Chorea and the Oral Contraceptives

Riddoch, Donald; Jefferson, Michael; Bickerstaff, Edwin R.

doi:10.1136/bmj.4.5781.217

Cited by 47 publications

(17 citation statements)

References 5 publications

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“…Results consistent with both reduction and increase of striatal dopaminergic function by estradiol have been reported for all indices of dopaminergic activity, including receptor levels/binding, membrane dopamine transporter levels, and release, depending on dose and treatment paradigm (Arvin et al, 2000;Bazzett and Becker, 1994;Becker and Beer, 1986;Becker and Rudick, 1999;Di Paolo, 1994, 1982, 1984, 1985Disshon et al, 1998;Disshon and Dluzen, 2000;Dluzen, 1997;Landry et al, 2002;McDermott, 1993;McDermott et al, 1994;Morissette et al, 2008;Morissette and Di Paolo, 1993;Peris et al, 1991;Shieh and Yang, 2008;Thompson and Moss, 1994;Zhou et al, 2002). It has been suggested that antidopaminergic effects are primarily exerted by high doses of estrogen or chronic administration, whereas pro-dopaminergic actions are more associated with lower physiological levels of estrogen (Barber et al, 1976;Becker, 1999;Bedard et al, 1977;Cyr et al, 2002;Di Paolo, 1994;Di Paolo et al, 1981;Hruska and Silbergeld, 1980;McEwen and Alves, 1999;Riddoch et al, 1971). The specific mechanisms by which estradiol exerts the effects observed here remain to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Contrasting Effects of Increased and Decreased Dopamine Transmission on Latent Inhibition in Ovariectomized Rats and Their Modulation by 17β-Estradiol: An Animal Model of Menopausal Psychosis?

Arad

Weiner

2010

Neuropsychopharmacol

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Women with schizophrenia have later onset and better response to antipsychotic drugs (APDs) than men during reproductive years, but the menopausal period is associated with increased symptom severity and reduced treatment response. Estrogen replacement therapy has been suggested as beneficial but clinical data are inconsistent. Latent inhibition (LI), the capacity to ignore irrelevant stimuli, is a measure of selective attention that is disrupted in acute schizophrenia patients and in rats and humans treated with the psychosisinducing drug amphetamine and can be reversed by typical and atypical APDs. Here we used amphetamine (1 mg/kg)-induced disrupted LI in ovariectomized rats to model low levels of estrogen along with hyperfunction of the dopaminergic system that may be occurring in menopausal psychosis, and tested the efficacy of APDs and estrogen in reversing disrupted LI. 17b-Estradiol (50, 150 mg/kg), clozapine (atypical APD; 5, 10 mg/kg), and haloperidol (typical APD; 0.1, 0.3 mg/kg) effectively reversed amphetamine-induced LI disruption in sham rats, but were much less effective in ovariectomized rats; 17b-estradiol and clozapine were effective only at high doses (150 mg/kg and 10 mg/kg, respectively), whereas haloperidol failed at both doses. Haloperidol and clozapine regained efficacy if coadministered with 17b-estradiol (50 mg/kg, an ineffective dose). Reduced sensitivity to dopamine (DA) blockade coupled with spared/potentiated sensitivity to DA stimulation after ovariectomy may provide a novel model recapitulating the combination of increased vulnerability to psychosis with reduced response to APD treatment in female patients during menopause. In addition, our data show that 17b-estradiol exerts antipsychotic activity.

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Section: Discussionmentioning

confidence: 99%

Contrasting Effects of Increased and Decreased Dopamine Transmission on Latent Inhibition in Ovariectomized Rats and Their Modulation by 17β-Estradiol: An Animal Model of Menopausal Psychosis?

Arad

Weiner

2010

Neuropsychopharmacol

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“…Relatively high levels of estrogens, including oral contraceptives and estrogen replacement therapy, exacerbate symptoms of Parkinson's disease (6,249,250), pointing to antidopaminergic actions that are opposite to the actions of physiological levels of estradiol. A similar antagonistic effect of chronic or high-dose estrogen was found in male and female rats for drug-induced motor activity (251,252).…”

Section: Catecholaminergic Neuronsmentioning

confidence: 99%

Estrogen Actions in the Central Nervous System¹

1999

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“…The efficacy of the antibiotics used in secondary prophylaxis may be limited due to the uncertain quality of some products; 4. Other non-rheumatic causes of chorea, such as viral infections, tumors of the central nervous system, degenerative processes, among others, [18][19][20][21] have to be considered. This is especially so for those patients who present with recurrent isolated chorea while on adequate prophylaxis.…”

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confidence: 99%

Sydenham's chorea: clinical and evolutive characteristics

et al. 2002

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CONTEXT: During the last 12 years we have observed an increase in the frequency of Sydenham's chorea in our country. We have observed that some of our patients have presented recurrence of the chorea despite regular treatment with benzathine penicillin. OBJECTIVE: The aim of our study was to evaluate clinical and evolutive characteristics of Sydenham's chorea in a group of patients followed in our Pediatric Rheumatology Unit. TYPE OF STUDY: Retrospective study. SETTING: Section of Pediatric Rheumatology - Discipline of Allergy, Clinical Immunology and Rheumatology - Department of Pediatrics - UNIFESP - EPM. PARTICIPANTS: Two hundred and ninety patients with rheumatic fever followed between 1986 and 1999. METHODS: We reviewed the records of 290 patients with rheumatic fever followed between 1986 and 1999. All patients were diagnosed according to the revised Jones criteria (1992). We included 86 patients that presented Sydenham's chorea as one of the major criteria (one or more attacks) and evaluated their clinical and evolutive characteristics as well the treatment. RESULTS: Fifty-five patients were girls and 31 were boys. The mean age at onset was 9.7 years and mean follow-up period was 3.6 years. The 86 Sydenham's chorea patients presented 110 attacks of chorea. We observed isolated chorea in 35% of the patients, and 25 (29%) presented one or more recurrences. We included only 17 of the 25 patients for further analysis, with a total of 22 recurrences of which 14 were attacks of chorea, because it was not possible to precisely detect the interval between attacks in the other patients. The approximate interval between the attacks ranged from 4 to 96 months. In 71% of the patients there was no failure in the secondary prophylaxis with benzathine penicillin, which was performed every 3 weeks. CONCLUSION: Despite the regular use of secondary benzathine penicillin prophylaxis, children with rheumatic fever have a high risk of Sydenham's chorea recurrence.

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Chorea and the Oral Contraceptives

Cited by 47 publications

References 5 publications

Contrasting Effects of Increased and Decreased Dopamine Transmission on Latent Inhibition in Ovariectomized Rats and Their Modulation by 17β-Estradiol: An Animal Model of Menopausal Psychosis?

Contrasting Effects of Increased and Decreased Dopamine Transmission on Latent Inhibition in Ovariectomized Rats and Their Modulation by 17β-Estradiol: An Animal Model of Menopausal Psychosis?

Estrogen Actions in the Central Nervous System¹

Sydenham's chorea: clinical and evolutive characteristics

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Chorea and the Oral Contraceptives

Cited by 47 publications

References 5 publications

Contrasting Effects of Increased and Decreased Dopamine Transmission on Latent Inhibition in Ovariectomized Rats and Their Modulation by 17β-Estradiol: An Animal Model of Menopausal Psychosis?

Contrasting Effects of Increased and Decreased Dopamine Transmission on Latent Inhibition in Ovariectomized Rats and Their Modulation by 17β-Estradiol: An Animal Model of Menopausal Psychosis?

Estrogen Actions in the Central Nervous System1

Sydenham's chorea: clinical and evolutive characteristics

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Estrogen Actions in the Central Nervous System¹