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SEPTEMBER 2007

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29th September 2007 : New research  

IS ROPINIROLE better than l-dopa in THE LONG TERM ?

Movement Disorders 2007 Sep 25; [Epub ahead of print] (Hauser RA, Rascol O, Korczyn AD, Jon Stoessl A, Watts RL, Poewe W, De Deyn PP, Lang AE.) Complete abstract

In a five year study, people with Parkinson's disease who were randomized to initial treatment with ropinirole had a significantly lower incidence of dyskinesia compared with subjects randomized to L-dopa, although other symptom scores were significantly more improved in the L-dopa group. Ropinirole is a dopamine agonist. For more information go to Ropinirole.

Subjects who completed the original study were eligible to participate for a total of 10 years. The incidence of dyskinesia was still found to be significantly lower in the ropinirole group, and the average time before dyskinesia was significantly longer. The incidence of at least moderate wearing off was also significantly lower in the ropinirole group. There were no significant differences in change in UPDRS activities of daily living or motor scores, or scores for the 39-item PD questionnaire, Clinical Global Impression, or the Epworth Sleepiness Scale.

 

28th September 2007 : New research  

drooling is secondary to swallowing difficulties

Parkinsonism Related Disorders [2007] Sep 22; [Epub ahead of print] (Nobrega AC, Rodrigues B, Torres AC, Scarpel RD, Neves CA, Melo A.) Complete abstract

Drooling is a common manifestation in Parkinson's Disease. It causes psychosocial difficulties and can result in aspiration and chest infection. Previous studies pointed to an association between dysphagia (swallowing difficulties) and sialorrhea (excessive saliva). The aim of this study was to determine if drooling is associated with swallowing difficulties in people with Parkinson's Disease. Changes in the oral stage of swallowing were seen in 100% of the patients, and in the pharyngeal stage (when it goes behind the mouth) in 94% of the patients. The results showed a correlation between the drooling scale score and the level of dysphagia. Patients with the worst dysphagia had the worst drooling.

 

27th September 2007 : News report

parkinson's disease market to exceed two billion dollars

The Parkinson's Disease market is set to continue to grow over the next seven years, reaching over $2.37 billion in 2013, a 39% increase from 2006 levels. Combinations, reformulations, and indication expansions will drive the majority of this growth, with key brands expected to be Novartis/Orion's Stalevo, GlaxoSmithKline's, Requip Modutab, and UCB-Schwarz's Neupro. Requip Modutab will become the market leading brand in 2011.

It will be intuitive for prescribers to believe that sustained activation of dopamine receptors with Requip Modutab could have a significant clinical benefit over pulsed agonism with standard drugs.  For more information go to the Complete article. Despite the ever increasing profits of the pharmaceutical companies, the number of people with Parkinson's Disease is continuously increasing, and those with Parkinson's Disease are tending to get progressively worse. Due to a biochemical process called feedback inhibition, their use actually increases the medical need for their products, and could never result in a long term ridding of the disorder. 

 

26th September 2007 : News report

THE VATICAN "EUTHANIZED" POPE JOHN PAUL ii

For the last twelve years of his life, Pope John Paul II had Parkinson's Disease, which in its later stages can cause an inability to swallow. An Italian medical doctor, Lina Pavanelli, has alleged that the Catholic church essentially euthanized Pope John Paul II by not inserting a feeding tube into the ailing pontiff until it was too late. Dr. Pavanelli said she based her conclusions on media coverage and a book by the Pope's personal physician. After reviewing the coverage, Dr. Pavanelli concluded a feeding tube was not inserted until three days before the pope died - a delay that accelerated the pope's demise. In response, Pope Benedict XIV, John Paul's successor, issued a document denouncing the cutting off of food and water to patients in a vegetative state. For more information go to the Complete article.

 

22nd September 2007 : New clinical trial 

ritalin being tested for walking difficulties in parkinson's disease

Methylphenidate (MPD), commonly known as Ritalin®, is a drug that can excite or stimulate certain systems of the body that control motor function. For more information go to Ritalin. It is FDA approved for the treatment of attention hyperactivity disorder, a condition unrelated to Parkinson's Disease. The purpose of this clinical trial is to examine whether Methylphenidate can result in improvement of gait (walking) in a population of people with Parkinson's disease whose main disability is freezing of gait. They hypothesize that daily treatment with a tolerable daily oral dose of MPD will improve gait velocity, stride length, cadence, and decrease freezing. For more information go to the Complete article.

 

21st September 2007 : New research  

can pesticides actually cause parkinson's disease ?

Experimental Neurology [2007] Aug 22; [Epub ahead of print] (Rojo AI, Cavada C, de Sagarra MR, Cuadrado A.) Complete abstract

Paraquat and Rotenone are pesticides that have previously been thought to be able to cause Parkinson's Disease. For more information go to Toxic causes of Parkinson's Disease. However, it is difficult to assess the risk of their toxicity causing Parkinson's Disease because methods of assessment use non-natural methods of pesticide exposure, such as intraperitoneal or intravenous injection, that might bypass body defences.

A new model based on daily inoculation of neurotoxins in the nasal cavity of mice or rats was used to evaluate the risks caused by rotenone, paraquat and MPTP (another known cause of Parkinson's Disease). MPTP-treated mice showed all the effects expected of a known toxic cause of Parkinson's Disease. However, rotenone-treated mice or rats remained without any symptoms. Paraquat induced severe hypokinesia and vestibular damage but did not have the physical effects that would be expected if it caused Parkinson's Disease. This brings in to question whether these pesticides actually can cause Parkinson's Disease.

 

20th September 2007 : New research  

Ipratropium spray as A treatment for EXCESSIVE SALIVA

Movement Disorders [2007] Sep 17; [Epub ahead of print] (Thomsen TR, Galpern WR, Asante A, Arenovich T, Fox SH) Complete abstract

Excessive saliva that can cause drooling (Sialorrhea) is a significant problem in advanced Parkinson's disease. Current treatment options include systemic anticholinergics, which frequently cause side effects. It was considered whether sublingual application of Ipratropium bromide spray, an anticholinergic agent that does not cross the blood brain barrier, may reduce drooling without side effects.

A study was carried out on people that had Parkinson's Disease and bothersome drooling. Patients took ipratropium bromide or placebo (one to two sprays, maximum of four times per day) for two weeks. The primary outcome was an objective measure of weight of saliva production. There were no significant adverse events.  There was a mild beneficial effect on subjective measures of sialorrhea. However, Ipratropium bromide spray had no significant effect on reducing the amount of saliva produced.

 

20th September 2007 : New research

OLFACTORY DYSFUNCTION IN PARKINSON'S DISEASE

Arquivos de Neuro-psiquiatria [2007] 65 (3A) : 647-652 (Quagliato LB, Viana MA, Quagliato EM, Simis S) Complete abstract

The olfactory function in Parkinson's Disease was assessed in fifty patients using the University of Pennsylvania 12 smell identification test (UPSIT), comparing them to 76 age-matched healthy controls. Parkinson's Disease symptoms were evaluated in the "on" phase. Patients that presented initially with resting tremor and those that currently have tremor, rigidity and bradykinesia had significantly worse scores. There was no correlation between olfactory scores, age at the initial Parkinson's symptoms and disease duration. However, among Parkinson's Disease patients as a whole 80% had olfactory deficit. Therefore, smell evaluation may be a tool to make a differential diagnosis of Parkinson's Disease.

 

19th September 2007 : New research

DO PEOPLE WITH PARKINSON'S DISEASE BECOME MACHIAVELLIAN ?

Cognitive Neuropsychiatry [2007] 12 (4) : 285-300 ( McNamara P, Durso R, Harris E ) Complete abstract

Machiavelli (1469-1527) was an Italian Renaissance diplomat and political philosopher, most famous for his book "The Prince" in which he detailed how a Prince could keep control of his realm. For more information go to Niccolo Macchiavelli. The tactics he proposed led to the word Machiavellian, which means using clever but often dishonest methods in order to gain power or control.

Reports have identified significant personality differences in people with Parkinson's disease. This study hypothesised that these differences may be related to impairment in prefrontal inhibitory functions that resulted in "Machiavellian" personality traits. People with Parkinson's Disease with elevated Machiavellian traits were found to be selectively impaired on tests of prefrontal function. Those with such traits also had a greater willingness to affiliate with a fictional Machiavellian character and scored significantly lower on "cooperativeness" and "self-directedness". The authors suggest that Parkinson's patients with frontal impairment are vulnerable to dramatic personality change, and that the frontal lobes are required for maintenance of pro-social personality traits.

 

18th September 2007 : News report

Gene Abnormality Tied To Getting Parkinson's Disease At A Younger Age

People with mutations in the glucocerebrosidase gene are more likely to get Parkinson's disease before the age of 50. A recent study found that 14% of people with Parkinson's disease carried mutations in the gene compared to only 5% of people without Parkinson's Disease. The gene abnormality was found in 22 % of people who were diagnosed with Parkinson's disease before age 50 compared to 10 % of the people with disease onset after age 50.

"Our results confirm that GBA mutations are risk factors for Parkinson's disease and may lead to getting the disease at a younger age," said the authors. The study also found that of those people with Parkinson's disease, those people with Jewish ancestry were much more likely to have the abnormality. For more information go to the Complete article. Mutations in the glucocerebrosidase gene cause Gaucher's disease, which is a disorder that prevents organs, such as the spleen and brain, from working properly due to the build-up of a fatty substance called glucocerebroside. For more information go to Gaucher's Disease.

 

12th September 2007 : New research

TREADMILL TRAINING IMPROVES GAIT AND QUALITY OF LIFE

Archives of physical medicine and rehabilitation [2007] 88 (9) : 1154-1158 (Herman T, Giladi N, Gruendlinger L, Hausdorff JM.)  Complete abstract

An evaluation was made of six weeks of intensive treadmill training on gait rhythmicity, functional mobility, and quality of life in patients with Parkinson's disease. Patients walked on a treadmill for 30 minutes during each training session, 4 training sessions a week, for 6 weeks.  Quality of Life, as measured by the PDQ-39, was reduced (improved) from 32 to 22. Parkinsonian symptoms, as measured by the UPDRS, decreased (improved) from 29 to 22. Usual gait speed increased from 1.11 to 1.26m/s. Swing time variability was lower (better) in all but one patient, changing from 3.0% to 2.3%. Interestingly, many of the improvements persisted even 4 weeks later. These results suggest that a progressive and intensive treadmill training program can be used to minimize impairments in gait, reduce fall risk, and increase QOL in these patients.

 

12th September 2007 : New research

GENDER DIFFERENCES IN PARKINSON'S DISEASE

Journal of Neurology, Neurosurgery and Psychiatry [2007] 78 (8) : 819-824 (Haaxma CA, Bloem BR, Borm GF, Oyen WJ, Leenders KL, Eshuis S, Booij J, Dluzen DE, Horstink MW.)  Complete abstract

Researchers investigated gender differences in characteristics, motor deterioration and nigrostriatal degeneration in Parkinson's disease. Age at onset was 2.1 years later in women (53.4 years) than in men (51.3 years). In women, age at onset correlated positively with parity, age at menopause and fertile life span. Women more often presented with tremor (67%) than men (48%).

Overall, patients presenting with tremor had a 3.6 year higher age at onset and a 38% slower deterioration. Symptom scores at disease onset were equal for both genders, as was the rate of deterioration. Results suggest that, in women, the development of Parkinsons' Disease may be delayed by higher dopamine levels, possibly due to the activity of oestrogens. This could explain the epidemiological observations of a lower incidence and higher age at onset in women. Women also presented more often with tremor which, in turn, is associated with milder motor deterioration and striatal degeneration.

 

8th September 2007 : New research

FAMILY HISTORY DOUBLES LIKELIHOOD OF PARKINSON'S AND ALZHEIMER'S

Neurogenetics [2007] Sep 6; [Epub ahead of print] (Rosen AR, Steenland NK, Hanfelt J, Factor SA, Lah JJ, Levey AI.) Complete abstract

This study examined Parkinson's disease and Alzheimer's disease using reported family history. People with a family history of Parkinson's Disease had more than double (2.2 times) the likelihood of developing Parkinson's Disease. People with a family history of Alzheimer's Disease had more than double (2.3 times) the likelihood of developing Alzheimer's Disease. They found no increased likelihood of Parkinson's Disease when there was a family history of Alzheimer's Disease, and no increased likelihood of Alzheimer's Disease when there was a family history of Parkinson's Disease.

 

6th September 2007 : News report

GO AHEAD FOR HYBRID EMBRYO STEM CELL RESEARCH

The Human Fertilisation and Embryology Authority (HFEA) in the U.K. has ruled in favour of scientists being able to create hybrid embryos for stem cell research. This involves using embryos created from animal eggs and human DNA.

They hope the research will help them to understand more about debilitating diseases including Parkinson's Disease. In a statement on its decision the HFEA said it had concluded that "there is no fundamental reason to prevent cytoplasmic (human-animal) hybrid research". For more information go to the Complete article. It is widely claimed that there is massive loss of dopaminergic neurons in Parkinson's Disease, and that embryonic stem cells are a means of replacing them. However, not a single piece of research has ever shown that there is a massive loss of dopaminergic neurons in Parkinson's Disease.

 

5th September 2007 : New clinical trial

BOTOX TO BE TESTED ON DYSKINESIA

The primary objective of the forthcoming clinical trial is to determine whether intramuscular injections of botulinum toxin type A (BOTOX®) in selected cervical (neck) muscles can reduce L-dopa induced dyskinesias, or uncontrollable movements, in the neck region in participants with idiopathic Parkinson’s disease (PD).

It is hypothesized that intramuscular injection of botulinum toxin into cervical muscles will decrease the duration and severity of dyskinesias. For more information go to the Complete article. Botulinum toxin is a neurotoxin produced by bacteria.  It is one of the most poisonous naturally occurring substances, but is used in minute doses to treat painful muscle spasms. For more information go to the Botulinum toxin.

 

5th September 2007 : New research

DBS SURGERY SIGNIFICANTLY WORSENS SPEECH

Journal of Neurology, Neurosurgery and Psychiatry [2007] August 31 [Epub ahead of print] (Klostermann F, Ehlen F, Vesper J, Nubel K, Gross M, Marzinzik F, Curio G, Sappok T.) Complete abstract

Motor deficits in Parkinson's disease are reduced by Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN), but the impact of this therapy on speech problems remains controversial. Speech and motor functions of Parkinson's patients with DBS were studied when their therapeutic stimulation was active (STIM-ON) versus switched off (STIM-OFF). DBS significantly worsened speech performance according to all perceptual rating methods applied. So stimulation-induced speech impairment should be considered a likely problem in the course of the treatment.

 

4th September 2007 : News report

SMOKING INCREASES DEMENTIA

Dementia occurs in a large proportion of those people with Parkinson's Disease. People who smoke are more likely to develop Dementia than non-smokers or those who smoked in the past, according to a study in the September 4, 2007, issue of Neurology. The study followed nearly 7,000 people age 55 and older for an average of seven years.

Over that time, 706 of the participants developed dementia. People who were current smokers at the time of the study were 50% more likely to develop dementia than people who had never smoked or past smokers. The researchers claim that this may be because "Smoking increases the risk of cerebrovascular disease, which is also tied to dementia. Another mechanism could be through oxidative stress, which can damage cells in the blood vessels and lead to hardening of the arteries. Smokers experience greater oxidative stress than nonsmokers. Increased oxidative stress is also seen in Alzheimer's disease." For more information go to the Complete article.

             

2nd September 2007 : New research

COENZYME Q10 HAS NO EFFECT

Archives of Neurology [2007] 64 (7) : 938-944 (Storch A, Jost WH, Vieregge P, Spiegel J, Greulich W, Durner J, Muller T, Kupsch A, Henningsen H, Oertel WH, Fuchs G, Kuhn W, Niklowitz P, Koch R, Herting B, Reichmann H)
Complete abstract

Coenzyme Q10 is claimed to be a potent antioxidant that can partially recover the function of dopaminergic neurons (the cells involved in Parkinson's Disease). Coenzyme Q10 is consequently very widely taken by people with Parkinson's Disease.

A formal clinical trial involving 131 patients was carried out using 300mg dosages of Coenzyme Q10 (100mg three times per day) for three months. Patients were assessed using the UPDRS (the standard Parkinson's Disease symptom assessment). The placebo group actually did better, lowering their symptom scores by 3.69, in contrast to the Coenzyme Q10 group, who reduced their scores by only the lesser amount of 3.33. So Coenzyme Q10 was found to be no better than taking nothing. The 300mg dosage led to similar plasma levels to 1200mg dosage, so the dosage not being high enough can not be a cause of the Coenzyme Q10 having no effect.

 

2nd September 2007 : New research

GDNF CAUSES SERIOUS TOXICITY

Toxicologic Pathology [2007] 35 (5) : 676-692 (Hovland DN Jr, Boyd RB, Butt MT, Engelhardt JA, Moxness MS, Ma MH, Emery MG, Ernst NB, Reed RP, Zeller JR, Gash DM, Masterman DM, Potter BM, Cosenza ME, Lightfoot RM.) Complete abstract

GDNF is a neurotrophic factor - a protein that regulates neuronal survival, differentiation, growth and regeneration.
Amgen previously carried out a trial using GDNF. Patients claimed it to be a cure. Despite ongoing protests, Amgen
ceased its use because they claimed it was toxic and ineffective. For more information go to the  Complete article In small independent trials GDNF was initially shown to have effect, but larger and more recent clinical trials by the same researchers demonstrated no effect in Parkinson's Disease. For more information go to the Complete abstract.

A six month toxicology study has been carried out on GDNF. Notable observations included reduced food consumption, reduced body weight, meningeal thickening underlying the medulla oblongata and/or overlying various spinal cord segments. In addition, there was multifocal cerebellar Purkinje cell loss (with associated atrophy of the molecular layer and, in some cases, granule cell loss). This cerebellar finding has not been observed in previous nonclinical studies evaluating GDNF. This study was carried out on animals, and so the dosages might not be comparable to those used in humans.

 

2nd September 2007 : New research

THE EFFECTS ON PARKINSON'S DISEASE OF DBS SURGERY

Neurosurgery [2007] 61 (2) : 297-305 (Tir M, Devos D, Blond S, Touzet G, Reyns N, Duhamel A, Cottencin O, Dujardin K, Cassim F, Destee A, Defebvre L, Krystkowiak P.) Complete abstract

An assessment was made of the impact of subthalamic nucleus (STN) deep brain stimulation (DBS) one year after DBS surgery in a series of 100 consecutive patients. The main symptom score for Parkinson's Disease is the UPDRS.

One year after surgery, the UPDRS Part III score decreased by 43%. The UPDRS Part II score (activities of daily living) fell by 34%. The severity of dyskinesia-related disability decreased by 61%. The main surgical complications after STN-DBS were as follows: infection (7%), intracerebral hematoma (5%), electrode fracture (4%), and incorrect lead placement (8%). Cognitive decline was observed in 7%, and depression in 18% of the patients, respectively. The mean patient-rated overall improvement score was 70.7%.

 

1st September 2007 : News report

ANTI-DEPRESSANTS FAIL TO RID DEPRESSION IN PARKINSON'S DISEASE

Preliminary results of the pan-European PRODEST study in over a thousand patients with Parkinson`s disease confirmed that depression symptoms associated with Parkinson's Disease are highly prevalent.

In those patients with a medical history of depression, the study results also showed that with two thirds of those receiving anti-depressant treatment, there was a persistence of depressive symptoms despite treatment. It is claimed that data from recent studies with pramipexole, a dopamine agonist, have shown a beneficial effect on the depressive and motivational symptoms in Parkinson's disease. However, these claims are made by the manufacturers, who add that ongoing trials are needed to confirm these previous findings, and who continue to investigate this aspect of pramipexole's clinical profile in more detail. For more information go to the Complete article.

                                                                                                                               

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