tag:blogger.com,1999:blog-46610084506528192942024-03-05T19:07:06.320-08:00Parkinsons DiseaseDiscussion and review of available treatments for primary parkinsons disease symptoms, and secondary related symptoms. The focus is on the new but clinically justifiable treatments.Roberthttp://www.blogger.com/profile/14162612785884606407noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-4661008450652819294.post-25460951695095842172011-10-21T03:30:00.000-07:002011-10-21T03:32:40.449-07:00Neupro Transdermal Parkinson's Patch Approved<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4J-Ca5WwQC3xLKUbIQbzXRUo63AvY_1yM6ZP-gmpaVJkZkj4utQfPtDPcAU9-D5C-RPQPfKz8Oc3Oe09FM4ZYNA3r9vfXN5PYM_J5qic8nu-1pDjaS8C-WP94Nth-ccY1sZWCklyW_A/s1600/Neupro-Parkinson-Disease-Transdermal-Patch.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4J-Ca5WwQC3xLKUbIQbzXRUo63AvY_1yM6ZP-gmpaVJkZkj4utQfPtDPcAU9-D5C-RPQPfKz8Oc3Oe09FM4ZYNA3r9vfXN5PYM_J5qic8nu-1pDjaS8C-WP94Nth-ccY1sZWCklyW_A/s200/Neupro-Parkinson-Disease-Transdermal-Patch.jpg" width="200" /></a></div><span class="Apple-style-span" style="color: #151515; font-family: Arial, Helvetica, sans-serif; line-height: 15px;">A transdermal patch for early symptoms of Parkinson's disease has won FDA approval. </span><br />
<span class="Apple-style-span" style="color: #151515; font-family: Arial, Helvetica, sans-serif; line-height: 15px;"><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; line-height: 19px;">The agent called Neupro represents both the first transdermal patch for Parkinson's and the first U.S. approval of any kind for the active ingredient, the dopamine agonist rotigotine, the agency announced.</span><br />
<div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">The silicone-based patch delivers a measured dose of rotigotine, a nonergoline agent, over 24 hours.<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">According to the FDA, the effectiveness of Neupro was demonstrated in a fixed-dose response study and two flexible-dose studies. The parallel group randomized, double-blinded, placebo-controlled studies involved 1,154 patients with early Parkinson's who were not on other anti-Parkinson's agents.<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">The most commonly reported adverse events in clinical trials included patch-site skin reactions, dizziness, nausea, vomiting, drowsiness and insomnia. Other adverse events included narcolepsy-like sleep attacks, hallucinations, and postural hypotension.<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">In an open-label extension study of the patch, reported at the American Neurological Association meeting last October, the 137 patients on the active medication showed an immediate reduction in scores on the Unified Parkinson's Disease Rating Scale (UPDRS) of about seven points, and after six months that score remained four points below baseline.<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">At the end of the trial, the patients who had been on placebo and were then switched to the patch in the open-label extension phase showed an immediate drop in the Unified Parkinson's Disease Rating Scale scores, but as with the patients who continued on rotigotine, the scores slowly rose during the 85 week total length of the study, said Ray L. Watts, M.D., chairman of neurology at the University of Alabama at Birmingham.<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">In an early online release from the Jan. 23 issue of <em>Neurology</em>, Dr. Watts and colleagues reported that early-stage Parkinson's responded with significant relief of symptoms, compared with placebo, for at least six months with rotigotine, with acceptable side effects.<em><o:p></o:p></em></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">In the <em>Neurology</em> study, patients were randomly assigned to placebo (96 patients) or rotigotine (181 patients).<o:p></o:p><br />
<br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">Rotigotine was started at a dose of 2 mg/24 hours (10-cm<sup>2</sup> patch size; 4.5-mg total drug content), titrated weekly up to 6 mg/24 hour (30-cm<sup>2</sup> patch size; 13.5-mg total drug content), and then maintained for six months.<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">The primary efficacy measures were change from baseline in the UPDRS parts II and III scores, and percentage of responders, defined as patients with at least a 20% improvement.<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">The authors found that patients receiving rotigotine had a mean absolute difference of 5.28 (<u>+</u> 1.18) points lower in UPDRS subtotal scores compared with those receiving placebo (<em>P</em><0.0001).<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">The largest contributor to the difference was the mean change in UPDRS part III motor score, which decreased by 3.50 points (<u>+</u> 7.26).<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">Nearly half of all patients who received rotigotine (48%) had at least a 20% improvement in UPDRS score, compared with about 19% of patients on placebo (<em>P</em><0.0001).<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">Adverse events included application-site reactions in 44% of patients on rotigotine versus 12% of those on placebo, nausea in 41% versus 17% respectively, somnolence in 33% of those on active drug versus 20% of those on placebo, and dizziness in 19% of those on rotigotine versus13% of controls.<o:p></o:p></div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;"><br />
</div><div style="font: normal normal normal 1em/1.2em Arial, sans-serif;">Most of the side effects were mild or moderate in intensity. In all, 14% of patients on the active drug and 6% of those on placebo discontinued using the patch because of adverse events.</div>Roberthttp://www.blogger.com/profile/14162612785884606407noreply@blogger.com6tag:blogger.com,1999:blog-4661008450652819294.post-76257488291410760362011-10-14T06:17:00.001-07:002011-10-16T04:19:35.173-07:00Long-Term Use of Parkinson’s Drug May Impact Vision<span class="Apple-style-span" style="color: #444444; font-family: 'Trebuchet MS', Tahoma, Arial, sans-serif; font-size: 13px; line-height: 18px;"></span><br />
<div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjzcyBzSxi1PSOtOSH300jE_JoM6TXtw2JeLDY7HT2JMl0UurIsD-UhQKdMXpRbj65Z6p2L8bk50P-C59wxAR5GX0euHB_7eMFVeAucfodCN8H9tUPUVLwgeuIci1HUo4O76LY9SLUww/s1600/Amantadine-Vision-Impairment.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjzcyBzSxi1PSOtOSH300jE_JoM6TXtw2JeLDY7HT2JMl0UurIsD-UhQKdMXpRbj65Z6p2L8bk50P-C59wxAR5GX0euHB_7eMFVeAucfodCN8H9tUPUVLwgeuIci1HUo4O76LY9SLUww/s320/Amantadine-Vision-Impairment.jpg" width="320" /></a></div>Parkinson’s disease, the second most common neurodegenerative disease after Alzheimer’s, is often treated with amantadine.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">The drug helps alleviate patients’ motor problems and may be taken for years. Doctors have long known that amantadine treatment causes abnormal changes in the cornea in some Parkinson’s patients.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">The cornea is the eye’s clear outer surface that provides most of the visual power. Usually corneal reactions occur soon after starting the drug and disappear a few weeks after it is withdrawn. But sometimes corneal disorders appear only after years of treatment, and the corneas of these patients often do not recover when amantadine is stopped.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Won Ryang Wee, MD, PhD, and his colleagues at Seoul National University College of Medicine, South Korea, studied whether the effect of amandatine on corneal endothelial cells is dependent on the cumulative dose received.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">The researchers compared 169 eyes of amandatine-treated patients with an equal number of matched controls; the average age of all subjects was 59. They found that the patient group with the highest cumulative amandatine intake and/or longest duration of treatment (up to 8 years) had the most significant reductions in endothelial cell density (ECD). Endothelial cells work to keep excess water out of the main body of the cornea. When there are too few endothelial cells, corneal edema (swelling) results and vision is impaired. This study noted two early indicators of abnormal corneal changes in response to amandatine, before ECD reduction occurred: deformation of the normal hexagonal cell shape, and increase in cell size variation. The findings also show that ECD reduction in response to amandatine treatment does not occur quickly.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">“Assuming other studies confirm these results, ophthalmologists and neurologists should consider evaluating a patient’s corneal endothelium at the beginning of treatment with amandatine and reassess at regular intervals if the drug is used long term,” Dr. Wee said, “and additional monitoring would be needed for patients with other conditions that reduce ECD-such as recent cataract surgery or ongoing glaucoma, uveitis or Fuch’s dystrophy-because corneal edema could develop during treatment.”</div>Roberthttp://www.blogger.com/profile/14162612785884606407noreply@blogger.com2tag:blogger.com,1999:blog-4661008450652819294.post-60369658085846994152011-10-14T06:16:00.001-07:002011-10-16T04:20:33.917-07:00Spinal Cord Stimulation May Benefit Parkinson’s Patients<span class="Apple-style-span" style="color: #444444; font-family: 'Trebuchet MS', Tahoma, Arial, sans-serif; font-size: 13px; line-height: 18px;"></span><br />
<div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnAx8EpVp-Wwyt0GPaA5qe1uWc542FJj38Vi4pZ2LD36HMspQ5g1KDUdJ0mXaouc09YyHiiUPF45-CKmXOGP2AEJRjZVs4I9ZyNJP8-JqO9c7I38qoxA8RGt9ME_Jofiw622S23h_xKw/s1600/spinal-cord-stimulation-parkinsons-disease.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnAx8EpVp-Wwyt0GPaA5qe1uWc542FJj38Vi4pZ2LD36HMspQ5g1KDUdJ0mXaouc09YyHiiUPF45-CKmXOGP2AEJRjZVs4I9ZyNJP8-JqO9c7I38qoxA8RGt9ME_Jofiw622S23h_xKw/s320/spinal-cord-stimulation-parkinsons-disease.jpg" width="284" /></a></div>A new study from Rhode Island Hospital indicates that spinal cord stimulation may be able to modulate Parkinson’s disease symptoms.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">The lead author will present the findings at the 2010 American Society for Stereotactical and Functional Neurosurgery (ASSFN) Biennial Meeting, June 14-16 in New York City.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Ming Cheng, MD, is a neurosurgeon at Rhode Island Hospital and the lead author on an abstract called “<strong style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">Outcome of Spinal Cord Stimulation</strong>.” Other studies previously found motor function improvement with spinal cord stimulation (SCS) in an animal model of Parkinson’s disease (PD). The findings from these studies prompted the researchers to test SCS on a single 82-year-old male with PD.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Cheng, who is also an assistant professor of neurosurgery at The Warren Alpert Medical School of Brown University, worked with colleagues at Brown to implant the SCS system and then test the effects at multiple frequencies while the patient was off medication.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">“Our study shows no changes in pain assessment to control for reduction in pain as the reason for motor improvement,” says Cheng. “What we did find is that low-frequency SCS produced a readily apparent and statistically significant worsening of Parkinson’s disease symptoms.” Cheng, who is also a physician with the Neurosurgery Foundation, Inc., continues, “These findings and locomotion ‘walking time’ were reversed at high stimulation frequencies.”</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">This work has been replicated in a second patient, with similar results. Cheng notes that the results of the study are extremely limited as it was performed in only one patient; however, he believes that further studies are in order to determine the possible benefits of this approach for PD patients.</div>Roberthttp://www.blogger.com/profile/14162612785884606407noreply@blogger.com1tag:blogger.com,1999:blog-4661008450652819294.post-53897680952861672342011-10-14T06:14:00.000-07:002011-10-16T04:23:36.741-07:00Drug Improves Tremors, Involuntary Movements In Parkinson Patients<span class="Apple-style-span" style="color: #444444; font-family: 'Trebuchet MS', Tahoma, Arial, sans-serif; font-size: 13px; line-height: 18px;"></span><br />
<div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeBRIuMBREZYrC7Kkj22ptW2RiPkCuc3K_cXXViQlbnxlAfjWG_vDBujfODtGm5JusReHFKck6pJHeaGWDsG2aWjtljK8vD7euK-T2hEZF05i2IPFlyUj8lG8lERwOo5Zn2AI3YpDcqQ/s1600/Zonisamide-Zonegran-Parkinsons-disease-Tremor.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeBRIuMBREZYrC7Kkj22ptW2RiPkCuc3K_cXXViQlbnxlAfjWG_vDBujfODtGm5JusReHFKck6pJHeaGWDsG2aWjtljK8vD7euK-T2hEZF05i2IPFlyUj8lG8lERwOo5Zn2AI3YpDcqQ/s1600/Zonisamide-Zonegran-Parkinsons-disease-Tremor.jpg" /></a></div>A drug used to treat epilepsy has been found to significantly improve tremors, motor fluctuations, and other involuntary movements, or dyskinesias, in patients with Parkinson disease, according to a study published in the January 2, 2007, issue of Neurology, the scientific journal of the American Academy of Neurology.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">The three-month, multi-center study in Japan involved 279 Parkinson disease patients who weren’t responding well to the commonly used drug, <span class="domtooltips" id="domtooltipsspan1" style="color: #750909; cursor: help; font-style: italic; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: underline;" title=".....">levodopa</span>, to manage their symptoms. The patients were divided into groups that took 25, 50 or 100 mg a day of the drug zonisamide or placebo.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Researchers found at least 30 percent of patients taking zonisamide experienced a more than 30-percent reduction in their score on a rating scale used to follow the progression of a person’s Parkinson disease. The most significant improvement was seen in the group taking 50 mg of zonisamide a day. That group saw a nearly 40-percent improvement in the score.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">“Zonisamide treatment improved all main Parkinson disease symptoms in these patients, including tremor and other disabling dyskinesias. This is consistent with findings from other, smaller studies,” said lead author Miho Murata, MD, PhD, with the National Center of Neurology and Psychiatry in Tokyo, Japan. “Zonisamide is safe, effective, and well tolerated at 25 to 100 mg a day as an added treatment in patients with Parkinson disease.”</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">While this study lasted only 12 weeks, Murata says their preliminary data shows the benefits of zonisamide observed at 12 weeks were maintained for more than a year in all 17 patients involved in a study on the long term effects of zonisamide on Parkinson disease.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Murata says it’s not fully understood yet as to why zonisamide helps Parkinson disease symptoms and further study is needed to clarify the mechanism behind the drug’s benefits.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">According to the study, the drug’s most common side effects were drowsiness, apathy, weight loss, and constipation.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">The study was supported by Dainippon Sumitomo Pharma, which discovered zonisamide.</div>Roberthttp://www.blogger.com/profile/14162612785884606407noreply@blogger.com5tag:blogger.com,1999:blog-4661008450652819294.post-5148253089209714942011-10-14T06:07:00.001-07:002011-10-16T04:24:45.242-07:00Guideline Issued for Treating Sleep, Constipation, Sexual Problems in Parkinson’s Disease<span class="Apple-style-span" style="color: #444444; font-family: 'Trebuchet MS', Tahoma, Arial, sans-serif; font-size: 13px; line-height: 18px;"></span><br />
<div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvKCcRChzrOUj37Mdnt8Q-5_zZJYsvVQHuA0K7rCwCLHUToipLfxAoW-QK4DULeayMsILuKNSsLl089QF3bo_dWOAN1CUc2naEBCI0A3JXAg7prgwybpAZvZeSf2exhpouyjlPAf49lw/s1600/American-Academy-of-Neurology-Guidelines-Parkinsons-disease-symptoms.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvKCcRChzrOUj37Mdnt8Q-5_zZJYsvVQHuA0K7rCwCLHUToipLfxAoW-QK4DULeayMsILuKNSsLl089QF3bo_dWOAN1CUc2naEBCI0A3JXAg7prgwybpAZvZeSf2exhpouyjlPAf49lw/s1600/American-Academy-of-Neurology-Guidelines-Parkinsons-disease-symptoms.jpg" /></a></div>The American Academy of Neurology has issued a new guideline recommending the most effective treatments to help people with Parkinson’s disease who experience sleep, constipation, and sexual problems, which are common but often underrecognized symptoms.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">The guideline is published in the March 16, 2010, issue of <em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">Neurology®,</em> the medical journal of the American Academy of Neurology.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">“While the main symptom of Parkinson’s disease is movement problems, there are many other symptoms to be aware of, including sleep disorders, constipation, and problems with urination and sexual function,” said lead guideline author Theresa A. Zesiewicz, MD, with the University of South Florida in Tampa and a Fellow of the American Academy of Neurology. “Without treatment, these symptoms can cause as much pain and discomfort as movement problems and greatly affect daily routines and quality of life.”</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Sexual problems often affect people with Parkinson’s disease. In men with Parkinson’s, erectile dysfunction is common. According to the guideline, the drug sildenafil citrate may improve erectile dysfunction. The guideline also found the drug isosmotic macrogol may improve constipation in people with Parkinson’s disease.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">For problems with excessive daytime sleepiness, the guideline recommends that doctors consider the drug <span class="domtooltips" id="domtooltipsspan1" style="color: #750909; cursor: help; font-style: italic; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: underline;" title="Modafinil is an analeptic drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea. It has recently been researched for Parkinson's Disease sleep disorders. <div><br></div><div>Modafinil is also known as: Provigil, Alertec, Modavigil, Modalert, Modiodal, Modafinilo, Carim, Vigia</div>">modafinil</span> to help people feel more awake. However, it’s important to note that one study showed people taking modafinil had a false sense of alertness. This may pose a safety risk for activities such as driving. The guideline also found the drug methylphenidate may help with fatigue.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">The guideline mentions two tests to help identify nonmotor symptoms of Parkinson’s disease. One is the NMSQuest rating scale. The other is the Unified Parkinson’s Disease Rating Scale (UPDRS). The original UPDRS mainly tests for movement problems. Doctors use the updated version of the UPDRS to test for all Parkinson’s symptoms, including those unrelated to movements. People with Parkinson’s disease should talk to their doctor about whether these tests may be helpful.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">“More research is needed into these symptoms of Parkinson’s disease since there are still a lot of unknown answers as to what causes these symptoms and how they can best be treated to improve lives,” said Zesiewicz.</div>Roberthttp://www.blogger.com/profile/14162612785884606407noreply@blogger.com1tag:blogger.com,1999:blog-4661008450652819294.post-74320716947912011402011-10-14T06:06:00.000-07:002011-10-14T06:06:11.897-07:00Modafinil Can Improve Physical Fatigue in Patients With Parkinson’s Disease<span class="Apple-style-span" style="color: #444444; font-family: 'Trebuchet MS', Tahoma, Arial, sans-serif; font-size: 13px; line-height: 18px;"></span><br />
<div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;"><span class="domtooltips" id="domtooltipsspan1" style="color: #750909; cursor: help; font-style: italic; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: underline;" title="Modafinil is an analeptic drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea. It has recently been researched for Parkinson's Disease sleep disorders. <div><br></div><div>Modafinil is also known as: Provigil, Alertec, Modavigil, Modalert, Modiodal, Modafinilo, Carim, Vigia</div>">Modafinil</span> can reduced physical fatigue commonly seen in patients with Parkinson’s disease, researchers reported here at the 132nd Annual Meeting of the American Neurological Association (ANA).</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">“It was very gratifying to find that modafinil improves physical fatigue in patients with Parkinson’s disease,” reflected study presenter Jau-Shin Lou, MD, Associate Professor of Neurology, University of Oregon Medical School, Portland, Oregon, United States.</div><div class="simplePullQuote" style="-webkit-box-shadow: rgb(129, 129, 129) 7px 7px 8px; background-attachment: initial; background-clip: initial; background-color: initial; background-image: url(http://www.aboutparkinsons.net/wp-content/plugins/simple-pull-quote/images/quote.png); background-origin: initial; background-position: 0% 0%; background-repeat: no-repeat no-repeat; border-bottom-color: rgb(134, 134, 134); border-bottom-style: solid; border-bottom-width: 3px; border-top-color: rgb(134, 134, 134); border-top-style: solid; border-top-width: 3px; float: right; margin-bottom: 10px; margin-left: 10px; margin-right: 0px; margin-top: 10px; padding-bottom: 6px; padding-left: 6px; padding-right: 6px; padding-top: 6px; text-indent: 10px; width: 200px;">Dr. Lou concluded that, “at the regular dose used in narcolepsy, modafinil clearly reduced physical fatigue in Parkinson’s disease.”</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Dr. Lou and colleagues undertook the study because Parkinson’s disease patients at all stages of the disease are known to have physical fatigue. Studies have shown that more than half of patients with Parkinson’s experience physical fatigue. “This is a well-documented phenomenon,” he lamented.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">“Modafinil is approved for narcolepsy and has been shown to improve fatigue in multiple sclerosis, so we deduced that it was worth evaluating in Parkinson’s disease,” said Dr. Lou.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">In their study, the researchers assessed fatigue levels in 19 Parkinson’s disease patients using the Multidimensional Fatigue Inventory (MFI), a measurement tool that has been in use for about 20 years.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Nine patients who were on current Parkinson’s disease treatments were randomly assigned to modafinil 100 mg BID and 10 patients received placebo. Finger tapping and intermittent force generation were used to evaluate physical fatigue objectively and MFI was used to measure fatigue subjectively. Subjects completed the Epworth Sleepiness Scale (ESS), the Center for Epidemiologic Studies Depression Scale (CES-D), and the multidimensional McGill Quality of Life (MQOL).</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Results showed that the modafinil group, but not the placebo group, showed increased finger tapping frequency (<em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">P</em> <.05), increased tapping velocity (<em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">P</em> <.05), less fatigue from finger tapping (<em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">P</em> <.05), less general fatigue in the MFI (<em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">P</em> <.05), less fatigue from intermittent force generation (<em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">P</em> <.1), and less sleepiness (<em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">P</em> <.1) from week 1 to 8. Both groups reported improved quality of life.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Dr. Lou concluded that, “at the regular dose used in narcolepsy, modafinil clearly reduced physical fatigue in Parkinson’s disease.”</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">He recommended that physicians prescribe modafinil to their patients with Parkinson’s disease who are suffering from fatigue.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">“The agent can be used as an adjunctive medication to <span class="domtooltips" id="domtooltipsspan2" style="color: #750909; cursor: help; font-style: italic; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: underline;" title=".....">levodopa</span> or a <span class="domtooltips" id="domtooltipsspan3" style="color: #750909; cursor: help; font-style: italic; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: underline;" title="...">dopamine agonist</span>,” he added.</div><div style="padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">Dr. Lou and his group hope to perform a larger trial, “but there’s no need to wait to start using modafinil,” he urged.</div>Roberthttp://www.blogger.com/profile/14162612785884606407noreply@blogger.com2tag:blogger.com,1999:blog-4661008450652819294.post-24962271107297092652011-10-13T18:29:00.001-07:002011-10-14T06:18:55.213-07:00Parkinsonian symptoms<span style="font-family: sans-serif;">Dear Dr <--->, </span><span style="font-size: small;"><br />
</span><span style="font-family: sans-serif;"><br />
(1) Thank you for seeing my father this coming Tuesday, <strong>16th February 2010</strong>, for consultation on potential <strong>pharmacological intervention for my fathers Parkinsonian symptoms</strong>.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
(2) Please be advised that through the assistance of Ms <---->, you will also be seeing my father the following day, on Wednesday <strong>17th February, 2010</strong>, for <strong>botox injections</strong> for my father's body rigidity.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
==========</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
My name is <----> and my father suffers from a broad range of Parkinson's like symptoms. He in fact has all the cardinal symptoms of PD, but has been unresponsive to Levodopa.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
I have had a very frustrating time finding help for my father, apart from Dr <---->, my father's Rehabilitation specialists, who has also tried in vain to find a Parkinson's Syndrome specialist willing to try and treat my father. The neurologists I have so far seen have only suggested Sinimet and nothing else.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
I am asking for your assistance as a Neurologist specialising in movement disorders for (i) assistance in trialling other pharmacological medications that may provide some minor to moderate relief of my father's most troublesome symptoms, and assistance and guidance on botox and its potential application to assist in my father's rigidity, body pain, tremors and/or freezing.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
I do understand from the out-set that my father's condition is atypical Parkinsons, and his circumstances may rule many potential treatments out. This is not an ideal case because my father does not suffer from idiopathic Parkinson's disease , but I beg you to please help us to sequentially trial some treatments that may modestly alleviate some of my fathers most inhibiting symptoms. A modest response would make a huge impact to my father's quality of life, and this is all we are expecting. </span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><strong><br />
Some important history regarding my father's condition</strong></span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><strong><br />
Overview of History</strong></span><span style="font-size: small;"> </span> <br />
<ul><li><span style="font-family: sans-serif;">Road Accident: April 2002 - prior to this perfect health</span><span style="font-size: small;"> </span> </li>
<li><span style="font-family: sans-serif;">Traumatic impact to top-side of head (right-side). Mid-line shift, bleeding in brain observed, fracture at base of skull. No surgical intervention.</span><span style="font-size: small;"> </span> </li>
<li><span style="font-family: sans-serif;">Induced coma for 6 days</span><span style="font-size: small;"> </span> </li>
<li><span style="font-family: sans-serif;">6 weeks in hospital. Had to re-learn to swallow, talk and walk again.</span><span style="font-size: small;"> </span> </li>
<li><span style="font-family: sans-serif;">2 weeks after accident started to experience Sundowner Syndrome. Significant sleeping problems.</span><span style="font-size: small;"> </span> </li>
<li><span style="font-family: sans-serif;">Improvement generally observed over next 3 years, although ongoing mobility and balance issues.</span><span style="font-size: small;"> </span> </li>
<li><span style="font-family: sans-serif;">From 2005 onwards condition started to slowly deteriorate. </span> </li>
<li><span style="font-family: sans-serif;">From about 2006, Parkinson's like symptoms became visible. These were noted by medical specialist as far back as 2005, although they were quite subtle back then.</span><span style="font-size: small;"> </span> </li>
<li><span style="font-family: sans-serif;">Over past 6 months, rapid increase in severity of symptoms. </span></li>
</ul><span style="font-family: sans-serif;"><strong><br />
Symptoms</strong></span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
<br />
The two most problematic symptoms are;</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><strong><br />
<br />
(1) Mobility problems, comprising:</strong></span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
1. General weakness in leg muscles</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
2. Rigidity in muscles, most noticeably calf muscles, neck muscles and trunk of body.</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
3. Stiffness and pain in calf muscles. Experiences ongoing pain in calf and waist/abdomen/lower back</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
4. Slowness in movement</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
5. Freezing, especially in left leg when attempting to take first step</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
6. Festinated pace of walking <br />
7. Shuffling of feet (small dragging steps)</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
8. Gait - pronounced leaning forward and head down</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
9. Impaired balance - cannot gauge back and forth movement</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
10. No arm movement when walking</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><strong><br />
(2) Cognitive issues</strong></span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
1. Increasing loss of mental alertness</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
2. Increasing forgetfulness</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
3. Increasing paranoia</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
4. General confusion</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
5. Orientation , gets lost within house</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
6. Frequently losing track of a word or thought </span><span style="font-size: small;"><br />
</span><span style="font-family: sans-serif;"><strong><br />
(2) Faecal Inconsistence</strong></span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
1. Lately can happen up to 3 times a day.</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
2. Is not aware of urge until just before it happens.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><strong><br />
<br />
(3) Other symptoms which are problematic, but not as disruptive as above two</strong></span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
1. Left hand resting tremor (has been steadily increasing over past few years) <br />
2. Loss of strength, nimbleness and dexterity in hands <br />
3. Very low speaking voice- strangulation episodes at night</span><span style="font-size: small;"> </span><span style="font-family: sans-serif;"><br />
4. Urinary incontinence <br />
6. Drooling - Saliva drooping from lip <br />
7. Micrographia <br />
8. Toned down facial expressions <br />
9. Frequent nightmares involving body movements. Believes that he stops breathing during night.</span><span style="font-size: small;"> <br />
<br />
</span><span style="font-family: sans-serif;"><strong><br />
Attempted Treatments</strong></span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
July-2008 - Levodopa - duration: about 7 days - dosage from 400mg to 600mg per day. Stopped due to worsening of symptoms and hallucintions.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
April-2009 - Artane 2 mg- 7 days duration - half tab per day. Stopped due to worsening of symptoms and cognitive issues.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
Dec-2009 - Sinimet 100/25 - half a tab to one tab - duration only 3 days. Stopped due to worsening symptoms </span><span style="font-size: small;"><br />
</span><span style="font-family: sans-serif;"><br />
Oct-2009 to Current - Two by 5 minutes of whole body vibration - no detected improvement in symptoms.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
Jan-2010 - Nicotine Therapy (patches) - from 7mg to 21 mg over 24 hrs. Initial 7mg had immediate improvement for 5 days. No response since then despite increase in dosage, but 21mg seems to have created sleep disturbance.</span><span style="font-size: small;"> <br />
<br />
</span><span style="font-family: sans-serif;"><br />
Trial of cardilopa-levodopa never reaches some recommended therapeutic doses because of issue of tolerability</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
,</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
Thank you for agreeing to see my father on the 10th December, 2009. We look forward to seeing you then.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
I hereby supply some further information to you prior to the appointment (along with a few suggestions and questions). </span><span style="font-size: small;"><br />
</span><span style="font-family: sans-serif;"><br />
I hope you can take my suggestions as my effort at providing further information, rather than my trying to make medical decisions or pre-empt your expert advise. I hope you understand.</span><span style="font-size: small;"> </span> <br />
<ul><li><span style="font-family: sans-serif;">You should by now have received a referral letter from Dr xxxxxxn (Rehabilitation Specialist, xxxxxx Hospital) with a clinical background of my father's situation. This letter was originally sent to Dr xxxt who was not available to see my father this year. </span></li>
</ul><span style="font-family: sans-serif;"><strong><br />
If you have not received this letter please advise me. If you have, could you please advise if this letter is sufficient as a referral letter?</strong></span><span style="font-size: small;"> </span> <br />
<ul><li><span style="font-family: sans-serif;">Although my father had previously tried Sinimet, due to a number of factors I do not believe that we tested this drug thoroughly. </span></li>
</ul><span style="font-family: sans-serif;"><br />
With your agreement and support, <strong>I was hopeful that another attempt with Sinimet would be worth a try,</strong> at least as a first attempt, maybe for a longer duration, higher ultimate dosage, and/or in combination with other newly developed agonists or other ldopa enhancers. </span><span style="font-size: small;"> </span> <br />
<ul><li><span style="font-family: sans-serif;">Four days after the appointment with you, we will be seeing Dr xxxxx for botox injections. One area that I am not certain about (although I have yet to discuss with Dr xxxxx), is whether botox may be appropriate to alleviate the stiffness in the trunk of my father's body.</span></li>
</ul><span style="font-family: sans-serif;"><br />
I have already discussed with Dr xxxx the (i) stiffness in my father's calfs, the (ii) lower back pain my father has, and possibly the (iii) pain my father feels in the soles of his feet.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
I however do not know whether botox can help with the generalised dystonia my father experiences in the trunk of his body and neck.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><strong><br />
If it is possible, I would value any suggestions that you may have on the sites of administration of botox to assist in my father's tense muscles across his body.</strong></span><span style="font-size: small;"> </span> <br />
<ul><li><span style="font-family: sans-serif;">Please note that we are realistic about the progressiveness of my father's condition, and we are merely seeking some improvement in my father's Parkinson's like symptoms. Even a small improvement would make a big difference in my father's quality of life.</span></li>
</ul><span style="font-family: sans-serif;"><br />
PS. I will bring with me the various brain scans that were taken subsequent to my father's head injury, and any other reports I may have. Please feel free to ask me for these if they will help in your assessment on the day.</span><span style="font-size: small;"> <br />
<br />
</span><span style="font-family: sans-serif;"><strong><br />
</strong><br />
##refer to surgical intervention for urinary tract scarring <br />
<br />
With thanks</span><span style="font-size: small;"> <br />
<br />
</span><span style="font-family: sans-serif;"><br />
##At the very least, my father's case would be a remarkable case study highlighting an indisputable link between direct and catastrophic head trauma and the development of of post-traumatic parkinsonism.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
I am writing to you after having read about you on the web, and after having heard about your well received speeches for a Parkinson's xxx support group on the pharmacological treatment of PD.</span><span style="font-size: small;"> <br />
</span><span style="font-family: sans-serif;"><br />
I would also add that if there is any possibility, my father would probably greatly benefit from a multi-disciplinary approach, given what looks like the onset of (i) depression, (ii) modest cognitive decline and the contra-indications of treating these conditions along with my father's advancing age.</span><span style="font-size: small;"> </span>Roberthttp://www.blogger.com/profile/14162612785884606407noreply@blogger.com2