflex parameters. Our results revealed that Tetrazepam reduces tone in spastic muscles and has a slight effect on tendon hyperreflexia. It has no influence on muscle strength, Babinski sign and ankle clonus. Tetrazepam acts by decreasing motoneurone activity and increasing presynaptic inhibition.     

Study of the 111In-DTPA complex by the electromigration method.

The electrophoretic behavior of the 111In-DTPA radiopharmaceutical has been investigated. The stability constant, diffusion coefficient and effective charge of the complex as well as the temperature dependence of the electrophoretic mobility were determined. No-carrier-added 111In with high specific activity was used in the electrophoretic experiments in ultramicroconcentrations (10(-9)M).     

The replantation of the thumb in avulsive amputations]

A comparative assessment of results of operations was made in 2 groups of patients with abruption of the first finger. An analysis of immediate and long-term results of operations has shown advantages of the method of replantation with heterotopic revascularization of the replanted first finger and reinnervation by means of plasty of the palmar digital nerve.     

Mechanisms of baclofen action on spasticity

This investigation estimated the mechanisms of baclofen action on spasticity using a battery of electromyographic methods. Thirty patients with old post-stroke spastic hemiparesis took part in the investigation. They were treated with baclofen-mean daily dose 54.3 alpha 11.6 mg for a mean of 26.3 alpha 4.9 days. A questionnaire for assessment of subjective improvement after treatment used a 5-point scale. For standardization of the neurological examination 5-point scales were used to assess muscle tone, muscle force and tendon reflexes. A battery of electromyographic methods was used to analyse different mechanisms of spasticity: for alpha motoneurone activity--the F wave parameters; for gamma motoneurone activity--the T/H reflex amplitude ratio; for presynaptic inhibition--the ratio of H reflex amplitudes before and after vibration on the achilles tendon (Hvibr./Hmax); for common interneurone activity--the flexor reflex parameters. Our results revealed that baclofen reduces spastically increased muscle tone and Babinski sign. It has no influence on muscle force, tendon reflexes and ankle clonus. Baclofen acts by normalizing the altered interneurone activity and decreasing of alpha motoneurone activity. When spasticity has altered interneurone activity and increased motoneurone activity, it is better to treat with baclofen.