Nimodipine was administered at the daily dose of 90 mg po, for 30 days, to ten chronic undifferentiated schizophrenics, eight men and two women, aged 31-35 years, maintained on previously longlasting neuroleptic treatments. In five patients, a placebo period of 15 days preceded the administration of the drug. Monitoring of psychiatric symptomatology by the Brief Psychiatric Rating Scale (BPRS) revealed significant nimodipine-induced improvement. However, the Andreasen Rating Scale for Positive Symptoms (SAPS) showed favourable effects only in the five patients who had not received placebo, while in the others both SAPS and the Andreasen Rating Scale for Negative Symptoms (SANS) showed no significant effect of therapy. The Tardive Dyskinesia Scale revealed no improvements of neurological symptoms after either placebo or drug treatment. Measurement of plasma MHPG concentrations revealed no significant changes induced by either placebo or nimodipine, while HVA plasma levels showed a trend toward decrease, and prolactin a trend toward increase, after nimodipine.

Background: Patients with Rett syndrome (RTT) may demonstrate parkinsonianfeatures. Here, we report a preliminary cross-sectional and prospectiveevaluation of the evolution, regional distribution, and eventual incidenceof rigid tone in a cohort of MECP2 mutation-positivepatients. Methods: In 51 participants, muscle tone rigidity in extremity regions andneck plus hypomimia were quantified using an RTT rigidity distribution(RTTRD) score with a range of 0 to 15. RTTRD scores were correlated withage, ability to walk and speak, mutation type, and, in a small subgroup(n=9), cerebrospinal fluid (CSF) homovanillic acid (HVA) and5-hydroxyindole-acetic acid levels. Results: Participant ages ranged from 2 years and 5 months, to 54 years.Rigidity was found in 43/51 (84.3%); it appeared as early as age 3,increased in extent with age, and was present in all participants aged ≥13.Ankle region rigidity appeared first, followed by proximal legs, arms, neck,and face. Ambulatory participants (n=21) had lower RTTRD scores thannonambulatory (n=30; p=0.003). We found a trend to lower scores inparticipants with retained speech (n=13) versus those with none (n=38;p=0.074), and no difference in scores for those with truncating (n=25)versus missense mutations (n=22; p=0.387). RTTRD scores correlatednegatively with CSF HVA levels (R=−0.83; p=0.005), but not with5-hydroxyindole-acetic acid levels (R=−0.45; p=0.22). Conclusions: Although assessment of muscle tone is somewhat subjective and theRTTRD has not been validated, this study nevertheless suggests thatparkinsonian rigidity in RTT is common and frequently increases in extentwith age; its severity correlates directly with impaired ambulation andinversely with CSF HVA levels.

Over the past 25 years much effort has been put into the research of the relationship between neuropsychiatric disorders and the concentrations of CSF-monoamine metabolites. Most of this research has beenfocused on the relation between CSF-concentrations of 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) and specific symptomatological entities, particularly schizophrenia, Alzheimer's dementia and endogenous depression. It appeared that specific relations between diseases and CSF-concentrations of monoamine metabolites cannot be longer maintained and that a more functional psychopathology should be considered as the future research strategy.