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Sortium of clinical researchers--the Parkinson Study Group : Parkinson-study-group ; . Future success in treatment of PD will depend on a close collaboration between clinical researchers and primary care physicians. Accepted for publication October 7, 2002. This work was supported in part by a grant from the National Parkinson Foundation, Miami, Fla. Corresponding author and reprints: Joseph Jankovic, MD, Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin St, Suite 1801, Houston, TX 77030.
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Accession number & update 09396034 Medline 20070223. Source No to shinkei Brain and nerve Nov 1997, vol. 49, no. 11, p. 1021-6, ISSN: 0006-8969. Author s ; Shinjo-H, Ueki-A, Miwa-C, Morita-Y. Author affiliation Department of Neuropsychiatry, Hyogo College of Medicine, Japan. Abstract In a healthy 49-year-old man, a decrease in job efficiency was noticed along with bizarre behavior. On admission, he was euphoric, childish, superficial and had increased libido. Neurological findings were normal. There were no abnormal findings on routine blood tests, hematochemistry or urine analysis. MRI showed no abnormal findings. However, single photon emission CT SPECT ; showed diffuse hypoaccummulation of tracer from the temporal to frontal regions. Lumbar puncture showed clear cerebrospinal fluid CSF ; with pleocytosis and an elevated protein level. Moreover, antibody IgG titers to herpes simplex virus HSV ; and measles virus were elevated, according to EIA serum HSV -1, 202.2x, measles virus 47.1x: CSF HSV-116.1x, measles virus 9.9x ; . The ratio of serum to CSF antibody titers of HSV and measles virus were 12.5 and 4.75, respectively. The antibody index values of HSV and measles virus IgG titers were 8.42 and 22.22. The ratio of albumin was 105.7. Chronic, progressive HSV encephalitis is rare, and there have been very few reports of encephalitis due to double infection by HSV and another virus. Our patient was diagnosed as having encephalitis due to double infection with HSV and measles virus, because the ratio of serum to CSF antibody titers was less than 20 and the antibody index values were over 1.91. Moreover, since the IgG index was elevated and the ratio of albumin was not low, it was suggested that the blood-brain-barrier had not been disrupted, and antibodies were being produced chronically in the medullary cavity. Hyperaccummulation of tracer on SPECT studies has been reported in the early stages of HSV encephalitis. In our case, while CT and MRI showed no abnormal findings, SPECT showed diffuse hypoaccummulation. SPECT appears to be a useful tool in the diagnosis of this disorder. In case of chronic, progressive personality change in middle-aged adults, we must be aware of double virus infection of the brain as a possible causal factor. Language Japanese. Publication year 1997.
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Drug Induced Suicides. The IMR model uses some internal sequences to calculate the growing population of patients from the amount of medication that was consumed. But in order to calculate the probable number of drug induced suicides it is necessary to have a suicide rate per given number of patients at risk. This suicide rate must be provided externally and must relate to actual trials and studies, it cannot be generated by IMR. In view of the serious implications of the tables 3 and 4 that follow, it is most important to briefly review the sources to give provenance to the chosen rates. All new patients or volunteers on SSRIs regardless of their mental condition, child or adult, face a finite risk of drug induced suicide in excess of any risk of suicide that they had before medication. GSK presented randomised clinical trial RCT ; results to the MCA for Seroxat in 1990 in their UK licence application. This showed that Seroxat was 8 times more likely to cause suicide or suicide attempts than placebo giving a rate of 236 suicides per 100K patients, zero for placebo. After some debate the application was withdrawn. GSK then manipulated the results of the same trial, shifting suicides from Seroxat onto placebo, and re-applied in 1991. The adjusted figures showed that placebo was now twice as dangerous as Seroxat, giving a rate for Seroxat of 168 suicides 100K patients and an incredible 361 100K for placebo. This affront to medical ethics, logic and common sense did not dismay the MCA and on the basis of this data the MCA granted the lifetime UK licence for Seroxat, which was never to be scientifically and critically reviewed subsequently. This dangerous, inexplicable and incompetent approval in the UK undoubtedly influenced the FDA to follow suit 2 years later when the Paxil licence was granted. In 1993, epidemiological studies Ref.3 ; carried out by the Drug Safety Research Unit on a cohort of 50 K patients who were using various SSRIs found gross rates of suicide as follows: - 269 deaths 100Kfor Seroxat, 244 100K for Prozac and 173 100K for Zoloft. The weighted average from the whole study is 219 100K. These gross figures must be reduced by an estimate of suicides that might have occurred in that population if they had never received medication. This additional data, provided by a study on 460K people over 5 years, suggests a cautious figure of 60 100K Ref.4 ; . The result is that the average SSRI may typically cause at least 160 100K suicides in excess of the suicides that may occur without medication. Both clinical and epidemiological studies suggest that it would be quite justifiable to run IMR with an average SSRI induced suicide rate of about 160 100K. However, in the interests of careful science and caution, a range of excess rates between only 32 to 104 drug induced suicides per100K patients has been chosen to predict the range of total drug induced deaths. To put it another way, the results have been calculated using rates of one fifth to three fifths of the excess induced suicide rates that have been measured in actual clinical trials and epidemiological studies on SSRIs. Although all SSRI patients are at risk of induced suicide and other harm at every dose transition starting, stopping and increasing dose ; the drug induced withdrawal suicides and mid treatment dose change suicides are not included in this analysis and remeron.
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