Okay, here’sโ a breakdown of the key information from the provided text regarding eachโ patient, focusing on their symptoms, treatment, and response to ADLL (Tanganilโข) โtherapy. I’ll organize it for clarity.
Vital Note: โข MSA-P+C โคrefers โขto Multiple System Atrophy, Parkinsonian type with Cerebellar features. RBD refers to REMโ Sleep Behavior Disorder, and pisa โsyndrome is a lateral bending of the trunk.
patient #1 (Not detailed โขenough to summarize โeffectively – information is missing)
Table of Contents
The โขtext starts to describe Patient #1 but abruptly cuts off. There isn’t enough information to provide a useful summary.
Patient #2
* โฃ Diagnosis: Parkinson’s Disease with REM Sleep Behavior Disorder (RBD) and Pisa โSyndrome.
* Age: โขNot specified.
* โค Key Symptoms:
โ * โฃ Parkinson’sโ symptoms (general, โคnot detailed)
โค * โ Restless โLegsโ Syndrome (RLS) โ- initially around age 50, managed โwith โขpramipexole and levodopa.
* REM Sleep Behavior Disorder (RBD) – nightly episodes with falls approximately โคonce a week, but decreasing in severity over 2-3 years. โฃhe adapted his habitat for safety.
โ * Pisa Syndromeโ – a leaning of theโฃ trunk.
* Baseline Medication:
* โข Baclofen (for nocturnal cramps)
* โ Pramipexoleโค 3.75mg extended-release (for RLS)
โ * โLevodopa 100mg extended-release (forโ RLS)
* response to ADLL (Tanganilโข):
*โฃ Positive: โคNearly complete regression of RBD symptoms within the first fourโ weeks.
* โฃ Negative: Worsening of balanceโ and critically important โข exacerbation of Pisa Syndrome. This necessitated discontinuation of ADLL.
* Rechallenge: Reintroduction of ADLL at a lower dose also caused balance issues,โ confirming the link.
* Recovery: Balance returned to baseline after stopping ADLL, but RBD symptoms returned.
* Overall: ADLL wasโฃ not tolerated due to โฃits negative impact on balance and Pisa syndrome, despite the benefit for RBD.
Patient โฃ#3
* Diagnosis: Multiple System Atrophy, Parkinsonian type with Cerebellar features (MSA-P+C) โ- diagnosed 3โข years prior, butโ symptomsโฃ were initially misattributed to psychosomatic causes for 6 โyears.
* Age: โ46
* key Symptoms:
โ * Erectile Dysfunction (first symptom, age 37)
* โคBladder Dysfunction (requiring catheter, age 40)
โข * Extrapyramidalโ Syndrome (progressively disabling, leading to loss of walking โคability)
โข * โค Recurrent Infections (pulmonary and urinary,โ exacerbating โฃMSA symptoms)
โ โ * โฃ RBD – pronounced early โon (ages 39-41), but no longer noticeable at the time of โthe study. He reported non-restorative sleep.
โ* Pisa Syndrome – pre-existing.
* Baseline Status: Confined to a wheelchair, institutionalized โdue to infections and worsening MSA.
* Response to ADLL (Tanganilโข):
* Initial Effects: Sudden awakenings 3 hours after sleep onset, followed by calm,โค deep sleep with fewer dreams.
* โฃโฃ Negative: โ Significant worsening of trunk stability and Pisa Syndrome. Unable toโ sit upright.โ Episodes of severe rigidity requiring assistance.
โฃ * Recovery: Symptoms improved to baseline after discontinuation of ADLL,and sleep patterns reverted.
โ โ* Complication: Developed severeโฃ pulmonary and then urinary infections during the observation period, making it difficultโ to isolate the effect ofโฃ ADLL.
* โข Overall: โ ADLL โขwas likelyโฃ detrimental,worsening truncal ataxia and rigidity,but the concurrent โinfections complicate the interpretation.
In summary: Both Patient #2 and Patient #3 experienced negative effects on their balance and โpostural โฃstability (Pisa Syndrome) with ADLL therapy, leadingโฃ to its discontinuation. while ADLL showed a โคpositive effect on RBD in Patient #2, the balance sideโข effects outweighed the benefit. โค The situation withโค Patient #3 is โmore complex due to the complicating factor of infections.