Reappraisal of Temporary Levodopa Withdrawal ("Drug Holiday") in Parkinson's Disease

Transient withdrawal of therapy has been advocated as a method of dealing with the complications of long-term use of levodopa in the treatment of Parkinson's disease. We retrospectively examined the effect of a 10-day period of levodopa withdrawal, or "drug holiday," in 28 patients. We then compared the subsequent clinical course of these patients over one year with that of 30 other randomly selected, similar patients with Parkinson's disease. In both groups the disease progressed; there was no difference in disease severity, capacity for daily living activities, or total amounts of dopamine agonists eventually used. For some patients, it was possible to reduce dopamine agonists used immediately after the drug holiday without causing deterioration, but a pulmonary embolus and other complications occurred. Subsequent complications related to long-term dopamine-agonist therapy during the follow-up period were similar in the two groups. This investigation indicates that a drug holiday carries some risk and does not improve the efficacy of levodopa therapy or prevent the problems that occur with long-term administration

Statin usage, vascular diagnosis and vascular risk factors in Parkinson's disease

Background and aims: Vascular disease is a common comorbidity in Parkinson’s disease patients. Statins are potentially neuroprotective for Parkinson’s disease through non-vascular mechanisms. We investigated prevailing statin use in a Parkinson’s disease cohort. Methods and results: Data on diagnostic indication for statins, anti-Parkinson therapy, vascular risk factors, and statin prescription, were obtained from electronic medical record review for consecutive Parkinson’s disease patients. The ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network system was used to calculate future cardiovascular risk and identify those warranting statin use. Of 441 patients included, 59.9% were male, with a mean age of 68.9 years (standard deviation 10.3). One hundred and seventy-four (39.5%) patients had at least one diagnostic indication for statin use, of whom 136 (78.2%) were prescribed a statin. In the 267 (60.5%) cases without a diagnostic indication, 54 (20.2%) were excluded owing to age limitations defined in ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network. Of the remaining 213, 62 (29.1%) had an ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network score in the recommended range for statin therapy, of whom 15 (24.1%) were prescribed statins. Conclusion: There is suboptimal implementation of statin therapy in Parkinson’s disease patients. Given the possible neuroprotective effects of statins in Parkinson’s disease in addition to reducing cardiovascular risk, reasons for suboptimal implementation warrant further investigation

Progress Notes : a report from the Parkinson's Disease Center at Boston University Medical Center

News and updates from the Boston University Medical Center, Parkinson's Disease Cente

Pain-motor integration in the primary motor cortex in Parkinson's disease

In Parkinson's disease (PD), the influence of chronic pain on motor features has never been investigated. We have recently designed a technique that combines nociceptive system activation by laser stimuli and primary motor cortex (M1) activation through transcranial magnetic stimulation (TMS), in a laser-paired associative stimulation design (Laser-PAS). In controls, Laser-PAS induces long-term changes in motor evoked potentials reflecting M1 long-term potentiation-like plasticity, arising from pain-motor integration

216 Jewish Hospital of St. Louis

https://digitalcommons.wustl.edu/bjc_216/1153/thumbnail.jp

Effects of tapentadol on pain, motor symptoms and cognitive functions in Parkinson\u2019s disease

Background: Pain is a common and undertreated non-motor symptom in patients with Parkinson\u2019s disease (PD). Opioids have been seldom used in PD because they could worsen cognitive and motor functions. Objective: We aimed to assess efficacy and tolerability of tapentadol in PD patients. Methods: We retrospectively reviewed 21 PD patients treated with tapentadol extended release (ER) for chronic pain. Patients were evaluated before treatment and at 3 and 6 months during treatment for pain intensity (current, 24-hour average, and minimum and worst) with a 0-10 Numerical Rating Scale and the painDETECT questionnaire; for motor symptom severity with the Unified Parkinson\u2019s Disease Rating Scale part III and the Hoehn and Yahr scale; for cognitive functions with MiniMental Status Examination, Corsi\u2019s Block Tapping test, Digit Span, Digit-Symbol Substitution test, FAS test, Rey\u2019s Auditory Verbal Learning test, Trail Making-A and -B, and the 9 Hole-Peg Test; for anxiety and depression with the Hospital Anxiety and Depression Scale; and for the quality of life with the Short Form-12 for Quality of Life. Data were analyzed by one-way ANOVA and paired t-test, and by Friedman\u2019s and Wilcoxon\u2019s test. Statistical significance was taken in all cases as P < 0,05. Results: Pain intensity decreased over the course of treatment. No differences were found in PD symptom severity and dopaminergic drug dosages between pretreatment and treatment evaluations . No decrement in cognitive neuropsychological performances was found and an improvement was observed in Digit Span, Digit-Symbol Substitution test and FAS test. The levels of anxiety, depression and of quality of life improved. Overall tapentadol ER was well tolerated and most patients reported no or mild and short-lived gastroenterological and neurological side effects. Conclusions: These results indicate the potential efficacy and tolerability of medium-high dose of tapentadol ER for the treatment of pain in PD

Glutamatergic-dopaminergic balance in the brain. Its importance in motor disorders and schizophrenia

Dopamine appears to be of less importance in the regulation of psychomotor functions than was previously thought. A central dopaminergic-glutamatergic balance may be important for both akinetic motor disorders and psychosis. In Parkinson's disease glutamate antagonists may counteract central glutamatergic hyperactivity and may be of value as anti-parkinsonian drugs. An increase of dopaminergic activity and/or a reduction of glutamatergic activity may contribute to the development of paranoid hallucinatory psychosis in schizophrenic patients and of pharmacotoxic psychosis in Parkinson's disease. Because of possibly severe side-effects of glutamatergic antagonists and agonists in the treatment of akinesia and psychosis, the development of partial glutamate agonists/antagonists could be an alternative strategy capable of producing antipsychotic or anti-kinetic effects with only mild adverse reaction

A systematic review of biomarkers for disease progression in Parkinson's disease

Peer reviewedPublisher PD

Barnes Hospital Bulletin

https://digitalcommons.wustl.edu/bjc_barnes_bulletin/1225/thumbnail.jp