JULY 2010


31st July 2010 - New research


Movement Disorders [2010] Jul 28 [Epub ahead of print] (Hauser RA, Schapira AH, Rascol O, Barone P, Mizuno Y, Salin L, Haaksma M, Juhel N, Poewe W.) Complete abstract

Movement Disorders [2010] Jul 28 [Epub ahead of print] (Rascol O, Barone P, Hauser RA, Mizuno Y, Poewe W, Schapira AH, Salin L, Sohr M, Debieuvre C) Complete abstract

The objective of this study was to evaluate the efficacy and safety of pramipexole extended release (ER) administered once daily in early Parkinson's Disease. Pramipexole extended release (ER) is marketed as Mirapex ER. Pramipexole immediate release (IR) is administered three times daily. Pramipexole ER was proven to be effective. The level of efficacy was almost identical to that of immediate release Pramipexole, demonstrating that there was no loss of activity when changing over from the immediate release version of Pramipexole. Adverse events more common with Pramipexole ER than placebo included somnolence, nausea, constipation, and fatigue.

In a separate study, the feasibility was assessed, in early Parkinson's Disease, of an overnight switch from immediate-release (IR) pramipexole to a once-daily extended-release (ER) pramipexole. Over 80% of people successfully changed over to the extended release version of pramipexole after 4 weeks, and around 85% successfully changed over to the extended release version of pramipexole after 9 weeks. So changing over to the extended release version is not quick and always successful. In order to refer to this article on its own click here.


29th July 2010 - New research


CNS Neuroscience & Therapeutics [2010] Jul 23 [Epub ahead of print] (Ferreira JJ, Rascol O, Poewe W, Sampaio C, Rocha JF, Nunes T, Almeida L, Soares-da-Silva P) Complete abstract

Nebicapone, is a new COMT inhibitor undergoing clinical trials for the treatment of motor fluctuations in Parkinson's Disease. COMT inhibitors help to prolong the effect of L-dopa. The two COMT inhibitors that have already being used to treat Parkinson's Disease are Tolcapone (Tasmar), and Entacapone (Comtan), which is also marketed as Stalevo in a combination with L-dopa and carbidopa.

A clinical trial compared the use of Nebicapone (50 mg, 100 mg, 150 mg) with Entacapone (200 mg) or placebo administered with L-dopa/carbidopa (Sinemet) or levodopa/benserazide (Madopar). The 150mg dosage of Nebicapone were found to be more effective than the existing COMT inhibitors, by decreasing the off time by 81 minutes in comparison to Entacapone, and by 106 minutes in comparison to the placebo. The 50mg and 100mg dosages of Nebicapone failed to have a significant effect in reducing off time. Treatment-emergent adverse events were reported by 32% to 49% of patients in any treatment group, with no observed dose relationship in the Nebicapone groups. Liver transaminases were elevated in 8% of the 150mg Nebicapone group. In order to refer to this article on its own click here.


28th July 2010 - New book


Lori A.Newell

Publisher's description : This book covers a wide range of movement therapies such as range of motion exercises, low to no-impact aerobics, strength training, yoga, and T'ai Chi. It is unique in that it covers a wide range of techniques, which are specifically geared to, and have been proven helpful for, those with Parkinson's disease. The exercises are all explained in detail utilizing safe body mechanics and are illustrated in standing, standing holding onto a chair, and seated variations to accommodate a wide variety of abilities. This complete wellness program goes beyond the traditional exercise book offering information on home safety, fall prevention, activities of daily living, and body mechanics.  Click here for more details. For more books concerning Parkinson's Disease go to Parkinson's Disease Books.


26th July 2010 - New review


The mitochondria is the part of the cells that produces energy. The first step in producing energy in the mitochondria is Complex I (NADH : ubiquinone oxidoreductase). In people with Parkinson's Disease, Complex I is reduced in activity in the substantia nigra, which is the part of the brain primarily affected in Parkinson's Disease. Complex I needs Coenzyme Q10 in order to function properly [1]. However, energy production has no direct effect on increasing dopamine formation  It has been claimed that Coenzyme Q10 is a potent antioxidant that can partially recover the function of dopaminergic neurons (the cells involved in Parkinson's Disease).

Coenzyme Q10 was found to be completely ineffective in Parkinson's Disease in daily doses of 200mg [2], 300mg [3], 400mg [4], 600mg [4], and 800mg [4]. Only one Coenzyme Q10 study has ever shown any improvement in Parkinson's Disease, using 360mg, but the effects were mild and were only assessed for four weeks [5]. Daily doses of 300mg, 600mg and 1200 mg of Coenzyme Q10 failed to improve the symptoms of Parkinson's Disease, but reduced the rate of deterioration [6]. Coenzyme Q10 was safe to use in doses of 1200mg [6] [7], 1800mg [7], 2400 [7], and 3000 mg [7]. Plasma levels of Coenzyme Q10 did not increase in doses above 2400mg [7]. In order to refer to this article on its own click here.


21st July 2010 - New review


Cabergoline is also known by the brand names Dostinex and Cabaser. Cabergoline is a dopamine agonist that primarily stimulates the D2 receptor activity and has a very long half-life [1]. Besides being used for the treatment of Parkinson's Disease, cabergoline is also used for the treatment of hyperprolactinemia, and also exerts anti-depressant effects [2]. For more information got to Dostinex and Cabaser.

When cabergoline was compared to the use of L-dopa for Parkinson's Disease : motor complications, such as dyskinesia occurred less frequently [3], symptoms overall were worse [4], some symptom scores apart from motor disability were better [3], off time was reduced [5] [6], there were greater side effects [3] [4] [7], including nausea, vomiting, dyspepsia, gastritis, dizziness, postural hypotension, and peripheral oedema [8]. When cabergoline was added to the use of L-dopa : symptoms improved [9] [10] [11] [12] [13] [14] but not by much [13], there was a small reduction in off time [3] [12] [13] [15] [16], L-dopa dose could be reduced [3] [5], and side effects increased [10] [11] [13]. Cabergoline was found to be slightly better or similar than the use of bromocriptine [15] [17].

Cabergoline is associated with the risk of valvular heart disease [18], valvular regurgitation [19] [20] [21] [22] [23] [24], and worsens contrast sensitivity [25]. In order to refer to this article on its own click here.


16th July 2010 - New research

THE most troubling SYMPTOMS IN parkinson's diseasE

Movement Disorders [2010] May 14 [Epub ahead of print] (Politis M, Wu K, Molloy S, G Bain P, Chaudhuri KR, Piccini P.) Complete abstract

People with Parkinson's Disease typically experience a range of symptoms over time, each of which will affect a particular individual to varying degrees. However, patients' perceptions of troublesome symptoms often differ from the clinician's view, and these discrepancies can hamper effective management of Parkinson's Disease. In this study, people with Parkinson's Disease were asked to rank their three most troublesome symptoms. Patients were divided into early Parkinson's Disease (less than 6 years) and late Parkinson's Disease (longer than 6 years).

In early Parkinson's Disease, the five most prevalent complaints ranked in descending order were : slowness, tremor, stiffness, pain, and then loss of smell or taste. In advanced Parkinson's Disease the five most prevalent complaints ranked in descending order were :  fluctuating response to medication (most commonly wearing  off followed by dyskinesia), mood changes, drooling, sleep problems (most commonly middle and late night insomnia followed by daytime sleepiness), and then tremor. So as Parkinson's Disease progresses the most troublesome issues change considerably. In order to refer to this article on its own click here.


13th July 2010 - New research

vitamin d deficiency linked to parkinson's diseasE

Archives of Neurology [2010] 67 (7) : 808-811 (Knekt P, Kilkkinen A, Rissanen H, Marniemi J, Sääksjärvi K, Heliövaara M.) Complete abstract

It has been widely reported that low vitamin D increases the likelihood of Parkinson's Disease, such as in the following News report. However, of the two studies referred to, one of them does not concern Parkinson's Disease at all. In the other study, those people with Parkinson's Disease who had the lowest amounts of vitamin D were three times more likely to develop Parkinson's than those with the highest amounts of vitamin D. In a previous study assessing the same question, 55% of people with Parkinson's Disease had insufficient vitamin D, in comparison to 36% of  healthy controls, which statistically, is not very significant. For the details go to the Complete abstract. The researchers claim that this data supports a possible role of vitamin D insufficiency in causing Parkinson's Disease.

However, Vitamin D has no role at all in the formation of dopamine, the substance whose deficiency causes Parkinson's Disease. For more information go to the Biochemistry of Parkinson's Disease. In severe cases of Vitamin D deficiency, there is no known relationship with Parkinson's Disease as there certainly would be if Vitamin D deficiency could cause it. Sunlight is a primary source of Vitamin D. So the link between Vitamin D and Parkinson's Disease may be due to some people with Parkinson's Disease who have mobility problems being exposed to less sunlight, and so having lower vitamin D levels. In order to refer to this article on its own click here.


11th July 2010 - New research


Cochrane Database Systematic Reviews [2010] 7 : CD007166 (Stowe R, Ives N, Clarke CE, Deane K; van Hilten, Wheatley K, Gray R, Handley K, Furmston A.) Complete abstract

At some point, medical practitioners usually add an additional drug to L-dopa when treating Parkinson's Disease from one of three other types of Parkinson's Disease drugs : dopamine agonists, COMT inhibitors (tolcapone, entacapone), or MAO inhibitors (selegiline, rasagiline). However, it remained unclear as to the whether one class of drug is more effective than the other.  The three types of drug were compared, using all of the relevant clinical trials.

Adding another drug to L-dopa reduced off-time by only an hour, reduced the L-dopa dosage by about 55mg per day, and slightly improved symptom scores. A lot of side effects increased : nausea, dyskinesia, constipation, dizziness, dry mouth, hallucinations, hypotension, insomnia, somnolence and vomiting. Comparisons of the three drug types suggested that dopamine agonists were more effective in reducing off-time, reducing L-dopa dosage, and improving symptom scores.  Incidence of side effects was least with MAO inhibitors, but only marginally better than dopamine agonists. In order to refer to this article on its own click here.

                                                                                                                                                    9th July 2010 - New research


Molecular Therapy [2010] Jul 6 [Epub ahead of print] (Muramatsu SI, Fujimoto KI, Kato S, Mizukami H, Asari S, Ikeguchi K, Kawakami T, Urabe M, Kume A, Sato T, Watanabe E, Ozawa K, Nakano I.) Complete abstract

The primary fault in Parkinson's Disease is the inability to produce sufficient dopamine via dopamine producing enzymes in the brain. Gene transfer of dopamine producing enzymes into the brain has led to recovery in animal
models of Parkinson's Disease.

So researchers evaluated the safety, tolerability, and potential efficacy of adeno-associated virus (AAV) gene delivery of the enzyme that produces dopamine into the brain of people with Parkinson's Disease. Six Parkinson's Disease patients were evaluated at the start and after six months, using a variety of measures. The procedure was well tolerated. Six months after surgery, motor functions in the off-medication state improved by an average of 46% based on the UPDRS symptom questionnaire. Assessment using scanning saw a 56% improvement, which persisted up to 96 weeks. In order to refer to this article on its own click here.


5th July 2010 - New book


Dr Daniel Brooks

Publisher's description : Daniel Brooks was a 50-year-old husband, father and district-level administrator in a public school system, when he first noticed pronounced tremors, speech difficulties and walking problems developing. In this book, Daniel chronicles his life with a Parkinson’s Plus syndrome and explains how he dealt with the neurological decline that resulted. Read a user-friendly, patient's explanation of the defining symptoms of these atypical Parkinsonism disorders and find out how this neuro-degenerative disease progressed in Dan’s case. He writes a compelling and inspirational story of how he maintained his faith in God, while facing life with a movement disorder. Click here for more details. For more books concerning Parkinson's Disease go to Parkinson's Disease Books. For Daniel's blog, go to We Will Go On.


3rd July 2010 - New research


Annals of Neurology [2010] 68 (1) : 18-27 (Stocchi F, Rascol O, Kieburtz K, Poewe W, Jankovic J, Tolosa E, Barone P, Lang AE, Olanow CW.)  Complete abstract

Entacapone is a COMT inhibitor, which is able to slow down the breakdown of L-dopa. It is marketed for Parkinson's Disease on its own as Comtan, and also as Stalevo in combination with L-dopa and carbidopa, the same two substances in Sinemet. Adding Entacapone to the equivalent of Sinemet was considered to be potentially advantageous over Sinemet in the treatment of Parkinson's Disease.

However, in recent clinical trials, the time taken for the effectiveness to wear off between the two methods was not actually significantly different. There was a tendency that favoured those taking Entacapone. However, the Entacapone group received a higher dose equivalent. Adding Entacapone to the equivalent of Sinemet was also found to speed up the onset of dyskinesia. This was especially so in people that were also taking dopamine agonists. These results make the claimed advantages of adding Entacapone to Sinemet questionable. In order to refer to this article on its own click here.


2nd July 2010 - New book


Bill Schmalfeldt

Publisher's description : It was just about three weeks after his 45th birthday in 2000 when Bill Schmalfeldt was diagnosed with Parkinson's disease. In 2007 while working at a federal agency as a writer and podcaster, telling other people about the importance of clinical trials, Bill heard about and volunteered for an experimental brain surgery to determine whether or not "deep brain stimulation" could be done on patients in the earlier stages of the disease. This is the story of Bill's "Parkinson's Decade" from being diagnosed in 2000, to having the surgery in 2007, through today. The story is told in a humorous, satirical, almost jovial style considering the fact that Bill's motor skills and cognition continue to degenerate. Click here for more details. For more books concerning Parkinson's Disease go to Parkinson's Disease Books.


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