Melatonin modulates apomorphine-induced rotational behaviour

Fine-tuning the circadian system with light treatment for Parkinson's disease: an in-depth, critical review

Late in the twentieth century, interest intensified regarding the involvement of the circadian system in the aetiology and treatment of Parkinson's disease (PD). It has been envisaged that this approach might provide relief beyond the limited benefits and severe side effects achieved by dopamine (DA) replacement. In the first clinical article, published in 1996, polychromatic light was used to shift the circadian clock as it is considered to be the most powerful zeitgeber (time keeper) that can be implemented to realign circadian phase. Since that time, 11 additional articles have implemented light treatment (LT) in various forms as an adjuvant to DA replacement. In spite of the growing interest in this area, the systematic exploration of LT in PD has been stymied by several methodological factors. Such factors include time of LT presentation, duration of studies undertaken, frequency of light employed, dose of light prescribed and relevance of experimental design to the prolonged course of the illness. On this basis, it is the purpose of this review to provide an in-depth examination of these papers, and the underlying preclinical work, to provide critique, thereby giving direction for future studies in therapeutic applications of LT for PD. Consideration of this collective work may serve to carve a path for future research and thereby improve the lives of those suffering from this debilitating disorder.

The effects of regular swimming exercise and melatonin on the neurons localized in the striatum of hemiparkinsonian rats

Parkinson's disease is a progressive neurodegenerative movement disorder. We aimed to investigate the effects of regular swimming exercise and melatonin applied in the 6-Hydroxydopamine-induced Parkinson's disease rats by analysing dendritic spine of striatal neurons. Twenty-four male Wistar albino rats were used. 6-Hydroxydopamine unilaterally injected four (control, exercise, melatonin and exercise + melatonin) groups were included in the study. Tyrosine hydroxylase expression was detected by immunohistochemistry. Neurons and structures were identified from three-dimensional images by Neurolucida software. There was not any apparent difference for tyrosine hydroxylase positive neurons in the substantia nigra pars compacta and fibres in the striatum between the lesion sides of hemiparkinsonian groups. The treatment groups blocked the apomorphine-induced increase in rotations compared to the control group. In stepping test, the treatment groups prevented the loss of stepping in the contralateral side of hemiparkinsonian groups. The melatonin mostly had a positive effect on motor activity tests. In morphological analyses, the 6-Hydroxydopamine-induced lesion led to the reduction of the total dendritic length and number of branches. In the treatment groups, the reduction of the dendritic parameters was not observed. 6-Hydroxydopamine lesion led to a decrease in the total spine density, spine densities of thin and mushroom types. The exercise and melatonin treatments prevented the loss of spine density. The exercise treatment prevented the loss of spine density of mushroom type spines. The melatonin treatment blocked the loss of spine density of stubby type. In conclusion, these results provide evidence for effective additional protective therapeutic strategies for Parkinson's disease. In conclusion, results from the current study provide evidence for swimming exercise and melatonin as a promising candidate for effective additional protective strategies for PD.

Melatonin as a Chronobiotic and Cytoprotective Agent in Parkinson's Disease

This article discusses the role that melatonin may have in the prevention and treatment of Parkinson’s disease (PD). In parkinsonian patients circulating melatonin levels are consistently disrupted and the potential therapeutic value of melatonin on sleep disorders in PD was examined in a limited number of clinical studies using 2–5 mg/day melatonin at bedtime. The low levels of melatonin MT1 and MT2 receptor density in substantia nigra and amygdala found in PD patients supported the hypothesis that the altered sleep/wake cycle seen in PD could be due to a disrupted melatonergic system. Motor symptomatology is seen in PD patients when about 75% of the dopaminergic cells in the substantia nigra pars compacta region degenerate. Nevertheless, symptoms like rapid eye movement (REM) sleep behavior disorder (RBD), hyposmia or depression may precede the onset of motor symptoms in PD for years and are index of worse prognosis. Indeed, RBD patients may evolve to an α-synucleinopathy within 10 years of RBD onset. Daily bedtime administration of 3–12 mg of melatonin has been demonstrated effective in RDB treatment and may halt neurodegeneration to PD. In studies on animal models of PD melatonin was effective to curtail symptomatology in doses that allometrically projected to humans were in the 40–100 mg/day range, rarely employed clinically. Therefore, double-blind, placebo-controlled clinical studies are urgently needed in this respect.

Beneficial Effect of Melatonin on Motor and Memory Disturbances in 6-OHDA-Lesioned Rats

Previous evidence has shown a link between neurodegenerative diseases, including Parkinson's disease (PD), and melatonin. The data in the literature about the impact of the hormone under different experimental PD conditions are quite controversial, and its effect on memory impairment in the disease is very poorly explored. The current research was aimed at investigating the role of melatonin pretreatment on memory and motor behavior in healthy rats and those with the partial 6-hydroxydopamine (6-OHDA) model of PD. All rodents were pretreated with melatonin (20 mg/kg, intraperitoneally) for 5 days. At 24 h and 7 days after the first treatment for healthy rats, and at the second and third week post-lesion for those with PD, the animals were tested behaviorally (apomorphine-induced rotations, rotarod, and passive avoidance tests). The neurochemical levels of dopamine (DA), acetylcholine (ACh), noradrenaline (NA), and serotonin (Sero) in the brain were also determined. The results showed that in healthy animals, melatonin pretreatment had amnestic and motor-suppressive effects and did not change the levels of measured brain neurotransmitters. In animals with PD, melatonin pretreatment exerted a neuroprotective effect, manifested as a significantly decreased number of apomorphine-induced rotations, reduced number of falls in the rotarod test, and improved memory performance. The brain DA and ACh concentrations in the same animals were restored to the control levels, and those of NA and Sero did not change. Our results demonstrate a beneficial effect of melatonin on memory and motor disturbance in 6-OHDA-lesioned rats.

Melatonin serum level, sleep functions, and depression level after bilateral anodal transcranial direct current stimulation in patients with Parkinson's disease: a feasibility study

Objective

Parkinson's disease (PD) is associated with non-motor complications such as sleep disturbance and depression. Transcranial direct current stimulation (tDCS) showed therapeutic effects on the motor dysfunctions. However, the potential effects of tDCS therapy on melatonin hormone, sleep dysfunctions, and depression in patients with PD still unclear. This feasibility study aimed to identify any potential changes in melatonin serum level, sleep functions and depression after the bilateral anodal tDCS in patients with PD.

Material and Methods

Tensessions of bilateral anodal tDCS stimulation applied over left and right prefrontal and motor areas were given to twenty-five patients with PD. Melatonin serum level, Pittsburgh sleep quality index, and geriatric depression scale examined before and after tDCS stimulation.

Results

After bilateral anodal tDCS, there was a significant reduction in melatonin serum level, improvement in depression, improvements in overall sleep quality, and sleep latency. Correlations test showed significant associations between melatonin serum level reduction and changes in subjective sleep quality, and sleep duration, as well as between improvements in depression and overall sleep quality, sleep latency, and sleep disturbance.

Conclusion

Bilateral anodal tDCS therapy was a feasible and safe tool that showed potential therapeutic effects on melatonin serum level, sleep quality, and depression level in patients with PD. Although the further large scale and randomized-control trial studies are crucially needed, there is still a need for such a feasibility study to be established before such trials can be implemented as is recommended in the new medical research council guidelines.

Melatonin: Clinical Perspectives in Neurodegeneration

Prevention of neurodegenerative diseases is presently a major goal for our Society and melatonin, an unusual phylogenetically conserved molecule present in all aerobic organisms, merits consideration in this respect. Melatonin combines both chronobiotic and cytoprotective properties. As a chronobiotic, melatonin can modify phase and amplitude of biological rhythms. As a cytoprotective molecule, melatonin reverses the low degree inflammatory damage seen in neurodegenerative disorders and aging. Low levels of melatonin in blood characterizes advancing age. In experimental models of Alzheimer's disease (AD) and Parkinson's disease (PD) the neurodegeneration observed is prevented by melatonin. Melatonin also increased removal of toxic proteins by the brain glymphatic system. A limited number of clinical trials endorse melatonin's potentiality in AD and PD, particularly at an early stage of disease. Calculations derived from animal studies indicate cytoprotective melatonin doses in the 40-100 mg/day range. Hence, controlled studies employing melatonin doses in this range are urgently needed. The off-label use of melatonin is discussed.

The effect of directed photic stimulation of the pineal on experimental Parkinson's disease

The role of the circadian system in Parkinson's disease (PD) is a topic of increasing scientific interest. This has emerged from recent studies demonstrating an altered response of PD patients to treatment in relation to the phase of the light/dark cycle and from other work defining the functional significance of melanocytes in PD: a cell type that the nigro-striatal dopamine (NSD) system and circadian system both contain. The present study was undertaken to determine the sensitivity of the pineal, as the final common pathway of the circadian system, to light delivered directly to the pineal via surgical implantation of LEDs. Direct photic stimulation of the pineal altered the course of experimental PD while anatomical controls receiving stimulation of the frontal cortex exhibited a negative impact on the course of recovery of these animals. These effects were closely linked to the phase of the light/dark cycle. The present results suggest that while pineal photoreceptors are regarded as vestigial, functional photo-reactivity of the pineal remains. It is inferred that melanocytes are the active cells responsible for the observed effect since they remain functionally intact in mammalian pineal even though pineal photoreceptors are functionally inert. Although the stimuli applied in the present study may be regarded as artificial this study demonstrates that brain parenchyma remains differentially reactive to direct light exposure and presents a novel mechanism in circadian structures that needs to be explored.

Emerging preclinical interest concerning the role of circadian function in Parkinson's disease

The importance of circadian function in the aetiology, progression and treatment of Parkinson's disease is a topic of increasing interest to the scientific and clinical community. While clinical studies on this theme are relatively new and limited in number there are many preclinical studies which explore possible circadian involvement in Parkinson's disease and speculate as to the mechanism by which clinical benefit can be derived by manipulating the circadian system. The present review explores the sequelae of circadian related studies from a historical perspective and reveals mechanisms that may be involved in the aetiology and progression of the disease. A systematic review of these studies also sets the stage for understanding the basic neuroscientific approaches which have been applied and provides new direction from which circadian function can be explored.

Melatoninergic System in Parkinson's Disease: From Neuroprotection to the Management of Motor and Nonmotor Symptoms

Melatonin is synthesized by several tissues besides the pineal gland, and beyond its regulatory effects in light-dark cycle, melatonin is a hormone with neuroprotective, anti-inflammatory, and antioxidant properties. Melatonin acts as a free-radical scavenger, reducing reactive species and improving mitochondrial homeostasis. Melatonin also regulates the expression of neurotrophins that are involved in the survival of dopaminergic neurons and reduces α-synuclein aggregation, thus protecting the dopaminergic system against damage. The unbalance of pineal melatonin synthesis can predispose the organism to inflammatory and neurodegenerative diseases such as Parkinson's disease (PD). The aim of this review is to summarize the knowledge about the potential role of the melatoninergic system in the pathogenesis and treatment of PD. The literature reviewed here indicates that PD is associated with impaired brain expression of melatonin and its receptors MT₁ and MT₂. Exogenous melatonin treatment presented an outstanding neuroprotective effect in animal models of PD induced by different toxins, such as 6-hydroxydopamine (6-OHDA), 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), rotenone, paraquat, and maneb. Despite the neuroprotective effects and the improvement of motor impairments, melatonin also presents the potential to improve nonmotor symptoms commonly experienced by PD patients such as sleep and anxiety disorders, depression, and memory dysfunction.

Parkinson's disease, lights and melanocytes: looking beyond the retina

Critical analysis of recent research suggesting that light pollution causes Parkinson's disease (PD) reveals that such a hypothesis is unsustainable in the context of therapeutic use of light in treating various neuropsychiatric conditions. Reinterpretation of their findings suggests that retinal damage caused by prolonged light exposure may have contributed to the observed enhancement of experimental PD. To test this hypothesis further, forty-two Sprague Dawley rats received microinjections of 6-hydroxydopamine (6-OHDA), 1-methyl-4-phenyl-2, 4, 6-tetrahydropyridine (MPTP), paraquat or rotenone into the vitreal mass in doses so minute that the effects could not be attributed to diffusion into brain. Significant changes in five motor parameters consistent with symptoms of experimental PD were observed. These findings support the interpretation that the retina is involved in the control of motor function and in the aetiology of PD.

Primary and Secondary Features of Parkinson's Disease Improve with Strategic Exposure to Bright Light: A Case Series Study

The antagonism of melatonin in models of Parkinson's disease (PD) can reduce the severity of motor impairment associated with dopamine (DA) degeneration. In consideration of the potent antidepressant effects of bright light therapy (LT), that LT suppresses melatonin secretion, that depression is commonly observed in PD, and that exposure to constant light facilitates recovery from experimental PD, the object of the present study was to strategically administer LT to PD patients and observe the effects on depression, insomnia, and motor performance. Twelve patients diagnosed with PD were exposed to white fluorescent light for 1-1.5 h at an intensity of 1000 to 1500 lux once daily commencing 1 h prior to the usual time of sleep onset, approximately 22:00 h in most patients. All patients were assessed before LT commenced and at two weeks, five weeks, and regular intervals thereafter. Within two weeks after commencing LT, marked improvement in bradykinaesia and rigidity was observed in most patients. Tremor was not affected by LT treatment; however, agitation, dyskinaesia, and psychiatric side effects were reduced, as verified by decreased requirement for DA replacement therapy. Elevated mood, improved sleep, decreased seborrhea, reduced impotence, and increased appetite were observed after LT. LT permitted the reduction of the dose of L-dopa, bromocriptine, or deprenyl in some patients by up to 50% without loss of symptom control. Factors limiting the efficacy of LT included multiple disease states, treatment compliance, polypharmacy, emotional stress, advanced age, and predominance of positive symptoms. The results of this case series study confirms previous work describing light as efficacious in the treatment of PD and suggest that controlled trials may help to elucidate how LT might be used strategically as an adjunct therapy to improve the morbidity of PD patients.

Parkinson's disease as a neuroendocrine disorder of circadian function: dopamine-melatonin imbalance and the visual system in the genesis and progression of the degenerative process

For more than 50 years, Parkinson's disease (PD) has been conceptualized as a product of nigro-striatal dopamine (NSD) system degeneration. In spite of a growing body of evidence depicting the mammalian brain as an interrelated complexity of circuitous systems, dopamine (DA) deficiency of the NSD is still regarded as the main problem, with DA replacement being the purpose of therapeutic intervention. For at least 191 years circadian involvement in various aspects of PD, including depression and insomnia, has been recognized as an integral part of the symptom matrix of PD and yet attempts to elucidate the involvement of this system is uncharted territory. The present review attempts a major reorganization of mammalian brain into a coordinated complex involving the NSD and the retinal hypothalamic tract (RHT) as the primary systems involved in the retino-diencephalic/mesencephalic-pineal (RDMP) axis. Secondary systems including the lateral hypothalamus (LH), the area postraema (AP) and the subthalamic nucleus (STN) also form an integral part of this system as they have been shown to be either intimately related to the primary systems of the RDMP axis or have been shown to be significantly involved in the expression and treatment of PD. A large volume of evidence suggests that the RDMP axis is activated during the course of PD and during therapeutic intervention. Four types of neurotoxicity associated with melatonin are identified and the susceptibility of various parts of the RDMP axis to undergo neuropathological change, the tendency for melatonin to induce PD-like behavioural toxicity, and the relationship of this to PD symptomotology are described. This includes adverse effects of melatonin on motor function, hypotension, the adjuvant use of benzodiazepines, depression, insomnia, body weight regulation and various biochemical effects of melatonin administration: all problems currently facing the proposal to introduce melatonin as an adjuvant. It is suggested further that traditional DA replacement may well work by exerting its effect upon the circadian system, rather than simply replacing deficient DA. Activation of the circadian function by antagonizing melatonin with bright light not only has therapeutic value in treating the primary symptoms of PD but it shares a common mechanism with L-dopa in reducing the occurrence of seborrheic dermatitis. Concepts at the centre of understanding pineal function in PD, including pineal calcification, melatonin deficiency, symptomatic versus protective features of melatonin and antioxidative effects, are explained in a counterintuitive context. Intriguing propositions including the role of the retina in the aetiology of PD and that the nigra functions as a retina in this disorder are presented with the intention to provide a new understanding of the underlying compromised function in PD and to provide new treatment strategies. For the first time, abundant evidence is presented describing PD as an endocrine disorder of melatonin hyperplasia. The role of circadian interventive therapies and internal desynchrony in the aetiology and progression of PD provides a new direction for understanding the underlying physiology of a disease which is currently in a state of impasse and provides new hope for those who suffer from its debilitating effects.

Recovery of experimental Parkinson's disease with the melatonin analogues ML-23 and S-20928 in a chronic, bilateral 6-OHDA model: a new mechanism involving antagonism of the melatonin receptor

Over the past 10 years, there has been a resurgence of interest in examining the role of melatonin in health and disease. While the brunt of research in this area has portrayed melatonin in a favorable light, there is a growing body of evidence suggesting that melatonin may possess adverse effects contributing to the development of various neuropsychiatric disease states. In preclinical models of Parkinson's disease (PD), melatonin has been shown to enhance the severity of this condition while its antagonism, using constant light or pinealectomy, facilitates recovery. To test this hypothesis further, the present study employed the melatonin analogues ML-23 and S-20928 in a post-6-OHDA injection regime to determine whether they may have a favorable effect on the symptoms of this more chronic model of PD. When ML-23 was injected I.P. in a dose of 3 mg/kg twice daily for 3.5 days after 6-OHDA, significant improvement in motor function and regulatory deficits was observed. Similarly, the injection of S-20928 in a 1 mg/kg dose (I.P.), in the same regimen, facilitated modest improvement in motor function and regulatory deficits while the larger dose enhanced the severity of behavioural deficits and produced severe side effects causing deterioration in condition during the course of drug administration. ML-23 administration totally abolished the 6-OHDA-induced mortality, which accompanies dopamine (DA) degeneration, while S-20928 had no effect on this parameter. These results suggest that some melatonin analogues can aid in recovery from DA depleting lesions after DA degeneration has commenced and the recovery is not attributable to the antioxidative properties of this hormone. While the exact mechanism by which ML-23 and S-20928 are exerting their therapeutic effect is unclear, it is possible that antagonism of melatonin receptors may play some role and this should be considered when assessing the potential of melatonin analogues for treatment of human neuropsychiatric disorders.

The therapeutic effects of dopamine replacement therapy and its psychiatric side effects are mediated by pineal function

There are reports that melatonin secretion from the pineal gland gradually diminishes with advancing age. It has been suggested that various forms of neuropsychiatric disease, in particular, Parkinson's disease (PD), is consequentially related to this decrease by virtue of increased oxidative stress which enhances the process of dopamine (DA) degeneration. There is, however, considerable disagreement on this theme as very little is generally known about the role of the pineal gland in the aetiology and treatment of PD. To assess the role of the pineal gland in PD and in dopamine replacement therapy (DART), the effect of three anti-Parkinsonian drugs on motor and psychiatric function was assessed in normal, pinealectomized (PX) and DA deficient, PX rats. In the first study, rats underwent PX or sham operation and were then injected (IP) with Amantadine (30 or 50 mg/kg), Bromocriptine (5 or 10 mg/kg) or L-Dopa (30 or 60 mg/kg plus 50 mg/kg of R-044602) 3-8 weeks after surgery. Open field performance and motor reflex tests were assessed during the light and dark phases of the L/D cycle. In a second study, clinically effective doses of Bromocriptine (10 mg/kg) and L-Dopa (30 and 100 mg/kg with 50 mg/kg R-044602) were injected into depleted, PX or sham operated rats. In study I, sham operated and PX rats responded differently to Bromocriptine and L-Dopa, while Amantadine did not differentially effect motor performance in the two groups. In study II, 6-OHDA induced degeneration of the nigro-striatal system abolished the effects of Bromocriptine and dramatically altered the effects of L-Dopa seen in study I, in sham operated versus PX rats. DART significantly altered emotionality, as measured by escape attempts, agitation and rage in sham operated animals, compared to PX rats. DA deficiency abolished the tendency to escape in all groups except those treated with 100mg/kg of L-Dopa. Conversely, agitation and rage scores were greater after 100 mg/kg of L-Dopa, in rats with intact pineal function, than in PX rats. These results provide compelling evidence that altered pineal function plays a major role in the aetiology of PD, the therapeutic effect of anti-Parkinsonian drugs and in the psychiatric side effects of DART.

Melatonin protects against 6-OHDA-induced neurotoxicity in rats: a role for mitochondrial complex I activity

Unilateral injection into the right substantia nigra of the catecholaminergic neurotoxin 6-hydroxydopamine (6-OHDA) produces extensive loss of dopaminergic cells ('hemi-parkinsonian rat'). The pineal hormone melatonin, which is a potent antioxidant against different reactive oxygen species and has been reported to be neuroprotective in vivo and in vitro, was evaluated for potential anti-Parkinson effects in this model. Imbalance in dopaminergic innervation between the striata produced by intranigral administration of 6-OHDA results in a postural asymmetry causing rotation away from the nonlesioned side. Melatonin given systemically prevented apomorphine-induced circling behavior in 6-OHDA-lesioned rats. Reduced activity of mitochondrial oxidative phosphorylation enzymes has been suggested in some neurodegenerative diseases; in particular, selective decrease in complex I activity is observed in the substantia nigra of Parkinson's disease patients. Analysis of mitochondrial oxidative phosphorylation enzyme activities in nigral tissue from 6-OHDA-lesioned rats by a novel BN-PAGE histochemical procedure revealed a clear loss of complex I activity, which was protected against in melatonin-treated animals. A good correlation between behavioral parameters and enzymatic (complex I) analysis was observed independent of melatonin administration. A deficit in mitochondrial complex I could conceivably contribute to cell death in parkinsonism via free radical mechanisms, both directly via reactive oxygen species production and by decreased ATP synthesis and energy failure. Melatonin may have potential utility in the treatment of neurodegenerative disorders where oxidative stress is a participant.

Melatonin administration increases the affinity of D2 dopamine receptors in the rat striatum

Rats receive melatonin (MEL) (476 +/- 6.5 microg/kg/day) via their drinking water for 2 weeks. At the end of this period, the density of D2 dopamine (DA) receptors and their affinity for [3H]-YM-09151-2 are measured in the striatum. MEL treatment increases the apparent affinity (decreases the Kd) of D2 DA receptors for [3H]YM-09151-2 by 48%, while it does not significantly alter the density (Bmax). These findings indicate that the affinity of D2 DA receptors in the striatum is influenced by exposure to MEL. The possible implications of these results are discussed.

Transcranial AC pulsed applications of weak electromagnetic fields reduces freezing and falling in progressive supranuclear palsy: a case report

Freezing is a common and disabling symptom in patients with Parkinsonism. It affects most commonly the gait in the form of start hesitation and sudden immobility often resulting in falling. A higher incidence of freezing occurs in patients with progressive supranuclear palsy (PSP) which is characterized clinically by a constellation of symptoms including supranuclear ophthalmoplegia, postural instability, axial rigidity, dysarthria, Parkinsonism, and pseudobulbar palsy. Pharmacologic therapy of PSP is currently disappointing and the disease progresses relentlessly to a fatal outcome within the first decade after onset. This report concerns a 67 year old woman with a diagnosis of PSP in whom freezing and frequent falling were the most disabling symptoms of the disease at the time of presentation. Both symptoms, which were rated 4 on the Unified Parkinson Rating Scale (UPRS) which grades Parkinsonian symptoms and signs from 0 to 4, with 0 being normal and 4 being severe symptoms, were resistant to treatment with dopaminergic drugs such as levodopa, amantadine, selegiline and pergolide mesylate as well as with the potent and highly selective noradrenergic reuptake inhibitor nortriptyline. Weekly transcranial applications of AC pulsed electromagnetic fields (EMFs) of picotesla flux density was associated with approximately 50% reduction in the frequency of freezing and about 80-90% reduction in frequency of falling after a 6 months follow-up period. At this point freezing was rated 2 while falling received a score of 1 on the UPRS. In addition, this treatment was associated with an improvement in Parkinsonian and pseudobulbar symptoms with the difference between the pre-and post EMF treatment across 13 measures being highly significant (p < .005; Sign test). These results suggest that transcranial administration AC pulsed EMFs in the picotesla flux density is efficacious in the treatment of PSP.

The antidopaminergic action of S-20098 is mediated by benzodiazepine/GABA(A) receptors in the striatum

The naphthalenic compound S-20098, which is a melatonergic agonist, inhibits [3H]diazepam binding in striatal membranes. S-20098 also inhibits apomorphine-induced turning in 6-hydroxydopamine lesioned rats. This antidopaminergic effect is blocked by either intraperitoneal injection of the central-type benzodiazepine (BZ) antagonist, flumazenil, or intrastriatal injection of the GABA(A) antagonist, bicuculline. These findings indicate that S-20098 can activate central-type BZ receptors, and its antidopaminergic action, like that of melatonin, involves a GABAergic mechanism in the striatum.

Reversal of an acute parkinsonian syndrome associated with multiple sclerosis by application of weak electromagnetic fields

The occurrence of movement disorders and particularly Parkinsonian symptoms is uncommon in patients with multiple sclerosis (MS) despite the rather frequent presence of demyelinating plaques in the basal ganglia. This disparity between the occurrence of clinical symptoms in MS and the distribution of demyelinating plaques suggests that impairment of neurotransmitter functions rather than demyelination may be critical to the clinical manifestations of the disease. A 48 year old woman with remitting-progressive MS developed a bilateral Parkinsonian syndrome in association with acute emotional stress which resolved after she received two brief successive extracerebral applications of low frequency picotesla flux density electromagnetic fields (EMFs). It is believed that in this patient Parkinsonism may have existed in a subclinical form and that acute stress, which previously has been shown to precipitate symptoms of Parkinson's disease, triggered the onset of Parkinsonism by further reducing dopaminergic and serotonergic neurotransmission in the basal ganglia. The rapid reversal of the Parkinsonian syndrome by EMFs was related to a presumed augmentation of dopaminergic and serotonergic neurotransmission which, on the basis of CSF studies, is reduced in chronic MS patients. The efficacy of EMFs in the treatment of Parkinson's disease had been documented previously but this report demonstrates that this treatment modality is beneficial also for the treatment of Parkinsonism developing in the setting of other neurodegenerative disorders.

Bidirectional effect of electromagnetic fields on ketanserin-induced yawning in patients with multiple sclerosis: the role of melatonin

5-HT2 receptors regulate sleep including yawning behavior. Ritanserin, a selective 5-HT2A receptor antagonist, increases the duration of slow wave in rats and humans. This effect is more pronounced during the light period when melatonin plasma levels are low; melatonin inhibits the sleep effects of ritanserin. These findings indicate that melatonin co-determines the effects of ritanserin on sleep. In a cohort of multiple sclerosis (MS) patients ketanserin, a selective 5-HT2A receptor antagonist, induces recurrent yawning particularly when administered in daytime. The frequency of yawning induced by the drug was modified by AC pulsed picotesla flux electromagnetic fields (EMFs) which affect melatonin secretion. Two MS patients are presented in whom the frequency of ketanserin-induced yawning was altered in opposite directions by these EMFs. The first patient, a 50 year old woman with a remitting-relapsing course, developed recurrent yawning and sleepiness after administration of ketanserin (10 mg, PO). Yawning was decreased dramatically during application of EMFs but was unaffected by a placebo EMFs treatment. The second patient, a 35 year old man with a chronic progressive course, manifested a single and brief yawn after administration of an equal dose of ketanserin. Yawning was increased dramatically during application of EMFs while remaining unchanged during a placebo EMFs treatment. These observations demonstrate a bidirectional effect of picotesla flux EMFs on ketanserin-induced yawning which may be related to differences in daytime melatonin plasma levels among MS patients. If validated by estimations of melatonin plasma levels in a larger cohort of patients the information derived from the effects of picotesla EMFs on ketanserin-induced yawning could be used to: (a) assess pineal melatonin functions in patients with MS; (b) indicate differences in pineal functions between male and female MS patients; and (c) indicate a relationship between plasma melatonin levels and the fatigue of MS.

Freezing of gait in Parkinson's disease is improved by treatment with weak electromagnetic fields

Freezing, a symptom characterized by difficulty in the initiation and smooth pursuit of repetitive movements, is a unique and well known clinical feature of Parkinson's disease (PD). It usually occurs in patients with long duration and advanced stage of the disease and is a major cause of disability often resulting in falling. In PD patients freezing manifests most commonly as a sudden attack of immobility usually experienced during walking, attempts to turn while walking, or while approaching a destination. Less commonly it is expressed as arrest of speech or handwriting. The pathophysiology of Parkinsonian freezing, which is considered a distinct clinical feature independent of akinesia, is poorly understood and is believed to involve abnormalities in dopamine and norepinephrine neurotransmission in critical motor control areas including the frontal lobe, basal ganglia, locus coeruleus and spinal cord. In general, freezing is resistant to pharmacological therapy although in some patients reduction or increase in levodopa dose may improve this symptom. Three medicated PD patients exhibiting disabling episodes of freezing of gait are presented in whom brief, extracerebral applications of pulsed electromagnetic fields (EMFs) in the picotesla range improved freezing. Two patients had freezing both during "on" and "off" periods while the third patient experienced random episodes of freezing throughout the course of the day. The effect of each EMFs treatment lasted several days after which time freezing gradually reappeared, initially in association with "off" periods. These findings suggest that the neurochemical mechanisms underlying the development of freezing are sensitive to the effects of EMFs, which are believed to improve freezing primarily through the facilitation of serotonin (5-HT) neurotransmission at both junctional (synaptic) and nonjunctional neuronal target sites.

Effect of weak electromagnetic fields on the amplitude of the pattern reversal VEP response in Parkinson's disease

Visual evoked potential (VEP) studies are widely used for the diagnosis of multiple sclerosis (MS) and are also useful in monitoring the effects of various therapeutic modalities in the disease. Prolongation of the VEP latencies has been demonstrated in patients with MS and in other neurodegenerative disorders including Parkinson's disease (PD), a disorder characterized by deficient cerebral dopamine (DA) functions. Pharmacological and biochemical studies have demonstrated a positive correlation between the amplitude of the VEP response and cerebral DA levels. Since brief, extracerebral applications of picotesla (pT) range flux intensity electromagnetic fields (EMFs) of low frequency have been shown to produce rapid improvement in motor and cognitive symptoms in PD, it is expected that application these EMFs would lead also to an increase in the amplitude of VEP response. This report documents three randomly selected PD patients who, following two successive brief extracerebral applications of pT range EMFs, showed an almost 3-fold increase of the mean pretreatment amplitude of the pattern reversal VEP in response to monocular stimulation. One patient underwent also a placebo EMF treatment which did not result in a significant change in the posttreatment amplitude. The study demonstrates that in Parkinsonian patients extracerebral application of these EMFs rapidly increases in amplitude of the VEP response and, by inference, cerebral DA levels presumably by increasing DA release.

Effects of picotesla flux electromagnetic fields on dopaminergic transmission in Tourette's syndrome

Tourette's syndrome (TS), a chronic familial neuropsychiatric disorder of unknown etiology, is characterized clinically by the presence of motor and vocal tics that wax and wane in severity over the time and by the occurrence of a variety of neurobehavioral disorders. It is believed that the tics of TS result from increased dopamine (DA) activity caused by postsynaptic DA receptor supersensitivity. The synthesis and release of DA is regulated presynaptically by a specific class of DA D2 receptors, termed autoreceptors activation of which causes inhibition of DA synthesis and release. In experimental animals and humans administration of small doses of apomorphine, a DA D2 autoreceptor agonist, produces yawning. Recurrent episodes of yawning followed by increased motor tic activity was observed in two patients with TS during exposure to brief, extracranial applications of picotesla flux electromagnetic fields (EMFs). On the basis of these observations it is suggested that recurrent episodes of yawning in response to application of EMFs was induced by activation of presynaptic DA D2 autoreceptors while further exposure to these EMFs caused excessive stimulation of postsynaptic DA D2 receptors resulting in exacerbation of the tics. Thus, the dual effects of picotesla flux EMFs on the DA D2 autoreceptor and the postsynaptic receptor resemble the biphasic pharmacological and behavioral properties of apomorphine, a DA agonist which activates the autoreceptors in low doses while in higher doses causes stimulation of the postsynaptic receptors producing exacerbation of symptoms of TS. These findings demonstrate that picotesla flux EMFs applied extracerebrally may influence nigrostriatal DA transmission at pre- and postsynaptic DA D2 receptor sites.

Treatment with weak electromagnetic fields improves fatigue associated with multiple sclerosis

It is estimated that 75-90% of patients with multiple sclerosis (MS) experience fatigue at some point during the course of the disease and that in about half of these patients, subjective fatigue is a primary complaint. In the majority of patients fatigue is present throughout the course of the day being most prominent in the mid to late afternoon. Sleepiness is not prominent, but patients report that rest may attenuate fatigability. The pathophysiology of the fatigue of MS remains unknown. Delayed impulse conduction in demyelinated zones may render transmission in the brainstem reticular formation less effective. In addition, the observation that rest may restore energy and that administration of pemoline and amantadine, which increase the synthesis and release of monoamines, often improve the fatigue of MS suggest that depletion of neurotransmitter stores in damaged neurons may contribute significantly to the development of fatigue in these patients. The present report concerns three MS patients who experienced over several years continuous and debilitating fatigue throughout the course of the day. Fatigue was exacerbated by increased physical activity and was not improved by rest. After receiving a course of treatments with picotesla flux electromagnetic fields (EMFs), which were applied extracranially, all patients experienced improvement in fatigue. Remarkably, patients noted that several months after initiation of treatment with EMFs they were able to recover, after a short period of rest, from fatigue which followed increased physical activity. These observations suggest that replenishment of monoamine stores in neurons damaged by demyelination in the brainstem reticular formation by periodic applications of picotesla flux intensity EMFs may lead to more effective impulse conduction and thus to improvement in fatigue including rapid recovery of fatigue after rest.

Weak electromagnetic fields reverse visuospatial hemi-inattention in Parkinson's disease

Drawing tasks, both free and copied, have achieved a central position in neuropsychological testing of patients with unilateral cerebral dysfunction by virtue of their sensitivity to different kinds of organic brain disorders and their ability to provide information on lateralized brain damage. In the drawings of patients with right hemispheric damage, visuospatial neglect is revealed by the omission of details on the side of the drawing contralateral to the hemispheric lesion. Patients with unilateral cerebral damage, particularly those with left hemispheric damage, also demonstrate a tendency to place their drawings on the side of the page ipsilateral to the cerebral lesion, a phenomenon which has been termed visuospatial hemi-inattention. It has been reported previously that brief external application of alternating pulsed electromagnetic fields (EMFs) in the picotesla (pT) range intensity improved visuoperceptive and visuospatial functions and reversed neglect in Parkinsonian patients. The present communication concerns four fully medicated elderly nondemented Parkinsonian patients (mean age: 74.7 +/- 4.6 yrs; mean duration of illness: 7.7 +/- 5.2 yrs) in whom application of these EMFs produced reversal of visuospatial hemi-inattention related to left hemispheric dysfunction. These findings support prior observations demonstrating that pT EMFs may bring about reversal of certain cognitive deficits in Parkinsonian patients.

Reversal of visuospatial hemi-inattention in patients with chronic progressive multiple sclerosis by treatment with weak electromagnetic fields

The occurrence of cognitive impairment including visuoperceptive and visuospatial deficits have long been recognized to occur in patients with multiple sclerosis (MS) particularly among patients with a chronic progressive course. In MS visuospatial and visuoperceptive deficits have been attributed to the presence of diffuse demyelinating plaques which "disconnect" the brainstem reticular formation and other subcortical structures involved in attention and arousal from cortical areas thus causing a state of hypoarousal. It has been reported recently that brief external applications of alternating pulsed electromagnetic fields (EMFs) in the picotesla (pT) range intensity improved visuoperceptive and visuospatial functions in MS patients. The present communication concerns three female patients with chronic progressive course of MS (mean age: 52.3 +/- 2.0 yrs; mean duration of illness: 17.6 +/- 10.2 yrs) who, on tests of free drawings, demonstrated visuospatial hemi-inattention as a feature of more global cognitive deterioration. In all patients brief applications of EMFs rapidly reversed this cognitive deficit. These findings support prior observations demonstrating that pT EMFs may bring about reversal of certain cognitive deficits in MS patients which, to my knowledge, remain unaffected by any other treatment modality.

Naltrexone attenuates the antiparkinsonian effects of picoTesla range magnetic fields

Extracranial treatment with magnetic fields (MF) in the picoTesla range has been shown an efficacious treatment modality in the management of Parkinsonism. The mechanisms by which such extremely weak MF improve Parkinsonian symptoms are unknown. As the pineal gland has been shown to function as a "magnetosensor" and since exposure to various intensities of MF disrupts melatonin secretion, it has been proposed that the beneficial effects of MF in Parkinsonism are partly mediated through the actions of pineal melatonin. Animal studies indicate that externally applied MF also influence the activity of the opioid peptides which have been implicated in a broad range of pathological conditions including Parkinsonism. To explore whether the beneficial effects of MF in Parkinsonism involve the mediation of the opioid systems and following informed consent, we administered the opiate receptor antagonist naltrexone (50 mg, P.O.) to a Parkinsonian patient after he showed improvement of symptoms with application of MF. Results of the trial showed that naltrexone partially reversed the antiparkinsonian effects of MF thus suggesting that opioid peptides are involved in mediating the clinical effects of these extremely weak MF in Parkinsonism. These results also suggest that intact opioid systems may be required for a full expression of the antiparkinsonian effect of picoTesla range MF.

Improvement in word-fluency performance in Parkinson's disease by administration of electromagnetic fields

The association between degeneration of the nigrostriatal dopamine (DA) system and the motor manifestations of Parkinson's disease (PD) provided the impetus for the development of DA replacement therapy. However, clinical experience has demonstrated that DA-ergic drugs, while attenuating the motor symptoms of PD, have little or no consistent effect on the mental and cognitive symptoms of the disease which are thought to be related partly to degeneration of the meso-cortico-limbic DA system. Thus, failure of DA-ergic drugs to improve the mental and cognitive deficits of PD indicates that these agents cannot fully restore DA functions in the meso-cortico-limbic circuits. The present communication concerns five fully medicated Parkinsonian patients in whom application of a series of treatments with electromagnetic fields (EMF) of extremely low intensity (in the picotesla range) and frequency (5-8Hz) produced a dramatic improvement in performance on Thurstone's World-Fluency Test, a sensitive marker of frontal lobe functions. These findings suggest that in contrast to DA replacement therapy application of low intensity EMF may improve frontal lobe functions in patients with PD presumably by augmenting DA activity in the mesocortical system. As deficiency of the frontal DA system has been implicated also in the development of akinesia and freezing in PD these observations may explain the beneficial effects of EMF on the motor manifestations of the disease.

Reversal of micrographia in Parkinson's disease by application of picoTesla range magnetic fields

Micrographia, a common and often early sign of Parkinson's disease (PD), is a sensitive clinical marker of the severity of bradykinesia and rigidity in the disease. As micrographia may be reversed by treatment with dopaminergic drugs and may emerge during therapy with neuroleptic agents, it is thought to reflect striatal dopaminergic deficiency. It has been reported recently that external application of picoTesla range magnetic fields (MF) produced a dramatic improvement in the motor symptoms of PD suggesting that these weak MF enhance striatal dopaminergic neurotransmission. In the present communication, we present a 61 year old patient with PD in whom picoTesla range MF attenuated the severity of bradykinesia and rigidity, improved postural stability, and rapidly reversed the micrographia within 30 minutes after termination of treatment. In contrast, sham (placebo) MF did not influence the severity of the motor symptoms of the disease or the associated micrographia. This report demonstrates the antiParkinsonian effect of picoTesla range MF and highlights the unique efficacy of these weak MF in the therapy of Parkinsonism.

Successful treatment of respiratory dyskinesia with picoTesla range magnetic fields

Respiratory dyskinesia, a syndrome characterized by an irregular respiratory rate, tachypnea, and grunting, is a serious complication of chronic neuroleptic therapy. It frequently occurs in elderly women and is commonly associated with clinical features of Tardive dyskinesia (TD). Respiratory dyskinesia initially was considered to be a rare complication of chronic neuroleptic treatment, but more recent reports indicate that respiratory abnormalities are common in patients treated with antipsychotic medications. The appropriate management of patients with respiratory dyskinesia has not been determined as the underlying pathophysiology is incompletely understood. We present a schizophrenic patient on long term antipsychotic therapy who presented with respiratory dyskinesia associated with symptoms of TD and tardive Tourette's syndrome which emerged coincident with an abrupt withdrawal of neuroleptic therapy. In this patient, external application of picoTesla range magnetic fields (MF) produced rapid attenuation in the severity of respiratory and motor dyskinesias. As the pineal gland is considered a magnetosensor and since exposure of experimental animals and humans to external MF alters melatonin secretion, we then propose that the beneficial effects of MF involve the mediation of the pineal gland which has been implicated previously in the pathophysiology of drug-induced movement disorders including TD.

Treatment of Parkinson's disease with magnetic fields reduces the requirement for antiparkinsonian medications

Recently, I reported that extracranial treatment with picoTesla range magnetic fields (MF) is an effective, safe, and revolutionary modality in the management of Parkinsonism including those patients manifesting levodopa-induced motor complications. This treatment, which has emerged as a potentially more advantageous modality than pharmacologic therapy, also produces improvements in nonmotor aspects of the disease including mood, cognitive functions, sleep, pain, appetite, autonomic functions, and sexual behavior, which are usually minimally, if at all, ameliorated by long term therapy with levodopa or anticholinergic agents. The present communication concerns a 69 year old Parkinsonian patient who, following a series of two treatments with extracranial picoTesla range MF on two separate days, improved to the point where he was able to discontinue most of his antiparkinsonian medications for a period of two weeks without experiencing deterioration in symptoms. On the third week he began to develop recurrence of symptoms and resumed taking his regular medications. At the end of the fourth week the patient received a series of four magnetic treatments on four successive days after he completely discontinued his antiparkinsonian medications. During this period he experienced a remarkable improvement in motor disability as well as in cognitive functions (i.e., visuospatial performance), mood, sleep, appetite, bowel functions and resolution of pain in the lower extremity. This report attests to the antiparkinsonian efficacy of picoTesla range MF and suggests that this treatment, when applied on a regular basis, may reduce the requirement for antiparkinsonian medications. This observation, when confirmed in a larger cohort of patients, may carry important implications for the therapy of Parkinsonism as it may offer an alternative treatment for patients who develop levodopa failure or experience intolerable side effects from dopaminergic medication. The observation that magnetic treatment improved the patient's symptoms while being off dopaminergic therapy supports the role of nondopaminergic mechanisms in the pathophysiology of Parkinsonism.

Rapid improvement of visuoperceptive functions by picoTesla range magnetic fields in patients with Parkinson's disease

Impairment in perceptual motor or visuospatial tasks is among the most frequently encountered abnormality in neuropsychological testing of patients with Parkinson's disease, being present in up to 90% of cases. Visuoperceptive deficits can result from cortical and subcortical lesions involving the right hemisphere, thalamus, and basal ganglia and are thought to reflect a defect in attentional-arousal mechanisms induced by lesions that interrupt a cortical-limbic-reticular activating loop. Clinically, the presence of visuoperceptive impairment may not be noted by Parkinsonian patients but may contribute to various disabilities including difficulty driving a vehicle and difficulties performing daily tasks which require intact visuospatial abilities (i.e., walking, dressing, drawing and copying designs). The present communication concerns two fully medicated Parkinsonian patients who responded to extracranial treatment with picoTesla range magnetic fields (MF), behaviorally and also demonstrated rapidly and dramatically enhanced visuoperceptive functions as demonstrated on various drawing tasks. These findings demonstrate the efficacy of extremely weak MF in enhancing cognitive functions in patients with Parkinson's disease.

The effects of external picoTesla range magnetic fields on the EEG in Parkinson's disease

We report a 68 year old man with a 7 year history of Parkinson's disease (PD) who obtained little benefit from treatment by dopaminergic and anticholinergic agents. During the six months prior to presentation, he experienced more rapid deterioration in symptoms including memory functions, increasing depression, and dystonia of the foot. External application of picoTesla range magnetic fields (MF) resulted in rapid attenuation of tremor and foot dystonia with improvements in gait, postural reflexes, mood, anxiety, cognitive, and autonomic functions. Plasma prolactin and luteinizing hormone (LH) levels rose three days after initiation of treatment. In addition, distinct electroencephalographic (EEG) changes were recorded nine days after two treatments with MF and included enhancement of alpha and beta activities as well as resolution of the theta activity. These findings demonstrate, for the first time, objective EEG changes in response to picoTesla range MF in PD. Since the pineal gland is a magnetosensor and as some of the clinical effects produced by MF such as relaxation, sleepiness, mood elevation, increased dreaming, and enhancement of alpha and beta activities in the EEG have also been noted in healthy subjects administered melatonin, we propose that the clinical effects as well as the EEG changes noted after treatment with MF were mediated by the pineal gland which previously has been implicated in the pathophysiology of PD.

Magnetic fields normalize visual evoked potentials and brainstem auditory evoked potentials in multiple sclerosis

The present communication concerns a 46 year old woman with a 10 year history of chronic progressive multiple sclerosis (MS) in whom external application of magnetic fields (MF) (7.5 picoTesla; 5 Hz) during a period of remission resulted in a rapid and dramatic improvement in symptoms including vision, cerebellar symptomatology (ataxia and dysarthria), mood, sleep, bowel and bladder functions as well as fatigue. Improvement in the patient's symptoms was associated with normalization of the pretreatment latencies of the visual evoked potentials and brainstem auditory evoked potential responses within a week after initiation of magnetic treatment. This report demonstrates that treatment with picoTesla MF is an effective, nonpharmacological modality in the management of MS and for the first time documents reversal of abnormal evoked potential responses by this treatment. The pineal gland is a magnetosensor. As MF affect the release of the pineal gland's principal hormone, melatonin, it is hypothesized that the effects of picoTesla MF in MS are partly mediated by the pineal gland which has recently been implicated in the pathogenesis of MS (Sandyk, 1992 a; b).