Comparison of the Efficacy of Different Drugs on Non-Motor Symptoms of Parkinson's Disease: a Network Meta-Analysis.

BACKGROUND/AIMS: A network meta-analysis is used to compare the efficacy of ropinirole, rasagiline, rotigotine, entacapone, apomorphine, pramipexole, sumanirole, bromocriptine, piribedil and levodopa, with placebo as a control, for non-motor symptoms in Parkinson's disease (PD). METHODS: PubMed, Embase and the Cochrane Library were searched from their establishment dates up to January 2017 for randomized controlled trials (RCTs) investigating the efficacy of the above ten drugs on the non-motor symptoms of PD. A network meta-analysis combined the evidence from direct comparisons and indirect comparisons and evaluated the pooled weighted mean difference (WMD) values and surfaces under the cumulative ranking curves (SUCRA). The network meta-analysis included 21 RCTs. RESULTS: The analysis results indicated that, using the United Parkinson's Disease Rating Scale (UPDRS) III, the efficacies of placebo, ropinirole, rasagiline, rotigotine, entacapone, pramipexole, sumanirole and levodopa in treating PD were lower than that of apomorphine (WMD = -10.90, 95% CI = -16.12∼-5.48; WMD = -11.85, 95% CI = -17.31∼-6.16; WMD = -11.15, 95% CI = -16.64∼-5.04; WMD = -11.70, 95% CI = -16.98∼-5.60; WMD = -11.04, 95% CI = -16.97∼-5.34; WMD = -13.27, 95% CI = -19.22∼-7.40; WMD = -10.25, 95% CI = -15.66∼-4.32; and WMD = -11.60, 95% CI = -17.89∼-5.57, respectively). Treatment with ropinirole, rasagiline, rotigotine, entacapone, pramipexole, sumanirole, bromocriptine, piribedil or levodopa, with placebo as a control, on PD exhibited no significant differences on PD symptoms when the UPDRS II was used for evaluation. Moreover, using the UPDRS III, the SUCRA values indicated that a pomorphine had the best efficacy on the non-motor symptoms of PD (99.0%). Using the UPDRS II, the SUCRA values for ropinirole, rasagiline, rotigotine, entacapone, pramipexole, sumanirole, bromocriptine, piribedil and levodopa treatments, with placebo as a control, indicated that bromocriptine showed the best efficacy on the non-motor symptoms of PD (75.6%). CONCLUSION: Among ropinirole, rasagiline, rotigotine, entacapone, apomorphine, pramipexole, sumanirole, bromocriptine, piribedil and levodopa, with placebo as a control, apomorphine may be the most efficacious drug for therapy in treating the non-motor symptoms of PD.

[Effect of Electroacupuncture at "Shuigou" (GV 26) on Immunoactivity and Content of Protein Kinase C in the Middle Cerebral Artery in Acute Cerebral Infarction Rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) intervention on expression and content of protein kinase C (PKC) in the middle cerebral artery in acute cerebral infarction (ACI) rats so as to explore its mechanism underlying improvement of ACI. METHODS: Wistar rats were randomly divided into normal control (n = 6), sham operation (n = 30), ACI model (n = 30), and EA (n = 30) groups, and the latter three groups were further divided into 0. 5 h, 1 h, 3 h, 6 h and 12 h subgroups (n = 6 in each subgroup). The ACI model was established by occlusion of the middle cerebral artery (MCAO). EA (15 Hz, 1 mA) was applied to "Shuigou" (GV 26) for 20 min. The PKC expression levels and activity in the vascular smooth muscle of the middle cerebral artery were detected using immunohistochemistry and ELISA, respectively. RESULTS: In comparison with the control group, the immunoactivity and activities of PKC in the middle cerebral artery tissue at 0. 5 h, 1 h, 3 h, 6 h and 12 h were significantly increased in the model group (P<0. 05). After EA intervention, the expression levels and activities of PKC at the 5 time-points were markedly down-regulated in comparison with the model group at the same corresponding time-point (P<0. 05). No significant changes of PKC expression and activity were found in the sham operation group (P>0. 05). CONCLUSION: EA intervention can up-regulate the immunoactivity and activity of PKC in the vascular smooth muscle of the middle cerebral artery in ACI rats, which may contribute to its effect in improving ACI by relieving arterial spasm.