133 EFFECT OF AMANTADINE IN CHOREA AND ON URINARY
.
5-H.I.A.A.
AND H.V.A. EXCRETION
S.C. = senile chorea. H.C. Huntington’s chorea. I.M. involuntary movements, cause unknown. t Following encephalitis lethargia. t Refers to duration of therapy and dose at time of post-drug urine collection. All patients subsequently took =
=
benefit from amantadine. It may appear paradoxical that a drug with significant antiparkinsonian activity should be of value, since the drugs usually administered in chorea deplete the brain of its amines or block dopamine receptors. However, amantadine may possibly act -as a partial agonist since it has been reported both to induce stereotyped behaviourand to antagonise the stereotypy produced by amphetamineand apomorphine. 7 ,9 Thus, according to a combination of factors such as the sensitivity of receptors and the availability of endogenous transmitter substances, amantadine may act as an agonist or an antagonist. Apomorphine has also been reported to be of benefit in both Parkinson’s disease 10 and Huntington’s chorea.l1
University Departments of Medicine and Pharmacology, Ninewells Hospital, Dundee DD1 9SY.
200 mg.
daily.
triglyceride level-0-76 mmol/1. (68 mg./l00 ml.)considerably lower than that of the subjects in our previous study, which was 1.33 mmol/1. (118mg. /100ml.). Thus, we confirm that bran is ineffective when there is a low initial triglyceride level. The question remains as to whether bran is effective in subjects with higher starting levels, as suggested by our earlier study in which only
mean was
SERUM-LIPIDS IN
12 HEALTHY YOUNG MEN
(MEAN :J:S.E.M.)
M. W. GRAY L. HERZBERG J. A. R. LENMAN M. J. TURNBULL G. VICTORATOS.
those EFFECT OF BRAN ON BLOOD-LIPIDS
SiR,—In previous work from this department, we found that wheat bran lowered the serum-triglyceride level.12 Connell et al.13 failed to confirm this, and we suggested 14 three possible reasons: the use of cooked rather than raw bran, the administration of the day’s bran in one dose rather than in divided doses with meals, and the use of young rather than middle-aged subjects with consequently lower initial triglyceride levels. We now have data which suggest that the last of these factors is the most important. Raw wheat bran was taken by 12 healthy male volunteers, aged 21-24 years, for six weeks,the same period as in our earlier study. The dose was 15 g. twice daily with meals. The bran was the raw material used by Kelloggs in manufacturing ’All-Bran’, and was essentially the same as the coarse bran used in our previous study. Therefore the type and amount of bran and the plan of administration were all similar. In spite of this, the mean serum-triglyceride level did not change in the present study (see accompanying table). By the paired t test, there was no significant difference between the initial level and any of the subsequent levels. It is noteworthy that the initial 7. 8. 9.
10. 11. 12. 13. 14.
Cox, B., Tha, S. J. Eur. J. Pharmac. 1973, 24, 96. Menon, M. K., Clark, W. G., Fleming, R. M. ibid. 1973, 21, 311. Hackman, R., Pentikainen, P., Neuvonen, P. J., Vapaatalo, H. Experientia, 1973, 29, 1524. Schwab, R. S., England, A. C., Poskanzer, D. C., Young, R. R. J. Am. med. Ass. 1969, 208, 1168. Tolosa, E. S., Sparber, S. B. Life Sci. 1974, 15, 1371. Heaton, K. W., Pomare, E. W. Lancet, 1974, i, 49. Connell, A. M., Smith, C. L., Somsel, M. ibid. 1975, i, 496. Heaton, K. W., Pomare, E. W. ibid. p. 800.
subjects who began with a level over 1.12 mmol/1. (100 mg./100 ml.) showed a significant fall with bran. As shown in the table, bran had no significant effect on serum-cholesterol levels. This is in agreement with our previous findings as well as those of several other in-
vestigators. 11-11 P. DURRINGTON A. C. B. WICKS K. W. HEATON.
University Department of Medicine, Royal Infirmary, Bristol BS2 8HW.
GLUTEN-FREE DIET SIR,-So the character-assassination of the gluten-free diet continues! First Dr Jellinek’s rigours of the diet " (Oct. 26, p. 1006) and now Professor Edwards’ tedious diet " (July 5, p. 41). I dealt with the former in my letter of Nov. 16 (p. 1204). Tedious " is defined as " wearisome by continuance " (Shorter Oxford English Dictionary). Having been on a strict gluten-free diet for over two years, I have first-hand knowledge that it is anything but " wearisome by continuance ". I enjoy a good variety of highly palatable food-quite a change from the ubiquitous sandwich snack (now there’s tedium for you). Surely there are some doctors who can supply this diet with a reference ? "
"
"
22 Ribblesdale Avenue,
Congleton, Cheshire.
BRIAN S. HUNT.
15. Jenkins, D. J. A., Leeds, A. R., Newton, C., Cummings, J. H. ibid. p. 1116. 16. Truswell, A. S., Kay, R. M. ibid. p. 922. 17. Eastwood, M. A., Kirkpatrick, J. R., Mitchell, W. D., Bone, A., Hamilton, T. Br. med. J. 1973, iv, 392.
.
5-H.I.A.A.
AND H.V.A. EXCRETION
S.C. = senile chorea. H.C. Huntington’s chorea. I.M. involuntary movements, cause unknown. t Following encephalitis lethargia. t Refers to duration of therapy and dose at time of post-drug urine collection. All patients subsequently took =
=
benefit from amantadine. It may appear paradoxical that a drug with significant antiparkinsonian activity should be of value, since the drugs usually administered in chorea deplete the brain of its amines or block dopamine receptors. However, amantadine may possibly act -as a partial agonist since it has been reported both to induce stereotyped behaviourand to antagonise the stereotypy produced by amphetamineand apomorphine. 7 ,9 Thus, according to a combination of factors such as the sensitivity of receptors and the availability of endogenous transmitter substances, amantadine may act as an agonist or an antagonist. Apomorphine has also been reported to be of benefit in both Parkinson’s disease 10 and Huntington’s chorea.l1
University Departments of Medicine and Pharmacology, Ninewells Hospital, Dundee DD1 9SY.
200 mg.
daily.
triglyceride level-0-76 mmol/1. (68 mg./l00 ml.)considerably lower than that of the subjects in our previous study, which was 1.33 mmol/1. (118mg. /100ml.). Thus, we confirm that bran is ineffective when there is a low initial triglyceride level. The question remains as to whether bran is effective in subjects with higher starting levels, as suggested by our earlier study in which only
mean was
SERUM-LIPIDS IN
12 HEALTHY YOUNG MEN
(MEAN :J:S.E.M.)
M. W. GRAY L. HERZBERG J. A. R. LENMAN M. J. TURNBULL G. VICTORATOS.
those EFFECT OF BRAN ON BLOOD-LIPIDS
SiR,—In previous work from this department, we found that wheat bran lowered the serum-triglyceride level.12 Connell et al.13 failed to confirm this, and we suggested 14 three possible reasons: the use of cooked rather than raw bran, the administration of the day’s bran in one dose rather than in divided doses with meals, and the use of young rather than middle-aged subjects with consequently lower initial triglyceride levels. We now have data which suggest that the last of these factors is the most important. Raw wheat bran was taken by 12 healthy male volunteers, aged 21-24 years, for six weeks,the same period as in our earlier study. The dose was 15 g. twice daily with meals. The bran was the raw material used by Kelloggs in manufacturing ’All-Bran’, and was essentially the same as the coarse bran used in our previous study. Therefore the type and amount of bran and the plan of administration were all similar. In spite of this, the mean serum-triglyceride level did not change in the present study (see accompanying table). By the paired t test, there was no significant difference between the initial level and any of the subsequent levels. It is noteworthy that the initial 7. 8. 9.
10. 11. 12. 13. 14.
Cox, B., Tha, S. J. Eur. J. Pharmac. 1973, 24, 96. Menon, M. K., Clark, W. G., Fleming, R. M. ibid. 1973, 21, 311. Hackman, R., Pentikainen, P., Neuvonen, P. J., Vapaatalo, H. Experientia, 1973, 29, 1524. Schwab, R. S., England, A. C., Poskanzer, D. C., Young, R. R. J. Am. med. Ass. 1969, 208, 1168. Tolosa, E. S., Sparber, S. B. Life Sci. 1974, 15, 1371. Heaton, K. W., Pomare, E. W. Lancet, 1974, i, 49. Connell, A. M., Smith, C. L., Somsel, M. ibid. 1975, i, 496. Heaton, K. W., Pomare, E. W. ibid. p. 800.
subjects who began with a level over 1.12 mmol/1. (100 mg./100 ml.) showed a significant fall with bran. As shown in the table, bran had no significant effect on serum-cholesterol levels. This is in agreement with our previous findings as well as those of several other in-
vestigators. 11-11 P. DURRINGTON A. C. B. WICKS K. W. HEATON.
University Department of Medicine, Royal Infirmary, Bristol BS2 8HW.
GLUTEN-FREE DIET SIR,-So the character-assassination of the gluten-free diet continues! First Dr Jellinek’s rigours of the diet " (Oct. 26, p. 1006) and now Professor Edwards’ tedious diet " (July 5, p. 41). I dealt with the former in my letter of Nov. 16 (p. 1204). Tedious " is defined as " wearisome by continuance " (Shorter Oxford English Dictionary). Having been on a strict gluten-free diet for over two years, I have first-hand knowledge that it is anything but " wearisome by continuance ". I enjoy a good variety of highly palatable food-quite a change from the ubiquitous sandwich snack (now there’s tedium for you). Surely there are some doctors who can supply this diet with a reference ? "
"
"
22 Ribblesdale Avenue,
Congleton, Cheshire.
BRIAN S. HUNT.
15. Jenkins, D. J. A., Leeds, A. R., Newton, C., Cummings, J. H. ibid. p. 1116. 16. Truswell, A. S., Kay, R. M. ibid. p. 922. 17. Eastwood, M. A., Kirkpatrick, J. R., Mitchell, W. D., Bone, A., Hamilton, T. Br. med. J. 1973, iv, 392.
