Okay, here’s a breakdown of the key information from the provided text regarding each patient, focusing on their symptoms, treatment, and response to ADLL (Tanganil™) therapy. I’ll organize it for clarity.
Vital Note: MSA-P+C refers to Multiple System Atrophy, Parkinsonian type with Cerebellar features. RBD refers to REM Sleep Behavior Disorder, and pisa syndrome is a lateral bending of the trunk.
patient #1 (Not detailed enough to summarize effectively – information is missing)
Table of Contents
The text starts to describe Patient #1 but abruptly cuts off. There isn’t enough information to provide a useful summary.
Patient #2
* Diagnosis: Parkinson’s Disease with REM Sleep Behavior Disorder (RBD) and Pisa Syndrome.
* Age: Not specified.
* Key Symptoms:
* Parkinson’s symptoms (general, not detailed)
* Restless Legs Syndrome (RLS) - initially around age 50, managed with pramipexole and levodopa.
* REM Sleep Behavior Disorder (RBD) – nightly episodes with falls approximately once a week, but decreasing in severity over 2-3 years. he adapted his habitat for safety.
* Pisa Syndrome – a leaning of the trunk.
* Baseline Medication:
* Baclofen (for nocturnal cramps)
* Pramipexole 3.75mg extended-release (for RLS)
* Levodopa 100mg extended-release (for RLS)
* response to ADLL (Tanganil™):
* Positive: Nearly complete regression of RBD symptoms within the first four weeks.
* Negative: Worsening of balance and critically important exacerbation of Pisa Syndrome. This necessitated discontinuation of ADLL.
* Rechallenge: Reintroduction of ADLL at a lower dose also caused balance issues, confirming the link.
* Recovery: Balance returned to baseline after stopping ADLL, but RBD symptoms returned.
* Overall: ADLL was not tolerated due to its negative impact on balance and Pisa syndrome, despite the benefit for RBD.
Patient #3
* Diagnosis: Multiple System Atrophy, Parkinsonian type with Cerebellar features (MSA-P+C) - diagnosed 3 years prior, but symptoms were initially misattributed to psychosomatic causes for 6 years.
* Age: 46
* key Symptoms:
* Erectile Dysfunction (first symptom, age 37)
* Bladder Dysfunction (requiring catheter, age 40)
* Extrapyramidal Syndrome (progressively disabling, leading to loss of walking ability)
* Recurrent Infections (pulmonary and urinary, exacerbating MSA symptoms)
* RBD – pronounced early on (ages 39-41), but no longer noticeable at the time of the study. He reported non-restorative sleep.
* Pisa Syndrome – pre-existing.
* Baseline Status: Confined to a wheelchair, institutionalized due to infections and worsening MSA.
* Response to ADLL (Tanganil™):
* Initial Effects: Sudden awakenings 3 hours after sleep onset, followed by calm, deep sleep with fewer dreams.
* Negative: Significant worsening of trunk stability and Pisa Syndrome. Unable to sit upright. Episodes of severe rigidity requiring assistance.
* Recovery: Symptoms improved to baseline after discontinuation of ADLL,and sleep patterns reverted.
* Complication: Developed severe pulmonary and then urinary infections during the observation period, making it difficult to isolate the effect of ADLL.
* Overall: ADLL was likely detrimental,worsening truncal ataxia and rigidity,but the concurrent infections complicate the interpretation.
In summary: Both Patient #2 and Patient #3 experienced negative effects on their balance and postural stability (Pisa Syndrome) with ADLL therapy, leading to its discontinuation. while ADLL showed a positive effect on RBD in Patient #2, the balance side effects outweighed the benefit. The situation with Patient #3 is more complex due to the complicating factor of infections.
