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Bougea A. Digital biomarkers in Parkinson's disease. Adv Clin Chem 2024; 123:221-253. [PMID: 39181623 DOI: 10.1016/bs.acc.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Digital biomarker (DB) assessments provide objective measures of daily life tasks and thus hold promise to improve diagnosis and monitoring of Parkinson's disease (PD) patients especially those with advanced stages. Data from DB studies can be used in advanced analytics such as Artificial Intelligence and Machine Learning to improve monitoring, treatment and outcomes. Although early development of inertial sensors as accelerometers and gyroscopes in smartphones provided encouraging results, the use of DB remains limited due to lack of standards, harmonization and consensus for analytical as well as clinical validation. Accordingly, a number of clinical trials have been developed to evaluate the performance of DB vs traditional assessment tools with the goal of monitoring disease progression, improving quality of life and outcomes. Herein, we update current evidence on the use of DB in PD and highlight potential benefits and limitations and provide suggestions for future research study.
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Affiliation(s)
- Anastasia Bougea
- Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Olvera CE, Fleisher JE, Kramer NM. Motor Complications and Treatment in Advanced Parkinson's Disease #456. J Palliat Med 2023; 26:730-731. [PMID: 37130285 DOI: 10.1089/jpm.2023.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
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Levodopa-Induced Dyskinesia in Parkinson's Disease: Pathogenesis and Emerging Treatment Strategies. Cells 2022; 11:cells11233736. [PMID: 36496996 PMCID: PMC9736114 DOI: 10.3390/cells11233736] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
The most commonly used treatment for Parkinson's disease (PD) is levodopa, prescribed in conjunction with carbidopa. Virtually all patients with PD undergo dopamine replacement therapy using levodopa during the course of the disease's progression. However, despite the fact that levodopa is the "gold standard" in PD treatments and has the ability to significantly alleviate PD symptoms, it comes with side effects in advanced PD. Levodopa replacement therapy remains the current clinical treatment of choice for Parkinson's patients, but approximately 80% of the treated PD patients develop levodopa-induced dyskinesia (LID) in the advanced stages of the disease. A better understanding of the pathological mechanisms of LID and possible means of improvement would significantly improve the outcome of PD patients, reduce the complexity of medication use, and lower adverse effects, thus, improving the quality of life of patients and prolonging their life cycle. This review assesses the recent advancements in understanding the underlying mechanisms of LID and the therapeutic management options available after the emergence of LID in patients. We summarized the pathogenesis and the new treatments for LID-related PD and concluded that targeting pathways other than the dopaminergic pathway to treat LID has become a new possibility, and, currently, amantadine, drugs targeting 5-hydroxytryptamine receptors, and surgery for PD can target the Parkinson's symptoms caused by LID.
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Higher cerebrospinal fluid to plasma ratio of p-cresol sulfate and indoxyl sulfate in patients with Parkinson's disease. Clin Chim Acta 2019; 501:165-173. [PMID: 31726035 DOI: 10.1016/j.cca.2019.10.038] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), impairment of brain to blood barrier and/or blood-cerebrospinal fluid (CSF) barrier is described. It can increase the level of uremic toxins in CSF. So far, role of these compounds in neurological disorders has not been completely understood. However, a link has been observed between chronic kidney disease and neurological disorders. We measured the concentrations of uremic toxins (i.e. indoxyl sulfate (IS), p-cresol sulfate (pCS), symmetric dimethylarginine (SDMA), asymmetric dimethylarginine (ADMA), and trimethylamine N-oxide (TMAO)) in CSF and plasma, and correlated them with inflammation and oxidative stress biomarkers. METHODS Plasma and CSF samples were collected from 27 volunteers (18 with PD and 9 controls). The level of toxins was determined using liquid chromatography coupled with tandem mass spectrometry. RESULTS In PD, for IS and pCS, CSF-plasma ratio was higher. Concentration of pCS in CSF was higher in PD compared to controls. TMAO level was also higher in plasma of that group. Patients with motor fluctuations had higher level of uremic toxins in CSF, but not in plasma. CONCLUSIONS The level of pCS and IS in CSF of PD is higher than expected, based on their blood level. It can influence pathogenesis and progression of PD.
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Nakajima A, Shimo Y, Sekimoto S, Kamagata K, Jo T, Oyama G, Umemura A, Hattori N. Dopamine transporter imaging predicts motor responsiveness to levodopa challenge in patients with Parkinson's disease: A pilot study of DATSCAN for subthalamic deep brain stimulation. J Neurol Sci 2018; 385:134-139. [PMID: 29406893 DOI: 10.1016/j.jns.2017.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 12/18/2017] [Accepted: 12/25/2017] [Indexed: 01/06/2023]
Abstract
Imaging studies are necessary prior to subthalamic deep brain stimulation (STN-DBS). Dopamine transporter (DAT) imaging is a powerful tool for visualizing dopamine terminals in the striatum, but its usefulness in STN-DBS is unclear. Here, we retrospectively investigated the relationship between motor symptoms and the specific binding ratio (SBR) on DAT imaging in patients with Parkinson's disease (PD). We included 23 consecutive patients (9 female; 14 male) who were evaluated for DBS eligibility between October 2013 and October 2014 and subsequently received bilateral STN-DBS. Correlation and simple regression analyses were performed on SBR values and clinical parameters before and after surgery. SBR value was negatively correlated with Unified Parkinson's Disease Rating Scale (UPDRS) motor score in the "ON" state before surgery (rs=-0.637, p=0.001) and positively correlated with the reduction of the levodopa equivalent daily dose by surgery (r=0.422, p=0.045). A simple regression analysis revealed that SBR value was positively correlated with UPDRS motor score improvement after levodopa challenge before surgery (p=0.001, R2=0.423). DAT imaging may be useful in STN-DBS candidate selection and the identification of the therapeutic mechanism of STN-DBS in patients with advanced PD and motor symptom fluctuations.
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Affiliation(s)
- Asuka Nakajima
- Department of Neurology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Yasushi Shimo
- Department of Neurology, School of Medicine, Juntendo University, Tokyo, Japan; Department of Research and Therapeutics for Movement Disorders, School of Medicine, Juntendo University, Tokyo, Japan.
| | - Satoko Sekimoto
- Department of Neurology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Takayuki Jo
- Department of Neurology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Genko Oyama
- Department of Neurology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Atsushi Umemura
- Department of Research and Therapeutics for Movement Disorders, School of Medicine, Juntendo University, Tokyo, Japan; Department of Neurosurgery, School of Medicine, Juntendo University, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, School of Medicine, Juntendo University, Tokyo, Japan
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Tanguy A, Jönsson L, Ishihara L. Inventory of real world data sources in Parkinson's disease. BMC Neurol 2017; 17:213. [PMID: 29216834 PMCID: PMC5721688 DOI: 10.1186/s12883-017-0985-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Real world data have an important role to play in the evaluation of epidemiology and burden of disease; and in assisting health-care decision-makers, especially related to coverage and payment decisions. However, there is currently no overview of the existing longitudinal real world data sources in Parkinson’s disease (PD) in the USA. Such an assessment can be very helpful, to support a future effort to harmonize real world data collection and use the available resources in an optimal way. Methods The objective of this comprehensive literature review is to systematically identify and describe the longitudinal, real world data sources in PD in the USA, and to provide a summary of their measurements (categorized into 8 main dimensions: motor and neurological functions, cognition, psychiatry, activities of daily living, sleep, quality of life, autonomic symptoms and other). The literature search was performed using MEDLINE, EMBASE and internet key word search. Results Of the 53 data sources identified between May and August 2016, 16 were still ongoing. Current medications (81%) and comorbidities (79%) were frequently collected, in comparison to medical imaging (36%), genetic information (30%), caregiver burden (11%) and healthcare costs (2%). Many different measurements (n = 108) were performed and an interesting variability among used measurements was revealed. Conclusions Many longitudinal real world data sources on PD exist. Different types of measurements have been performed over time. To allow comparison and pooling of these multiple data sources, it will be essential to harmonize practices in terms of types of measurements.
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Affiliation(s)
- Audrey Tanguy
- Lundbeck SAS, 37-45 Quai du Président Roosevelt, CEDEX 92445, Issy-les-Moulineaux, France
| | - Linus Jönsson
- Lundbeck SAS, 37-45 Quai du Président Roosevelt, CEDEX 92445, Issy-les-Moulineaux, France
| | - Lianna Ishihara
- Lundbeck SAS, 37-45 Quai du Président Roosevelt, CEDEX 92445, Issy-les-Moulineaux, France.
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Martino T, Melchionda D, Tonti P, De Francesco V, Lalla A, Specchio LM, Avolio C. Weight loss and decubitus duodenal ulcer in Parkinson’s disease treated with levodopa–carbidopa intestinal gel infusion. J Neural Transm (Vienna) 2016; 123:1395-1398. [PMID: 27614656 DOI: 10.1007/s00702-016-1618-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/04/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Tommaso Martino
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy.
| | - Donato Melchionda
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | - Paolo Tonti
- Gastroenterology Unit-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | | | - Alessandra Lalla
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
| | | | - Carlo Avolio
- SC Neurologia Universitaria-AOU Ospedali Riuniti of Foggia, Foggia, Italy
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Fabbri M, Coelho M, Abreu D, Guedes LC, Rosa MM, Costa N, Antonini A, Ferreira JJ. Do patients with late-stage Parkinson's disease still respond to levodopa? Parkinsonism Relat Disord 2016; 26:10-6. [DOI: 10.1016/j.parkreldis.2016.02.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
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Belin J, Houéto JL, Constans T, Hommet C, de Toffol B, Mondon K. [Geriatric particularities of Parkinson's disease: Clinical and therapeutic aspects]. Rev Neurol (Paris) 2015; 171:841-52. [PMID: 26573332 DOI: 10.1016/j.neurol.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/03/2015] [Accepted: 08/13/2015] [Indexed: 11/24/2022]
Abstract
Parkinson's disease (PD) is a frequent and complex progressive neurological disorder that increases in incidence with age. Although historically PD has been characterized by the presence of progressive dopaminergic neuronal loss of the substantia nigra, the disease process also involves neurotransmitters other that dopamine and regions of the nervous system outside the basal ganglia. Its clinical presentation in elderly subjects differs from that in younger subjects, with more rapid progression, less frequent tremor, more pronounced axial signs, more frequent non-motor signs linked to concomitant degeneration of non-dopaminergic systems, and more frequent associated lesions. Despite the high prevalence of PD in elderly subjects, few therapeutic trials have been conducted in geriatric patients. Nevertheless, to improve functional disability while ensuring drug tolerance, the principles of optimized and multidisciplinary clinical management have to be known. The aim of this review is to provide an update on clinical and therapeutic features of PD specifically observed in elderly subjects.
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Affiliation(s)
- J Belin
- Service de neurologie et de neurophysiologie clinique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France.
| | - J L Houéto
- Service de neurologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - T Constans
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - C Hommet
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Centre mémoire de ressources et de recherche (CMRR) de la région Centre, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - B de Toffol
- Service de neurologie et de neurophysiologie clinique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France
| | - K Mondon
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Centre mémoire de ressources et de recherche (CMRR) de la région Centre, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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Abstract
PURPOSE OF REVIEW Later stage Parkinson's disease, sometimes referred to as advanced disease, has been characterized by motor complication, as well as by the potential emergence of nonlevodopa responsive motor and nonmotor symptoms. The management of advanced stage Parkinson's disease can be complex. This review summarizes the currently available treatment strategies for addressing advanced Parkinson's disease. RECENT FINDINGS We will discuss the latest pharmacological strategies (e.g., inhibitors of dopamine-metabolizing enzymes, dopamine agonists, and extended release dopamine formulations) for addressing motor dysfunction. We will summarize the risks and benefits of current invasive treatments. Finally, we will address the current evidence supporting the treatment of nonmotor symptoms in the advanced Parkinson's disease patient. We will conclude by detailing the potential nonpharmacological and multidisciplinary approaches for advanced stage Parkinson's disease. SUMMARY The optimization of levodopa is, in most cases, the most powerful therapeutic option available; however, medication optimization requires an advanced understanding of Parkinson's disease. Failure of conventional pharmacotherapy should precipitate a discussion of the potential risks and benefits of more invasive treatments. Currently, there are no comparative studies of invasive treatment. Among the invasive treatments, deep brain stimulation has the largest amount of existing evidence, but also has the highest individual per patient risk. Nonmotor symptoms will affect quality of life more than the motor Parkinson's disease symptoms, and these nonmotor symptoms should be aggressively treated. Many advanced Parkinson's disease patients will likely benefit from multi and interdisciplinary Parkinson's disease teams with multiple professionals collaborating to develop a collective and tailored strategy for an individual patient.
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Wu H, Dong F, Wang Y, Xiao Q, Yang Q, Zhao J, Quinn TJ, Chen SD, Liu J. Catechol-O-methyltransferase Val158Met polymorphism: modulation of wearing-off susceptibility in a Chinese cohort of Parkinson's disease. Parkinsonism Relat Disord 2014; 20:1094-6. [PMID: 25108642 DOI: 10.1016/j.parkreldis.2014.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 02/04/2023]
Abstract
Catechol-O-methyltransferase (COMT) is one of the cardinal enzymes that metabolize dopamine and other catecholamine neurotransmitters in the central and peripheral nervous system. Recent studies have shown that the impact of COMT haplotypes on the development of wearing-off phenomenon is in dispute, while the relationship between COMT haplotypes and wearing-off phenomenon in ethnic Chinese population is lacking. The purpose of this study was to characterize the correlation between the Val158Met polymorphism in the COMT gene and the motor complication "wearing-off" in Chinese PD patients. We have sequenced the COMT gene in 259 PD patients and 257 healthy controls. Our results demonstrated that Met/Met homozygosity of the COMT Val158Met polymorphism was related to a decreased risk of developing wearing-off. This finding suggests that COMT Val158Met may affect susceptibility to wearing-off in PD.
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Affiliation(s)
- Hui Wu
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Department of Neurology, Minhang Hospital, Shanghai 201100, China
| | - Fangyi Dong
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ying Wang
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qin Xiao
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qiong Yang
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Shanghai 201100, China
| | - Thomas J Quinn
- Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, NY 10461, USA
| | - Sheng-di Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Late-stage Parkinson's disease: the Barcelona and Lisbon cohort. J Neurol 2010; 257:1524-32. [PMID: 20411272 DOI: 10.1007/s00415-010-5566-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
Abstract
Studies of late stages of Parkinson's disease (LS-PD) are limited. To provide an adequate health plan for patients in these most advanced stages, accurate information on their clinical condition is necessary. We characterize clinical features and medication use of LS-PD. A cross-sectional study of LS-PD stage 4 or 5 of Hoehn and Yahr during on states is presented in this paper. Demographics, clinical features and medication data were obtained using a structured questionnaire and physical examination. Patients were asked to grade the perceived impact of symptoms on their health status. Fifty patients (mean age 74.1 years and mean disease duration 17.9 years) were studied. Severe akinetic symmetric parkinsonism was present in most, with negligible rigidity and tremor, and most patients were wheelchair-bound. Severe postural instability and freezing of gait, causing frequent falls and fractures, and prominent dysarthria and dysphagia dominated the motor syndrome. Levodopa remained effective in most patients in relieving motor symptoms including tremor. Motor fluctuations and dyskinesias were present in 78 and 62% of patients, respectively, but were not perceived as disabling. All had neuropsychiatric and dysautonomic symptoms. Visual hallucinations were present in 44%, depression in 62% and dementia in 50%. Lack of tremor (p < 0.01) and absence of depression (p < 0.01) were independently associated with dementia (R(2) = 45%). Symptoms causing greatest impact on perceived health status were falls, gait unsteadiness, urinary dysfunction and sweats. Motor and non-motor non-levodopa responsive problems were frequent and the main cause of disability. Fluctuations and dyskinesias were frequent though not disabling. Dementia is not unavoidable in these very late stages.
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Bishop C, Krolewski DM, Eskow KL, Barnum CJ, Dupre KB, Deak T, Walker PD. Contribution of the striatum to the effects of 5-HT1A receptor stimulation in L-DOPA-treated hemiparkinsonian rats. J Neurosci Res 2009; 87:1645-58. [PMID: 19115412 DOI: 10.1002/jnr.21978] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Clinical and experimental studies implicate the use of serotonin (5-HT)1A receptor agonists for the reduction of L-3,4-dihydroxyphenylalanine (L-DOPA)-induced dyskinesia (LID). Although raphe nuclei likely play a role in these antidyskinetic effects, an unexplored population of striatal 5-HT1A receptors (5-HT1AR) may also contribute. To better characterize this mechanism, L-DOPA-primed hemiparkinsonian rats received the 5-HT1AR agonist +/-8-OH-DPAT (0, 0.1, 1.0 mg/kg, i.p.) with or without cotreatment with the 5-HT1AR antagonist WAY100635 (0.5 mg/kg, i.p.) 5 min after L-DOPA, after which abnormal involuntary movements (AIMs), rotations, and forelimb akinesia were quantified. To establish the effects of 5-HT1AR stimulation on L-DOPA-induced c-fos and preprodynorphin (PPD) mRNA within the dopamine-depleted striatum, immunohistochemistry and real-time reverse transcription polymerase chain reaction, respectively, were used. Finally, to determine the contribution of striatal 5-HT1AR to these effects, L-DOPA-primed hemiparkinsonian rats received bilateral intrastriatal microinfusions of +/-8-OH-DPAT (0, 5, or 10 microg/side), WAY100635 (5 microg/side), or both (10 microg + 5 microg/side) 5 min after L-DOPA, after which AIMs and rotations were examined. Systemic +/-8-OH-DPAT dose- and receptor-dependently attenuated L-DOPA-mediated AIMs and improved forelimb akinesia. Striatal c-fos immunoreactivity and PPD mRNA ipsilateral to the lesion were strongly induced by L-DOPA, while +/-8-OH-DPAT suppressed these effects. Finally, intrastriatal infusions of +/-8-OH-DPAT reduced AIMs while coinfusion of WAY100635 reversed its antidyskinetic effect. Collectively, these results support the hypothesis that the cellular and behavioral properties of 5-HT1AR agonists are conveyed in part via a population of functional 5-HT1AR within the striatum.
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Affiliation(s)
- Christopher Bishop
- Behavioral Neuroscience Program, Department of Psychology, State University of New York at Binghamton, Binghamton, NY 13902, USA.
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Zesiewicz TA, Sullivan KL, Hauser RA. Levodopa-induced Dyskinesia in Parkinson’s disease: Epidemiology, etiology, and treatment. Curr Neurol Neurosci Rep 2007; 7:302-10. [PMID: 17618536 DOI: 10.1007/s11910-007-0046-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although levodopa is the gold standard for treating motor symptoms of Parkinson's disease (PD), long-term therapy leads to levodopa-induced dyskinesia (LID). Dyskinesia refers to involuntary movements other than tremor and most commonly consists of chorea that occurs when levodopa-derived dopamine is peaking in the brain ("peak-dose dyskinesia"). However, dyskinesia can also consist of dystonia or myoclonus and occur during other parts of the levodopa dosing cycle. New validated rating scales and home diaries can better help the health care provider assess the timing and severity of dyskinesia. The exact etiology of LID is unknown, but there is evidence that abnormal pulsatile stimulation of dopamine receptors may be contributory. Treatment of LID includes adjustment of PD medications to maximize "on" time without troublesome dyskinesia. Amantadine is the only medication available with demonstrated ability to reduce the expression of established LID without reducing antiparkinsonian benefit. Other medications that are currently being studied to treat established LID include antiepileptics and serotonergic medications. Deep brain stimulation of the subthalamic nucleus is now the most commonly used surgical procedure for PD patients, and it is very effective in treating LID.
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Affiliation(s)
- Theresa A Zesiewicz
- Parkinson's Disease and Movement Disorders Center, University of South Florida, Tampa, Florida 33612, USA.
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