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Cerebellar hemorrhage Nonsurgical forms.

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NOTES AND LETTERS
AmvotroDhic Lateral
Scl&rosisLFailure of
Transfer Factor Therapy
Saran Jonas, MD, Melvin Wichter, MD,
and Lynn Spitler, M D
Amyotrophic lateral sclerosis ( ALS) typically progresses relentlessly to death. The cause is unknown; current speculations include persistent poliovirus infection and impaired
cell-mediated immunity [ I , 31. Recently, chronic fungal
infection associated with defective cell-mediated immunity
and resistant to conventional therapy has been treated, possibly with benefit 121, by the addition of transfer factor
(TF), a dialyzable extract of leukocytes. W e attempted to
treat ALS, for which no effective therapy exists, in a similar
manner.
The subjects were 7 male and 3 female ALS patients
ranging in age from 34 to 63 (average, 54.4) years. All had
given informed consent. They had had their disease 7 to 28
months (average, 13.4). All had limb weakness (9 with fasciculations, 7 with muscle atrophy). Two had spasticity.
Another had dpsphagia, dysarthria, and tongue atrophy and
fasciculations.
T F was prepared 141 from normal donors. In vitro tests
showed it to be active in enhancing the lymphocyte proliferative response to phytohemagglutinin. O u r patients
began weekly treatment (subcutaneous injection of 0.75 ml
of TF, the amount derived from 1.25 X 10’ lymphocytes)
between September, 1976, and March, 1977. Immune responses were not tested.
By the end of May, 1978, the patients had received an
average of 2.87 (range, 2.1 to 4.0) monthly injections for 3
to 2 0 months (average, 11.3 months). Two had died. Six
survivors, who initially had been walking, were in bed or in
a wheelchair; 1 other had become aphonic; the eighth had
become dysarthric and dysphagic.
TF, as used, had no apparent benefit as therapy for ALS.
Supported by Research Grant A1 10686 from the National Institutes of Health.
Ref t-ences
virus in
motor-neurone disease. Lancet 2: 1176, 1977
2. Gross PA, Patel C, Spitler LE: Disseminated cryptococcus
treated with transfer factor. JAMA 240:2460-2462, 1978
3. Kott E, Livni E, Zarnir R, et al: Amyotrophic lateral sclerosis:
cell-mediated immunity to poliovirus and basic myelin protein
in patients with high frequency of HLA-BW35. Neurology
(Minneap) 26:376-377, 1976
1. Behan PO, Behan WM, Bell E, et ak Possible persistent
From the Department of Neurology, New York University School
of Medicine, New York, NY, and the Department of Medicine,
Children’s Hospital and the University of California Medical
Center, San Francisco, CA.
Accepted for publication Jan 2, 1979.
Address reprint requests to Dr Jonas, New York University Medical Center, 566 First Ave, New York, N Y 10016.
84
4. Spitler LE, Levin AS, Fudenberg HH: Human lymphocyte
transfer factor, in Busch H (ed): Methods in Cancer Research.
New York, Academic, 1973, vol 8, pp 59-106
Cerebellar Hemorrhage:
Nonsurgical Forms
-
M. Feijoo De Freixo, MD, M. Jimenez Garcia, MD,
and L. Galdos Alcelay, M D
In keeping with the experience of Drs Heiman and
Satya-Murti [2], we have recently treated cerebellar hemorrhages nonsurgically in 2 women 64 and 78 years old,
respectively. in whom the diagnosis was proved by C T
scan. Both patients had a good outcome without significant
neurological sequelae 131.
W e believe that two clinical variables indicate a surgical
approach to the problem: the presence of hydrocephalus or
deterioration in the level of consciousness, or both. Hydrocephalus, which was absent in our 2 patients as well as in
Heiman and Satya-Murti’s, would be produced by block of
the fourth ventricle or the aqueduct. This could result from
blood clot 141, compression produced by the parenchymatous cerebellar hemorrhage and its surrounding edema, or
both. T h e degree of hydrocephalus and the effect of the
mass compressing the brainstem would affect the level of
consciousness.
T h e letter by Freeman et a1 [ 11does not contradict either
Heiman and Satya-Murti’s conclusions or the idea of “benign hemorrhage” as a nonsurgical lesion. T h e availability
of CT scanning allows a new approach to treating these
lesions.
Refwences
1. Freeman JW, Kennedy RM, Petty SS: Prognosis of nonoperated cerebellar hemorrhage. Ann Neurol 4389-390, 1978
2. Heiman TD,Satya-Murti S: Benign cerebellar hemorrhages.
Ann Neurol 3:366-368, 1978
3. Jimenet h*, Galdos L, Feijoo M:Hematoma de cerebelo. Formas no qulrurgicas. Med Clin (Barcelona) (in press)
4. Richardson A: Spontaneous intracerebral and cerebellar hemorrhage, in Ross Russell RW (ed): Cerebral Arterial Diseases.
Edinburgh and London, ChurchilULivingstone, 1976, p 223
From the Secciones de Neurologia, Residencia Sanitaria S. Social,
Burgos, and Ciudad Sanitaria S. Social, Barcelona, Spain.
Accepted for publication Feb 9, 1970.
Address reprint requests to Dr Feijoo, Seccion de Neurologia,
Residencia Sanitaria S. Social, Burgos, Spain.
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forma, cerebellar, hemorrhagic, nonsurgical
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