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Chen S, Chan P, Sun S, Chen H, Zhang B, Le W, Liu C, Peng G, Tang B, Wang L, Cheng Y, Shao M, Liu Z, Wang Z, Chen X, Wang M, Wan X, Shang H, Liu Y, Xu P, Wang J, Feng T, Chen X, Hu X, Xie A, Xiao Q. The recommendations of Chinese Parkinson's disease and movement disorder society consensus on therapeutic management of Parkinson's disease. Transl Neurodegener 2016; 5:12. [PMID: 27366321 PMCID: PMC4928283 DOI: 10.1186/s40035-016-0059-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a chronic, progressive and debilitating disease, which affects over 2.5 million people in China. PD is characterized clinically by resting tremor, muscular rigidity, bradykinesia and postural instability. As the disease progresses, additional complications can arise such as non-motor and neurobehavioral symptoms. Pharmacological treatment and surgical intervention for PD have been implemented in China. Until 10 years ago, there was lack of standardization for the management of PD in different regions and among different physicians, leading to different treatment levels in different regions and different physicians. Since then, the Chinese Parkinson's Disease and Movement Disorder Society have published three versions of guidelines for the management of PD in China, in 2006, 2009 and 2014, respectively. Correspondingly, the overall level of treatment for PD in China improved. OBJECTIVES To update the treatment guidelines based on current foreign and domestic practice guidelines and clinical evidence, and to improve the treatment options available to physicians in the management of PD. SUMMARY A variety of treatment recommendations in the treatment guidelines have been proposed, including physical activity and disease-modifying medication, which should be initiated at the early-stage of the disease. The principles of dosage titration should be followed to avoid acute adverse reactions to the drugs, to achieve a satisfactory clinical effect with a low dose and to reduce the incidence of long-term motor complications. Moreover, different treatment strategies should be considered at different stages of the disease. Importantly, treatment guidelines and personalized treatments should be valued equally. A set of treatment recommendations has been developed to assist physicians to improve and optimize clinical outcomes for patients with PD in China.
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Affiliation(s)
- Shengdi Chen
- />Department of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Piu Chan
- />Xuanwu Hospital affiliated to Capital Medical University, Beijing, China
| | - Shenggang Sun
- />Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | | | - Baorong Zhang
- />The Second Hospital affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Le
- />The First Hospital affiliated to Dalian Medical University, Dalian, China
| | - Chunfeng Liu
- />The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoguang Peng
- />The First Hospital affiliated to Chongqing Medical University, Chongqing, China
| | - Beisha Tang
- />Xiangya Hospital, Central South University, Changsha, China
| | - Lijuan Wang
- />Guangdong General Hospital, Guangzhou, China
| | - Yan Cheng
- />General Hospital affiliated to Tianjin Medical University, Tianjin, China
| | - Ming Shao
- />Sichuan Rehabilitation Hospital, Chengdu, China
| | - Zhenguo Liu
- />Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenfu Wang
- />Chinese PLA General Hospital, Beijing, China
| | - Xiaochun Chen
- />Fujian Medical University Union Hospital, Fuzhou, China
| | - Mingwei Wang
- />The First Hospital affiliated to Hebei Medical University, Shijiazhuang, China
| | - Xinhua Wan
- />Peking Union Medical College Hospital, Beijing, China
| | - Huifang Shang
- />West China Hospital affiliated to Sichuan University, Chengdu, China
| | - Yiming Liu
- />Qilu Hospital affiliated to Shandong University, Jinan, China
| | - Pingyi Xu
- />The First Hospital affiliated to Guangzhou Medical University, Guangzhou, China
| | - Jian Wang
- />Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Tao Feng
- />Tiantan Hospital affiliated to Capital Medical University, Beijing, China
| | - Xianwen Chen
- />The First Hospital affiliated to Anhui Medical University, Hefei, China
| | - Xingyue Hu
- />Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Anmu Xie
- />The Affiliated Hospital, Qingdao University School of Medicine, Qingdao, China
| | - Qin Xiao
- />Department of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
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Homayoun H, Goetz CG. Facing the unique challenges of dyskinesias in Parkinson’s disease. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dyskinesia is among the most challenging complications of levodopa and dopaminergic drug therapy in advanced Parkinson’s disease. This symptom has a negative impact on the quality of life of patients with Parkinson’s disease and is hard to manage. Current advances in our understanding of the diverse phenomenology and complicated pathophysiology of dyskinesia have led to a number of novel strategies aimed at better control of this complication. Further insight has been gained from focusing on the characteristics of the rating scale used for assessment of dyskinesia and from the inherent susceptibility of dyskinesia to placebo effect. Here, we will briefly review the phenomenology, pathophysiology and the treatment of dyskinesia in Parkinson’s disease.
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Affiliation(s)
- Houman Homayoun
- Rush University Medical Center, Chicago, IL 60612, USA; Suite 755, 1725 W. Harrison Street, Chicago, IL 60612, USA
| | - Christopher G Goetz
- Rush University Medical Center, Chicago, IL 60612, USA; Suite 755, 1725 W. Harrison Street, Chicago, IL 60612, USA
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Hadjiconstantinou M, Neff NH. Enhancing aromatic L-amino acid decarboxylase activity: implications for L-DOPA treatment in Parkinson's disease. CNS Neurosci Ther 2009; 14:340-51. [PMID: 19040557 DOI: 10.1111/j.1755-5949.2008.00058.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aromatic L-amino acid decarboxylase (AAAD) is an essential enzyme for the formation of catecholamines, indolamines, and trace amines. Moreover, it is a required enzyme for converting L-DOPA to dopamine when treating patients with Parkinson's disease (PD). There is now substantial evidence that the activity of AAAD in striatum is regulated by activation and induction, and second messengers play a role. Enzyme activity can be modulated by drugs acting on a number of neurotransmitter receptors including dopamine (D1-4), glutamate (NMDA), serotonin (5-HT(1A), 5-HT(2A)) and nicotinic acetylcholine receptors. Generally, antagonists enhance AAAD activity; while, agonists may diminish it. Enhancement of AAAD activity is functional, as the formation of dopamine from exogenous L-DOPA mirrors activity. Following a lesion of nigrostriatal dopaminergic neurons, AAAD in striatum responds more robustly to pharmacological manipulations, and this is true for the decarboxylation of exogenous L-DOPA as well. We review the evidence for parallel modulation of AAAD activity and L-DOPA decarboxylation and propose that this knowledge can be exploited to optimize the formation of dopamine from exogenous L-DOPA. This information can be used as a blue print for the design of novel L-DOPA treatment adjuvants to benefit patients with PD.
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Affiliation(s)
- Maria Hadjiconstantinou
- Division of Molecular Neuropsychopharmacology, Department of Psychiatry, College of Medicine, Ohio State University, Columbus, OH 43210, USA
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Elman LB, Houghton DJ, Wu GF, Hurtig HI, Markowitz CE, McCluskey L. Palliative care in amyotrophic lateral sclerosis, Parkinson's disease, and multiple sclerosis. J Palliat Med 2007; 10:433-57. [PMID: 17472516 DOI: 10.1089/jpm.2006.9978] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis, Parkinson's disease, atypical parkinsonian syndromes, and multiple sclerosis are progressive neurologic disorders that cumulatively afflict a large number of people. Effective end-of-life palliative care depends upon an understanding of the clinical aspects of each of these disorders. OBJECTIVES The authors review the unique and overlapping aspects of each of these disorders with an emphasis upon the clinical management of symptoms. DESIGN The authors review current management and the supporting literature. CONCLUSIONS Clinicians have many effective therapeutic options to choose from when managing the symptoms produced by these disorders.
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Affiliation(s)
- Lauren B Elman
- ALS Association Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
Levodopa-induced dyskinesias (LID) are common and difficult to treat. This review focuses on three issues related to LID: clinical features, classification and rating, pathophysiology and pathogenesis, and management. The three primary clinical syndromes are OFF-period dystonia, peak-dose dyskinesia, and diphasic dyskinesia. Several other forms also occur, making the evaluation and choice of treatment complicated. A core component of the pathophysiology of LID is overactivity of the direct striatal output pathway. This pathway provides a direct GABAergic connection by which the striatum inhibits the output regions of the basal ganglia, i.e., the internal globus pallidus and the substantia nigra pars reticulata. Altering dopaminergic dosing and timing can abate dyskinesias, but usually impact the control of parkinsonism. Putative therapies to reduce the problem of dyskinesias could focus on the glutamatergic, GABAergic, alpha2 adrenergic, serotonergic (5HT1A, 5HT2A), opioid, histamine H3, adenosine A2A receptors, the monoamine transport or cannabinoid CB1 receptors systems. The only currently available drug with an evidence-based recommendation on efficacy for dyskinesia is amantadine. Therapy goals include the prevention of dyskinesia and treatment of dyskinesias that are troublesome clinically. New rating measures to assess severity and disability related to dyskinesia are in the process of development and clinimetric testing.
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Affiliation(s)
- Giovanni Fabbrini
- Department of Neurological Sciences University of Rome "La Sapienza", Rome, Italy
| | - Jonathan M Brotchie
- Toronto Western Research Institute, Toronto Western Hospital, Toronto, Canada
| | - Francisco Grandas
- Department of Neurology, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Masahiro Nomoto
- Department of Therapeutic Medicine, Faculty of Medicine, Ehime University Hospital, Ehime, Japan
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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Snyder CH, Adler CH. The patient with Parkinson's disease: part I-treating the motor symptoms; part II-treating the nonmotor symptoms. ACTA ACUST UNITED AC 2007; 19:179-97. [PMID: 17430539 DOI: 10.1111/j.1745-7599.2007.00211.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE This two-part article provides the nurse practitioner (NP) with information on the developments in the pathophysiology and expanded treatment options in the motor and nonmotor symptoms of Parkinson's disease (PD). The discussion provides treatment strategies that may offer improved ability to manage the disabling symptoms of this neurodegenerative disorder. DATA SOURCES Review of scientific literature from PubMed search for English language articles on PD from 1998 to 2005 and books or chapters in textbooks published on the disease in the same time frame provided the data source for this article. The content reflects our clinical judgments and experience from clinical practice in the Movement Disorder Clinic at Mayo Clinic Arizona. CONCLUSIONS The high prevalence of the disease and important advances in its management means that the NP needs to have knowledge of the disorder and the combination of multiple treatment options available for both the motor and the nonmotor symptoms. IMPLICATIONS FOR PRACTICE PD is a progressive neurodegenerative disease affecting 1% of persons over the age of 60 in the United States. As prevalence increases with age, so does the need for early accurate diagnosis and proper treatment of the PD by the clinician. Advances in the treatment for the motor and nonmotor symptoms of PD provide the clinician with increased options to improve the patient's quality of life.
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Abstract
Although levodopa remains the gold standard treatment for Parkinson's disease, many patients develop motor complications with chronic levodopa exposure. Tolcapone is a catechol-O-methyltransferase inhibitor that extends the action of levodopa. When used in conjunction with levodopa, tolcapone has been shown to be effective in improving motor fluctuations and reducing levodopa requirements in Parkinson's disease patients. However, rare reports of severe hepatotoxicity have limited its use. A recent review of the data on tolcapone-treated patients suggests that, with proper monitoring of liver function, the potential for hepatotoxicity with tolcapone use is negligibly small.
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Affiliation(s)
- Julie Leegwater-Kim
- Columbia University Medical Center, Department of Neurology, Division of Movement Disorders, 710 W. 168th Street, New York, NY 10032, USA
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Abstract
The management of advancing Parkinson's disease (PD) is a daunting task, complicated by dynamic medication responses, side effects, and treatment-refractory symptoms in an aging patient population. The motor and nonmotor complications of advancing PD are reviewed, and practical treatment strategies are provided. Careful assessment in the context of the known natural history of advancing PD and rational treatment choices can create significant improvement in the lives of patients who have advancing PD.
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Affiliation(s)
- John L Goudreau
- Department of Neurology and Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI 48842, USA.
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