Læknablaðið : fylgirit - 01.05.2002, Blaðsíða 42

POSTERS / 3 3HD SNC & 2ND SCNN
showed a reduced bone circulation in the left leg and hyperaemic
soft tissues.
Treatment with intermittent local botulinum toxin A and physio-
therapy improved the posture of his hand and leg, he was gradually
able to walk with an aid but grip function in his left hand is minimal
and the arm remains paralysed. His pain responds poorly to
medical treatment and transcutanous nerve stimulation therapy.
Conclusion: RSD syndrome may be associated with dystoni and can
develop months after the initial injury. Awareness of the character-
istics and latency of these symptoms and early diagnosis with
initiation of treatment may improve outcome. Spinal cord slimula-
tion may produce pain relief in these cases.
P12 - Proctalgia and Parkinson's disease
Örvar KB’, Sveinbjörnsdóttir S2
‘Pelvic Floor Clinic St. Joseps s, 2Department of Neurology, Landspítalinn -
University Hospital
Pain in Parkinsons's disease is frequently associated with muscle
spasms or dystonia and often improves with adjustments in medical
therapy. Proctalgia of various causes is a relatively common
complaint in the female population. Frequently the etiology is
unkonwn and treatment attempts unsuccessful. In this report we
describe proctalgia in three patients with Parkinsons s disease and
one patient with Multiple System Atrophy (MSA). All had a normal
gynecological examination, vaginal ultrasounds and endoscopic
procedures. All patients had severe levator muscle tenderness.
Despite extensive diagnostic workup in a referral pelvic floor
clinic no etiology was found for the significantly troublesome proc-
talgia in these patients. Adjustment in Parkinson's therapy did not
improve the symptoms.
Conclusion: Despite poor response to Parkinson's therapy we pro-
pose that the proctalgia may have been caused by muscle spasms or
pelvic dystonia associated with the underlying neurological disease.
P13 - Central extrapontine myelinolysis due to polydipsia
causing basal ganglia dysfunction with Parkinsonism. A case
report
Sveinbjörnsdóttir S, Daníelsdóttir G, Benediktsdóttir K
Depts. of neurology, rehabilitation and radiology, Landspítali University Hospital,
Reykjavík, Iceland.
We descripe the case history of a 43 year old woman who in June
2000 developed severe parkinsonism with prominent rigidity,
dystonia and somnolence. These symptoms occurred while she was
an inpatient in a psychiatric ward because of a manic episode during
which she had polydipsia. Prior medical history included several
manic episodes in the last 15 years. MRI of the brain showed signal
changes in bilateral basal ganglia, in particular in the lentiform
nuclei without similar changes in the pons.
Her symptoms were initially considered as being side effects
from chronic treatment with Lithium but serum sodium concentra-
tion was 123 p.mol/1, indication myeliniolysis caused by hypona-
termia. Sodium was slowly corrected and her extrapyramidal symp-
toms treated with clonazepam. Her symptoms slowly resolved,
although minor residual extrapyramidal symptoms were still pre-
sent at discharge seven months after the episode.
Conclusion: Polydipsia can be the underlying cause of myelinolysis
in the cerebrum. Extrapontine myelinolysis is a rare complication
but may occur without myelinolysis in the pons and may cause
severe extrapyramidal symptoms.
P14 - Long-term efficacy and safety of entacapone as an
adjunct to levodopa in patients with parkinson's disease and
motor fluctuations
Larsen JP, Siden Á, Worm-Petersen J, Gordin A, Reinikainen K, Kultalahti
E-R
Department of Neurology, University of Trondheim, Trondheim, Norway
Objective: The COMT inhibitor entaca-
pone has been studied in a Nordic, rando-
mised, placebo controlled, double-blind
study over 6 months. We here report
especially the safety results of its extension
study; an open, uncontrolled 3-year trial
were all patients were administered entaca-
pone.
Material and methods: Of 152 patients
completing the Nordic study, 132 continued
in this study. All patients had Parkinson's
disease (PD) with motor fluctuations. Enta-
capone, 200 mg, was administered with each
daily levodopa dose. Efficacy was evaluated
by the duration of effect of a single levodopa
dose, the UPDRS, and levodopa dosing.
Safety was evaluated by adverse events, BP,
HR, ECG and laboratory safety analyses.
Results: Eighty-six patients (65%) com-
pleted the 3-year follow-up. The mean
duration of benefit from a single levodopa
dose remained prolonged after 3 years of
treatment (without and with entacapone, p<0.001). There was no
worsening of PD disability scores from baseline in the activities of
daily living (ADL). Most patients had the proportion of daily OFF-
Table
Case 1 Case 2 Case 3 Case 4
Disease 2 yrs 6 yrs 8 yrs 4 yrs
duration
Pain location perianal perianal perianal perianal
Defecation difficult difficult difficult difficult
T pain T pain T pain T pain
Rectal exam levator levator levator levator
tenderness tenderness tenderness tenderness
Anorectal poor sphincters poor not done poor
manometry poor emptying emptying emptying
Defecography rectocele rectocelc not done levator
enterocele levator spasm spasm
MRI not done L-4-L5 normal not done
prolapse
Treatment entero/rectocele prolapse medication Fibers
operation operation biofeedback
biofeedback biofeedback
Treatment poor poor poor excellent
outcome
42 Læknablaðið/Fylgirit 43 2002/88