Levodopa alone and in combination with a peripheral decarboxylase inhibitor benserazide (madopar®) in the treatment of Parkinson's disease

Summary A combination of levodopa and the extracerebrally acting decarboxylase inhibitor benserazide (ratio 4:1) (Madopar^®), was compared with levodopa alone in a controlled double-blind clinical multicenter trial on 94 patients with Parkinson's disease. During 4 months of therapy levodopa + benserazide proved superior to levodopa on several accounts. Nausea and vomiting occurred with statistically significant less severity and frequency. Clinical improvement expressed through improvement in Webster rating occurred sooner and was all together greater.The treatment schedules did not differ with regard to other side effects, in particular involuntary movements and reduction in supine blood pressure. Neither treatment seemed to influence liver function, renal function and hematological parameters.

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Zusammenfassung Levodopa in Kombination mit dem extracerebral wirkenden Dekarboxylasehemmer Benserazid (Dosisverhältnis 4:1) (Madopar^®) wurde mit Levodopa allein in einer kontrollierten, doppelblinden, klinischen Multizenterprüfung an 94 Patienten mit Morbus Parkinson verglichen. Während der viermonatigen Therapie zeigte sich in mehreren Beziehungen Levodopa + Benserazid dem Levodopa überlegen. Übelkeit und Erbrechen waren statistisch signifikant weniger schwerwiegend und traten seltener auf. Klinische Besserung, ausgedrückt durch Reduktion im Webster Rating, trat schneller ein und war im großen und ganzen höher.Andere Nebenerscheinungen, insbesondere unwillkürliche Bewegungen und Reduktion des Blutdruckes im Liegen, verteilen sich gleich über die beiden Gruppen. Bestimmungen von sowohl Leberfunktion und Nierenfunktion als auch hämatologischen Parametern ergaben keine signifikanten Änderungen.

     

Effects of L-tryptophan treatment on central indoleamine metabolism and short-lasting neurologic disturbances in multiple sclerosis

Summary Twelve MS patients were treated with L-tryptophan with or without decarboxylase inhibitor for 30 days, and the daily dose was either 1.5 g or 8 g. Tryptophan, 5-HIAA and HVA were analysed from lumbar punctures before and during tryptophan treatment. Clinical evaluation of MS symptoms was performed before, during and at the end of the tryptophan treatment period as well as after a 30-day placebo period. Tryptophan and 5-HIAA levels were found to be elevated 10 hours after the last dose of L-tryptophan. HVA concentrations remained approximately constant. A slight alleviation of changeable MS symptoms was noticed during the first month. The best response was found in symptoms like motility and bladder disturbances as well as in the mood of patients. These findings are indicative of the neural transmission changes during the rapid functional disturbances in MS.     

Neuropeptide converting enzyme activities in CSF of low back pain patients

The activity levels of a dynorphin converting enzyme (DCE), a substance P endopeptidase (SPE) and a substance P alpha-amidating enzyme (SP-GLYE) were measured in the cerebrospinal fluid (CSF) of 90 patients with chronic low back pain, sciatica and neurological signs of rhizopathy. The DCE activity was significantly higher in men than in women. Age was related to the DCE activity independent of sex, i.e., older patients had higher enzyme activity. The activities of two substance P converting enzymes were not related to sex or age. Self-reported pain experience and affective covariates (anxiety, depression, hostility, somatization) of pain, and myelography data were not found to be related to the enzyme activity levels once adjustment had been made for sex and age. The activity levels of the enzymes measured here had no predictive value for the long-term outcome of rehabilitation and therapy at the 5-year follow-up of the patients. The sex difference in DCE activity provides further evidence in favor of the role of gender in the psychoendocrine coping with pain distress.     

Monoamine metabolite levels in cerebrospinal fluid and brain atrophy in lobotomized schizophrenic patients.

Baseline concentrations of homovanillic acid (HVA), 5-hydroxyindole acetic acid (5-HIAA) and MHPG in the cerebrospinal fluid (CSF) were determined in 67 lobotomized and 30 non-lobotomized patients with chronic schizophrenia. In addition, in 69 of these patients the degree of brain atrophy was assessed by a pneumoencephalographic (PEG) technique. There were no significant differences in the concentrations of the monoamine metabolites in the CSF between the two patient groups studied despite the fact that the group of lobotomized schizophrenics had significantly more central and cortical brain atrophy than the group of nonlobotomized schizophrenic patients. The amine metabolite levels were also unrelated to the subtype of schizophrenia, duration of illness, or degree of mental incapacitation.     

Prolactin and cortisol responses to the experience of low back pain

Demographic, clinical and psychological characteristics of 92 patients with low back pain were correlated with prolactin and cortisol levels in cerebrospinal fluid (CSF). Somatization and depression scores correlated statistically significantly with the CSF serum ratio of prolactin both in men and in the total group. An increased CSF/serum ratio of cortisol was slightly associated with somatization scores in the total group. Multiple stepwise regression, furthermore, revealed that somatization, anxiety and one of the pain indices contributed to the variance in the CSF prolactin level, which was mostly dependent on the respective serum level. Sex and electromyographic findings (EMG) accounted for 12 and 7%, respectively, of the variance in the afternoon cortisol levels. Women reported more somatization and depression feelings than did men. Most of the data support our earlier assumption that male and female pain patients have different coping mechanisms. In spite of the common underlying endocrine responses to distress in men and women, gender differences in psychological response appear to modify endocrine responses to the experience of low back pain.     

Couple therapy improves mental well-being in chronic low back pain patients. A controlled, five year follow-up study.

Fifty-six chronic low back pain (CLBP) patients participated in a controlled, prospective 5-yr follow-up study evaluating the long-term effects of five-session couple therapy. Twenty-eight patients were included both in the treatment group and in the control group. Outcome measures were self-reported psychological distress, marital satisfaction, health locus of control, pain and disability as well as clinical examinations. The reliability of the outcome measures was statistically analysed and found acceptable. At the 5-yr follow-up assessments, psychological distress was found to be decreased in the treatment group and increased in controls. The difference between the groups was significant. No difference was found in the other self-reported or clinical outcome measures. We conclude that couple therapy has a prolonged beneficial effect on the mental well-being of CLBP patients.