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4.
JAMA ; 323(6): 548-560, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044947

RESUMO

Importance: Parkinson disease is the most common form of parkinsonism, a group of neurological disorders with Parkinson disease-like movement problems such as rigidity, slowness, and tremor. More than 6 million individuals worldwide have Parkinson disease. Observations: Diagnosis of Parkinson disease is based on history and examination. History can include prodromal features (eg, rapid eye movement sleep behavior disorder, hyposmia, constipation), characteristic movement difficulty (eg, tremor, stiffness, slowness), and psychological or cognitive problems (eg, cognitive decline, depression, anxiety). Examination typically demonstrates bradykinesia with tremor, rigidity, or both. Dopamine transporter single-photon emission computed tomography can improve the accuracy of diagnosis when the presence of parkinsonism is uncertain. Parkinson disease has multiple disease variants with different prognoses. Individuals with a diffuse malignant subtype (9%-16% of individuals with Parkinson disease) have prominent early motor and nonmotor symptoms, poor response to medication, and faster disease progression. Individuals with mild motor-predominant Parkinson disease (49%-53% of individuals with Parkinson disease) have mild symptoms, a good response to dopaminergic medications (eg, carbidopa-levodopa, dopamine agonists), and slower disease progression. Other individuals have an intermediate subtype. For all patients with Parkinson disease, treatment is symptomatic, focused on improvement in motor (eg, tremor, rigidity, bradykinesia) and nonmotor (eg, constipation, cognition, mood, sleep) signs and symptoms. No disease-modifying pharmacologic treatments are available. Dopamine-based therapies typically help initial motor symptoms. Nonmotor symptoms require nondopaminergic approaches (eg, selective serotonin reuptake inhibitors for psychiatric symptoms, cholinesterase inhibitors for cognition). Rehabilitative therapy and exercise complement pharmacologic treatments. Individuals experiencing complications, such as worsening symptoms and functional impairment when a medication dose wears off ("off periods"), medication-resistant tremor, and dyskinesias, benefit from advanced treatments such as therapy with levodopa-carbidopa enteral suspension or deep brain stimulation. Palliative care is part of Parkinson disease management. Conclusions and Relevance: Parkinson disease is a heterogeneous disease with rapidly and slowly progressive forms. Treatment involves pharmacologic approaches (typically with levodopa preparations prescribed with or without other medications) and nonpharmacologic approaches (such as exercise and physical, occupational, and speech therapies). Approaches such as deep brain stimulation and treatment with levodopa-carbidopa enteral suspension can help individuals with medication-resistant tremor, worsening symptoms when the medication wears off, and dyskinesias.


Assuntos
Antiparkinsonianos/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Carbidopa/uso terapêutico , Terapia Combinada , Estimulação Encefálica Profunda , Diagnóstico Diferencial , Progressão da Doença , Combinação de Medicamentos , Humanos , Levodopa/uso terapêutico , Doença de Parkinson/fisiopatologia , Prognóstico
6.
Drugs Aging ; 37(3): 215-223, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31919803

RESUMO

INTRODUCTION: Immediate-release (IR) amantadine has been marketed for Parkinson's disease (PD) therapy for 50 years, while two novel extended-release formulations have only recently reached the market in the US. OBJECTIVES: The aim of this study was to describe amantadine IR utilization patterns in the French COPARK cohort, at baseline and after 2 years of follow-up. METHODS: Overall, 683 PD patients from the COPARK survey were evaluated. All patients were assessed in a standardized manner (demographics, treatments, Unified Parkinson's Disease Rating Scale [UPDRS], Hospital Anxiety and Depression Scale, Pittsburg Questionnaire and health-related quality-of-life scales (Short Form-36 [SF-36], 39-item Parkinson's Disease Questionnaire [PDQ-39]). Longitudinal data were only available for 401/683 patients (59%) with a median (P25-75) follow-up period of 23 months (18-31). Patients were assessed in the same way as in the baseline visit. RESULTS: At baseline, amantadine was prescribed to 61/683 (9%) patients (median dose 200 mg/day, range 100-300 mg/day). Amantadine was initiated after a median of 7 years from PD diagnosis, and its prescription was correlated with the presence of dyskinesia (logistic regression odds ratio [OR] 3.72, 95% confidence interval [CI] 1.95-7.08) and hallucinations (UPDRS I.2) [OR 1.57, 95% CI 1.08-2.29]. After 2 years, the amantadine prescription increased from 33 (8%) patients at baseline to 54 (14%) patients in the subset of 401 patients analysed twice (p = 0.001). Among the 33 patients receiving amantadine at baseline, 9 (27%) stopped amantadine, 5 (15%) increased the dose, 6 (18%) reduced the dose and 13 (40%) stayed at the same doses. Treatment was initiated in 30/54 new patients (55%). Patients who started amantadine or increased its dose (n = 35) had more levodopa-induced dyskinesias at baseline (OR 7.02, 95% CI 3.09-15.90) and higher Mini-Mental State Examination score at follow-up (OR 1.37, 95% CI 1.06-1.79). Undergoing deep brain stimulation was related to stopping or downtitrating amantadine (OR 22.02, 95% CI 4.24-114.44; n = 15). CONCLUSIONS: In this cohort, amantadine was used in 10% of patients. Its use increased during follow-up, despite the fact that one-third of patients who received amantadine at baseline stopped taking it. Amantadine prescription was mainly correlated with the presence of dyskinesia.


Assuntos
Amantadina/uso terapêutico , Antiparkinsonianos/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Idoso , Estimulação Encefálica Profunda , Preparações de Ação Retardada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
7.
PLoS One ; 15(1): e0227128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31910240

RESUMO

INTRODUCTION: Parkinson's disease (PD) patients treated with pramipexole (PPX) and ropinirole (ROP) exhibit a higher risk of developing impulse control disorders (ICDs), including gambling disorder, compulsive shopping, and hypersexuality. The management of ICDs in PD is challenging, due to the limited availability of effective therapeutic alternatives or counteractive strategies. Here, we used a pharmacoepidemiological approach to verify whether the risk for PPX/ROP-associated ICDs in PD patients was reduced by drugs that have been posited to exert therapeutic effects on idiopathic ICDs-including atypical antipsychotics (AAs), selective serotonin reuptake inhibitors (SSRIs), and glutamatergic modulators (GMs). METHODS: To quantify the strength of the associations between PPX/ROP and other medications with respect to ICD risk, odds ratios (ORs) were calculated by multivariable logistic regression, adjusting for age, gender, marital status race, psychiatric comorbidities, and use of cabergoline and levodopa. RESULTS: A total of 935 patients were included in the analysis. Use of GMs, SSRIs, and AAs was not associated with a decreased ICD risk in PD patients treated with PPX/ROP; conversely, ICD risk was significantly increased in patients treated with either GMs (Adjusted Odds Ratio, ORa: 14.00 [3.58-54.44]) or SSRIs (ORa: 3.67 [1.07-12.59]). Results were inconclusive for AAs, as available data were insufficient to compute a reliable ORa. CONCLUSIONS: These results suggest that some of the key pharmacological strategies used to treat idiopathic ICD may not be effective for ICDs associated with PPX and ROP in PD patients. Future studies with larger cohorts are needed to confirm, validate, and extend these findings.


Assuntos
Antiparkinsonianos/efeitos adversos , Antipsicóticos/uso terapêutico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/prevenção & controle , Doença de Parkinson/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Idoso , Antiparkinsonianos/uso terapêutico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/tratamento farmacológico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/etiologia , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Indóis/efeitos adversos , Indóis/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pramipexol/efeitos adversos , Pramipexol/uso terapêutico
8.
PLoS One ; 15(1): e0227555, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31935247

RESUMO

People with Parkinson's disease have been shown to have difficulty switching between movement plans. In the great majority of studies, the need to switch between tasks was made explicitly. Here, we tested whether people with Parkinson's disease, taking their normal medication, have difficulty switching between implicitly specified tasks. We further examined whether this switch is performed predictively or reactively. Twenty five people with Parkinson's disease continuously increased or decreased the frequency of their arm movements, inducing an abrupt-but unaware-switch between rhythmic movements (at high frequencies) and discrete movements (at low frequencies). We tested whether that precipitous change was performed reactively or predictively. We found that 56% of participants predictively switched between the two movement types. The ability of people with Parkinson's disease, taking their regular medication, to predictively control their movements on implicit tasks is thus preserved.


Assuntos
Doença de Parkinson/fisiopatologia , Desempenho Psicomotor , Idoso , Antiparkinsonianos/uso terapêutico , Braço/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Doença de Parkinson/tratamento farmacológico , Estimulação Luminosa
9.
Expert Opin Pharmacother ; 20(18): 2201-2207, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31670988

RESUMO

Introduction: Parkinson's disease is a neurodegenerative disorder which is characterized by the combination of motor and non-motor symptoms. As yet, there is no curative treatment. The gold standard for symptom control is levodopa. Two years after the start of substitution therapy, around 50% of patients experience some degree of fluctuation in motor performance. Catechol-O-methyltransferase (COMT) inhibitors are important agents in treating these fluctuations.Areas covered: This article summarizes our knowledge about a new third-generation COMT inhibitor, namely opicapone (OPC) (Search period: 2016-2019). The authors detail the pharmacological profile of OPC and summarize the results of completed clinical trials. In addition, they briefly summarize the achievements of the past few years.Expert opinion: Based on clinical trials conducted so far, OPC is an effective and safe new drug. In comparison to entacapone and tolcapone, it does not require close laboratory monitoring or multiple oral administrations, which may result in better adherence. No serious adverse event was reported during the drug development phases. Dyskinesia was the most common complaint. Further comparative studies and broader trial inclusion criteria are needed to help the decision between COMT inhibitors and to expand the patient spectrum where this drug can be applied.


Assuntos
Antiparkinsonianos/uso terapêutico , Oxidiazóis/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Administração Oral , Inibidores de Catecol O-Metiltransferase/uso terapêutico , Catecóis/uso terapêutico , Discinesia Induzida por Medicamentos/etiologia , Humanos , Levodopa/uso terapêutico , Nitrilos/uso terapêutico
10.
J Clin Neurosci ; 69: 281-284, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477464

RESUMO

We have evaluated an 82 years old PD patient who has acutely developed VH secondary to acute visual loss that was associated with increased electroencephalographic activity in the gamma range over the parietal, occipital and frontal regions. In this respect, we have tested the therapeutic effect of occipital lobe oriented rTMS application and its electrophysiological correlates that led to significant improvement in the hallucinatory symptomatology of the patient after two weeks. We have revealed that the improved hallucinatory symptoms after rTMS application resolved completely after switching from the pramipexole treatment to L-Dopa indicating that there could be a combined therapeutic effect of L-Dopa and rTMS. Furthermore, Quantitative-Electroencephalography analysis has shown that the therapeutic effects of rTMS and L-Dopa were seen with the improvement of impaired gamma power spectrum. Although the main limitation of this report is that this a single case study and that these findings need to be replicated in a larger sample, e.g., as part of a controlled trial, our present findings help us to enlighten the unknown pathophysiological overlapping between the visual hallucinations in PD and Charles Bonnet Syndrome. Finally, our study revealed increased gamma coherence and power spectrum which is seen with visual hallucinations and improved after the application of 1 Hz rTMS on the occipital lobe. These findings together suggest that rTMS could be used as a therapeutic tool for parkinsonian complex VH and probably due affecting gamma coherence and power spectrum.


Assuntos
Alucinações/etiologia , Alucinações/terapia , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Estimulação Magnética Transcraniana/métodos , Idoso de 80 Anos ou mais , Antiparkinsonianos/uso terapêutico , Eletroencefalografia , Humanos , Levodopa/uso terapêutico , Masculino , Pramipexol/uso terapêutico
11.
Brain Nerve ; 71(9): 953-959, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31506397

RESUMO

Among the therapeutic agents for Parkinson's disease (PD), there are important drugs that precede drug repositioning. Amantadine, developed as a treatment for influenza A, has been long used as a treatment for PD. Zonisamide is an antiepileptic drug developed in Japan, where its therapeutic effects on PD were also discovered and developed. In recent years, dabrafenib, a therapeutic agent for malignant melanoma, has bean identified as a potential therapeutic agent for PD. Amantadine and zonisamide are drugs that have been serendipitously developed in clinical settings for patients with PD. Meanwhile, the potential for repurposing dabrafenib was discovered by utilizing the results of genome-wide association studies, drug databases, and protein-protein interaction databases.


Assuntos
Amantadina/uso terapêutico , Antiparkinsonianos/uso terapêutico , Imidazóis/uso terapêutico , Oximas/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Zonisamida/uso terapêutico , Reposicionamento de Medicamentos , Estudo de Associação Genômica Ampla , Humanos
12.
BMJ Case Rep ; 12(8)2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31434666

RESUMO

A 62-year-old man presented with a 2-year history of syncope, collapse and fluctuating blood pressure (BP). His medications included midodrine (10 mg, three times per day) and fludrocortisone (0.1 mg, two times per day), but neither treatment afforded symptomatic relief. Autonomic testing was performed. Head-up tilt table testing revealed a supine BP of 112/68 mm Hg (heart rate, 74 beats per minute (bpm)) after 6 min, which dropped to 76/60 mm Hg (83 bpm) within 2 min of 80° head-up tilt. Findings from a heart rate with deep breathing test and a Valsalva test were consistent with autonomic dysfunction. The patient was diagnosed with neurogenic orthostatic hypotension and treated with droxidopa (100 mg, two times per day; titrated to 100 mg, one time per day). After initiating treatment with droxidopa, the patient no longer reported losing consciousness on standing and experienced improvement in activities of daily living. These improvements were maintained through 1 year of follow-up.


Assuntos
Antiparkinsonianos/uso terapêutico , Sistema Nervoso Autônomo/fisiopatologia , Droxidopa/uso terapêutico , Hipotensão Ortostática/diagnóstico , Síncope/etiologia , Teste da Mesa Inclinada , Acidentes por Quedas , Atividades Cotidianas , Humanos , Hipotensão Ortostática/tratamento farmacológico , Hipotensão Ortostática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Clin Drug Investig ; 39(11): 1067-1075, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31327127

RESUMO

BACKGROUND: Parkinson's disease is a disorder growing in prevalence, disability, and deaths. Healthcare databases provide a 'real-world' perspective for millions of individuals. We envisioned helping accelerate drug discovery by using these databases. OBJECTIVES: The objectives of this study were to assess the association of marketed medications with the risk of parkinsonism in four US claims databases and to evaluate the consistency of the association of ß-adrenoreceptor modulation with parkinsonism. METHODS: The study was conducted using a self-controlled cohort design in which subjects served as their own control. The time from treatment initiation until discontinuation or end of observation was the exposed period and a similar time preceding medication was the unexposed period. Medications were studied at ingredient and class level. The incidence rate ratio (IRR) and combined IRR were calculated. RESULTS: We assessed 2181 drugs and 117,015,066 people. Diphenhydramine, isradipine, methylphenidate, armodafinil, and modafinil were associated with reduced risk for parkinsonism in at least two databases. Armodafinil, modafinil, methylphenidate, and the ß-agonist albuterol were associated with a 56%, 54%, 39%, and 17% reduction in the risk of having parkinsonism, respectively. Isradipine results were heterogeneous and no significant association was found. Propranolol was associated with a 32% increased risk, the only ß-adrenoceptor antagonist (ß-blocker) associated with an increased risk. CONCLUSIONS: Armodafinil, modafinil, and methylphenidate were associated with a decreased risk of parkinsonism, as were ß-agonists. Of the ß-blockers, only propranolol was associated with increased risk. Healthcare database analyses that incorporate scientific rigor provide insight and direction for drug discovery efforts. These findings show association not causality; however, they offer considerable support to the association between ß-adrenergic receptor modulation and risk of Parkinson's disease.


Assuntos
Antiparkinsonianos/uso terapêutico , Descoberta de Drogas/métodos , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson Secundária/diagnóstico , Vigilância de Produtos Comercializados/métodos , Antagonistas Adrenérgicos beta/efeitos adversos , Adulto , Estudos de Coortes , Bases de Dados Factuais/normas , Feminino , Humanos , Masculino , Metilfenidato/efeitos adversos , Modafinila/efeitos adversos , Doença de Parkinson Secundária/prevenção & controle
14.
Rev Med Suisse ; 15(656): 1288-1290, 2019 Jun 19.
Artigo em Francês | MEDLINE | ID: mdl-31268258

RESUMO

Parkinson disease is a progressive neurodegenerative disease affecting the basal ganglia and causing the degeneration of dopaminergic neurons. It is a chronic affection with a slow evolution characterized by motor dysfunctions. Considering voice and speech, 90 % of patients present problems affecting their communication, social skills and quality of life. Although L-dopa has some effect on motor performance, speech and voice do not improve. So, the applicability and efficacy of non-pharmacological treatment, based on therapy is to be considered for voice impairment. Today, voice therapy is being viewed as a therapeutic option to be prescribed early in the course of Parkinson disease that may potentially contribute to slowing of motor symptom progression.


Assuntos
Doença de Parkinson , Distúrbios da Voz , Antiparkinsonianos/uso terapêutico , Humanos , Levodopa/uso terapêutico , Doença de Parkinson/complicações , Qualidade de Vida , Distúrbios da Voz/tratamento farmacológico , Distúrbios da Voz/etiologia
15.
Drugs ; 79(13): 1367-1374, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31332769

RESUMO

Onset of involuntary movement patterns of the face, body and limbs are known as dyskinesia. They mostly appear in association with long-term levodopa (L-dopa) therapy in patients with Parkinson's disease. Consequences include patient distress, caregiver embarrassment and reduced quality of life. A severe intensity of this motor complication may result in troublesome disability; however, patients typically prefer motor behaviour with slight, non-troublesome dyskinesia to 'OFF' states. Pharmacotherapy of dyskinesia is complex. Continuous nigrostriatal postsynaptic dopaminergic receptor stimulation may delay onset of L-dopa-associated dyskinesia, while non-physiological, 'pulsatile' receptor stimulation facilitates appearance of dyskinesia. In the past, there have been many clinical trial failures with compounds that were effective in animal models of dyskinesia. Only the N-methyl-D-aspartate antagonist amantadine has shown moderate antidyskinetic effects in small well-designed clinical studies. Amantadine is an old antiviral compound, which moderately improves impaired motor behaviour. Recently, there has been a resurgence of its use due to the US Food and Drug Administration approval of an extended-release (ER) amantadine formulation for treatment of L-dopa-induced dyskinesia. This pharmacokinetic innovation improved dyskinesia and 'OFF' states in pivotal trials, with a once-daily oral application in the evening. Amantadine ER provides higher and more continuous amantadine plasma bioavailability than conventional immediate-release formulations, which require administration up to three times daily.


Assuntos
Amantadina/uso terapêutico , Antiparkinsonianos/uso terapêutico , Discinesia Induzida por Medicamentos/tratamento farmacológico , Levodopa/efeitos adversos , Animais , Antivirais/uso terapêutico , Humanos , Doença de Parkinson/tratamento farmacológico , Qualidade de Vida
16.
Med J Aust ; 211(6): 277-283, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31203580

RESUMO

Parkinson disease (PD) is a complex neurodegenerative disorder that can present heterogeneously with a combination of motor and non-motor symptoms. α-synuclein, a neuronal protein, can undergo aberrant conformational change resulting in the intra-neuronal accumulation of toxic oligomers that form Lewy bodies, the pathological hallmark of PD. There is evidence that pathological α-synuclein exhibits prion-like behaviour in its mode of transmission through the nervous system. The choice of initial dopaminergic treatments should be individually tailored but long term outcomes appear to be equivalent. There is level A evidence supporting the benefit of three different device-assisted therapies in treating troublesome motor fluctuations and dyskinesias. Stem cell transplantation as currently being trialled is predominantly a symptomatic therapy targeting only limited regions of the brain affected by PD, and will need to be proven to be not only as effective but as safe as currently available device-assisted therapies. New modes of treatment including active immunisation against oligomeric α-synuclein and drugs that alter cellular metabolism show some promise. The inability to effectively treat a range of non-motor, non-dopaminergic symptoms remains a major therapeutic challenge.


Assuntos
Doença de Parkinson/terapia , Antiparkinsonianos/uso terapêutico , Estimulação Encefálica Profunda , Humanos
17.
Expert Rev Clin Pharmacol ; 12(7): 681-691, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31159608

RESUMO

Introduction: Parkinson's disease psychosis (PDP) may affect up to 60% of patients with Parkinson's disease over the course of their disease, and is associated with poor prognosis, including increased risks of mortality and nursing home placement. PDP treatments have been limited to off-label use of atypical antipsychotics, most of which pose risks of worsened motor symptoms and other potential adverse events (AEs) due to their dopamine receptor blockade and additional off-target receptor affinities. Pimavanserin is a highly selective 5-HT2A inverse agonist and poses no known risks for worsening of parkinsonism or other off-target receptor AEs. Pimavanserin is the first and only medication approved for PDP treatment. Areas covered: This review covers estimated prevalence, clinical characteristics, diagnostic criteria, and risk factors for PDP; the hypothetical progression of PDP; management of PDP including use of antipsychotics; pharmacology and clinical trial data on pimavanserin; and expert opinion on PDP treatment. The NLM/PubMed database was searched for papers using the search terms of "PDP" AND "treatment" AND "pimavanserin" for the last 10 years. Expert opinion: The recent insights into PDP pathophysiology and approval of the only medication specifically to treat PDP are key advances that should improve the recognition, diagnosis, and management of PDP.


Assuntos
Doença de Parkinson/tratamento farmacológico , Piperidinas/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Ureia/análogos & derivados , Antiparkinsonianos/farmacologia , Antiparkinsonianos/uso terapêutico , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Progressão da Doença , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Piperidinas/farmacologia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia , Fatores de Risco , Agonistas do Receptor 5-HT2 de Serotonina/farmacologia , Agonistas do Receptor 5-HT2 de Serotonina/uso terapêutico , Ureia/farmacologia , Ureia/uso terapêutico
18.
Drugs Aging ; 36(9): 807-821, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31161581

RESUMO

Levodopa is the mainstay of treatment in Parkinson's disease (PD). As the disease progresses, variations in plasma levodopa levels lead to motor fluctuations. The common reasons behind variations in the plasma levels include delayed gastric emptying, small intestinal bacterial overgrowth, protein interaction with levodopa absorption, and limited oral bioavailability of levodopa. Efforts to find newer delivery systems for older drugs to avoid the problems associated with oral delivery of medications are continuing. This review aims to provide up-to-date information about the newer delivery options for drugs used for PD and provides a summary of infusion therapy with apomorphine, modifications to other dopamine agonists, various oral formulations of carbidopa/levodopa, inhaled levodopa, intrajejunal infusion of levodopa, and sublingual apomorphine. The advantages, dose, and adverse effects of each treatment modality are reviewed. We also discuss several drugs under investigation, such as the subcutaneous carbidopa/levodopa infusion and subcutaneous rotigotine.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Doença de Parkinson/tratamento farmacológico , Antiparkinsonianos/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Humanos , Levodopa/uso terapêutico , Inibidores da Monoaminoxidase/uso terapêutico
19.
Expert Opin Pharmacother ; 20(13): 1659-1670, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150294

RESUMO

Introduction: Parkinson's disease (PD) causes progressive motor symptoms including tremor, rigidity, and bradykinesia, along with non-motor symptoms such as dementia, orthostatic hypotension, and depression. Over time, PD can lead to falls, disability, institutionalization, and caregiver burden. Its treatment is symptomatic and can be associated with high costs. Areas covered: The authors performed a literature search of PubMed, Web of Science, and Cochrane Library Current for English language PD pharmacoeconomic evaluations starting from 1 January 2000. The authors found 26 papers covering treatment of motor symptoms (n = 24), dementia (n = 1), and orthostatic hypotension (n = 1). The scope of literature was limited in that there were few articles overall. Expert opinion: Overall, the authors found a scarcity of primary PD pharmacoeconomic literature in the 21st Century. Given the myriad of PD motor and non-motor treatments, only 24 papers evaluating motor treatments and two papers evaluating non-motor treatments met our search criteria. More studies are clearly needed to better define the pharmacoeconomics of PD therapeutics.


Assuntos
Antiparkinsonianos/uso terapêutico , Farmacoeconomia , Doença de Parkinson/tratamento farmacológico , Antiparkinsonianos/economia , Humanos , Doença de Parkinson/economia
20.
Ideggyogy Sz ; 72(5-6): 187-193, 2019 May 30.
Artigo em Húngaro | MEDLINE | ID: mdl-31241263

RESUMO

Background and purpose: There is relatively few data regarding the usage of dopaminagonists for the treatment of Parkinson's disease; furthermore, there are no publications regarding Central- and Eastern-European countries. The aim of the study was to evaluate the use of dopamine agonists as a therapeutic option amongst Parkinson's disease patients admitted to the Neurological Clinics of Tîrgu Mures during the last 15 years. Methods: In our study we investigated the data of all Parkinson's patients treated at our clinics between the 1st of January 2003 and the 31st of December 2017. We analyzed the particularities of dopamine agonists' usage based on the therapeutic recommendations from the final report of these patients. Regarding time since the diagnosis, we divided the patients in two groups: less than or equal to 5 years and more than 5 years. Results: During the studied period a total of 2379 patients with Parkinson's disease were treated at the Clinics. From the 1237 patients with disease duration under 5 years 665 received dopamine agonists: 120 as monotherapy, 83 together with monoamine oxidase inhibitors and in 234 cases associated with levodopa. The remaining 228 patients were treated with a triple combination of levodopa, dopamine agonists and monoamine oxidase inhibitors. In patients suffering from Parkinson's disease for more than 5 years, in 364 cases out of 653 a dopamine agonist was part of the therapy. Conclusion: The usage of dopamine agonists was similar to the data presented in other studies. We consider that clinicians treating the disease should, with the necessary prudence, use the available and recommended dopamine agonist with the utmost courage to their maximum therapeutic potential.


Assuntos
Antiparkinsonianos/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Levodopa/uso terapêutico , Inibidores da Monoaminoxidase/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Estudos Transversais , Humanos , Resultado do Tratamento
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