DE MICHELE, GIUSEPPE

FILLA, ALESSANDRO

SACCA', FRANCESCO

Archivio della ricerca - Università degli studi di Napoli Federico II

DOI 10.1212/WNL.0b013e318257ea5d 2012;78;1538NeurologyAlessandro Filla, Francesco Sacca and Giuseppe De Micheleof Spinocerebellar Ataxia Type 3A Randomized Trial of Varenicline (Chantix) for the Treatment December 3, 2012This information is current as of    http://www.neurology.org/content/78/19/1538.1.full.htmllocated on the World Wide Web at: The online version of this article, along with updated information and services, is rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.Allsince 1951, it is now a weekly with 48 issues per year. Copyright © 2012 by AAN Enterprises, Inc. ® is the official journal of the American Academy of Neurology. Published continuouslyNeurology WriteClick:Editor’s ChoiceA RANDOMIZED TRIAL OF VARENICLINE(CHANTIX) FOR THE TREATMENT OFSPINOCEREBELLAR ATAXIA TYPE 3Alessandro Filla, Francesco Sacca, Giuseppe DeMichele, Napoli, Italy: Zesiewicz et al.1 reportedthat varenicline improved ataxia in patients withspinocerebellar ataxia type 3 (SCA3), yet the follow-ing issues should be considered.1. Why did the authors use the Fisher test for com-parison of baseline characteristics (table 1)? Pa-tients in the placebo group appeared to be olderand more severely compromised. For this reason,wouldn’t the subjects respond less to treatment?Blocked randomization may have prevented un-equal distribution between groups.2. The number of patients was small. Furthermore,due to the large number of dropouts in the placebogroup, the authors could not complete the originallyplanned crossover study. This weakens the studyand its results. Power calculation, which also ac-counts for patient dropout, was not performed.3. Primary efficacy measures included all the SARAsubscores and there were no corrections made formultiple comparisons. The SARA subscore forgait improved more in the varenicline group (ta-ble 21), but stance improved more in the placebo.Can the authors explain this discrepancy? In con-trolled trials, it is preferable to choose a priori asingle, major study endpoint.4. Beck Anxiety Inventory score improved in the va-renicline group. Could mood improvement con-tribute to better performance for SARA?This article contributes to the study of degenera-tive ataxias where effective treatments are lacking andnew strategies are needed. However, the results of thestudy should be taken cautiously. This trial might beconsidered more a safety trial than a study on effi-cacy. Results of drug efficacy should be obtained in alarger study that complies with the guidelines of awell-designed, controlled, randomized trial.Copyright © 2012 by AAN Enterprises, Inc.1. Zesiewicz TA, Greenstein MB, Sullivan KL, et al. A random-ized trial of varenicline (Chantix) for the treatment of spino-cerebellar ataxia type 3. Neurology 2012;78:545–550.ROLE OF DATSCAN AND CLINICALDIAGNOSIS IN PDNin P.S. Bajaj, Nottingham, UK: The authors dis-cuss the role of DaTSCAN and paint a rosy pictureof clinical diagnostic accuracy in PD.1 Clinicopatho-logic studies2 suggest good diagnostic accuracy in PDyet experience from drug trials suggests a PD diagno-sis error rate of up to 15% and community studies anerror rate of over 50%.3 A recent blinded video studyshowed high false-positive and false-negative errorrates in PD diagnosis and poor concordance betweenmovement disorder experts, which illustrates the fra-gility and subjectivity of clinical diagnosis in tremu-lous patients.3 The indication of DaTSCAN is notfor diagnosis of PD or parkinsonian syndromes butper US Food and Drug Administration prescribinginformation is “for visualization of the dopaminetransporter (DaT) distribution within the striatum . . .to assist in the evaluation of adult patients with sus-pected parkinsonian syndromes.”4 Only a cliniciancanmake a diagnosis. DaTSCANmay enable that diag-Editors’ Note: A common argument offered to medicalstudents in favor of pursuing a career in neurology isthat it is among the rare specialties in which theexamination still must guide the imaging. There is nomagic bullet of neuroradiologic tests; no one studyevery patient must have before the neurologist evensets eyes on them. This edict comes to mind as authorDr. de la Fuente-Fernandez and WriteClick contributor Dr.Bajaj debate the role of DaTSCAN, a radioisotope used incombination with SPECT imaging to view the striataldopaminergic system, as an aid in the diagnosis ofParkinson disease (PD). Dr. Bajaj argues that PD clinicaldiagnostic accuracy and concordance between specialists islower than reported and that DaTSCAN may be useful inchallenging patients. Dr. de la Fuente-Fernandez countersthat the radiation risk may be too great for a test thatbenefits the doctor more than the patient.Megan Alcauskas, MD, and Robert C. Griggs, MDSection EditorRobert C. Griggs, MD1538 Neurology 78 May 8, 2012DOI 10.1212/WNL.0b013e318257ea5d 2012;78;1538NeurologyAlessandro Filla, Francesco Sacca and Giuseppe De MicheleAtaxia Type 3A Randomized Trial of Varenicline (Chantix) for the Treatment of Spinocerebellar December 3, 2012This information is current as of   ServicesUpdated Information & http://www.neurology.org/content/78/19/1538.1.full.htmlincluding high resolution figures, can be found at:References st-1http://www.neurology.org/content/78/19/1538.1.full.html#ref-liThis article cites 1 articles, 1 of which can be accessed free at:Permissions & Licensing http://www.neurology.org/misc/about.xhtml#permissionstables) or in its entirety can be found online at: Information about reproducing this article in parts (figures, Reprints http://www.neurology.org/misc/addir.xhtml#reprintsusInformation about ordering reprints can be found online:

A randomized trial of varenicline (Chantix) for the treatment of spinocerebellar ataxia type 3.

A. Filla

F. Sacca

G. De Michele

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Neurology

A Randomized Trial of Varenicline (Chantix) for the Treatment of Spinocerebellar Ataxia Type 3

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A randomized trial of varenicline (Chantix) for the treatment of spinocerebellar ataxia type 3.

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