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underlies Parkinson disease, attempts were at rst made to administer dopamine directly However, dopamine as such cannot pass the blood-brain barrier and therefore has no therapeutic effect But its immediate dopamine precursor, L-dopa, does cross the bloodbarrier and is effective in decreasing the symptoms of Parkinson disease as well as of the above-described MPTP-induced parkinsonism This effect is enhanced by the addition of an inhibitor of dopadecarboxylase, an important enzyme in the catabolism of dopamine The addition of an enzyme inhibitor of this type (carbidopa or benserazide) to L-dopa results in an increase of dopamine concentration in the brain while sparing other organs from exposure to high levels of the drug Similarly, drugs that inhibit catechol O-methyltransferase (COMT), another enzyme that breaks down dopamine, can prolong the effects of administered L-dopa Because of the pharmacologic effects of ACh and dopamine, it was originally postulated by Hornykiewicz that a functional equilibrium exists in the striatum between the excitatory activity of ACh and the inhibitory activity of dopamine In Parkinson disease, the decreased release of dopamine by the substantia nigra onto the striatum disinhibits neurons that synthesize ACh, resulting in a predominance of cholinergic activity a notion supported by the observation that parkinsonian symptoms are aggravated by centrally acting cholinergic drugs and improved by anticholinergic drugs According to this theory, administration of anticholinergic drugs restores the ratio between dopamine and acetylcholine, with the new equilibrium being set at a lower-than-normal level because the striatal levels of dopamine are low to begin with The use of drugs that enhance dopamine synthesis or its release or that directly stimulate dopaminergic receptors in the striatum (eg, bromocriptine) represents a more physiologic method of treating Parkinson disease, but this approach has limitations, as outlined in Chap 39

If you create a global variant and fill in the Technical Name field, you still get an assignment into the RSRPARMETRIZA table, but it will look just a bit different The next two illustrations show the creation of the global variant and the table with the different variants that are available for display You can identify the two types of variants by looking at the User-Specific column on the far right of the screen This field contains an X if the variant is user-specific and therefore a local variant If the field is not checked, the variant is a global variant and available to all users of this query Also notice that the technical name of the variant is quite a bit different The global variant has a true technical name, whereas the local variant has the longer, system-generated technical name There are a number of differences between the local and global variants, but one important difference is that global variants can be used in scheduling processes, such as background job runs and Information Broadcaster settings, whereas the local variants, due to the nonconforming technical name, can t be used in scheduling processes because you can t assign them to the job

Bhatia and Marsden, relying on published imaging studies, some quite crude, reviewed some 240 cases in which there were lesions in the caudate, putamen, and globus pallidus associated with movement and behavioral abnormalities Dystonia had occurred in 36 percent, chorea in 8 percent, parkinsonism in only 6 percent, and dystonia-parkinsonism in 3 percent Bilateral lesions of the lenticular nuclei resulted in parkinsonism in 19 percent and dystonia-parkinsonism in 6 percent It is also notable that a common persisting behavioral abnormality was abulia (apathy and loss of initiative, spontaneous thought, and emotional responsivity), occurring in 28 percent of those with caudate lesions The de ciencies of this type of case analysis, conceded by the authors to be imprecise (eg, computed tomography studies) and obtained without regard to the temporal aspects of the functional disorder time of onset, duration, and changes during the course of the illness, are obvious We nd it surprising that choreoathetosis was not more frequent Needed, of course, are detailed anatomic (postmortem) studies of cases in which the disturbances of function were stable for many months or years Such an example is the case of generalized dystonia with pallidoluysian atrophy reported by Wooten and coworkers Table 4-3 summarizes the clinicopathologic correlations of extrapyramidal movement disorders that are accepted by most neurologists; it must be emphasized, however, that there is still some uncertainty as to the ner details

gress, or even remit to some extent on its own or with therapy, most of the patients succumb to the underlying tumor within a year Treatment If the tumor can be treated effectively, the neuropathy may improve, the exception being the pure sensory neuronopathy Treatment with plasma exchange, gamma globulin, or immunosuppression has had only a minimal effect, but there are anecdotal reports of success with very early immune treatment In the report by Uchuya and colleagues, only 1 of 18 patients with a subacute sensory neuropathy improved and another became dependent for sustained improvement on immune globulin; most of the others stabilized or worsened, and the authors concluded that treatment was of doubtful value Corticosteroids have not been tested in a systematic way but there is little clinical evidence to support their use

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