1/12. The relationship of pineal calcification and melatonin secretion to the pathophysiology of tardive dyskinesia and Tourette's syndrome.Despite current intensive research, the pathophysiology of tardive dyskinesia (TD), a serious neurological side effect of neuroleptic treatment, is poorly understood. Prompted by the observation of an increased incidence and severity of abnormal perioral movements in neuroleptic-treated pinealectomized, as compared to intact rats, we suggested that the pineal gland exerts a protective effect which mitigates against the development of TD and, by inference, that reduced melatonin secretion may be related to the pathophysiology of TD. To investigate this proposition further, we studied the association of TD with pineal calcification (PC) on CT scan in chronic schizophrenic patients. Our findings revealed a significant association between TD and PC and suggest, furthermore, that PC may be a neuroradiological marker of TD. Since PC may reflect diminished secretory activity of the gland, these findings support the hypothesis that the pathophysiology of TD is linked to disturbances of melatonin secretion. The clinical and therapeutic implications of these novel findings are discussed. In the following communication, in which we introduce the hypothesis that disturbances of 5-HT and melatonin secretion are related to the pathophysiology of TD. Subsequently, we present a series of studies which relate to the association of TD with PC. We conclude by presenting the hypothesis that disturbances in melatonin secretion may also be relevant to the pathophysiology of Tourette's syndrome.- - - - - - - - - - ranking = 1keywords = dyskinesia (Clic here for more details about this article) |
2/12. Use of the "inverse neuroleptic" metoclopramide in tourette syndrome: an open case series.Neuroleptics are generally highly effective in suppressing tics, but their many adverse effects limit their usefulness. Animal studies have shown that, compared with both typical and atypical neuroleptics, metoclopramide has effects that are regionally circumscribed to rat motor striatum. Based on this observation and two prior case reports, metoclopramide was openly prescribed and individually titrated to diminish tics in 10 patients with tourette syndrome. All patients improved on the Yale Global Tic Severity Scale by an average of 55%. Although we did not observe frank extrapyramidal symptoms, including tardive dyskinesia, these data are not sufficient to support clinical recommendations because of many limitations, including the absence of systematic ratings of nontic abnormal movements. However, controlled clinical studies and additional basic investigations of metoclopramide are warranted.- - - - - - - - - - ranking = 0.2keywords = dyskinesia (Clic here for more details about this article) |
3/12. carbamazepine-induced tics.Although a variety of dyskinesias are known to develop during anticonvulsant therapy, carbamazepine-induced tics are rarely recognized. We report three patients with an underlying movement disorder (Huntington's disease, tardive dyskinesia, and Tourette's syndrome) who experienced the onset or exacerbation of tics after the introduction of carbamazepine. These cases confirm the phenomenon of carbamazepine-induced tics and suggest that basal ganglia neuropathology may be an important predisposing factor. The dopaminergic effects of carbamazepine may be responsible for the induction of tics.- - - - - - - - - - ranking = 0.4keywords = dyskinesia (Clic here for more details about this article) |
4/12. deanol in Gilles de la tourette syndrome: a preliminary investigation.On the basis of its pharmacologic action deanol (dimethyl aminoethanol) was hypothesized to be of benefit in the Gilles de la tourette syndrome. In one case report the addition of deanol to perphenazine did not result in an improvement of uncontrollable movements or involuntary speech utterances. Gilles de la Tourette Syndrome is a condition combining organic and psychogenic features existing in the interface between two etiologies. Classically the disease begins in childhood and is characterized by the appearance of sudden involuntary movements, involuntary speech utterances frequently consisting of curse words (coprolalia), and imitative phenomena such as echolalia and echopraxia. Neurotic symptomatology such as anxiety and obsessive thinking have also been reported. This condition is regarded neuropharmacologically as a dopaminergic state that responds to drugs with antidopaminergic activity e.g. the phenothiazines and butyrophenones. deanol (dimethyl aminoethanol) is a putative cholinergic agonist and has reported effectiveness in conditions where there is a predominance of dopaminergic versus cholinergic activity, e.g. levodopa-induced dyskinesias, neuroleptic induced tardive dyskinesia, and Huntington's chorea. Because of its effectiveness in dopaminergic states it was hypothesized that deanol could also be of benefit in the Gilles de la tourette syndrome.- - - - - - - - - - ranking = 0.4keywords = dyskinesia (Clic here for more details about this article) |
5/12. Transient exacerbation of tics in treatment of Tourette's syndrome with clonidine.An 11-year-old boy with a history of behavioral problems was admitted to the inpatient child development Program of St. Louis University Medical Center. A diagnosis of Tourette's syndrome was made, and when family objected to a trial of haloperidol for fear of tardive dyskinesia, clonidine was initiated. A temporary period of worsening of motor and phonic tics ensued, while dose adjustments were made. When a maintenance level was achieved, approximately 2 weeks after initiating treatment, remission of symptoms was observed.- - - - - - - - - - ranking = 0.2keywords = dyskinesia (Clic here for more details about this article) |
6/12. Gilles de la tourette syndrome after long-term chlorpromazine therapy.Following 6 years of continuous chlorpromazine therapy for schizophrenia, a young woman developed multifocal tics and vocalizations characteristic of tourette syndrome. The symptoms first appeared when chlorpromazine was withdrawn. They were permanent, although partially ameliorated by chronic haloperidol therapy. Because of her age and past history, these symptoms were attributed to chronic neuroleptic therapy analogous to neuroleptic-induced tardive dyskinesia, rather than to tourette syndrome per se. These symptoms suggest that chronic receptor-site blockade can result in hypersensitivity of dopamine receptor sites, and that this may play a role in the pathophysiology of Gilles de la tourette syndrome. This is the first evidence that hypersensitivity of dopamine receptors is involved in the pathophysiology of tourette syndrome.- - - - - - - - - - ranking = 0.2keywords = dyskinesia (Clic here for more details about this article) |
7/12. Respiratory dyskinesia: review and case reports.Respiratory dyskinesia, the respiratory manifestations of tardive dyskinesia, has been recognized recently by several investigators. The literature is reviewed, two new cases are described, and possible directions for future research are discussed. It was concluded that respiratory dyskinesia is infrequently recognized clinically; more importantly, it may be easily mistaken for other medical disorders.- - - - - - - - - - ranking = 1.4keywords = dyskinesia (Clic here for more details about this article) |
8/12. Subtle and underrecognized side effects of neuroleptic treatment in children with Tourette's disorder.A variety of side effects developed in children treated with neuroleptics for Tourette's disorder. Of 208 children, 34 manifested dose-related symptoms of dysphoria, nine experienced a worsening of symptoms of Tourette's disorder that was attributed to akathisia, five became hostile and aggressive, three developed "fog states" that disappeared with discontinuation of neuroleptics or treatment with primidone, and three experienced symptoms of tardive dyskinesia that resolved with time. This data base of neuroleptic-treated children with Tourette's disorder demonstrates a variety of subtle and underrecognized side effects that may not be as readily discernible in children receiving neuroleptics for a primary psychiatric disorder.- - - - - - - - - - ranking = 0.2keywords = dyskinesia (Clic here for more details about this article) |
9/12. Treatment of Gilles de la Tourette's syndrome: eight-year, practice-based experience in a predominantly adult population.Over 86% of 58 patients with Gilles de la Tourette's syndrome achieved effective pharmacologic control of the symptoms for 3 months or longer. Differences in response patterns were common among patients and required individualized tailoring of management. dopamine-blocking neuroleptics were the mainstay of therapy. However, frequent mid-course alterations were required as previously successful drugs stopped working or as their side effects became intolerable. While haloperidol and now pimozide are most frequently used, trifluoperazine and thiothixene can provide superior relief in individual patients. A combination of neuroleptics or even a rotation from one to another may occasionally become necessary. No tardive dyskinesia was encountered in this population. clonidine proved inferior to neuroleptics in the treatment of the motor and vocal tics, but may have a role in some patients with prominent obsessive-compulsive symptomatology.- - - - - - - - - - ranking = 0.2keywords = dyskinesia (Clic here for more details about this article) |
10/12. Tardive dyskinesia in tourette syndrome.Three patients are reported who developed oral-buccal-lingual movements typical of tardive dyskinesia while being treated with stable doses of haloperidol for tourette syndrome. In each case signs resolved within a number of weeks after medication was discontinued. One of the patients experienced recurrence of the dyskinesia during a challenge with phenothiazine tranquilizers. In each case the dose of haloperidol was well within the usual therapeutic range. A strong family history of movement disorders, including tourette syndrome, was present in each family.- - - - - - - - - - ranking = 1.2keywords = dyskinesia (Clic here for more details about this article) |
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