Two strategies to manage symptom re-emergence due to wearing-off with conventional levodopa/dopa-decarboxylase inhibitor (DDCI) therapy were compared in patients with Parkinson’s disease (PD) in this randomized, open-label trial. PD patients receiving 3 daily doses of levodopa/DDCI were randomized to either levodopa/DDCI and entacapone or an increased dose frequency of levodopa/DDCI with or without an increased total daily dose (dose fractionation). After 1 month of treatment, patients were followed up for 1 year. A greater proportion of levodopa/DDCI and entacapone-treated patients had treatment success compared with dose-fractionated patients, according to investigator Clinical Global Impression of Change scores at 1 month (68 vs. 59%, respectively) and 1 year (60 vs. 51%, respectively). Mean ‘off’ time (time with symptoms) was improved in both groups at 1 month and 1 year, despite a reduction in the mean daily levodopa dose in the levodopa/DDCI and entacapone group at 1 month. The mean daily levodopa dose was increased in the dose fractionation group. At 1 month, there was a 4% reduction in patients experiencing dyskinesia with levodopa/DDCI and entacapone and a 3% increase with dose fractionation. These data suggest that levodopa/DDCI and entacapone reduces time with symptoms, the rate of motor complications and the daily levodopa dose compared with dose fractionation. However, as the observed differences were not statistically significant, further studies are required to confirm these results.

Une patiente de 18 ans presentait une psychose infantile depuis l'âge de 2 ans et 1/2. Apres un traumatisme affectif, elle developpa un etat catatonique aigu avec mutisme, anorexie, negativisme, rigidite plastique et catalepsie, hyperthermie a 38,5 o C. Le traitement neuroleptique aggrava le tableau clinique et fut responsable d'une symptomatologie evoquant un syndrome malin des neuroleptiques: alteration de la vigilance, aggravation de l'hypertonie, dereglement thermique. Une amelioration partielle fut observee sous bromocriptine puis carbamazepine. La guerison fut obtenue apres electroconvulsivotherapie

Similar clinical and biological features in lethal catatonia (LC) and neuroleptic malignant syndrome (NMS) suggest a relationship between both affections and common physiopathologic mechanisms. Pharmacological effects of several drugs--dopaminergic agonists, benzodiazepines, carbamazepine--suggest an impairment of several systems of neurotransmitters. We report the case of a young woman with infantile psychosis who developed catatonic syndrome worsened by neuroleptic treatment, arising the problem of the chronology of both affections. The evolution with treatment may partially explain the physiopathology. A 18-year old woman with an history of infantile psychosis, experienced insomnia, anorexia, paradoxical agitation developed after affective traumatism (mother's hospitalization). Chlorazepate (150 mg) remained inefficient and hospitalization was necessary. The patient was dumb, prostate in bed. She presented negativism, rigidity of the four limbs, catalepsia and hyperpyrexia (38.5 degrees C). Hepatic transaminases were increased (SGOT: 71 UI/l; N < 30). After cumulated dose of levomepromazine (100 mg) profuse sudation, thermic and cardiovascular instability, alteration of consciousness, major rigidity of limbs appeared. (Blood) hepatic transaminases and muscular enzymes increased. Bacteriological samples, cerebrospinal fluid analysis, CT-scan and EEG were normal. Within 48 hours after rehydratation and bromocriptine (30 mg per day) alteration of consciousness and autonomic disorders decreased but hyperpyrexia (38 degrees C) persisted. Biological parameters were normalized 10 days later. Negativism and psychomotor inertia remained. Lorazepam (3 mg per day) failed to be clinically beneficial. On carbamazepine (600 mg per day) she started speaking and moving spontaneously. Catalepsia disappeared but rigidity and anorexia persisted. Electroconvulsivotherapy (ECT) was necessary. After 2 shocks she started standing up, walking, taking food and speaking fluently.(ABSTRACT TRUNCATED AT 250 WORDS)

123Iodo-Amphetamine (IAMP) brain distribution was studied with a specially dedicated multilevel tomographic system in 30 patients with vascular ischemic (18) or hemorrhagic (12) disorders. Results were compared with clinical data, CT scan and rCBF measurement obtained by the 133Xe continuous inhalation method. Abnormalities with IAMP were found in 27 cases, in good agreement with the results obtained by the Xenon inhalation technique in 21 studies from the 22 where that method was possible. For 80% cases there was also a good agreement between the results obtained by the IAMP and CT scan: one case normal, and 23 observations with abnormalities. This is true for the localization of lesions, but IAMP appears able to shown remote abnormalities, i.e. crossed cerebellar diaschisis or functional deactivation, in the absence of CT scan lesions in the corresponding areas. This is of particular interest in the protracted regressive ischemic neurologic disorders (PRIND): CT scan were normal in all five observations but IAMP showed abnormalities in four cases. IAMP is however very expensive, so it has to be used only when 133Xe inhalation is technically impossible.

A 30 year old man admitted with a brain stem infarct presented with intellectual deterioration. A diagnosis of systemic lupus erythematosus (S.L.E.) was based on the presence of five A.R.A. criteria :photosensitivity, arthralgia, leukopenia and thrombopenia, false positive syphilitic serology, antinuclear factors on immunofluorescence. A lupus type circulating anticoagulant (L.C.A.) was no longer detected after corticotherapy. This appears to be a case of the "hematologic" form of S.L.E. in which the presence of L.C.A. predisposes towards thrombosis, not only of veins--which is typical--but also of arteries. These may be isolated and reveal the underlying disease as in the present case. The L.C.A. is an antibody possessing antiphospholipid specificity which explains the anticoagulant action in vitro and the thrombogenic effect in vivo. Some authors consider this to be sufficient justification for administration of anticoagulants and/or antiplatelet agents, but corticotherapy may be effective.

To the Editor. —De Luise et al 1 recently recalled the ocular signs of meningococcal disease. Ocular complications of bacterial septicemia are rare, but Neisseria meningitidis was once frequently implicated. 2 Since the use of antibiotics, other gram-negative bacteria are now more frequently responsible, as reported in the case below. Report of a Case. —A 62-year-old man had undergone a cholecystectomy 30 years prior to being seen for an intercostal herpes zoster eruption in July 1982. After four days with febrile diarrhea, the patient was admitted to our hospital on Nov 23,1982, because of an acute meningeal syndrome with stupor and hyperpyrexia (40 °C) without focal neurologic symptoms. The cerebrospinal fluid was purulent and without bacteria, but two blood cultures were positive for Klebsiella pneumoniae . There were abnormal hepatic and renal symptoms: right hypochondrium pain, hematuria, and proteinuria. The erythrocyte sedimentation rate was between 85 to 100 mm/hr and the

At 20 year-old a patient developed a paraplegia which regressed within several months, suggestive of an acute myelitis. Subsequently, several episodes of spastic paraplegia, posterior tracts lesions and retrobulbar optic neuritis, a transient cerebellar syndrome, modifications in cerebrospinal fluid (pleiocytosis, hypergammaglobulin levels, elevated Delpech's ratio) suggested multiple sclerosis. When aged 62 years, the patient developed articular lesions, Raynaud's phenomenon, and buccal ulcers attributed to lupus. LE cells, native DNA anti-antibodies, anti-Sm auto antibodies on immunofluorescence were present. The possibility of a collagen disease, expressed initially and for a long period in an exclusively neurological disorder is discussed. It was considered, however, to be more likely two distinct affections. This association has been reported very rarely, even though two immunity-mediated inflammatory affections are involved.