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Takeda A, Baba T, Watanabe J, Nakayama M, Hozawa H, Ishido M. Levodopa Prescription Patterns in Patients with Advanced Parkinson's Disease: A Japanese Database Analysis. PARKINSON'S DISEASE 2023; 2023:9404207. [PMID: 37799489 PMCID: PMC10550461 DOI: 10.1155/2023/9404207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 10/07/2023]
Abstract
Prescription doses of levodopa in patients with advanced Parkinson's disease (PD) are generally lower in Japan than in the United States or Europe, although Japanese guidelines for the management of PD recommend increasing the dosage as the disease progresses. However, data regarding levodopa prescription practices in patients with advanced PD in the clinical setting are limited. This retrospective observational study analyzed patterns of drug use for patients with advanced PD in Japan using claims data from hospitalized patients in the Medical Data Vision Co. database. Eligible patients had at least two PD-associated claims in two different quarters between April 1, 2008, and November 30, 2018, and a 10-item activities of daily living score <60 upon hospital discharge (as a proxy for advanced PD). The primary endpoint was the prescribed dosage of levodopa at the index hospitalization. Dosages of other PD drugs (medications with an on-label indication for PD) and non-PD drugs were also assessed. Overall, 4029 patients met the inclusion criteria (mean age, 76.9 years; 83.3% aged ≥70 years). At the index date, 74.0% were receiving levodopa. Patients received a median of one PD drug in addition to levodopa, and 27.4% and 20.2% received one or two concomitant PD drugs, respectively. Patients received a median of two non-PD drugs. The median levodopa dosage and total levodopa equivalent dosage (LED) at the index hospitalization were 418.2 and 634.8 mg/day (adjusted for body weight, 9.0 and 13.7 mg/kg/day), respectively. The median levodopa and total LED dosage in each 6-month increment during the 5 years before and after the index date ranged between 263.9 and 330.2 mg/day (5.0 and 6.5 mg/kg/day) and 402.0 and 504.9 mg/day (8.3 and 10.1 mg/kg/day), respectively. This study suggests that many Japanese patients with advanced PD could receive more intensive treatment with higher doses of levodopa.
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Affiliation(s)
- Atsushi Takeda
- Department of Neurology, National Hospital Organization Sendai Nishitaga Hospital, 2-11-11 Kagitorihoncho, Taihaku-ku, Sendai 982-8555, Japan
- Department of Cognitive & Motor Aging, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aobaku, Sendai 980-8575, Japan
| | - Toru Baba
- Department of Neurology, National Hospital Organization Sendai Nishitaga Hospital, 2-11-11 Kagitorihoncho, Taihaku-ku, Sendai 982-8555, Japan
| | - Jun Watanabe
- Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Masahiko Nakayama
- Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Hiroyuki Hozawa
- Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan
| | - Miwako Ishido
- Medical, AbbVie GK, 3-1-21 Shibaura, Minato-ku, Tokyo 108-0023, Japan
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Salwierz P, Davenport C, Sumra V, Iulita MF, Ferretti MT, Tartaglia MC. Sex and gender differences in dementia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:179-233. [PMID: 36038204 DOI: 10.1016/bs.irn.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The dementia landscape has undergone a striking paradigm shift. The advances in understanding of neurodegeneration and proteinopathies has changed our approach to patients with cognitive impairment. Firstly, it has recently been shown that the various proteinopathies that are the cause of the dementia begin to build up long before the appearance of any obvious symptoms. This has cemented the idea that there is an urgency in diagnosis as it occurs very late in the pathophysiology of these diseases. Secondly, that accurate diagnosis is required to deliver targeted therapies, that is precision medicine. With this latter point, the realization that various factors of a person need to be considered as they may impact the presentation and progression of disease has risen to the forefront. Two of these factors aside from race and age are biological sex and gender (social construct), as both can have tremendous impact on manifestation of disease. This chapter will cover what is known and remains to be known on the interaction of sex and gender with some of the major causes of dementia.
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Affiliation(s)
- Patrick Salwierz
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Carly Davenport
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Vishaal Sumra
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - M Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain; Women's Brain Project, Guntershausen, Switzerland
| | | | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada; Memory Clinic, Krembil Brain Institute, University Health Network, Toronto, ON, Canada.
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Dulski J, Cerquera-Cleves C, Milanowski L, Kwiatek-Majkusiak J, Koziorowski D, Ross OA, Pentela-Nowicka J, Sławek J, Wszolek ZK. L-Dopa response, choreic dyskinesia, and dystonia in Perry syndrome. Parkinsonism Relat Disord 2022; 100:19-23. [PMID: 35691177 DOI: 10.1016/j.parkreldis.2022.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A marked response to L-Dopa and L-Dopa-induced dyskinesia (LID) make the diagnosis of Parkinson's disease (PD) highly likely. This paper evaluates response to L-Dopa in Perry syndrome (PS), parkinsonism with distinct molecular and neuropathologic characteristics. METHODS Six patients with PS with a mean follow-up of 5 years (0.5-12) were assessed by movement disorder specialists and video recorded in states off and on. Additionally, DATSCAN-SPECT was performed in 3 subjects. RESULTS Four patients displayed a marked and sustained response to L-Dopa and LID. Additionally, we observed a distinct pattern of off-state predominant craniocervical dystonia responsive to L-Dopa in 4 patients, truncal dystonia in one, and dystonic head tremor in another. DATSCAN-SPECT was abnormal in 3 patients. CONCLUSIONS Patients with PS may present PD-like parkinsonism with a marked and sustained response to L-Dopa and LID. The characteristic pattern of craniocervical dystonia may be a helpful clue to the diagnosis of PS.
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Affiliation(s)
- Jarosław Dulski
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland; Neurology Department, St Adalbert Hospital, Copernicus PL Ltd., Gdansk, Poland
| | - Catalina Cerquera-Cleves
- Neurology Unit, Pontificia Universidad Javeriana, San Ignacio Hospital, Bogotá, Colombia; Movement Disorders Clinic, Clínica Universitaria Colombia, Bogotá, Colombia
| | - Lukasz Milanowski
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA; Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | | | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Jarosław Sławek
- Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland; Neurology Department, St Adalbert Hospital, Copernicus PL Ltd., Gdansk, Poland
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Nyholm D, Adnan M, Senek M. Real-Life Use of Levodopa/Carbidopa Intestinal Gel in Parkinson's Disease According to Analysis of Pump Data. JOURNAL OF PARKINSONS DISEASE 2021; 10:1529-1534. [PMID: 32651335 DOI: 10.3233/jpd-202114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Levodopa/carbidopa intestinal gel (LCIG) infusion is an efficacious treatment of motor and non-motor fluctuations in people with Parkinson's disease (PD). Real-life use of the treatment is not previously studied. OBJECTIVE The aims of the study were to explore the use of LCIG and to determine how extra doses of LCIG are used in daily life. METHODS Twenty-five PD patients with ongoing LCIG therapy were consecutively included. Pump data was retrieved from 30 days on average, by means of software, extracting the most recent pump events. RESULTS The daily duration of infusion was 15 hours on average, in 18 patients, whereas the remaining 7 patients used 24-hour infusion. Morning doses ranged from 38-190 mg levodopa, for patients who utilized this function. Median number of daily extra doses was 2.5 (range: 0-10.6) and median size of the extra dose was 24 mg (0-80 mg) levodopa. Median total daily levodopa intake with LCIG was 1201 mg (range: 417-2322 mg). CONCLUSION Retrieving pump data is possible and may be important for evaluating the at-home use of LCIG, to optimize the therapy. Adherence to treatment should be monitored, which is not technically difficult, at least in device-aided treatments for PD.
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Affiliation(s)
- Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Sweden
| | - Malak Adnan
- Department of Neuroscience, Neurology, Uppsala University, Sweden
| | - Marina Senek
- Department of Neuroscience, Neurology, Uppsala University, Sweden
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Chae D, Chung SJ, Lee PH, Park K. Predicting the longitudinal changes of levodopa dose requirements in Parkinson's disease using item response theory assessment of real-world Unified Parkinson's Disease Rating Scale. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:611-621. [PMID: 33939329 PMCID: PMC8213413 DOI: 10.1002/psp4.12632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/11/2022]
Abstract
Item response theory (IRT) has been recently adopted to successfully characterize the progression of Parkinson's disease using serial Unified Parkinson's Disease Rating Scale (UPDRS) measurements. However, it has yet to be applied in predicting the longitudinal changes of levodopa dose requirements in the real‐world setting. Here we use IRT to extract two latent variables that represent tremor and non‐tremor‐related symptoms from baseline assessments of UPDRS Part III scores. We show that relative magnitudes of the two latent variables are strong predictors of the progressive increase of levodopa equivalent dose (LED). Retrospectively collected item‐level UPDRS Part III scores and longitudinal records of prescribed medication doses of 128 patients with de novo PD extracted from the electronic medical records were used for model building. Supplementary analysis based on a subset of 36 patients with at least three serial assessments of UPDRS Part III scores suggested that the two latent variables progress at significantly different rates. A web application was developed to facilitate the use of our model in making individualized predictions of future LED and disease progression.
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Affiliation(s)
- Dongwoo Chae
- Division of PharmacometricsDepartment of PharmacologyYonsei University College of MedicineSeoulSouth Korea
| | - Su Jin Chung
- Department of NeurologyMyongji HospitalHanyang University College of MedicineGoyangSouth Korea
| | - Phil Hyu Lee
- Department of NeurologyYonsei University College of MedicineSeoulSouth Korea
| | - Kyungsoo Park
- Division of PharmacometricsDepartment of PharmacologyYonsei University College of MedicineSeoulSouth Korea
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Abstract
A number of studies reported the possible differences between men and women in movement disorders. Evidence shows that estrogens may have a neuroprotective effect and may modulate the neurodevelopment of the different brain structures. Movement disorders including Parkinson's disease, dementia with Lewy body, Huntington's disease, Tourette's syndrome, and dystonia among others display significant clinical differences between sexes, with structural differences in the dopaminergic pathways between men and women. Here we summarize the most relevant clinical aspects of some of the most common movement disorders, highlighting the differences in disease onset, clinical presentation, therapy, and outcomes. Increased recognition of these differences may help physicians better understand the pathophysiology of these conditions and provide a tailored therapeutic approach.
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Affiliation(s)
- Pierpaolo Turcano
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
| | - Rodolfo Savica
- Department of Neurology and Health Science Research, Mayo Clinic, Rochester, MN, United States
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Safety of Levodopa-Carbidopa Intestinal Gel Treatment in Patients with Advanced Parkinson's Disease Receiving ≥2000 mg Daily Dose of Levodopa. PARKINSONS DISEASE 2020; 2020:9716317. [PMID: 32104560 PMCID: PMC7040420 DOI: 10.1155/2020/9716317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/17/2019] [Accepted: 12/24/2019] [Indexed: 12/16/2022]
Abstract
Background Levodopa-carbidopa intestinal gel (LCIG) provides continuous levodopa administration and clinical benefits to patients with advanced Parkinson's disease (PD). This report evaluates long-term safety and efficacy of high-dose LCIG in PD patients. Methods Data were collected from several prospective, phase III clinical studies and an observational registry. The phase III program (N = 412) included four multicenter studies: a 12-week, randomized, double-blind study and three open-label studies extending ≥12 months. GLORIA (N = 412) included four multicenter studies: a 12-week, randomized, double-blind study and three open-label studies extending ≥12 months. GLORIA (. Results A total of 72 of 412 (17.5%) patients required dosages ≥2000 mg/day LCIG in the phase III program and 47 of 375 (12.5%) patients in GLORIA. Baseline demographics and disease severity were similar between dosage groups with more men in the high-dosage group. Compared with the <2000 mg/day dosage group, patients requiring ≥2000 mg/day LCIG had higher rates of AEs/ADRs including polyneuropathy; improvements in "Off" time and discontinuations due to AEs were similar between dosage groups and lower for discontinuations due to ADRs reported in GLORIA. Conclusions Patients who require ≥2000 mg/day LCIG exhibited a safety profile comparable to the established safety/tolerability of LCIG with similar clinical improvements. Higher AEs were noted but within what is accepted for LCIG. Continuous administration of LCIG is beneficial to advanced PD patients who require very high doses of levodopa.
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Abstract
In a range of neurological conditions, including movement disorders, sex-related differences are emerging not only in brain anatomy and function, but also in pathogenesis, clinical features and response to treatment. In Parkinson disease (PD), for example, oestrogens can influence the severity of motor symptoms, whereas elevation of androgens can exacerbate tic disorders. Nevertheless, the real impact of sex differences in movement disorders remains under-recognized. In this article, we provide an up-to-date review of sex-related differences in PD and the most common hyperkinetic movement disorders, namely, essential tremor, dystonia, Huntington disease and other chorea syndromes, and Tourette syndrome and other chronic tic disorders. We highlight the most relevant clinical aspects of movement disorders that differ between men and women. Increased recognition of these differences and their impact on patient care could aid the development of tailored approaches to the management of movement disorders and enable the optimization of preclinical research and clinical studies.
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Patterns and Determinants of Prescribing for Parkinson's Disease: A Systematic Literature Review. PARKINSONS DISEASE 2019; 2019:9237181. [PMID: 31781365 PMCID: PMC6875178 DOI: 10.1155/2019/9237181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022]
Abstract
Since the discovery of levodopa (L-dopa) in 1967, the range of medications available to treat Parkinson's disease has increased significantly and guidance on the use, efficacy, and safety of these medications has evolved. To assess levels of adherence to national prescribing guidelines and awareness of changes in the efficacy and safety data published in the profiles of medications for the treatment of PD, we have reviewed studies on patterns and determinants of prescribing PD medications conducted in the last 50 years (since the discovery of L-dopa). A systematic literature review was conducted using EMBASE (1967 to March, 2018), Ovid MEDLINE(R) ALL (1967 to March 16, 2018), PsycINFO (1967 to the 2nd week of March, 2018), and PubMed to identify all studies measuring prescribing patterns of PD medication between 1967 and 2017. Study design, source of data, country, year of study, number of patients and/or prescriptions, unit of analysis, prescribing determinants, and percentage utilisation of PD medications were extracted where possible. 44 studies examining prescribing patterns and/or prescribing determinants across 17 countries were identified. Unsurprisingly, L-dopa was the most commonly prescribed medication in all studies, accounting for 46.50% to 100% of all prescriptions for PD. In several studies, the prescribing rate of ergot-derived dopamine agonists (DAs) decreased over time in concordance with guidance. In contrast, the prescribing rates of non-ergot DAs increased over the last ten years in most of the included studies. In examining prescribing factors, two major categories were exemplified, patients' factors and prescribers' factors, with patients' age being the most common factor that affected the prescription in most studies. In conclusion, L-dopa is now the most commonly prescribed medication for cases of PD but there is large variation in the prescribing rates of catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, amantadine, and anticholinergics between countries. New studies examining the effects of recent clinical trials and measuring the prescribing rates of newly approved medications are warranted.
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Sperens M, Hamberg K, Hariz GM. Challenges and strategies among women and men with Parkinson’s disease: Striving toward joie de vivre in daily life. Br J Occup Ther 2018. [DOI: 10.1177/0308022618770142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Sperens
- PhD candidate, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy, Umeå University, Sweden
| | - Katarina Hamberg
- Professor, Department of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Sweden
| | - Gun-Marie Hariz
- Associate Professor, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy, and Department of Clinical Neuroscience, Section of Neurology, Umeå University, Sweden
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San Luciano M, Wang C, Ortega RA, Giladi N, Marder K, Bressman S, Saunders-Pullman R. Sex differences in LRRK2 G2019S and idiopathic Parkinson's Disease. Ann Clin Transl Neurol 2017; 4:801-810. [PMID: 29159192 PMCID: PMC5682117 DOI: 10.1002/acn3.489] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 02/05/2023] Open
Abstract
Objective To evaluate sex differences and the relative effect of G2019S LRRK2 mutations in Parkinson's disease (PD). Methods 530 LRRK2 PD carriers and 759 noncarrier PD (idiopathic, IPD) evaluated as part of the Fox Foundation (MJFF) Consortium were included. All participants completed a study visit including information on clinical features, treatment, examination, and motor and nonmotor questionnaires. Clinical features were compared between men and women separately for IPD and LRRK2 PD; and features were compared between IPD and LRRK2 PD separately for men and women. Results Among IPD: men had higher levodopa equivalency dose (LED), worse activities of daily living and motoric severity but lower complications of therapy (UPDRS-IV). IPD women had higher olfaction and thermoregulatory scores and were more likely to report family history of PD. Among LRRK2 PD: Male predominance was not observed among G2019S LRRK2 cases. Women had worse UPDRS-IV but better olfaction. Among same sex:LRRK2 men and women had better olfaction than IPD counterparts. LRRK2 men demonstrated lower motor and higher cognitive, RBD and thermoregulation scores than IPD men and LRRK2 women had greater UDPRS-IV and rates of dyskinesia. Interpretation There were clinical differences between sexes with a more severe phenotype in IPD men and more complications of therapy in women. The more severe male phenotype was moderated by LRRK2, with LRRK2 men and women showing less diversity of phenotype. Our study supports that both genetics and sex drive phenotype, and thus trials in LRRK2 and IPD should consider gender stratification in design or analysis.
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Affiliation(s)
- Marta San Luciano
- Department of Neurology Mount Sinai Beth Israel Medical Center New York New York.,Department of Neurology University of California San Francisco San Francisco California
| | - Cuiling Wang
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx New York
| | - Roberto A Ortega
- Department of Neurology Mount Sinai Beth Israel Medical Center New York New York
| | - Nir Giladi
- Movement Disorders Unit Neurological Institute Tel Aviv Medical Center Sackler School of Medicine Sagol School of Neuroscience Tel Aviv University Tel Aviv Israel
| | - Karen Marder
- Department of Neurology Columbia University New York New York
| | - Susan Bressman
- Department of Neurology Mount Sinai Beth Israel Medical Center New York New York.,Department of Neurology Albert Einstein College of Medicine Bronx New York.,Department of Neurology Icahn School of Medicine at Mount Sinai New York New York
| | - Rachel Saunders-Pullman
- Department of Neurology Mount Sinai Beth Israel Medical Center New York New York.,Department of Neurology Albert Einstein College of Medicine Bronx New York.,Department of Neurology Icahn School of Medicine at Mount Sinai New York New York
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Frentzel D, Judanin G, Borozdina O, Klucken J, Winkler J, Schlachetzki JCM. Increase of Reproductive Life Span Delays Age of Onset of Parkinson's Disease. Front Neurol 2017; 8:397. [PMID: 28871235 PMCID: PMC5566617 DOI: 10.3389/fneur.2017.00397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/25/2017] [Indexed: 01/01/2023] Open
Abstract
One striking observation in Parkinson’s disease (PD) is the remarkable gender difference in incidence and prevalence of the disease. Data on gender differences with regard to disease onset, motor and non-motor symptoms, and dopaminergic medication are limited. Furthermore, whether estrogen status affects disease onset and progression of PD is controversially discussed. In this retrospective single center study, we extracted clinical data of 226 ambulatory PD patients and compared age of disease onset, disease stage, motor impairment, non-motor symptoms, and dopaminergic medication between genders. We applied a matched-pairs design to adjust for age and disease duration. To determine the effect of estrogen-related reproductive factors including number of children, age at menarche, and menopause on the age of onset, we applied a standardized questionnaire and performed a regression analysis. The male to female ratio in the present PD cohort was 1.9:1 (147 men vs. 79 women). Male patients showed increased motor impairment than female patients. The levodopa equivalent daily dose was increased by 18.9% in male patients compared to female patients. Matched-pairs analysis confirmed the increased dose of dopaminergic medication in male patients. No differences were observed in age of onset, type of medication, and non-motor symptoms between both groups. Female reproductive factors including number of children, age at menarche, and age at menopause were positively associated with a delay of disease onset up to 30 months. The disease-modifying role of estrogen-related outcome measures warrants further clinical and experimental studies targeting gender differences, specifically hormone-dependent pathways in PD.
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Affiliation(s)
- Dominik Frentzel
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Grigorij Judanin
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Olga Borozdina
- Department of Applied Econometrics and International Political Economy, Goethe University Frankfurt, Frankfurt, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes C M Schlachetzki
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA, United States
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Senek M, Aquilonius SM, Askmark H, Bergquist F, Constantinescu R, Ericsson A, Lycke S, Medvedev A, Memedi M, Ohlsson F, Spira J, Westin J, Nyholm D. Levodopa/carbidopa microtablets in Parkinson's disease: a study of pharmacokinetics and blinded motor assessment. Eur J Clin Pharmacol 2017; 73:563-571. [PMID: 28101657 PMCID: PMC5384948 DOI: 10.1007/s00228-017-2196-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/05/2017] [Indexed: 11/12/2022]
Abstract
Background Motor function assessments with rating scales in relation to the pharmacokinetics of levodopa may increase the understanding of how to individualize and fine-tune treatments. Objectives This study aimed to investigate the pharmacokinetic profiles of levodopa-carbidopa and the motor function following a single-dose microtablet administration in Parkinson’s disease. Methods This was a single-center, open-label, single-dose study in 19 patients experiencing motor fluctuations. Patients received 150% of their individual levodopa equivalent morning dose in levodopa-carbidopa microtablets. Blood samples were collected at pre-specified time points. Patients were video recorded and motor function was assessed with six UPDRS part III motor items, dyskinesia score, and the treatment response scale (TRS), rated by three blinded movement disorder specialists. Results AUC0–4/dose and Cmax/dose for levodopa was found to be higher in Parkinson’s disease patients compared with healthy subjects from a previous study, (p = 0.0008 and p = 0.026, respectively). The mean time to maximum improvement in sum of six UPDRS items score was 78 min (±59) (n = 16), and the mean time to TRS score maximum effect was 54 min (±51) (n = 15). Mean time to onset of dyskinesia was 41 min (±38) (n = 13). Conclusions In the PD population, following levodopa/carbidopa microtablet administration in fasting state, the Cmax and AUC0–4/dose were found to be higher compared with results from a previous study in young, healthy subjects. A large between subject variability in response and duration of effect was observed, highlighting the importance of a continuous and individual assessment of motor function in order to optimize treatment effect.
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Affiliation(s)
- Marina Senek
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.
| | | | - Håkan Askmark
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Filip Bergquist
- Department of Pharmacology, University of Gothenburg, Gothenburg, Sweden
| | - Radu Constantinescu
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Alexander Medvedev
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Mevludin Memedi
- Computer Engineering, Dalarna University, Falun, Sweden.,Informatics, School of Business, Örebro University, Örebro, Sweden
| | | | | | - Jerker Westin
- Computer Engineering, Dalarna University, Falun, Sweden
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
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Picillo M, Nicoletti A, Fetoni V, Garavaglia B, Barone P, Pellecchia MT. The relevance of gender in Parkinson’s disease: a review. J Neurol 2017; 264:1583-1607. [DOI: 10.1007/s00415-016-8384-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
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Altmann V, Schumacher-Schuh AF, Rieck M, Callegari-Jacques SM, Rieder CRM, Hutz MH. Influence of genetic, biological and pharmacological factors on levodopa dose in Parkinson's disease. Pharmacogenomics 2016; 17:481-8. [PMID: 27019953 DOI: 10.2217/pgs.15.183] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM Levodopa is first-line treatment of Parkinson's disease motor symptoms but, dose response is highly variable. Therefore, the aim of this study was to determine how much levodopa dose could be explained by biological, pharmacological and genetic factors. PATIENTS & METHODS A total of 224 Parkinson's disease patients were genotyped for SV2C and SLC6A3 polymorphisms by allelic discrimination assays. Comedication, demographic and clinical data were also assessed. RESULTS All variables with p < 0.20 were included in a multiple regression analysis for dose prediction. The final model explained 23% of dose variation (F = 11.54; p < 0.000001). CONCLUSION Although a good prediction model was obtained, it still needs to be tested in an independent sample to be validated.
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Affiliation(s)
- Vivian Altmann
- Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Mariana Rieck
- Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Carlos R M Rieder
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mara H Hutz
- Departamento de Genética, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease and pathologically is characterised by a progressive loss of dopaminergic cells of the nigrostriatal pathway. Clinically, PD is mainly defined by the presence of the motor symptoms of bradykinesia, rigidity, rest tremor and postural instability, but non-motor symptoms such as depression, dementia and autonomic disturbances are recognised as integral parts of the disease. Although pharmacotherapy for PD was introduced almost 50 years ago, and has improved significantly over the intervening period, the timing of initiation of treatment in newly diagnosed PD remains controversial. While some physicians favour an early start of pharmacotherapy at or soon after diagnosis, others prefer to delay pharmacological treatment until a certain degree of disability has developed. This article aims to discuss the advantages and disadvantages of both strategies by exploring their effects on symptoms, disease progression and quality of life. Although the data on putative disease-modifying effects of early pharmacological intervention in PD are still inconclusive, we believe that the most important indication for an early initiation of anti-parkinsonian treatment should be to maintain the quality of life of PD patients and to secure their socioeconomic status as long as possible.
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Loke H, Harley V, Lee J. Biological factors underlying sex differences in neurological disorders. Int J Biochem Cell Biol 2015; 65:139-50. [PMID: 26028290 DOI: 10.1016/j.biocel.2015.05.024] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
The prevalence, age of onset, pathophysiology, and symptomatology of many neurological and neuropsychiatric conditions differ significantly between males and females. Females suffer more from mood disorders such as depression and anxiety, whereas males are more susceptible to deficits in the dopamine system including Parkinson's disease (PD), attention-deficit hyperactivity disorder (ADHD), schizophrenia, and autism spectrum disorders (ASD). Until recently, these sex differences have been explained solely by the neuroprotective actions of sex hormones in females. Emerging evidence however indicates that the sex chromosome genes (i.e. X- and Y-linked genes) also contribute to brain sex differences. In particular, the Y-chromosome gene, SRY (Sex-determining Region on the Y chromosome) is an interesting candidate as it is expressed in dopamine-abundant brain regions, where it regulates dopamine biosynthesis and dopamine-mediated functions such as voluntary movement in males. Furthermore, SRY expression is dysregulated in a toxin-induced model of PD, suggesting a role for SRY in the pathogenesis of dopamine cells. Taken together, these studies highlight the importance of understanding the interplay between sex-specific hormones and sex-specific genes in healthy and diseased brain. In particular, better understanding of regulation and function of SRY in the male brain could provide entirely novel and important insights into genetic factors involved in the susceptibility of men to neurological disorders, as well as development of novel sex-specific therapies.
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Affiliation(s)
- Hannah Loke
- Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia
| | - Vincent Harley
- Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia; Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.
| | - Joohyung Lee
- Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia; Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.
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Wang T, Duan SJ, Wang SY, Lu Y, Zhu Q, Wang LJ, Han B. Coadministration of hydroxysafflor yellow A with levodopa attenuates the dyskinesia. Physiol Behav 2015; 147:193-7. [PMID: 25914172 DOI: 10.1016/j.physbeh.2015.04.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 01/03/2023]
Abstract
Levodopa (L-DOPA) is used as the most effective drug available for the symptomatic treatment of Parkinson's disease (PD). However, long-term treatment of L-DOPA frequently causes complications, including abnormal involuntary movements such as dyskinesia and response fluctuations in PD patients. In the present work, we investigated whether hydroxysafflor yellow A (HSYA) ameliorates L-DOPA-induced dyskinesia and motor fluctuations in the 6-hydroxydopamine-lesioned rat model of PD. Valid PD rats were treated daily with vehicle, HSYA alone, L-DOPA, or a combination of HSYA plus L-DOPA for 21days, respectively. L-DOPA (8mg/kg) and benserazide (15mg/kg) were treated intraperitoneally. HSYA was administrated intraperitoneally at a dose of 10mg/kg. The abnormal involuntary movements and rotational behavior were evaluated. The expression of the dopamine D3 receptor in the striatum was also assayed. The results demonstrated that daily administration of L-DOPA to PD rats for 21days induced a steady expression of dyskinesia. Coadministration of HSYA with L-DOPA significantly ameliorated L-DOPA-induced dyskinesia. The combination treatment also prevented the shortening of the motor response duration that defines wearing off motor fluctuations. HSYA also inhibited the increase of expression of the dopamine D3 receptor in the striatum. These findings demonstrated that HSYA provided anti-dyskinetic relief against L-DOPA in a preclinical model of PD via regulating the expression of the dopamine D3 receptor. The combination of L-DOPA and HSYA also reduced the likelihood of wearing off development, and may thus support the utility of such compounds for the improved treatment of PD.
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Affiliation(s)
- Tian Wang
- School of Pharmacy, Yantai University, Yantai, Shandong 264005, PR China; State key laboratory of Long-acting and Targeting Drug Delivery Technologies (luye Pharma Group Ltd.), Yantai, Shandong 264003, PR China
| | - Si-jin Duan
- School of Pharmacy, Yantai University, Yantai, Shandong 264005, PR China
| | - Shu-yun Wang
- School of Life Science, Yantai University, Yantai, Shandong 264005, PR China
| | - Yan Lu
- School of Life Science, Yantai University, Yantai, Shandong 264005, PR China
| | - Qing Zhu
- School of Life Science, Yantai University, Yantai, Shandong 264005, PR China
| | - Li-jie Wang
- School of Pharmacy, Yantai University, Yantai, Shandong 264005, PR China
| | - Bing Han
- School of Life Science, Yantai University, Yantai, Shandong 264005, PR China.
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Kestenbaum M, Fahn S. Safety of IPX066 , an extended release carbidopa-levodopa formulation, for the treatment of Parkinson's disease. Expert Opin Drug Saf 2015; 14:761-7. [PMID: 25697185 DOI: 10.1517/14740338.2015.1015986] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Levodopa (LD) is the most effective treatment for Parkinson's disease (PD). However, chronic use of LD commonly results in the development of motor complications, including wearing off and dyskinesia. The presumption that the short serum half-life of LD is associated with the development of motor complications has raised the need to develop treatments with increased durations of stable LD concentrations. AREAS COVERED We conducted a PubMed search for IPX066 articles and also reviewed abstracts from meetings that included this topic. IPX066 is a newly developed formulation of extended release carbidopa-LD (CD-LD) with a one to four ratio of CD to LD, that was approved by the FDA in January 2015 for the treatment of PD, post-encephalitic parkinsonism, and parkinsonism that may follow carbon monoxide or manganese intoxication. It will be marketed by the trade name Rytary®. A Phase III clinical trial showed that IPX066 is efficacious in improving motor symptoms in early PD patients. In advanced PD patients with motor fluctuations, IPX066 reduced off time and increased on time without troublesome dyskinesia compared to CD-LD immediate release and CD-LD with entacapone. IPX066 had an acceptable safety profile. Adverse events of IPX066 from the different trials are presented. EXPERT OPINION IPX066 will probably have a role in the treatment of advanced PD with motor fluctuations. IPX066 could also be used initially when LD therapy is prescribed, but the question of whether this usage could reduce or prevent the development of motor complications is yet to be answered.
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Affiliation(s)
- Meir Kestenbaum
- Columbia University, College of Physicians and Surgeons, Columbia University Medical Center, Department of Neurology , New York, NY , USA
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20
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Umeh CC, Pérez A, Augustine EF, Dhall R, Dewey RB, Mari Z, Simon DK, Wills AMA, Christine CW, Schneider JS, Suchowersky O. No sex differences in use of dopaminergic medication in early Parkinson disease in the US and Canada - baseline findings of a multicenter trial. PLoS One 2014; 9:e112287. [PMID: 25486269 PMCID: PMC4259292 DOI: 10.1371/journal.pone.0112287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/09/2014] [Indexed: 11/24/2022] Open
Abstract
Background Sex differences in Parkinson disease clinical features have been reported, but few studies have examined sex influences on use of dopaminergic medication in early Parkinson disease. The objective of this study was to test if there are differences in the type of dopaminergic medication used and levodopa equivalent daily dose between men and women with early Parkinson disease enrolled in a large multicenter study of Creatine as a potential disease modifying therapy – the National Institute of Neurological Disorders and Stroke Exploratory Trials in Parkinson Disease Long-Term Study-1. Methods Baseline data of 1,741 participants from 45 participating sites were analyzed. Participants from the United States and Canada were enrolled within five years of Parkinson Disease diagnosis. Two outcome variables were studied: type of dopaminergic medication used and levodopa equivalent daily dose at baseline in the Long-Term Study-1. Chi-square statistic and linear regression models were used for statistical analysis. Results There were no statistically significant differences in the frequency of use of different types of dopaminergic medications at baseline between men and women with Parkinson Disease. A small but statistically significant difference was observed in the median unadjusted levodopa equivalent daily dose at baseline between women (300 mg) and men (325 mg), but this was not observed after controlling for disease duration (years since Parkinson disease diagnosis), disease severity (Unified Parkinson's Disease Rating Scale Motor and Activities of Daily Living Scores), and body weight. Conclusions In this large multicenter study, we did not observe sex differences in the type and dose of dopaminergic medications used in early Parkinson Disease. Further research is needed to evaluate the influence of male or female sex on use of dopaminergic medication in mid- and late-stage Parkinson Disease.
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Affiliation(s)
- Chizoba C. Umeh
- Department of Neurology and Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Adriana Pérez
- Department of Biostatistics, The University of Texas School of Public Health, Austin, Texas, United States of America
| | - Erika F. Augustine
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Rohit Dhall
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, United States of America
| | - Richard B. Dewey
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - David K. Simon
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anne-Marie A. Wills
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Chadwick W. Christine
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Jay S. Schneider
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Oksana Suchowersky
- Departments of Medicine (Neurology), Medical Genetics and Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Compassionate trial of levodopa carbidopa intestinal gel infusion in two patients with progressive supranuclear palsy. Clin Neurol Neurosurg 2014; 116:1-3. [PMID: 24388506 DOI: 10.1016/j.clineuro.2013.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/27/2013] [Accepted: 11/15/2013] [Indexed: 11/22/2022]
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Kim SN, Doo AR, Park JY, Choo HJ, Shim I, Park JJ, Chae Y, Lee B, Lee H, Park HJ. Combined treatment with acupuncture reduces effective dose and alleviates adverse effect of L-dopa by normalizing Parkinson's disease-induced neurochemical imbalance. Brain Res 2013; 1544:33-44. [PMID: 24321617 DOI: 10.1016/j.brainres.2013.11.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 11/16/2022]
Abstract
This study first showed the behavioural benefits of novel combination therapy of L-dopa with acupuncture on Parkinson's disease, and its underlying mechanisms within basal ganglia. The previous study reported that acupuncture may improve the motor function of a Parkinson's disease (PD) mouse model by increasing the dopamine efflux and turnover ratio of dopamine. Hence, we hypothesised that combining L-dopa with acupuncture would have a behavioural benefit for those with PD. We performed unilateral injections of 6-OHDA into the striatum of C57Bl/6 mice to model hemi-Parkinsonian attributes. To test motor function and dyskinetic anomalies, we examined cylinder behaviour and abnormal involuntary movement (AIM), respectively. We found that (1) a 50% reduced dose of L-dopa (7.5 mg/kg) combined with acupuncture showed an improvement in motor function that was comparable to mice given the standard dose of L-dopa treatment (15 mg/kg) only, and that (2) the combination treatment (L-dopa +acupuncture) was significantly superior in reducing AIM scores when equivalent doses of L-dopa were used. The combination treatment also significantly reduces the abnormal increase of GABA contents in the substantia nigra compared to the standard L-dopa treatment. Furthermore, abnormal expression of FosB, the immediate early gene of L-dopa induced dyskinesia (LID), was mitigated in the striatum by the combination treatment. All of these results indicate that acupuncture enhances the benefits of L-dopa on motor function with reduced dose of L-dopa and alleviating LID by normalising neurochemical imbalance within the basal ganglia.
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Affiliation(s)
- Seung-Nam Kim
- Acupuncture and Meridian Science Research Centre (AMSRC), Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea; Department of Korean Medical Science, Graduate School of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Ah-Reum Doo
- Acupuncture and Meridian Science Research Centre (AMSRC), Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Ji-Yeun Park
- Acupuncture and Meridian Science Research Centre (AMSRC), Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Hyunwoo J Choo
- Department of Neuroscience, Brown University, Providence, RI 02912, USA
| | - Insop Shim
- Acupuncture and Meridian Science Research Centre (AMSRC), Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Jongbae J Park
- Department of Physical Medicine and Rehabilitation, UNC-Chapel Hill, School of Medicine, UNC Hospitals, Campus Box #7200, Chapel Hill, NC 27599, USA; Regional Centre for Neurosensory Disorders, UNC School of Dentistry, Chapel Hill, NC 27599, USA
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Centre (AMSRC), Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea; Department of Korean Medical Science, Graduate School of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Bena Lee
- Department of Physical Medicine and Rehabilitation, UNC-Chapel Hill, School of Medicine, UNC Hospitals, Campus Box #7200, Chapel Hill, NC 27599, USA
| | - Hyejung Lee
- Acupuncture and Meridian Science Research Centre (AMSRC), Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea; Department of Korean Medical Science, Graduate School of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Hi-Joon Park
- Acupuncture and Meridian Science Research Centre (AMSRC), Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea; Department of Korean Medical Science, Graduate School of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
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Motor fluctuations and Helicobacter pylori in Parkinson's disease. J Neurol 2013; 260:2974-80. [PMID: 24002418 DOI: 10.1007/s00415-013-7089-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 12/13/2022]
Abstract
The presence of Helicobacter pylori (HP) in the gastrointestinal tract may limit the absorption of levodopa. The objectives of this study were to investigate whether HP infection may affect the clinical response to levodopa as well as levodopa dose requirement in patients with Parkinson's disease (PD) as well as to investigate whether HP infection may affect plasma levels of vitamin B12, folic acid, and homocysteine. Seventy-five patients with PD diagnosed at least 4 years ago were included. Symptom fluctuations were assessed by UPDRS-IV and the WOQ9 wearing-off-scale. Plasma levels of vitamin B12, folic acid, and homocysteine were analyzed. Screening for HP was performed with a 13C-labeled urea breath test (Diabact UBT). A propensity-matched analysis was made where each patient in the HP-infected group was matched with one patient in the non-infected group with respect to age and gender. Of the 75 included patients, 20 were HP infected (27 %). Median Hoehn & Yahr scores were 3 in both HP infected patients and the matched group (n = 20). HP-infected patients had decreased "complications of therapy" with average total UPDRS-IV score of 4.8 ± 3.0 vs. 7.7 ± 3.8 (p < 0.05), despite no significant difference in levodopa equivalent dose. Wearing-off and sleep disturbance were significantly less common in the HP group (p < 0.05). There were no differences regarding vitamin B12, folic acid, or homocysteine values. HP infection in patients with PD may result in a decreased occurrence of symptom fluctuations according to this small study. This finding may be due to altered absorption of levodopa in the gastrointestinal tract in patients with HP infection, but further studies are required.
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Yacoubian TA. IPX066: a new intermediate-and extended-release carbidopa-levodopa formulation. Neurodegener Dis Manag 2013; 3:123-131. [PMID: 24501594 DOI: 10.2217/nmt.13.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Carbidopa-levodopa (CD-LD) is the mainstay of treatment for Parkinson's disease (PD), yet most patients with advanced PD develop motor fluctuations with time when treated with CD-LD. Development of longer-acting CD-LD formulations is a major goal for reducing motor fluctuations in advanced PD. IPX066 is a new formulation of CD-LD that contains both an immediate-release and a sustained-release levodopa component, which is currently under review by the US FDA. Recent clinical trials have demonstrated improved effectiveness of IPX066 compared with other CD-LD formulations in advanced PD, with a reduction in 'off' time of approximately 37%. While it has also been shown to be effective in early PD compared with placebo, its role in early PD compared with other available medications for PD is unclear at this time.
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Affiliation(s)
- Talene A Yacoubian
- Center for Neurodegeneration & Experimental Therapeutics, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; and Civitan International Research Center 560D, 1719 6th Avenue South, Birmingham, AL 35294, USA; Tel.: +1 205 996 7543; ;
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Ambermoon P, Carter A, Hall W, Dissanayaka N, O'Sullivan J. Compulsive use of dopamine replacement therapy: a model for stimulant drug addiction? Addiction 2012; 107:241-7. [PMID: 21793971 DOI: 10.1111/j.1360-0443.2011.03511.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The compulsive use of dopamine replacement therapy (DRT) or dopamine dysregulation syndrome (DDS) is one of the behavioural disturbances reported in some patients with Parkinson's disease (PD) and other disorders who are receiving DRT. We draw this phenomenon to the attention of the addiction field as a topic deserving of more systematic study. We outline: the clinical features, epidemiology and clinical correlates of the disorder; the unresolved issues in its definition and diagnosis; and its potential relevance to neurobiological models of psychostimulant addiction. We argue that compulsive DRT use may provide a useful model for drug addiction, while advancing our understanding of the neurobiology of addiction and improving the management of PD patients with the disorder.
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Affiliation(s)
- Polly Ambermoon
- The University of Queensland, UQ Centre for Clinical Research, Queensland, Australia
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Nyholm D, Johansson A, Lennernäs H, Askmark H. Levodopa infusion combined with entacapone or tolcapone in Parkinson disease: a pilot trial. Eur J Neurol 2011; 19:820-6. [DOI: 10.1111/j.1468-1331.2011.03614.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schapira AHV, Hillbom M. Publishing changes and information delivery in the clinical neurosciences. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.2011.03594.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hollingworth SA, Rush A, Hall WD, Eadie MJ. Utilization of anti-Parkinson drugs in Australia: 1995-2009. Pharmacoepidemiol Drug Saf 2011; 20:450-6. [PMID: 21322083 DOI: 10.1002/pds.2114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 12/14/2010] [Accepted: 01/08/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine trends in the prescribing of anti-Parkinsonian drugs (APD) in Australia from 1995 to 2009. METHODS We analyzed the Medicare Australia and Drug Utilisation Sub-Committee (DUSC) databases for prescription data for overall APD dispensed use from 1995. We were able to examine prescribing by gender, age, and type of prescriber between 2002 and 2009. Prescriptions were converted to defined daily doses (DDD)/1000 population/day using Australian Bureau of Statistics population data. RESULTS Dispensed use of levodopa + carbidopa remained steady from 1995 to 2009 (0.76-0.82 DDD/1000 population/day); levodopa + benserazide use increased from 0.34 to 0.55 DDD/1000 population/day. Since 2005 dispensed use of levodopa + carbidopa + entacapone has steadily increased, from 0.03 to 0.10 DDD/1000 population/day. In July 2009 levodopa + carbidopa was the most widely used agent, followed by levodopa + benserazide, then benztropine. Cabergoline increased from 1999, peaked in 2006, and thereafter declined. APD use peaked in males and females aged 60-69 years. Age-adjusted utilization was slightly higher in males than females. CONCLUSIONS The amount of levodopa dispensed has slowly increased with levodopa + benserazide increasing faster than levodopa + carbidopa. Use of cabergoline fell when pramipexole became available and the risk of ergot-related serosal adverse effects was more widely appreciated. Use of centrally acting anti-cholinergics decreased over a period of time when use of atypical anti-psychotic agents increased.
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