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Rodríguez-Sanz A, Peña-Llamas E, Alonso-Cánovas A, Alonso-Frech FA, Borrue-Fernández C, Catalán MJ, Fanjul-Arbós S, García-Cobos E, García-Ramos R, García Ruiz-Espiga P, Herreros-Rodríguez J, Kurtis-Urra M, López-Lozano JJ, López-Manzanares L, Martínez-Castrillo JC, Martínez-Fernández R, Mata M, Pérez-Sánchez JR, Posada IJ, Rojo A, Romero-Muñoz JP, Ruiz-Huete C, Sánchez-Alonso MP, Vivancos-Matellano F, En Representación Del Grupo de Trastornos Del Movimiento de la Asociación Madrileña de Neurología ERDGDTDMDLAMDN. [Clinical experience in the treatment of motor fluctuations in Parkinson's disease. Delphi consensus of a group of experts in movement disorders]. Rev Neurol 2020; 71:407-420. [PMID: 33205387 DOI: 10.33588/rn.7111.2020088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Motor fluctuations are one of the most common complications of Parkinson's disease and their treatment is still a complex matter. Therefore, from the Neurology Movement Disorders Group we present our clinical experience in the treatment of these complications, with the intention of it being useful in decision-making in daily clinical practice. DEVELOPMENT Nineteen questions were developed based on a literature review and an open survey answered by members of this group. These issues were discussed in two phases, using the Delphi methodology. Considering the results of the survey, levodopa dose adjustment and dopamine agonists are the option with the best efficacy/tolerability ratio in the treatment of motor fluctuations. Rotigotine is useful in the motor fluctuations associated with gastroparesis, and intermittent subcutaneous apomorphine has positive effects in patients with unpredictable off periods. The most relevant adverse effect associated with dopamine agonists is impulse control disorder. Catechol-O-methyltransferase inhibitors are useful in the initial stages of motor fluctuations, especially in wearing off. Monoamine oxidase inhibitors are generally drugs that are well-tolerated and useful in motor fluctuations. If these measures are not effective, second-line treatments should be indicated on a case-by-case basis. CONCLUSION The clinical profile of patients with Parkinson's disease is paramount in deciding the most appropriate therapy for the treatment of motor fluctuations.
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Affiliation(s)
| | | | | | | | | | - M J Catalán
- Hospital Universitario Clínico San Carlos, Madrid, España
| | | | | | - R García-Ramos
- Hospital Universitario Clínico San Carlos, Madrid, España
| | | | | | | | - J J López-Lozano
- Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, España
| | | | | | | | - M Mata
- Hospital Universitario Infanta Sofía, Madrid, España
| | | | - I J Posada
- Hospital Universitario 12 de Octubre, Madrid, España
| | - A Rojo
- Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, España
| | | | - C Ruiz-Huete
- Hospital Nuestra Señora del Rosario, Madrid, España
| | - M P Sánchez-Alonso
- Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, España
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Ruiz-Huete C, Bermejo PE, Terrón C, Anciones B. [Rotigotine in the treatment of Parkinson's disease. A study on a sample of 150 patients]. Rev Neurol 2008; 46:257-260. [PMID: 18351563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Rotigotine is a non-ergot dopamine agonist that has become the first treatment for Parkinson's disease formulated as a transdermal release system. Its side effects are very similar to those of other dopamine agonists, as well as those deriving from the site of application, while its advantages include a once-daily administration, the absence of interactions with foods and steady levels in plasma. AIM To determine the frequency of and reasons for withdrawing rotigotine in 150 consecutive patients diagnosed with Parkinson's disease. PATIENTS AND METHODS A retrospective analysis was carried out using the database at our Movement Disorders Unit in order to identify the first 150 patients who were treated with rotigotine. Only patients with Parkinson's disease who were free of intracranial lesions, psychiatric pathologies or dementia were eligible for inclusion in the sample. Patients were evaluated before and at two, four and six months after beginning treatment with rotigotine. RESULTS In all, 85 males and 65 females were identified. A total of 110 of them had previously been treated with dopamine agonists. Although 12% of the patients dropped out, 88% of them continued the treatment. The reasons for withdrawing were worsening of the clinical condition (12 patients), lack of effectiveness (three patients), drowsiness (two patients) and dyskinesias (one patient). CONCLUSIONS Rotigotine is safe and effective as medication in the treatment of Parkinson's disease. The fact that most of the drop-outs were due to a worsening of the clinical signs and symptoms after changing from another dopamine agonist suggests the need for an equivalence between other agonists and rotigotine.
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Affiliation(s)
- C Ruiz-Huete
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Sanatorio Nuestra Señora del Rosario, Hospital de La Zarzuela, Madrid, España
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Bermejo PE, Ruiz-Huete C, Dorado R, Anciones B. [Zonisamide in refractory essential tremor]. Rev Neurol 2008; 46:139-142. [PMID: 18297619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Essential tremor is one of the most frequent movement disorders. It is characterized by postural and action tremor that may affect different regions of the body. Among current treatments propranolol and primidone are included. However, these two drugs have demonstrated a limited efficacy and several adverse events. Additionally, they are contraindicated in patients with cardiac insufficiency and several respiratory diseases. New antiepileptic drugs are revealing as a possibility in the treatment of this disease. AIM. To evaluate efficacy and tolerability of zonisamide in the treatment of essential tremor. PATIENTS AND METHODS We perform a retrospective study about 13 patients with essential tremor refractory to an average of 2.8 drugs. Age, sex, zonisamide dosage, adverse events, duration and response to the treatment before and after the treatment were collected and analysed. Average zonisamide dosage was 215 mg/day and average duration of the treatment was 121 days. RESULTS Nine of 13 patients included in our study experienced a good response. A positive response was understood as a decrease on the limitation of daily activities and an improvement on neurological examination. Zonisamide was well tolerated and no patient abandoned the study for this reason. CONCLUSIONS Our data suggest that zonisamide is effective and well tolerated in the treatment of essential tremor. Placebo-controlled and bigger studies are warranted to confirm these results.
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Affiliation(s)
- P E Bermejo
- Unidad de Trastornos del Movimiento Sanatorio Nuestra Senora del Rosario, Hospital de Zarzuela, 28006 Madrid, Espana.
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Bermejo PE, Ruiz-Huete C, Terrón C. [Relationship between essential tremor, Parkinson's disease and dementia with Lewy bodies]. Rev Neurol 2007; 45:689-694. [PMID: 18050102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Although essential tremor (ET), Parkinson's disease (PD) and dementia with Lewy bodies (DLB) are considered to be distinct illnesses, there is a certain overlap between some of their clinical, pathological and genetic features. AIM To conduct a critical examination of the evidence for and against the association between these three pathological conditions. DEVELOPMENT The body of evidence supporting the notion of a relation between ET and PD is growing all the time; the same can be said of the fact that a postural tremor may appear years before the onset of other extrapyramidal symptoms, the involvement of common genes in the development of both conditions or the presence of common pathological findings. In addition, it has also been suggested that there are several aspects linking PD and DLB, and it has even been claimed that that they might be part of the clinical spectrum of the same disease. The concept of ET as a benign single-symptom disease has changed in recent years and, since it has been related to cognitive disorders and Lewy bodies in the central nervous system, it is now considered to be a neurodegenerative pathology. CONCLUSIONS. ET, PD and DLB could represent different points on the same clinical spectrum.
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Affiliation(s)
- P E Bermejo
- Servicio de Neurología, Clinica Nuestra Señora del Rosario. Hospital de la Zarzuela, Madrid, España.
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