The pharmacologic armamentarium used to treat dyskinesias in childhood is increasing. Anticonvulsant drugs as a class are still some of the broadest-spectrum antidyskinetic agents, probably because the class includes so many differently acting drugs or because dyskinesias are manifestations of subcortical electrical events. This group is enhanced by recent developments in γ-aminobutyric acid and glutamate receptor pharmacology, which promise new antidyskinetic drugs. Other drugs acting at receptors for monoamines (dopamine, norepinephrine, and serotonin), acetylcholine, opioids, or histamine may provide symptomatic improvement. Fewer pharmacotherapies address the underlying pathophysiology of movement disorders. Of these, drugs or biologicals for immunomodulation are the most developed, but the group also includes antioxidants, cofactors, metabolic inhibitors, and chelators. There is potential for drugs that block the neurotoxic effects of glutamate to treat movement disorders and reverse or prevent brain injury. Peripheral blockade of focal dyskinesias through botulinum toxin offers a useful alternative to drugs in some patients. (J Child Neurol 1996;11:355-369).
Get full access to this article
View all access options for this article.
References
1.
Pranzatelli MR: Update on pediatric movement disorders. Adv Pediatr1995;42:415-463.
2.
Pranzatelli MR: The immunopharmacology of the opsoclonus-myoclonus syndrome. Clin Neuropharmacol1996;19:1-47.
3.
Rosenberg RN : A neurological gene map. Arch Neurol1993;50: 1269-1271.
4.
Pranzatelli MR: An approach to movement disorders of childhood . Pediatr Ann1993;22:13-17.
5.
Receptor and ion channel nomenclature supplement. Trends Pharmacol Sci1994;15:1-48.
6.
Carpenter MB: Anatomy of the basal ganglia, in Vinken PJ, Bruyn GW, Klawans HL (eds): Handbook of Clinical Neurology, vol 5: Extrapyramidal Disorders. New York, Elsevier, 1986, pp 1-18.
7.
Afifi AK: Basal ganglia: Functional anatomy and physiology. Part 1. J Child Neurol1994;9:249-260.
8.
Afifi AK: Basal ganglia: Functional anatomy and physiology. Part 2. J Child Neurol1994;9:352-361.
9.
Marsden CD: The mysterious motor function of the basal ganglia: The Robert Wartenberg lecture. Neurology1982;32:514-539.
10.
Cote L., Crutcher MD: The basal ganglia, in Kandel ER , Schwartz JH, Jessell TM (eds): Principles of Neural Science. New York, Elsevier, 1991, pp 647-659.
11.
Marsden CD, Obeso JA: The functions of the basal ganglia and the paradox of stereotaxic surgery in Parkinson's disease. Brain1994 ;117:877-897.
12.
Cools AR: Clinical neuropharmacology of the basal ganglia, in Vinken PJ, Bruyn GW, Klawans HL (eds): Handbook of Clinical Neurology, vol 5: Extrapyramidal Disorders. New York, Elsevier, 1986, pp 47-63.
13.
Kanazawa I.: Clinical pathophysiology of basal ganglia disease, in Vinken PJ, Bruyn GW, Klawans HL (eds): Handbook of Clinical Neurology, vol 5: ExtrapyramidaL Disorders. New York, Elsevier, 1986, pp 65-85.
14.
Penny JB, Young AB: Speculations on the functional anatomy of basal ganglia disorders . Annu Rev Neurosci1982;6:73-94.
15.
Bhatia KP, Marsden CD: The behavioral and motor consequences of focal lesions of the basal ganglia in man. Brain1994;117: 859-976.
16.
Jankovic J. , Svendgen CN, Bird ED: Brain neurotransmitters in dystonia. N Engl J Med1987;316:278-279
17.
Homykiewicz O., Kish S., Becker LE, et al: Biochemical evidence for brain neurotransmitter changes in idiopathic torsion dystonia (dystonia musculorum deformans). Adv Neurol1988;50:157-165.
18.
Hosokawa S. , Ichiya Y., Kuwahara Y., et al: Positron emission tomography in cases of chorea with different underlying diseases. J Neurol Neurosurg Psychiatry1987;50:1284-1287.
19.
Guttman M., Lang AE, Garnett ES, et al: Regional cerebral glucose metabolism in SLE chorea: Further evidence that striatal hypometabolism is not a correlate of chorea. Mov Disord1987;2:201-210.
20.
Karbe H., Holthoff VA, Rudolf J., et al: Positron emission tomography demonstrates frontal cortex and basal ganglia hypometabolism in dystonia. Neurology1992;42:1540-1546.
21.
Sawle GV, Leenders KL, Brooks DJ, et al: Dopa-responsive dystonia: [18F]dopa positron emission tomography . Ann Neurol1991;30:24-30.
22.
Snow BJ, Nygaard TG, Takahashi H., et al: Positron emission tomographic studies of dopa-responsive dystonia and early-onset idiopathic parkinsonism. Ann Neurol1993;34:733-738.
23.
Singer HS, Reiss AL, Brown JE, et al: Volumetric MRI changes in basal ganglia of children with Tourette's syndrome. Neurology1993;43:950-956.
24.
Zeffiro T., Zee DS, Hallett M.: Symptomatic and essential palatal tremor. 1. Clinical, physiological and MRI analysis. Brain1994; 117:775-788.
25.
Delecluse F. , Waldemar G., Vestermark S., et al: Cerebral blood flow deficits in hereditary essential myoclonus. Arch Neurol1992;49:179-182.
26.
Jenkins IH, Bain PG, Colebatch JG, et al: A positron emission tomography study of essential tremor: Evidence for overactivity of cerebellar connections. Ann Neurol1993;34:82-90.
27.
Pranzatelli MR , DeVivo DC: Role of the central nervous system in blood pressure regulation, in Loggie J (ed): Pediatric Hypertension. Oxford, UK, Blackwell , 1991, pp 52-63.
28.
Ryan SG, Sherman SL, Terry JC, et al: Startle disease, or hyperekplexia: Response to clonazepam and assignment of the gene (STHE) to chromosome 5q by linkage analysis. Ann Neurol1992;31:663-668.
29.
Shiang R., Ryan SG, Zhu YZ, et al: Mutations in the alpha 1 subunit of the inhibitory glycine receptor cause the dominant neurologic disorder, hyperekplexia. Nat Genet1993;5:351-358.
30.
Morselli PL, Barthoini G., Lloyd KG: Progabide, in Meldrum BS, Porter RJ (eds): New Anticonvulsant Drugs. Current Problems in Epilepsy. London, John Libbey, 1986, pp 887-904.
31.
Roba J., Cavalier R., Cordi A., et al: Milacemide, in Meldrum BS, Porter RJ (eds): New Anticonvulsant Drugs. Current Problems in Epilepsy. London, John Libbey, 1986, pp 179-190.
Berkovic SF , Cochius J., Andermann E., Andermann F.: The progressive myoclonus epilepsies: Clinical and genetic aspects. Epilepsia1993;34(Suppl 3):519-530.
42.
Eldridge R. , Stem R., livananen M., et al: "Baltic" myoclonus epilepsy: Hereditary disorder of childhood made worse by phenytoin. Lancet1983;2:838-842.
43.
Leckman JF, Cohen DJ: Descriptive and diagnostic classification of tic disorders, in Cohen DJ, Bruun RD , Leckman JF (eds): Tourette's Syndrome and Tic Disorders. Clinical Understanding and Treatment . New York, John Wiley, 1988, pp 4-19.
44.
Le Witt PA: Therapeutics of Tourette syndrome. New medication approaches. Adv Neurol1992;58:263-270.
45.
Matthews WB : Treatment of restless legs syndrome with clonazepam . BMJ1979;1:751.
46.
Pujalte D., Bottaï T., Huë A., et al: A double-blind comparison of clonazepam and placebo in the treatment of neuroleptic-induced akathisia. Clin Neuropharmacol1994;17:236-242.
47.
Fibinger HC , Lloyd KG: Neurobiological substrates of tardive dyskinesia The GABA hypothesis. Trends Neurosci1984; 7:462-464.
48.
Koller WC, Hubble JP, Busenbark KL: Essential tremor, in Calne DB (ed): Neurodegenerative Diseases. Philadelphia , WB Saunders, 1994, pp 717-742.
49.
Daoud AS, Zaki M., Shakir R., et al: Effectiveness of sodium valproate in the treatment of Sydenham's chorea. Neurology1990; 40:1140-1141.
50.
Sethi KD, Patel BP: Inconsistent response to divalproex sodium in hemichorea/hemiballism . Neurology1990;40:1630-1631.
Gallager DW , Malcolm AB, Anderson SA, Gonsalves BF: Continuous release of diazepam: Electrophysiological and behavioral consequences. Brain Res1985 ;342:26-36.
57.
Miller LG, Greenblatt DJ, Barnhill JG, Shader RI: Chronic benzodiazepine administration. I. Tolerance is associated with benzodiazepine receptor down regulation and decreased gamma-aminobutyric acid A receptor function. J Phanaacol Exp Ther1988;246:170-176.
Martin WE, Resch JA, Barker AB: Juvenile parkinsonism. Arch Neurol1971;25:494-500.
70.
Lang AE, Meadows JC, Parkes JD, et al: Early onset of the "on-off" phenomenon in children with symptomatic parkinsonism. J Neurol Neurosurg Psychiatry1982;45:823-825.
71.
Fletcher NA , Thompson PD, Scadding JW, Marsden CD: Successful treatment of childhood onset symptomatic dystonia with levodopa. J Neurol Neurosurg Psychiatry1993;56:865-867.
72.
Pranzatelli MR, Mott S., Pavlakis S., et al: The clinical spectrum of secondary parkinsonism in childhood: A reversible disorder. Pediatr Neurol1994; 10: 131-140.
73.
Goetz CG, Tanner CM, Shannon KM, et al: Controlled-release carbidopa/levodopa (CR 4-Sinemet) in Parkinson's disease patients with and without motor fluctuations. Neurology1988;38: 1143-1146.
Granato JE, Stern BJ, Ringel A., et al: Neuroleptic malignant syndrome: Successful treatment with dantrolene and bromocriptine. Ann Neurol1983; 14:89-90.
77.
Friedman JH , Feinberg SS, Feldman RG: A neuroleptic malignant like syndrome due to levodopa therapy withdrawal. JAMA1985;254:2791-2795.
78.
Artieda J., Obeso JA: The pathophysiology and pharmacology of photic cortical reflex myoclonus . Ann Neurol1993;34:175-184.
79.
Colosimo C. , Merello M., Albanese A.: Clinical usefulness of apomorphine in movement disorders. Clin Neuropharmacol1994; 17:243-259.
80.
Campbell M. , Grega DM, Green WH, et al: Neuroleptic-induced dyskinesias in children. Clin Neuropharmacol1983;6:207-222.
81.
Jankovic J. , Orman J.: Tetrabenazine therapy of dystonia, chorea, tics, and other dyskinesias. Neurology1988 ;38:391-394.
82.
Stacy M., Cardoso F., Jankovic J.: Tardive stereotypy and other movement disorders in tardive dyskinesias . Neurology1993;43: 937-941.
83.
Mastaglia FL: latrogenic (drug-induced) disorders of the nervous system, in Aminoff MJ (ed): Neurology and General Medicine . New York, Churchill Livingstone , 1989, pp 505-532.
84.
Bressman SB, Greene PE: Treatment of hyperkinetic movement disorders. Clin Neuropharmacol1990;8:51-75.
Klawans HL, Brandabur MM: Chorea in childhood. Pediatr Ann1993 ;22:41-52.
87.
Johnson WG, Fahn S.: Treatment of vascular hemiballism and hemichorea. Neurology1977;27:634-636.
88.
Erenberg G. : Pharmacologic therapy of tics in childhood . Pediatr Ann1988;17:395-404.
89.
Frank LM: Gratification phenomena: A common but infrequently recognized movement disorder in childhood, abstract. Ann Neurol1994;36:536.
90.
Cohen DJ, Young JG, Nathanson AA, Shaywitz BA: Clonidine in Tourette's syndrome. Lancet1979 ;2:551-552.
91.
Goetz CG, Tanner CM, Wilson RS, et al: Clonidine and Gilles de la Tourette's syndrome: Double-blind study using objective rating methods. Ann Neurol1987;21:307-310.
92.
Walkup JT, Scahill LD, Riddle MA: Disruptive behavior, hyperactivity, and learning disabilities in children with Tourette's syndrome. Adv Neurol1995;65:259-272.
93.
Bain PG, Findley LJ, Thompson PD, et al: A study of hereditary essential tremor. Brain1994;117:805-824.
94.
Murray TJ: Long-term therapy of essential tremor with propranolol. Can Med Assoc J1976; 115:892-894.
95.
Ferro JM, Cahau ES: Treatment of familial essential myoclonus with propranolol. Lancet1977;2:143.
96.
Fowler GW: Propranolol treatment of infantile polymyoclonia. Neuropadiatrie1976;7:443-448.
97.
Bolthauser E., Deonna T., Hirt HR: Myoclonic encephalopathy of infants or "dancing eyes syndrome." Helv Paediatr Acta1979; 34:119-133.
98.
Barron TF, Younkin DP: Propranolol therapy for shuddering attacks. Neurology1992;42:258-259.
99.
Obeso JA, Rothwell JC, Lang AE, et al: Myoclonic dystonia. Neurology1983;33:825-830.
100.
Flament MF , Rapoport JL, Berg CJ, et al: Clomipramine treatment of childhood obsessive-compulsive disorder. A double-blind controlled study. Arch Gen Psychiatry1985;42:977-983.
101.
Riddle MA, Hardin MT, King R., et al: Fluoxetine treatment of children and adolescents with Tourette's and obsessive compulsive disorders: Preliminary clinical experience. JAm Acad ChildAdolesc Psychiatry1990;29:45-48.
102.
Singer HS, Brown J., Quaskey S., et al: The treatment of attention-deficit hyperactivity disorder in Tourette's syndrome: A double-blind placebo-controlled study with clonidine and desipramine. Pediatrics1995;95:74-81.
103.
Riddle MA, Geller B., Ryan N.: Another sudden death in a child treated with desipramine. J Am Acad Child Adolesc Psychiatry1993;32:792-797.
104.
Van Woert MH, Magnussen I., Rosenbaum D., Chung E.: Fluoxetine in the treatment of intention myoclonus. Clin Neuropharmacol1983;6:49-54.
105.
Jankovic J. : Deprenyl in attention deficit associated with Tourette's syndrome. Arch Neurol1993;50:286-288.
106.
Pranzatelli MR: Serotonin and human myoclonus: Rationale for the use of serotonin receptor agonists and antagonists. Arch Neurol1994;51:605-617.
107.
Pranzatelli MR, Tate E., Baldwin M.: Clinical responses to 5-hydroxy-L-tryptophan in chronic pediatric opsoclonus-myoclonus suggest biochemical heterogeneity: A double-blinded placebo crossover pilot study . Clin Neurophannacol1994; 17:103-116.
108.
Pranzatelli MR, Tate E., Huang Y., et al: The neuropharmacology of progressive myoclonus epilepsy: Response to 5-hydroxy-L-tryptophan. Epilepsia1995;36:783-791.
109.
Mizuno T., Yagari Y.: Prophylactic effect of L-5-hydroxytryptophan on self-mutilation in the Lesch-Nyhan syndrome. Neuropaediatrica1975;6:13-23.
110.
Pranzatelli MR, Franz D., Tate ED, Martens JM: Buspirone in progressive myoclonus epilepsy . J Neurol Neurosurg Psychiatry1993;56:114-115.
111.
Bonifati V. , Fabrizio E., Cipriani R., et al: Buspirone in levodopa-induced dyskinesias . Clin NeuropharmacoL1994;17:73-82.
112.
Pranzatelli MR, Snodgrass SR: Fenfluramine therapy for autism, letter. J Autism Dev Disord1985;15:439-441.
113.
Papini M., Pasquinelli A., Filippini A.: Steroid-dependent form of Kinsbourne syndrome: Successful treatment with trazodone . Ital J Neurol Sci1992;13:369-372.
114.
Growdon JH , Young RR, Shahani BT: L-5-Hydroxytryptophan in treatment of several different syndromes in which myoclonus is prominent . Neurology1976;26:1135-1140.
115.
Fahn S.: High dose anticholinergic therapy in dystonia. Neurology1983;33:1255-1261.
116.
Vogels Ojm , Maassen B., Rotteveel JJ, Merx JL: Focal dystonia and speech impairment responding to anticholinergic therapy. Pediatr Neurol1994;11:346-348.
117.
Talmi YP, Zohar Y., Finkelstein Y., Laurian N.: Reduction of salivary flow with scopoderm TTS. Ann Otol Rhinol Laryngol1988;97: 128-130.
118.
Siegel LK, Klingbeil MA: Control of drooling with transdermal scopolamine in a child with cerebral palsy. Dev Med Child Neurol1991;33:1010-1014.
119.
Jabbari B. , Gunderson CH: Palatal myoclonus responding to trihexyphenidyl . Ann Neurol1983; 14:95.
120.
Sachdev P. , Loneragan C.: Intravenous benztropine and propranolol challenges in acute neuroleptic-induced akathisia. Clin Neuropharmacol1993;16:324-331.
121.
Kang UJ, Burke R., Fahn S.: Natural history and treatment of tardive dystonia. Mov Disord1986 ; 1:193-208.
Anderson LT , Ernst M.: Self-injury in Lesch-Nyhan disease . J Autism Dev Disord1994;24:67-81.
124.
Walters A. , Hening W., Cote L., Fahn S.: Dominantly inherited restless legs with myoclonus and periodic movements of sleep: A syndrome related to the endogenous opiates?Adv Neurol1986 ;43:309-319.
125.
Montplaisir J., Lorrain D., Godbout R.: Restless legs syndrome and periodic leg movements in sleep: The primary role of dopaminergic mechanism . Eur Neurol1991;31:41-43.
126.
Walters AS , Picchietti DL, Ehrenberg BL, Wagner ML: Restless legs syndrome in childhood and adolescence . Pediatr Neurol1994; 11:241-245.
127.
Tate ED, Pranzatelli MR, Huang YY, Kaplan R.: An innovative approach to the problem of sedating children with opsoclonus-myoclonus syndrome: Effects on myoclonus and CSF monoamine metabolites, abstract. Ann Neurol1994;36:543-544.
128.
Reynolds LM , Koh JL: Prolonged spontaneous movement following emergence from propofol/nitrous oxide anesthesia. Anesth Analg1993;76:192-193.
129.
Burrows FA , Seeman RG: Ketamine and myoclonic encephalopathy of infants (Kinsbourne syndrome). Anesth Analg1982;61:873--875.
130.
Kertesz A. : Paroxysmal kinesigenic choreoathetosis: An entity within the paroxysmal choreoathetosis syndrome: Description of 10 cases, including 1 autopsied. Neurology1970;17:680-690.
131.
Lance JW: Familial paroxysmal dystonic choreoathetosis and its differentiation from related syndromes. Ann Neurol1977;2:285-293.
132.
Hirata K., Katayama S., Sarto T., et al: Paroxysmal kinesigenic choreoathetosis with abnormal electroencephalogram during attacks. Epilepsia1991;32:492-494.
133.
Porter RJ, Rogawski MA: Potential antiepileptic drugs, in Wyllie E (ed): The Treatment of Epilepsy: Principles and Practices . Philadelphia, Lea & Febiger , 1993, pp 974-984.
134.
Gouliaer AH, Senning A.: Piracetam and other structurally related nootropics. Brain Res Rev1994;19:180-222.
135.
Tacconi MT, Wurtman RJ: Piracetam: Physiological disposition and mechanism of action. Adv NeuroL1986;43:675-684.
Obeso JA, Artieda J., Quinn N., et al: Piracetam in the treatment of different types of myoclonus. Clin Neuropharmacol1988;11:529-536.
138.
Robinson RO , Thornett CE: Benign hereditary chorea — response to steroids. Dev Med Child Neurol1985;27:814-821.
139.
Pranzatelli MR: On the molecular mechanism of adrenocorticotrophic hormone: Neurotransmitters and receptors. Exp Neurol1994;125:142-161.
140.
Mayeux R., Fahn S.: Paroxysmal dystonic choreoathetosis in a patient with familial ataxia . Neurology1982;32:1184-1186.
141.
Jankovic J. , Brin MF: Therapeutic uses of botulinum toxin. N Engl J Med1991;324: l186-l194.
142.
Hallett M. , Glocker FX, Deuschl G.: Mechanism of action of botulinum toxin. Ann Neurol1994;36:449-450.
143.
Noetzel M. , Cawley LP, James VL, et al: Anti-neurofilament protein antibodies in opsoclonus-myoclonus. J Neuroimmunol1987 ; 15:137-145.
144.
Sugie H., Sugie Y., Akimoto H., et al: High-dose iv human immunoglobulin in a case with infantile opsoclonus polymyoclonus syndrome. Acta Paediatr1992 ;81:371-372.
145.
Pranzatelli MR: The neurobiology of opsoclonus-myoclonus . Clin Neuropharmacol1992;15:186-228.
146.
Berkman SA , Lee ML, Gale RP: Clinical uses of intravenous immunoglobulins . Ann Intern Med1990;12:278-292.
147.
Husby G., Van de Rijn I., Zabriskie JB, et al: Antibodies reacting with cytoplasm of subthalamic and caudate nuclei neurons in chorea and acute rheumatic fever. J Exp Med1976;144:1094-1110.
148.
Green LN: Corticosteroids in the treatment of Sydenham's chorea. Arch NeuroL1978;35:53-54.
149.
Kiessling LS, Marcotte AC, Culpepper L.: Antineuronal antibodies in movement disorders . Pediatrics1993;92:39-43.
150.
Nemni R., Braghi S., Natali-Sora MG, et al: Autoantibodies to glutamic acid decarboxylase in palatal myoclonus and epilepsy. Ann Neurol1994;36:665-667.
151.
Brashear HR , Phillips LH: Autoantibodies to GABAergic neurons and response to plasmapheresis in stiff-man syndrome. Neurology1991;41:1588-1592.
152.
Grimaldi Lme , Martino G., Braghi S., et al: Heterogeneity of autoantibodies in stiff-man syndrome. Ann Neurol1993;34:57-64.
153.
Greenamyre JT, Porter Rhp: Anatomy and physiology of glutamate in the CNS. Neurology1994;44(Suppl 8):S7-S13.
154.
Lipton SA, Rosenberg PA: Excitatory amino acids as a final common pathway for neurologic disorders . N Engl J Med1994;330:613-622.
155.
Meldrum BS : The role of glutamate in epilepsy and other CNS disorders. Neurology1994;44(Suppl 8):S14-S23.
156.
Ohya Y., Ochi N., Mizutani N., et al: Nonketotic hyperglycinemia: Treatment with NMDA antagonist and consideration of neuro-pathogenesis. Pediatr Neurol1991; 7:65-68.
157.
Hamosh A., McDonald JW, Valle D., et al: Dextromethorphan and high-dose benzoate therapy for nonketotic hyperglycinemia in an infant. J Pediatr1992 ;121:131-135.
158.
Von Wendt L., Simila S., Saukkonen A., Koivisto M.: Failure of strychnine treatment during the neonatal period in three Finnish children with non-ketotic hyperglycinemia . Pediatrics1980;65:1166-1169.
159.
Warburton D., Boyle R., Keats J., et al: Non-ketotic hyperglycinemia: Effects of strychnine therapy. Am J Dis Child1980 ;134: 273-275.
160.
Young AB, Snyder SH: Strychnine binding associated with glycine receptors of the central nervous system. Proc Natl Acad Sci USA1973 ; 70:2832-2836.
161.
Young AB, Zukin SR, Snyder SH: Interaction of benzodiazepines with central nervous glycine receptors: Possible mechanism of action. Proc Natl Acad Sci U S A1974;71:2246-2250.
162.
Matalon R. , Naidu S., Hughes JR, Michals K.: Nonketotic hyperglycinemia: Treatment with diazepam - a competitor for glycine receptors. Pediatrics1983;71:581-584.
163.
Goodman SI, Frerman FE: Organic acidemias due to defects in lysine oxidation: 2-Ketoadipic acidemia and glutaric acidemia, in Scriver CR, Beaudet AL, Sly WS, Valle D (eds): The Metabolic Basis of Inh.er ited Disease, 6th ed. New York, McGraw-Hill, 1989, pp 845-931.
164.
Bendich A. , et al: The antioxidant role of vitamin C. Free Radic Biol Med1986;2:419-444.
165.
Burton GW, Ingold KU: Beta-carotene: An unusual type of lipid antioxidant. Science1984;224:569-573.
166.
Spina MB, Cohen G.: Dopamine turnover and glutathione oxidation: Implications for Parkinson's disease. Proc Natl Acad Sci U S A1989;86:1398-1400.
167.
Mazzarello P., Poloni M., Spadari S., et al: DNA repair mechanisms in neurological diseases: Facts and hypotheses. J Neurol Sci1992;112:4-14.
168.
Hedera P., Whitehouse PJ: Neurotransmitters in neurodegeneration, in Calne DB (ed): Neurodegenerative Diseases. Philadelphia, WB Saunders, 1994, pp 97-117.
Danks DM: Disorders of copper transport, in Scriver CR, Beaudet AL, Sly WS, Valle D (eds): The Metabolic Basis of Inherited Disease, 6th ed. New York, McGraw-Hill, 1989, pp 1411-1432.
177.
Brewer GJ, Hill GM, Prasad AS, et al: Oral zinc therapy for WD. Ann Intern Med1983;99:314-320.
178.
Hefti F.: Growth factors and neurodegeneration, in Calne DB (ed): Neurodegenerative Diseases. Philadelphia, WB Saunders, 1994, pp 177-194.
