Tolcapone prolongs "on" time in fluctuating parkinsonian patients while allowing a reduction in daily levodopa dosage, thereby improving the efficacy of long term levodopa therapy.

High-speed memory scanning as assessed by the Sternberg paradigm was studied in 12 nondemented patients with fluctuating Parkinson's disease and 13 age-matched healthy controls. Patients were first assessed before taking their morning dose of levodopa ("off") and again after that dose had produced full clinical effect ("on") after that dose had produced full clinical effect ("on"). Although motor components of the measured choice reaction time were slower in patients when off than in control subjects, memory scanning speed was not different. After levodopa (on), patients' motor time normalized, but cognitive processing speed became significantly slower when compared with previous performance in the off condition and with controls. Contrary to previous concepts of bradyphrenia in patients with Parkinson's disease, these results indicate that dopaminergic stimulation can reduce cognitive processing speed.

Urgency and urge incontinence suggest detrusor overactivity, which was more prevalent in dementia with Lewy bodies than in Parkinson disease and Alzheimer disease, whereas mean voided volume, free flow, cystometric bladder capacity, and detrusor pressor were similar in the groups. Frequency of micturition could not be reliably assessed in patients with dementia.

Clinical course ofpatients I and 2. 1' = high dosage intravenous immunoglobulins (HIG); = HIG maintenance; * = plasmapheresis; P = prednisone, (alternate day dosage (mm) in parentheses); A = azathioprine; Cy = cyclosporin (daily dosage in parentheses); IFN-a = interferon-a (weekly dosage in miUion IU).temporary improvement during and after a flu like syndrome. In July 1992 solo treatment with interferon-a-2a (Roferon-A) at a dosage of 3 million intemational units (MIU) twice weekly was begun. On the third day after the first injection a dramatic improvement was seen and during 11 days the patient progressively recovered to normal. Serial nerve conduction studies showed progressive reduction of conduction blocks. Seven days after the reduction of interferon-a to 1 MIU/week, progressive weakness of distal muscles occurred that paralleled an increase in multiple conduction blocks. Reinstitution of interferon-a-2a treatment at a dosage of 2 MIU twice weekly, produced a complete recovery within six days. Again the dose of interferon was gradually reduced to 1 MIIU twice weekly, without clinical changes.Only minor adverse effects, such as fever and arthromyalgia, were seen during interferon treatment.Patient 2 was a healthy 3 year old boy who developed a waddling gait and muscle pain in his legs 20 days after an upper respiratory tract infection. The patient had recovered spontaneously after 15 days. During the next three months he had another three episodes of leg weakness lasting 10-15 days. Brain and spinal cord MRI was normal; electrophysiological studies showed delayed motor conduction velocity with multiple conduction blocks in all the nerves tested and normal sensory conduction velocities. The CSF contained 96 mg/dl protein and 3 white blood cells/ml, but no oligoclonal bands.During the fifth attack the child became unable to walk unaided and was admitted to our neurological department. He was treated with IVIg at a dose of 1 g/kg daily for two days and prednisone (at a dose of 50 mg every other day) and after three days he regained the ability to walk. Neurography showed disappearance of conduction blocks in two of three motor nerves. Twenty days later the boy had another relapse. Again treatment with IVIg improved motor symptoms in a few days. In the next 15 months he showed relapses every 13 to 20 days despite treatments with azathioprine and cyclosporin. All the episodes responded to IVIg. During three relapses the patient was treated with plasma exchange and showed improvement comparable with IVIg treatment. Treatment with interferon-a-2a (Roferon-A) (2-5 MUIIday)) was given. After this treatment the child regained normal strength within 15 days. The dose of interferon-a was reduced to 2 MIU twice a week after three months. The patient showed no relapses during the subsequent months and no adverse effects were seen. Neurography performed two months after interferon treatment showed improvement of motor conduction velocity in all nerves with pronounced reduction of conduction blocks.On the basis of the rese...

In the present study, side preferences in spontaneous visual exploration were assessed systematically in 27 patients with idiopathic Parkinson's disease (IPD) and 17 age-matched controls. Assessment of initial visual exploration asymmetry (IVE) was based on the exploration of texture arrays requiring attentive oculomotor scanning. As shown in a previous study, most healthy subjects exhibit a marked asymmetry of IVE with a strong left-sided bias when assessed by this paradigm, while most neglect patients initiate exploration in the right half of the arrays. Standard assessments for symptoms of neglect (line bisection, line cancellation and double simultaneous stimulation) were performed as reference tests. In the IVE task 65% of normal controls and 69% of patients with predominantly right-sided IPD started exploration in the left half of the arrays. By contrast only 14% of patients with predominantly left-sided disease showed a leftward IVE. The majority shows an ambiguous (21%) or rightward (64%) directional bias for initial exploration and thus a behaviour that corresponds to the IVE abnormalities found in neglect patients. No abnormalities were found in the standard neglect tests in any of the groups. The atypical IVE in patients with predominantly left-sided Parkinson's disease should be interpreted in the context of recent concepts of attention postulating that a bias in early spontaneous orientation directed to the ipsilesional hemifield reflects a mild and residual manifestation of hemineglect. Since this subtle orientational bias is less subject to compensation than more conspicuous clinical signs of neglect, sensitivity is higher in IVE testing than in conventional neglect assessments in chronic disorders with subclinical neglect. The present findings contribute a new aspect to the complex picture of cognitive and visuospatial abnormalities in Parkinson's disease. Furthermore our results extend previous knowledge on the mechanisms of neglect and the role of dopamine in the mediation of attention.