Resolution of tardive tremor after bilateral subthalamic nucleus deep brain stimulation placement

Background: Tardive tremor (TT) is an underrecognized manifestation of tardive syndrome (TS). In our experience, TT is a rather common manifestation of TS, especially in a setting of treatment with aripiprazole, and is a frequent cause of referrals for the evaluation of idiopathic Parkinson disease. There are reports of successful treatment of tardive orofacial dyskinesia and dystonia with deep brain stimulation (DBS) using globus pallidus interna (GPi) as the primary target, but the literature on subthalamic nucleus (STN) DBS for tardive dyskinesia (TD) is lacking. To the best of our knowledge, there are no reports on DBS treatment of TT. Case Description: A 75-year-old right-handed female with the medical history of generalized anxiety disorder and major depressive disorder had been treated with thioridazine and citalopram from 1980 till 2010. Around 2008, she developed orolingual dyskinesia. She was started on tetrabenazine in June 2011. She continued to have tremors and developed Parkinsonian gait, both of which worsened overtime. She underwent DBS placement in the left STN in January 2017 with near-complete resolution of her tremors. She underwent right STN implantation in September 2017 with similar improvement in symptoms. Conclusion: While DBS-GPi is the preferred treatment in treating oral TD and dystonia, DBS-STN could be considered a safe and effective target in patients with predominating TT and/or tardive Parkinsonism. This patient saw a marked improvement in her symptoms after implantation of DBS electrodes, without significant relapse or recurrence in the years following implantation.

Orofacial dyskinesia post resection of pineal gland tumor

We reported a case of a 33-year-old lady who was diagnosed with a Pineal tumor and underwent craniotomy and gross total surgical resection of the mass through a right occipital transtentorial approach. Immediately upon extubation, the patient started to have persistent chewing-like movements typical of orofacial dyskinesia that resulted later in buccal mucosal injury and swelling of the lips. The movements spontaneously resolved after 3 days. The patient was not taking any medications that were known to induce such movements. Literature review showed that one of the possible mechanisms could be that the suddenly reduced melatonin level in the acute postoperative period leads to dysregulation of dopamine secretion in the nigrostriatal and limbic system causing these abnormal movements. To the best of our knowledge, this is the first such reported complication of orofacial dyskinesia post craniotomy for resection of the pineal tumor in humans.

Crushing deutetrabenazine for treatment of tardive dyskinesia in a patient with severe orofacial symptoms: A case report

Purpose Tardive dyskinesia (TD) is a hyperkinetic movement disorder that results from exposure to dopamine receptor antagonists and/or first- and second-generation antipsychotics. While cessation of the offending agent(s) through early detection is recommended, TD symptoms may be irreversible and require further treatment. Deutetrabenazine is approved by the Food and Drug Administration for treatment of persistent TD. Irreversible orofacial dyskinesia, a common affliction in TD, can progress to severe oropharyngeal dysphagia requiring alternate means of nutrition and medication delivery. Enteral administration of crushed deutetrabenazine has not been studied, and its use to treat TD in patients who cannot take medications by mouth has not been reported previously. Summary A 38-year-old female patient with a history of bipolar I disorder and TD secondary to atypical antipsychotic exposure developed worsening athetosis, hyperkinesia, and severe orofacial dyskinesia after initiation of ziprasidone. The patient had no improvement after discontinuation of atypical antipsychotics and required percutaneous endoscopic gastrostomy (PEG) placement for nutrition due to persistent aspiration and inability to tolerate oral nutrition. Despite a lack of information regarding administration of crushed deutetrabenazine tablets via PEG, that form of therapy was initiated and resulted in improvement of TD symptoms without noticeable adverse effects. Conclusion TD can result in significant orofacial dyskinesia with impaired delivery of needed medications and nutrition. We describe a case in which a patient with severe TD and orofacial dyskinesia experienced improvement of symptoms with use of crushed deutetrabenazine. Larger studies to further evaluate use of crushed deutetrabenazine for treatment of TD are needed.

Evaluation of Antioxidant and Anti-Parkinson Activity of Portulaca oleracea Seed Methanolic Extract

Aim: Evaluation of Antioxidant and Anti-Parkinson activity of Portulaca oleracea seed methanolic extract. Place: C. U. Shah College of Pharmacy and Research, Wadhwan, Surendranagar, Gujarat, India. Methodology: Collect plant materials were extracted with methanol. Extract was subjected to qualitative and quantitative investigation and antioxidant properties of extract was determine by Nitric oxide free radical scavenging activity and Reducing power by FeCl3 method. Anti-Parkinson activity evaluated by two behavioral models namely, haloperidol induced catalepsy, and orofacial dyskinesia both models various behavioral activity/ parameter (catalepsy, vacuous chewing movement and tongue protrusion) were evaluated. Results: Preliminary qualitative phytochemical screening was to reveal presence of polyphenols, flavanoids, glycoside, alkaloids, carbohydrates and reducing sugar etc. Based preliminary qualitative phytochemical screening; quantitative estimation of methanolic extract showed significant amount of polyphenols. In-vitro antioxidants was performed by two method reducing power by FeCl3 and nitric oxide free radical scavenging, the methanolic extract shows significant antioxidant properties, based on polyphenols and antioxidant properties extracts was used for the Anti-Parkinson activity Haloperidol induced catalepsy in mice Treatment with Portulaca oleracea seed showed a significant (P<0.01) reduction in the duration of cataleptic behavior dose dependently when compared to haloperidol treated group. Haloperidol induced orofacial dyskinesia in rat recovery of orofacial dyskinesia as evidenced by decrease in the frequency of vacuous chewing movement and tongue significant (P<0.05) decrease in the frequency of vacuous chewing & tongue protrusion while Portulaca oleracea seed (200 mg/kg) was found to be insignificant in this respect. Conclusion: After Portulaca oleracea seed (MLPO) treatment, the significant alterations produced in Parkinson’s affected rodents in respect to lipid peroxidation and antioxidant concentration significantly contributing its antioxidant potential. This antiperoxide action observed in Portulaca oleracea seed (MLPO) treated animals might be due to the suppression of the production of reactive oxygen species. This compound may be found to scavenge free radicals, including hydroxyl anions and reduce the level of lipid peroxidation in MLPO animals. Inhibition of oxidative stress may be one of the possible mechanisms for the anti-Parkinson effects of Portulaca oleracea seed (MLPO).

INVESTIGATION OF THE NEUROPROTECTIVE EFFECT OF LINAGLIPTIN AND CELIPROLOL IN RESERPINE-INDUCED OROFACIAL DYSKINESIA AND ROTENONE-INDUCED NEURODEGENERATION IN RATS

Objective: Linagliptin, an anti-diabetic agent, proven to play an important role in regulating neuronal plasticity and reduce apoptosis and neuroinflammation by activating downstream AMPK/Sirt 1 pathway, which protects mitochondrial function and suppresses intracellular ROS accumulation and shows antioxidant action. Celiprolol, a β-1selective adrenoceptor blocker used as an anti-hypertensive agent, possesses a direct scavenging activity on oxygen radicals with antioxidant properties. The current study was designed to investigate the combined neuroprotective effect of linagliptin and celiprolol. Methods: Wistar rats of either sex were divided into different groups (n = 6). Eight groups each for Reserpine induced orofacial dyskinesia model and Rotenone induced neurodegeneration model to mimic Parkinson’s like conditions and treated or not with different doses of linagliptin and celiprolol. 24 h after the last dose, animals were subjected to behavioral, biochemical and histopathological evaluations. The data were analyzed by ANOVA and Bonferroni multiple comparison test. Results: Reserpine treatment increased VCMs, tongue protrusion and decreased locomotor activity. Rotenone treatment decreases the motor activity and exploratory ability of the animals. Reserpine as well as rotenone treatments decrease catalase, GSH, SOD and increase the LPO levels as compared to sham group animals. Reserpine and rotenone also showed the presence of ghost cells and vacuolated cytoplasm. Linagliptin and celiprolol alone as well as in combination normalized the behavioral, biochemical and histopathological complications. Conclusion: Linagliptin and Celiprolol showed neuroprotection by antioxidant activity as well as improved reserpine and rotenone-induced behavioral deficits. Both drugs have tenacious potential and can be used clinically with some further investigations.