Effect of sulfamethoxazole and trimethoprim on neurologic dysfunction in a patient with Joseph's disease.

Joseph's disease, an autosomal dominant, degenerative neurologic disease found in the Portuguese, is clinically manifested by extrapyramidal, pyramidal, and cerebellar dysfunction. A patient with the type II form of the disease reported improvement in gait and lessened spasticity while taking sulfamethoxazole and trimethoprim (Bactrim) for a noninfectious dysuria syndrome. A double-blind, placebo-controlled trial of Bactrim utilizing a subjective performance scale, physical examination, and six timed tests was performed in this patient. Results revealed lessened spasticity, improvement in walker-assisted gait, and correlative subjective responses. These results suggest an antispasticity effect of Bactrim or one of its components in this patient.