Bibliographic record
Abstract
Primary cervical dystonia (CD), spasmodic torticollis, is the most common focal dystonia. In the US between 60,000 and 90,000 people have been estimated to suffer from this painful disorder with rare recovery and high psychiatric co-morbidity. The therapy of CD has been symptomatic. The primary treatment, repeated chemodenervation of cervical muscles with botulinum toxin injections, is expensive and not available to the majority of persons with CD. Neither controlled studies of oral pharmacotherapy of dystonia, nor reports of sustained full remission were published. Thus, it was unclear if any effective and safe oral pharmacotherapy for CD exists, and if it is possible to remain asymptomatic. I report on a 48-year-old woman who has been symptom-free during nearly 4 years treatment with topiramate, after previously suffering from familial CD during 29 years. Her left-sided lateral postural and rotating dystonia increased in stressful situations and during physical exercise, and had not responded to any drugs including Botox injections. Topiramate (150 mg/day) was administered for her schizo-affective disorder in 2011, after 11 months of treatment with clozapine (150 mg/day) in a forensic psychiatric hospital. Postural and rotating symptoms subsided within 2 months, and muscular hypertrophy, pain, dysphagia, and daily headache recovered. The author examined her lifetime health care referrals and documented her symptoms in the hospital during 6 years. Informed consent was obtained. CD is associated with reduction of gamma-aminobutyric acidergic (GABAergic) neurons in the basal ganglia. Topiramate, a sulfamate-substituted monosaccharide, modulates both GABAergic and glutaminergic neurotransmission. It has been used since the 90s for epilepsy and many neurological and psychiatric disorders, on the basis of randomized controlled trials. My case study demonstrates that some patients recover from CD during treatment with topiramate, and remain asymptomatic for years. This is in accordance with the pharmacodynamic mechanisms of topiramate, the pathophysiology of involuntary movements, and the clinical evidence of other hyperkinetic movement disorders with similar pathophysiology. It would be important to conduct randomized controlled studies of topiramate in CD, and to define the subgroups who may benefit from it. J Med Cases. 2015;6(8):373-375 doi: http://dx.doi.org/10.14740/jmc2088w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".