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Over recent years, several types of freezing of gait (FOG) have been described, mainly according to their response to levodopa. FOG in Parkinson's disease presents in a variety of ways due to differences within the underlying pathophysiology. In a number of patients, increasing the dopaminergic stimulation may not improve this condition, and may even worsen it.We present two patients with Parkinson's disease who were evaluated during off, on and supra-on periods. Motor function was assessed with Unified Parkinson's Disease Rating Scale III, tapping test on lower limbs and quantification of FOG episodes during each of these periods. Both patients presented FOG episodes while in off period, experiencing a significant improvement during on period. However, when increasing the dopaminergic stimulation in order to try to improve their motor response, FOG episodes worsened to the point of impairing gait.FOG episodes are not always a consequence of akinesia or rigidity. Regarding the pathophysiology, the lack of an appropriate response to treatment would be explained by the involvement of structures exceeding the substantia nigra and the dopaminergic deficit. FOG worsening during periods of dopaminergic overstimulation could be related to a neurotransmitters disbalance affecting other nuclei involved in postural and gait control.Congelacion de la marcha en supra-on: a proposito de dos casos.Introduccion. Durante los ultimos años se han descrito diversos tipos de congelacion de la marcha (CDM), definidos fundamentalmente por su respuesta o no al tratamiento con levodopa. El fenomeno de la CDM en la enfermedad de Parkinson es de presentacion muy variable de unos pacientes a otros, con sustrato fisiopatologico diverso. En algunos pacientes, el aumento del estimulo dopaminergico no solo no mejora, sino que puede empeorar este problema. Casos clinicos. Se presentan dos pacientes con enfermedad de Parkinson que fueron evaluados en situacion off, on y supra-on. Para la evaluacion motora se utilizo la Unified Parkinson's Disease Rating Scale III (bilateral) y el tapping test en las extremidades inferiores, y se cuantificaron los episodios de CDM que presentaban los pacientes en las tres situaciones. Ambos pacientes sufrian episodios de CDM en situacion off que no mejoraban significativamente durante el on. Al aumentar el estimulo dopaminergico, en un intento de mejorar la respuesta motora, empeoraron significativamente los episodios de CDM, hasta el punto de imposibilitar la marcha por graves bloqueos. Conclusiones. Los episodios de CDM no siempre son una mera consecuencia de la acinesia o la rigidez. En la fisiopatologia de la CDM podrian intervenir estructuras que desbordan la sustancia negra y el deficit dopaminergico, lo cual podria explicar la falta de respuesta adecuada al tratamiento e incluso el empeoramiento por desequilibrio de los neurotransmisores, en relacion con la sobreestimulacion dopaminergica, en otros nucleos implicados en el control postural y de la marcha.

Movement disorders induced by central nervous system trauma are well recognized. The relation between peripheral injury and the subsequent development of movement disorders has been documented in many reports, specially dystonia and tremor. Pathophysiological mechanisms underlying these movement disorders are not well understood.We report a group of seven patients with movement disorders induced by peripheral trauma. The inclusion criteria used for the patients were: the trauma was well documented for the patient and the medical history, and the onset of the movement disorder was anatomically and temporally related to the injury. We describe seven patients presenting respectively oromandibular dystonia, radicular myoclonus, tremor, segmental dystonia, lower limbs dystonia, segmental myoclonus and tremor, of the body parts previously exposed to traumatic injuries.Individual predisposition and central changes with pathological reorganization in response to peripheral injury have been considered in the pathogenesis of peripherally induced movements disorders.

Background. 5-HT3-receptor antagonists are one of the mainstays of antiemetic treatment, and they are administered either i.v. or orally. Nevertheless, sometimes neither administration route is feasible, such as in patients unable to admit oral intake managed in an outpatient setting. Our objective was to evaluate the bioavailability of s.c. granisetron. Patients and Methods. Patients receiving platinum-based chemotherapy were randomized to receive 3 mg of granisetron either s.c. or i.v. in a crossover manner during two cycles. Blood and urine samples were collected after each cycle. Pharmacokinetic parameters observed with each administration route were compared by analysis of variance. Results. From May to November 2005, 31 patients were included and 25 were evaluable. Subcutaneous granisetron resulted in a 27% higher area under the concentration–time curve for 0–12 hours (AUC0–12h) and higher levels at 12 hours, with similar values for AUC0–24h. The maximum concentration was lower with the s.c. than with the i.v. route and was observed 30 minutes following s.c. administration. Conclusion. Granisetron administered s.c. achieves complete bioavailability. This is the first study that shows that s.c. granisetron might be a valid alternative to i.v. delivery. Further trials to confirm clinical equivalence are warranted. This new route of administration might be especially relevant for outpatient management of emesis in cancer patients.