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H. Satyanarayana Swamy , K. S. Anand , M. N. Subhash , V. Anisya , Hariharan Mohan

Abstract

The CSF HVA and 5-HIAA levels and their changes with drug treatment studied in 30 patients with idiopathic parkinson's disease (PD) and 30 patients with chores. Twenty cases of non neurological diseases formed the control for both groups and in them the mean CSF HVA level was 35.7 ± 12.5 ng/ml and the mean 5-HIAA level was 32.4 ± 1.4 ng/ml. The mean age of PD was 52.5 ± 10.4 years. The CSF HVA and 5-HIAA levels were estimated thrice in them: before starting treatment, 10 days after treatment with trihexiphenidyl 2 mg/three times a day and orphenadrine 50 mg/three times a day and the third estimation was made after another 10 days of treatment with amantadine 100 mg/twice a day in addition to the other two drugs. In them, before starting treatment the HVA levels were low, mean value being 13.3 ± 7.3 ng/ml (P < 0.001). It increased to 22.8 ± 8 ng/ml (P < 0.001) after 10 days and it further increased to 31.0 ± 22.8 ng/ml (p < 0.001) after 20 days of treatment . Patients with akinesia had lower levels of HVA compared to those with tremors but was not statistically significant. The mean 5-HIIA levels were low in all the 3 samples; 13.4 ± 6.2 ng/ml, 16.1 ± 5.2 ng/ml, 16.5 ± 5.9 ng/ml (P < 0.001) respectively. The mean age of patients with chorea was 11.5 ± 3.1 years. Seventeen of them fulfilled Jone's criteria for Sydenham's chorea (SC) and 13 did not fulfil the criteria but resembled rheumatic chorea. HVA and 5-HIIA levels in them was estimated twice, before starting treatment and after cessation of choreic movements following treatment with trifluperidl 10 mg/day. The mean duration of treatment was 4 days. The mean HVA levels were high in them before treatment, 71.18 ± 23.0 ng/ml (P < 0.001) and decreased to 49.0 ± 29.5 ng/ml (P < 0.001) after treatment. The mean 5-HIAA levels were low both before and after treatment, 23.4 ± 9.4 ng/ml (P < 0.001) and 22.6 ± 10.2 ng/ml (P < 0.05) respectively.

Keywords

Homovanillic Acid, Hydroxy Indoleacetic Acid, Parkinson's Disease, Chorea, Trifluperiodol, Trihexiphenidyl, Orphenadrine

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S. Gupta ¹, K. S. Anand ¹, S. Rashmi ¹

Affiliations
1 Department of Neurology, PGIMER and Dr. RML Hospital, New Delhi, IN

Abstract

Neurological manifestations of hypothyroidism are rare and usually seen in late stages of illness. Myopathy as initial manifestation of hypothyroidism is even rarer. Muscle hypertrophy, muscle stiffness and cramps in hypothyroid patient is known as Hoffmann’s syndrome. We report a case of a fourty year old male who presented with calf hypertrophy and very high levels of creatine phosphokinase which normalised after eight weeks of treatment with levothyroxine.

Keywords

Hypothyroidism, Myopathy.

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