Parkinson's Disease

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Parkinson's Disease

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Factors Associated With the Development of Motor Fluctuations and Dyskinesias in Parkinson Disease (Arch Neurol. 2006) "Conclusions Higher cumulative levodopa doses and higher cumulative levodopa equivalent doses (levodopa plus pramipexole) were associated with the earlier occurrence of motor complications. Motor fluctuations and dyskinesias appear to be interrelated because the presence of one is associated with the earlier development of the other."

A hospital-based study: Risk factors in development of motor complications in 555 Parkinson's patients on levodopa therapy (Clinical Neurology and Neurosurgery 2006) "Our study showed that the development of motor complications was associated with early onset PD, longer disease duration, advanced disease, higher initial LD dose, longer LD use, and late DA initiation, but not with the timing of LD initiation."

Parkinson's drug may raise risk of valve trouble "In some cases, patients taking a Parkinson's drug called cabergoline may experience damage to heart valves, a study suggests. High cumulative doses of and long-term treatment with this drug are risk factors for the development of "valvulopathy," Japanese doctors report in the journal Neurology this month."

Dopamine asymmetry interacts with medication to affect cognition in Parkinson's disease. (Neuropsychologia. 2006)

Levodopa can worsen tremor associated with dystonia. (Mov Disord. 2006)

Patterns of initial pharmacotherapy for Parkinson's disease in the United States. (J Geriatr Psychiatry Neurol. 2006) "The study confirms that levodopa remains the most often prescribed initial treatment for Parkinson's disease regardless of age or drug benefit coverage. The widespread use of levodopa in young Parkinson's patients (<65 years) with private insurance may indicate that physicians are not overly concerned about or are not fully aware of the association of levodopa with long-term motor complications. It may also indicate that currently available alternatives to levodopa are not sufficiently effective or well tolerated."

Parkinson's Drugs Linked to Compulsive Behaviors

Sleep complaints and their relation with drug treatment in patients suffering from Parkinson's disease. (Mov Disord. 2006)

A hospital-based study: Risk factors in development of motor complications in 555 Parkinson's patients on levodopa therapy. (Clin Neurol Neurosurg. 2006) "CONCLUSION: Our study showed that the development of motor complications was associated with early onset PD, longer disease duration, advanced disease, higher initial LD dose, longer LD use, and late DA initiation, but not with the timing of LD initiation."

Age-related differences in levodopa dynamics in Parkinson's: implications for motor complications. (Brain. 2006) "Treatment-related motor complications in Parkinson's disease have been previously linked to disease-induced pre-synaptic alterations: dopaminergic denervation and changes in dopamine (DA) release patterns. The occurrence of such complications is also known to be partly dependent on the age of disease onset, occurring more frequently in patients with disease onset at a younger age. . "

Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976-1990. (Arch Neurol. 2006) "CONCLUSIONS: Levodopa-associated dyskinesias can be expected to develop in nearly 60% of patients in our community after 10 years, but these will be severe enough to require medication adjustments in only 43% of patients. At 10 treatment years, nearly 90% of these patients can expect to be spared dyskinesias that could not be controlled by drug adjustments. This population-based study suggests dyskinesia risk may not be a major concern for most Parkinson disease patients."

Drugs

The effect of levodopa on cognitive function in Parkinson's disease with and without dementia and dementia with Lewy bodies. (J Neurol Neurosurg Psychiatry. 2006) "CONCLUSION: The use of L-dopa in patients with parkinsonism with dementia does not adversely affect cognitive function."

Ergoline and non-ergoline derivatives in the treatment of Parkinson's disease. (J Neurol. 2006)

Effect of rivastigmine on tremor in patients with Parkinson's disease and dementia. (Mov Disord. 2006) "Rivastigmine caused only slight worsening of tremor in demented PD patients, while improving cognition."

Safety and Effectiveness of Intravenous Morphine for Episodic Breakthrough Pain in Patients Receiving Transdermal Buprenorphine. (J Pain Symptom Manage. 2006)

Rasagiline-associated motor improvement in PD occurs without worsening of cognitive and behavioral symptoms. (J Neurol Sci. 2006)

Budipine in Parkinson's tremor. (J Neurol Sci. 2006) "It is generally accepted that patients with a tremor-dominant type of idiopathic Parkinson's disease progress more slowly than the ones with the rigid-akinetic type. On the other hand successful treatment of Parkinsonian tremor is a challenge. German neurologists use anticholinergics, budipine, beta-blockers, clozapine, dopaminergic substances and for most severe cases deep brain stimulation. Budipine is an enigma because its main mode of action is still unknown, although it is mostly listed under glutamate antagonists. . Budipine has been studied in open and double-blind studies as monotherapy and adjunct therapy. In both instances the drug showed beneficial effects to the patients. . When 3 years ago reports on budipine-induced prolongation of the QT interval in the ECG emerged larger trials were stopped and nowadays there are strict rules on how to use budipine."

Testosterone Therapy in Men With Parkinson Disease (Arch Neurol. 2006) "Until more definitive studies are reported, practitioners should be particularly cautious in treatment of low testosterone concentrations in men with PD and borderline testosterone deficiency, and careful consideration should be given to the risks vs the benefits of TT."

Selegiline slows the progression of the symptoms of Parkinson disease. (Neurology. 2006) "OBJECTIVE: To study the long-term effects of selegiline in monotherapy and in combination with levodopa in the early phase of Parkinson disease (PD). . CONCLUSIONS: The results of this long-term study confirm earlier findings indicating that selegiline delays the progression of the signs and symptoms of Parkinson disease."

Dopamine agonists in the treatment of Parkinson's disease. (Expert Rev Neurother. 2006)

Rasagiline improves quality of life in patients with early Parkinson's disease. (Mov Disord. 2006) "The objective of this study was to determine the effects of rasagiline as monotherapy on quality of life (QOL) in patients with early Parkinson's disease (PD). Rasagiline, a potent, second-generation, irreversible, selective monoamine oxidase B inhibitor improves PD symptoms in patients with early PD. . Rasagiline improved QOL compared with placebo. This QOL improvement appears to be accounted for primarily by the symptomatic benefit of rasagiline."

Cholinesterase inhibitors for Parkinson's disease dementia. (Cochrane Database Syst Rev. 2006) "AUTHORS' CONCLUSIONS: Rivastigmine appears to improve cognition and activities of daily living in patients with PDD. This results in clinically meaningful benefit in about 15% of cases. There is a need for more studies utilising pragmatic measures such as time to residential care facility and both patient and carer quality of life assessments. Future trials should involve other cholinesterase inhibitors, utilise tools to analyse the data that limit any bias and measure health economic factors. It is unlikely that relying solely on the last observation carried forward (LOCF) is sufficient. Publication of the observed case data in the largest trial would assist (Emre 2004). Adverse events were associated with the cholinergic activity of rivastigmine, but may limit patient acceptability as evidenced by the high drop out rate in the active arm."

Testosterone improves motor function in Parkinson's disease. (J Clin Neurosci. 2006) "The use of testosterone replacement in those men with decreased levels may improve the motor symptoms as well as increase general wellbeing."

Exercise

Pilates may give relief for Parkinson's patients "Movements in Pilates exercises are controlled — sometimes moving the body only inches — but those small motions are making a big difference to some people with Parkinson’s disease. No research has been done to prove Pilates’ effectiveness in reducing Parkinson’s symptoms, but a growing number of patients say they are finding some relief. … Instructors say the basic principal of Pilates — increasing core strength and improving flexibility and balance — is extremely helpful in countering the effects of Parkinson’s in some people."

Is Physical Exercise Beneficial for Persons with Parkinson's Disease? (Clinical Journal of Sport Medicine 2006) "Conclusions: The results of the present research synthesis support the hypothesis that patients with PD improve their physical performance and activities of daily living through exercise."

Impact of an exercise program on physical, emotional, and social aspects of quality of life of individuals with Parkinson's disease. (Mov Disord. 2006)

Exercise may slow Parkinson's downward spiral

Effects of home exercises on motor performance in patients with Parkinson's disease. (Clin Rehabil. 2005) "CONCLUSIONS: A home-based rehabilitation programme for patients with Parkinson's disease helped to improve motor performance compared to patients who did not take advantage of a regular, professionally designed exercise programme."

General Information

Long-term care of Parkinson's disease. Strategies for managing "wearing off" symptom re-emergence and dyskinesias. (Geriatrics. 2006)

Drug induced parkinsonism : A review. (J Neurol. 2006)

Initial treatment of Parkinson's disease. (Curr Treat Options Neurol)

Parkinson's disease management strategies. (Expert Rev Neurother. 2006)

Guidelines

NGC - Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. (2006)

NGC - Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. (2006)

NGC - Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. (2006)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Other

Other Treatments

Side-effects of subthalamic stimulation in Parkinson's disease: clinical evolution and predictive factors. (Eur J Neurol. 2006)

A randomized trial of deep-brain stimulation for Parkinson's disease. (N Engl J Med. 2006)

Brain stimulation seen best for late Parkinson's "Deep brain electrical stimulation appears to be more effective than the best medical treatment in reducing motor symptoms and improving quality of life in patients with advanced Parkinson's disease, according to the results of a clinical trial."

Fulfilment of patients' goals after thalamic deep brain stimulation: A follow-up study. (Parkinsonism Relat Disord. 2006)

[Psychiatric and cognitive complications arising from subthalamic stimulation in Parkinson's disease.] (Rev Neurol. 2006)

Experimental

Coenzyme Q(10) provides neuroprotection in iron-induced apoptosis in dopaminergic neurons. (J Mol Neurosci. 2006)

Neuroprotective and neurorescue effect of black tea extract in 6-hydroxydopamine-lesioned rat model of Parkinson's disease. (Neurobiol Dis. 2006)

Regenerative medicine in Parkinson's disease: generation of mesencephalic dopaminergic cells from embryonic stem cells. (Curr Opin Biotechnol. 2005)

Radiotherapy

Supplements-Vitamins-CAM

Antioxidants, Supplements, and Parkinson's Disease (The Annals of Pharmacotherapy 2006) "CONCLUSIONS: At present, antioxidants and supplements appear to have a limited role in the prevention or treatment of PD. Of those reviewed here, CoQ10 appears to provide some minor treatment benefits. More study is necessary to determine whether CoQ10 has a significant role as primary or adjunctive therapy in PD."

Use of nutritional supplements in Parkinson's disease patients. (Mov Disord. 2006)

Surgery

Deep brain stimulation improves orthostatic regulation of patients with Parkinson disease (NEUROLOGY 2006)

Mortality in patients with Parkinson's disease treated by stimulation of the subthalamic nucleus. (Mov Disord. 2006)

Neurosurgery in Parkinson disease: a distressed mind in a repaired body? (Neurology. 2006) "CONCLUSION: After STN stimulation, patients experienced difficulties in their relations with themselves, their spouses, their families, and their socio-professional environment. The authors suggest a multidisciplinary psychosocial preparation and follow-up to help patients and their entourage cope with the sudden changes in their existence following successful neurosurgery."

Pallidotomy versus pallidal stimulation (Parkinsonism & Related Disorders 2006)

Transplantation

Stem-cell treatment for Parkinson's brings mixed results "The symptoms of Parkinson's disease have been relieved in rats using a stem-cell treatment. But a potentially cancerous side effect might put the brakes on such therapies for humans"

Cell transplantation for patients with Parkinson's disease. (Handb Exp Pharmacol. 2006)

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