A COMPLEMENTARY APPROACH ON OLFACTORY DYSFUNCTION IN PARKINSONS DISEASE- RETROSPECTIVE OBSERVATIONAL STUDY

Olfactory dysfunction is a frequent non-motor symptom of Parkinson’s disease (PD) that involves deficits in odour detection, discrimination, and identification. Hyposmia may be related to neuronal degeneration with deposition of alpha-synuclein in primary olfactory areas as a very early component of the pathology of PD. Olfactory dysfunction also known as Gandhajnana or Gandhanaasha in Ayurveda is a result of improper functioning of different Vatasdue to either degeneration of Dhathus (Tissues) or obstruction in the normal movement of Vata. We analysed the smell test results within the population of Parkinsons patients admitted in Department of Neurology and Complementary medicine in Evangelical Hospital Hattingen from 2012 till 2017. Patients received the prescribed Allopathy and Ayurveda treatment for their ailments along with Ayurveda diet, Ayurveda massage and purification therapies. The primary and the only outcome measure was to assess the results of smelling sensation of the Parkinson’s patients already conducted by a Smell test with Sniffing Sticks supplied by Burghart Messtechnik. A paired t-test was conducted to compare scores obtained in smell test before and after treatment in each group separately. There was a significant difference in the scores of smell test in two groups. Results suggest that patients, treated first with Vasthi and then Ksheerabala oil Nasya showed significant improvement in the scores of smell test (t=-2.509, p= 0.017). The results of patients, treated with only Vasthi also showed significant improvement in the scores of smell test (t=-2.007, p= 0.053)

Efficacy of repeated intrathecal triamcinolone acetonide application in progressive multiple sclerosis patients with spinal symptoms

BACKGROUND: There are controversial results on the efficacy of the abandoned, intrathecal predominant methylprednisolone application in multiple sclerosis (MS) in contrast to the proven effectiveness in intractable postherpetic neuralgia. METHODS: We performed an analysis of the efficacy of the application of 40 mg of the sustained release steroid triamcinolone acetonide (TCA). We intrathecally injected in sterile saline dissolved TCA six times within three weeks on a regular basis every third day in 161 hospitalized primary and predominant secondary progressive MS patients with spinal symptoms. The MS patients did not experience an acute onset of exacerbation or recent distinct increased progression of symptoms. We simultaneously scored the MS patients with the EDSS and the Barthel index, estimated the walking distance and measured somatosensory evoked potentials. Additionally the MS patients received a standardized rehabilitation treatment. RESULTS: EDSS score and Barthel index improved, walking distance increased, latencies of somatosensory evoked potentials of the median and tibial nerves shortened in all MS patients with serial evaluation (p < 0.0001 for all variables). Side effects were rare, five patients stopped TCA application due to onset of a post lumbar puncture syndrome. CONCLUSIONS: Repeated intrathecal TCA application improves spinal symptoms, walking distance and SSEP latencies in progressive MS patients in this uncontrolled study. Future trials should evaluate the long-term benefit of this invasive treatment

Dose-dependent improvement of myoclonic hyperkinesia due to Valproic acid in eight Huntington's Disease patients: a case series

BACKGROUND: Chorea in Huntington's Disease (HD) is usually treated with antidopaminergic neuroleptics like haloperidol, olanzapine and tiaprid or dopamine depleting drugs like tetrabenazine. Some patients with hyperkinesia, however, react to treatment with antidopaminergic drugs by developing extrapyramidal side effects. In earlier studies valproic acid showed no beneficial effect on involuntary choreatic movements. Myoclonus is rare in HD and is often overseen or misdiagnosed as chorea. METHODS: In this report, we present eight patients whose main symptom is myoclonic hyperkinesia. All patients were treated with valproic acid and scored by using the Unified Huntington's Disease Rating Scale (UHDRS) motor score before and after treatment. In addition to this, two patients agreed to be videotaped. RESULTS: In seven patients myoclonus and, therefore the UHDRS motor score improved in a dose dependent manner. In three of these patients antidopaminergic medication could be reduced. CONCLUSION: In the rare subgroup of HD patients suffering from myoclonic hyperkinesia, valproic acid is a possible alternative treatment

Impact of Oral Fast Release Amantadine on Movement Performance in Patients with Parkinson’s Disease

Application of oral fast release amantadine and levodopa may induce an improvement of motor symptoms in patients with Parkinson’s disease (PD). The objective of this trial was to investigate the clinical efficacy of a fast release amantadine sulfate formulation on simple and complex movement performance and putative relations to the pharmacokinetic behavior in PD patients. We challenged two cohorts of 12 PD patients, who were taken off their regular antiparkinsonian treatment for at least 12 hours, with oral 300 mg amantadine sulfate. We scored motor symptoms and performed instrumental tasks, which ask for performance of simple or complex motion series under cued conditions. Motor symptoms and performance of complex movements significantly improved in contrast to the carrying-out of simple motions. N-methyl-D-aspartic acid antagonistic and dopaminomimetic amantadine also influences altered higher predominant prefrontal cognitive functions. Therefore, performance of complex motion series improved, whereas carrying-out of simple repetitive movements is more associated to the striatal dopamine dependent basal ganglia function

Repeat Intrathecal Triamcinolone Acetonide Application Reduces Acute Occurring Painful Dysesthesia in Patients with Relapsing Remitting Multiple Sclerosis

We describe four patients with relapsing remitting multiple sclerosis (RRMS) who experienced a relapse with acute onset of painful sensations. Pain sensations disappeared in two of them and markedly reduced in the other ones after repeat application of intrathecal triamcinolone acetonide (TCA) following a prior unsuccessful treatment with intravenous steroids. TCA administration was well tolerated and no serious side effects occurred. Repeated intrathecal TCA injection may provide a substantial benefit in RRMS patients with acute onset of pain due to an inflammatory lesion within the spinal cord