Advertisement

Failure of L-Dopa to Relieve Activated Rigidity in Parkinson’s Disease

  • David D. Webster
  • James A. Mortimer
Part of the Advances in Experimental Medicine and Biology book series (AEMB)

Abstract

Rigidity in Parkinson patients can be easily quantitated by determining net work required to passively flex and extend the fore arm through an arc of 100°. Rigidity thus measured can be subdivided into two very distinct types, resting and activated. Resting rigidity, measured while the patient is relaxed, responds to all effective therapeutic agents and correlates closely to degree of clinical improvement. Activated rigidity, measured during voluntary activity, is not relieved by any presently available medical treatment. It remains unchanged at pre-therapy levels even in patients who may temporarily appear to have dramatic improvement in clinical symptomatology. Longitudinal measurements made in hundreds of parkinson patients over intervals ranging from 5 to 15 years show continuing high levels of activated rigidity through the entire period of study.

In marked contrast to our wide experience with parkinson patients is a single, well documented case of Wilson’s disease who appears to have recovered completely both by clinical examination and by all of our machine measurements. This patient had high levels of extrapyramidal deficit, repeatedly measured over a period of four months when penicillamine therapy was being investigated. He then suddenly reverted to normal and returned to full time employment. High values of resting rigidity, activated rigidity, akinesia and resting tremor all reverted to normal and have remained normal for the past 6 years.

The implication of this study is that L-dopa and related treat ments only mask the symptomatology of Parkinson’s disease and are not retarding the underlying pathological process. Penicillamine, on the other hand, probably does relieve the destructive process in Wilson’s disease and may, in early cases, permanently relieve the extrapyramidal dysfunction.

Keywords

Walk Index Pursuit Score Amantadine Hydrochloride Penicillamine Therapy Shuffling Gait 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Webster, D.D. (1972). Clinical aspects of rigidity. In Parkinson’s Disease: Rigidity, Akinesia, Behavior (Siegfried, J., Ed.) pp. 66–92, Hans Huber, Bern, Stuttgart, Vienna.Google Scholar
  2. Webster, D.D. (1959). A method of measuring the dynamic characteris tics of muscle rigidity, strength, and tremor in the upper extremity. IRE Trans. on Medical Electronics 6 ,159–164.Google Scholar
  3. Webster, D.D. (1966). Rigidity in extrapyramidal disease. The Second Symposium on Parkinson’s Disease. J. Neurosurg., Suppl. Part II. 299–307.Google Scholar
  4. Webster, D.D. (1968). A critical analysis of disability in Parkinson’s Disease. Mod. Treat. 5 ,257–282.PubMedGoogle Scholar
  5. Sternlieb, I. and Scheinberg, I.H. (1968). Birth Defects Original Article Series, 4 (No. 2), 122–125.Google Scholar
  6. Denny-Brown, D. (1960). Diseases of the basal ganglia. Their relation to disorders of movement. Lancet ii, 1099–1105, 1155–1162.CrossRefGoogle Scholar
  7. Rushworth, G. (1961). The gamma system in Parkinsonism. Int. J. Neurol. 2 ,34–50.PubMedGoogle Scholar
  8. Andrews, C.J., Burke, D. and Lance, J.W. (1972). The response to muscle stretch and shortening in Parkinsonian rigidity. Brain 95 ,795–812.PubMedCrossRefGoogle Scholar
  9. Tatton, W.G. and Lee, R.G. (1975). Evidence for abnormal long-loop reflexes in rigid Parkinsonian patients. Brain Res. 100 ,671–676.PubMedCrossRefGoogle Scholar
  10. Landau, W.M., Struppler, A., and Mehls, . (1966) O. A comparative electromyographic study of the reactions to passive movement in Parkinsonism and in normal subjects. Neurology (Minneap.) 16 ,34–48.CrossRefGoogle Scholar
  11. Cooper, I.S., Riklan, M., Stellar, S., Waltz, J.M., Levita, E., Ribera, V.A., and Zimmerman, J. (1968). A multidisciplinary investigation of neurosurgical rehabilitation in bilateral parkinsonism. J. Amer. Geriat. Soc. 16 ,1177–1306.PubMedGoogle Scholar
  12. Van Buren, J.M., Li, C.L., Shapiro, D.Y., Henderson, W.G., and Sadowsky, D.A. (1973). A qualitative and quantitative evaluation of Parkinsonians three to six years following thalamotomy. Confin. neurol. 35 ,202–235.PubMedCrossRefGoogle Scholar
  13. Webster, D.D. (1959). A method of measuring the dynamic characteristics of muscle rigidity, strength, and tremor in the upper extremity. IRE Trans, on Medical Electronics 6 ,159–164.CrossRefGoogle Scholar
  14. Webster, D.D. (1966). Rigidity in extrapyramidal disease. The Second Symposium on Parkinson’s Disease. J. Neurosurg., Suppl. Part II. 299–307.Google Scholar
  15. Webster, D.D. (1968). A critical analysis of disability in Parkin sons Disease. Mod. Treat. 5 ,257–282.PubMedGoogle Scholar
  16. Webster, D.D. (1969). Dynamic evaluation of thalamotomy in Parkinson’s Disease: Analysis of 75 consecutive cases. In Third Symposium on Parkinson’s Disease (Gillingham, F.J. and Donaldson, I.M.L., Eds) pp. 266–271. E. &S. Livingstone, Ltd., Edinburgh and London.Google Scholar
  17. Webster, D.D. (1972). Clinical aspects of rigidity. In Parkinson’s Disease: Rigidity, Akinesia, Behavior (Siegfried, J., Ed.) pp. 66–92, Hans Huber, Bern, Stuttgart, Vienna.Google Scholar

Copyright information

© Plenum Press, New York 1977

Authors and Affiliations

  • David D. Webster
    • 1
  • James A. Mortimer
    • 1
  1. 1.Neurology Service and Surgery Service, Veterans Administration HospitalUniversity of MinnesotaMinneapolisUSA

Personalised recommendations