Parkinson hastalarında antipsikotik kullanımı

Aim: Psychotic symptoms associated with Parkinson;amp;#8217;s disease (PD) can lead to a serious condition that can increase mortality and hospitalization rates and can have a major impact on caregivers;amp;#8217; quality of life. In this study, we evaluated the efficacy and safety of olanzapine and quetiapine treatments in patients with PD who suffer from psychosis. Materials and Methods: We retrospectively inspected the files of patients who were diagnosed with PD. Among the patients who developed psychosis, 32 of them who used or were using quetiapin and olanzapin were enrolled in the study. The treatment response, deterioration of motor symptoms and interruption of treatment due to adverse effects were all evaluated. Results: In the group of the 32 patients, 20 had received olanzapin and 12 received quetiapine. Seven patients who received olanzapin presented an improvement of their condition, seven patients had motor worsening. Three subjects interrupted the use of olanzapine since it failed to induce the desired effect and three subjects interrupted due to adverse effects. Among the patients who received quetiapine, 10 presented an improvement. In one patient quetiapine was discontinued due to ineffectiveness and in another patient due to adverse effects. Conclusion: In our study treatment with quetiapine was found to be superior to olanzapine since it causes less worsening of motor functions and fewer side effects.Amaç: Parkinson hastalarında psikotik bir tablonun gelişmesi, mortaliteyi ve bakıcıların bakım yükünü arttıran, hastaneye veya bakım evlerine yatışa neden olan ciddi bir klinik tablodur. Bu nedenle Parkinson Hastalığında psikozun tedavisi önemlidir. Bu çalışmada psikoz gelişmiş Parkinson hastalarında, olanzapin ve ketiyapin kullanımını retrospektif olarak değerlendirilerek, olanzapin ve ketiyapinin etkinliğini karşılaştırmayı amaçladık. Gereç ve Yöntem: Bu çalışmada Parkinson polikliniğimize başvuran Parkinson hastalarının dosyaları tarandı. Psikotik tablo gelişmiş olan olgulardan ketiyapin ve olanzapin kullanan 32 olgu belirlendi. Olanzapin ve ketiyapin kullanan hastalar tedaviye yanıt verme, motor semptomlarda kötüleşme ve yan etkiye bağlı ilaç bırakma açısından karşılaştırıldı. Bulgular: Antipsikotik kullanan 32 hastanın 20 tanesi olanzapin, 12 tanesi ise ketiyapin kullanmaktaydı. Olanzapin kullanan hastalardan yedisinde iyileşme, yedisinde motor bulgularda kötüleşme, üçünde etkisizlik görülürken, diğer üç olguda ise yan etkiler nedeniyle ilaç kesilmiştir. Ketiyapin kullanan hastalarda ise, 10 olguda düzelme saptandı. Bir olgu etkisizlik nedeniyle, bir olgu ise yan etki nedeniyle ketiyapin kullanımını bırakmıştır. Sonuç: Bu çalışmada Parkinson hastalarında gelişen psikoz tablosunun tedavisinde ketiyapin, Parkinson Hastalığının motor bulgularında kötüleşme sağlamaması ve daha az yan etki gelişmesi açısından olanzapine üstün bulunmuştur

Vestibular impairment in Charcot–Marie–Tooth disease

Objective: To find out if Charcot–Marie–Tooth (CMT) patients, who have peripheral vestibular as well as peripheral somatosensory impairment, have worse postural balance than those who do not. Methods: We studied 32 patients with various CMT phenotypes and genotypes. Vestibular function was measured with the video head impulse test (vHIT) which tests vestibulo-ocular reflex (VOR) gain from each of the six semicircular canals in response to rapid head rotations. Postural balance was evaluated with a battery of four postural tests with emphasis on the modified clinical test of sensory integration in balance (mCTSIB). Results: Half of the 32 patients had some impairment of vestibular function ranging from mild, affecting only 1–2 semicircular canals, to almost total affecting all 6 semicircular canals. Their mCTSIB scores correlated with VOR gain from the vertical rather than from the lateral semicircular canals. The worse the vertical VOR gain the worse the mCTSIB score. Conclusion: We propose that any CMT patient could have clinically inapparent vestibular impairment that can be easily measured with the vHIT. This vestibular impairment could be contributing to their imbalance and could respond to a focused vestibular rehabilitation program. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.216S658 Türkiye Bilimsel ve Teknolojik Araştirma Kurumu, TÜBITAKStudy funded by the Scientific and Technological Research Council of Turkey (TÜBİTAK) under Grant no. (216S658). Acknowledgement