1
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Su D, Zhang X, Su Y, Chan P, Xu E. Effects of different levodopa doses on blood pressure in older patients with early and middle stages of Parkinson's disease. Heliyon 2023; 9:e17876. [PMID: 37483692 PMCID: PMC10362309 DOI: 10.1016/j.heliyon.2023.e17876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/03/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Levodopa is the first-line treatment for patients with Parkinson's disease (PD). However, only a few studies have focused on the tolerance of this drug in older patients with PD in the early and middle stages. Therefore, this study aimed to explore the effects of different levodopa doses on blood pressure (BP) in this subpopulation. Methods This cohort analysis enrolled 83 patients. The levodopa challenge test was used to evaluate drug responsiveness. After at least 12 h following anti-PD drug discontinuation, patients' BPs were measured in a lying position, after 1 min standing, and after 3 min standing, in "off state" and best "on state." Results BP in the 250 mg and 375 mg levodopa/benserazide groups decreased significantly in the lying and standing positions. The 3-min standing-position systolic BP was significantly influenced by the dose of levodopa/benserazide. However, no statistical change was observed in the 125 mg group. The postural-mediated systolic BP disparity was significant at 3 min in the upright position. Nineteen (incidence, 22.9%) and Twenty-five patients (incidence, 30.1%) developed complications of orthostatic hypotension (OH) in the "off state" and best "on state," respectively. Mild cognitive impairment was a risk factor for OH occurrence in the "off state." The OH occurrence in the best "on state" was associated with OH in the "off state" and urinary incontinence. Conclusion Our findings suggest that 250 mg or more of levodopa/benserazide could significantly reduce BP and orthostatic effect in older patients with PD in the early and middle stages. Therefore, they should routinely monitor their BP. Trial registration number ChiCTR2200055707.
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Affiliation(s)
- Dan Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing 102400, China
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Xiaojun Zhang
- Department of Geriatrics, Occupational Disease Prevention and Control Institute of Chemical Industry, Beijing 100093, China
| | - Yanling Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing 102400, China
| | - Piu Chan
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
- Clinical Center for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, China
| | - Erhe Xu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
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2
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Tsuboi T, Satake Y, Hiraga K, Yokoi K, Hattori M, Suzuki M, Hara K, Ramirez-Zamora A, Okun MS, Katsuno M. Effects of MAO-B inhibitors on non-motor symptoms and quality of life in Parkinson's disease: A systematic review. NPJ Parkinsons Dis 2022; 8:75. [PMID: 35697709 PMCID: PMC9192747 DOI: 10.1038/s41531-022-00339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
Non-motor symptoms (NMS) are common among patients with Parkinson's disease and reduce patients' quality of life (QOL). However, there remain considerable unmet needs for NMS management. Three monoamine oxidase B inhibitors (MAO-BIs), selegiline, rasagiline, and safinamide, have become commercially available in many countries. Although an increasing number of studies have reported potential beneficial effects of MAO-BIs on QOL and NMS, there has been no consensus. Thus, the primary objective of this study was to provide an up-to-date systematic review of the QOL and NMS outcomes from the available clinical studies of MAO-BIs. We conducted a literature search using the PubMed, Scopus, and Cochrane Library databases in November 2021. We identified 60 publications relevant to this topic. Overall, rasagiline and safinamide had more published evidence on QOL and NMS changes compared with selegiline. This was likely impacted by selegiline being introduced many years prior to the field embarking on the study of NMS. The impact of MAO-BIs on QOL was inconsistent across studies, and this was unlikely to be clinically meaningful. MAO-BIs may potentially improve depression, sleep disturbances, and pain. In contrast, cognitive and olfactory dysfunctions are likely unresponsive to MAO-BIs. Given the paucity of evidence and controlled, long-term studies, the effects of MAO-BIs on fatigue, autonomic dysfunctions, apathy, and ICD remain unclear. The effects of MAO-BIs on static and fluctuating NMS have never been investigated systematically. More high-quality studies will be needed and should enable clinicians to provide personalized medicine based on a non-motor symptom profile.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Yuki Satake
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Hiraga
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsunori Yokoi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neurology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Makoto Hattori
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Clinical laboratory, Nagoya University Hospital, Nagoya, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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3
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Suri JS, Paul S, Maindarkar MA, Puvvula A, Saxena S, Saba L, Turk M, Laird JR, Khanna NN, Viskovic K, Singh IM, Kalra M, Krishnan PR, Johri A, Paraskevas KI. Cardiovascular/Stroke Risk Stratification in Parkinson's Disease Patients Using Atherosclerosis Pathway and Artificial Intelligence Paradigm: A Systematic Review. Metabolites 2022; 12:metabo12040312. [PMID: 35448500 PMCID: PMC9033076 DOI: 10.3390/metabo12040312] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022] Open
Abstract
Parkinson’s disease (PD) is a severe, incurable, and costly condition leading to heart failure. The link between PD and cardiovascular disease (CVD) is not available, leading to controversies and poor prognosis. Artificial Intelligence (AI) has already shown promise for CVD/stroke risk stratification. However, due to a lack of sample size, comorbidity, insufficient validation, clinical examination, and a lack of big data configuration, there have been no well-explained bias-free AI investigations to establish the CVD/Stroke risk stratification in the PD framework. The study has two objectives: (i) to establish a solid link between PD and CVD/stroke; and (ii) to use the AI paradigm to examine a well-defined CVD/stroke risk stratification in the PD framework. The PRISMA search strategy selected 223 studies for CVD/stroke risk, of which 54 and 44 studies were related to the link between PD-CVD, and PD-stroke, respectively, 59 studies for joint PD-CVD-Stroke framework, and 66 studies were only for the early PD diagnosis without CVD/stroke link. Sequential biological links were used for establishing the hypothesis. For AI design, PD risk factors as covariates along with CVD/stroke as the gold standard were used for predicting the CVD/stroke risk. The most fundamental cause of CVD/stroke damage due to PD is cardiac autonomic dysfunction due to neurodegeneration that leads to heart failure and its edema, and this validated our hypothesis. Finally, we present the novel AI solutions for CVD/stroke risk prediction in the PD framework. The study also recommends strategies for removing the bias in AI for CVD/stroke risk prediction using the PD framework.
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Affiliation(s)
- Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
- Correspondence: ; Tel.: +1-(916)-749-5628
| | - Sudip Paul
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India; (S.P.); (M.A.M.)
| | - Maheshrao A. Maindarkar
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India; (S.P.); (M.A.M.)
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
- Annu’s Hospitals for Skin & Diabetes, Gudur 524101, India
| | - Sanjay Saxena
- Department of CSE, International Institute of Information Technology, Bhuneshwar 751003, India;
| | - Luca Saba
- Department of Radiology, University of Cagliari, 09121 Cagliari, Italy;
| | - Monika Turk
- Deparment of Neurology, University Medical Centre Maribor, 1262 Maribor, Slovenia;
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St. Helena, CA 94574, USA;
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India;
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia;
| | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
| | - Mannudeep Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
| | | | - Amer Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Kosmas I. Paraskevas
- Department of Vascular Surgery, Central Clinic of Athens, 106 80 Athens, Greece;
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4
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He X, Mo C, Zhang Y, Cai Y, Yang X, Qian Y, Xiao Q. Effect of Acute Levodopa Up-Titration on Blood Pressure in Patients With Early Stage Parkinson's Disease: Results of a Levodopa Challenge Test. Front Aging Neurosci 2022; 13:778856. [PMID: 35046792 PMCID: PMC8761988 DOI: 10.3389/fnagi.2021.778856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/08/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Levodopa up-titration is the primary therapeutic strategy as the Parkinson’s disease (PD) progresses. However, the effects of levodopa up-titration on blood pressure (BP) are inconclusive. This study aimed to investigate the effect of acute levodopa up-titration simulated by levodopa challenge test (LCT) on BP in patients with early stage PD. Methods: We monitored BP in 52 patients with early stage PD using a standardized standing test. BP was assessed in supine position after 10 min of rest and at 1 and 3 min after standing up. BP was measured in the “off-state” and the best “on-state” during LCT in the morning at hospital. In another day, “off-state” and the best “on-state” BP was measured before and after anti-PD drug uptake in the morning at home. Demographic and clinical features of the patients were evaluated and analyzed. Results: In the LCT, the prevalence of OH in the “off-state” and the best “on-state” was 11.5 and 13.5%, respectively. Additionally, the OH in the best “on-state” was associated with OH in the “off-state” and monoamine oxidase B inhibitor use. Although 38 (73.1%) patients experienced levodopa-induced hypotension during the LCT, no risk factors were identified. While BP reductions were observed after taking anti-PD drugs at home, no further reduction was seen during acute levodopa up-titration simulated by the LCT. Conclusion: Our results demonstrate that acute levodopa up-titration does not exacerbate BP reduction induced by anti-PD drugs at home. BP monitoring is critical for the management of patients with PD.
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Affiliation(s)
- Xiaoqin He
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengjun Mo
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Cai
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Yang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwei Qian
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Xiao
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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5
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Finberg JPM. Inhibitors of MAO-B and COMT: their effects on brain dopamine levels and uses in Parkinson's disease. J Neural Transm (Vienna) 2018; 126:433-448. [PMID: 30386930 DOI: 10.1007/s00702-018-1952-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/29/2018] [Indexed: 12/30/2022]
Abstract
MAO-B and COMT are both enzymes involved in dopamine breakdown and metabolism. Inhibitors of these enzymes are used in the treatment of Parkinson's disease. This review article describes the scientific background to the localization and function of the enzymes, the physiological changes resulting from their inhibition, and the basic and clinical pharmacology of the various inhibitors and their role in treatment of Parkinson's disease.
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Affiliation(s)
- John P M Finberg
- Neuroscience Group, Rappaport Faculty of Medicine, Haifa, Israel.
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6
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Kanegusuku H, Silva-Batista C, Peçanha T, Silva-Junior N, Queiroz A, Costa L, Mello M, Piemonte M, Ugrinowitsch C, Forjaz C. Patients with Parkinson disease present high ambulatory blood pressure variability. Clin Physiol Funct Imaging 2016; 37:530-535. [PMID: 28776928 DOI: 10.1111/cpf.12338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 11/13/2015] [Indexed: 11/30/2022]
Abstract
Patients with Parkinson disease (PD) present blunted nocturnal blood pressure fall and similar ambulatory blood pressure variability (ABPV) measured by standard deviation (SD) and coefficient of variation (CV) compared with healthy subjects. However, these classical indices of ABPV have limited validity in individuals with circadian blood pressure alterations. New indices, such as the average of daytime and night-time standard deviation weighted by the duration of the daytime and night-time intervals (SDdn ) and the average real variability (ARV), remove the influence of the daytime and the night-time periods on ABPV. This study assessed ABPV by SDdn and ARV in PD. Twenty-one patients with PD (11 men, 66 ± 2 years, stages 2-3 of modified Hoehn & Yahr) and 21 matched controls without Parkinson disease (9 men, 64 ± 1 years old) underwent blood pressure monitoring for 24 h. ABPV was analysed by 24 h, daytime and night-time SD and CV, and by the SDdn and ARV. Systolic/diastolic 24-h and night-time SD and CV were similar between the patients with PD and the controls. The patients with PD presented higher daytime systolic/diastolic CV and SD than the controls (10·4 ± 0·9/12·3 ± 0·8 versus 7·0 ± 0·3/9·9 ± 0·5%, P<0·05; 12·6 ± 1·0/9·1 ± 0·5 versus 8·6 ± 0·4/7·5 ± 0·3 mmHg, P<0·05, respectively) as well as higher systolic/diastolic SDdn (10·9 ± 0·8/8·2 ± 0·5 versus 8·2 ± 0·3/7·1 ± 0·2 mmHg, P<0·05, respectively) and ARV (8·8 ± 0·6/6·9 ± 0·3 versus 7·2 ± 0·2/6·0 ± 0·2 mmHg, P<0·05, respectively). In conclusion, patients with PD have higher ABPV than control subjects as assessed by SDd , CVd , SDdn and AVR.
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Affiliation(s)
- Hélcio Kanegusuku
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Carla Silva-Batista
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Tiago Peçanha
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Natan Silva-Junior
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Andreia Queiroz
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Luiz Costa
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Marco Mello
- School of Physical Education, Federal University of Minas Gerais, Sao Paulo, Brazil
| | - Maria Piemonte
- Faculty of Medical Science, University of São Paulo, Sao Paulo, Brazil
| | - Carlos Ugrinowitsch
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Cláudia Forjaz
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
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7
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Csoti I, Jost WH, Reichmann H. Parkinson's disease between internal medicine and neurology. J Neural Transm (Vienna) 2016; 123:3-17. [PMID: 26298728 PMCID: PMC4713462 DOI: 10.1007/s00702-015-1443-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/10/2015] [Indexed: 02/07/2023]
Abstract
General medical problems and complications have a major impact on the quality of life in all stages of Parkinson's disease. To introduce an effective treatment, a comprehensive analysis of the various clinical symptoms must be undertaken. One must distinguish between (1) diseases which arise independently of Parkinson's disease, and (2) diseases which are a direct or indirect consequence of Parkinson's disease. Medical comorbidity may induce additional limitations to physical strength and coping strategies, and may thus restrict the efficacy of the physical therapy which is essential for treating hypokinetic-rigid symptoms. In selecting the appropriate medication for the treatment of any additional medical symptoms, which may arise, its limitations, contraindications and interactions with dopaminergic substances have to be taken into consideration. General medical symptoms and organ manifestations may also arise as a direct consequence of the autonomic dysfunction associated with Parkinson's disease. As the disease progresses, additional non-parkinsonian symptoms can be of concern. Furthermore, the side effects of Parkinson medications may necessitate the involvement of other medical specialists. In this review, we will discuss the various general medical aspects of Parkinson's disease.
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Affiliation(s)
- Ilona Csoti
- Gertrudis-Clinic Parkinson-Center, Karl-Ferdinand-Broll-Str. 2-4, 35638, Leun, Germany.
| | - Wolfgang H Jost
- Parkinson-Klinik Wolfach, Kreuzbergstr.12-24, 77709, Wolfach, Germany.
| | - Heinz Reichmann
- Department of Neurology, University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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8
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Rocchi C, Pierantozzi M, Galati S, Chiaravalloti A, Pisani V, Prosperetti C, Lauretti B, Stampanoni Bassi M, Olivola E, Schillaci O, Stefani A. Autonomic Function Tests and MIBG in Parkinson's Disease: Correlation to Disease Duration and Motor Symptoms. CNS Neurosci Ther 2015. [PMID: 26205884 DOI: 10.1111/cns.12437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIMS Disorders of the autonomic nervous system (ANS) have a variable degree of clinical relevance in patients with Parkinson's disease (PD). Here, we assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests (AFTs), correlates with PD progression. METHODS A series of 27 consecutive patients with PD underwent extensive ANS investigations including the head-up tilt test (HUTT), Valsalva maneuver, deep-breathing test, and handgrip test (HG); further, they performed 123I-meta-iodobenzylguanidine (MIBG) scintigraphy. RESULTS Seven of the 27 patients showed orthostatic hypotension (OH) at HUTT and pathological responses to the deep-breathing and HG test and Valsalva maneuver. The majority of the remaining 20 patients with PD showed pathological responses to deep-breathing (n = 13) and/or HG (n = 11). Only 3 of 27 suffered relevant OH. MIBG uptake of myocardium was decreased in 19 patients with PD (H/M ratio 1.3 ± 0.2). Prolonged clinical observation (>3 years), persistent response to levodopa, and MIBG repetition allowed us to exclude negative MIBG as attributable to atypical Parkinsonism. MIBG uptake did not correlate with OH and other AFTs. Both HG test response and MIBG did correlate with the Unified Parkinson's Disease Rating Scale (UPDRS) motor score and disease duration. A positive correlation emerged between diastolic blood pressure (DBP) response to HG test and MIBG and with systolic blood pressure (SBP) response at tilt test. CONCLUSIONS Our investigation suggests that ANS impairment affects the majority of patients with PD, even those PD patients showing negative MIBG, irrespective of clinical neurovegetative symptoms. The strict correlation that has been revealed with disease progression supports the routine utilization of AFTs as a reliable and inexpensive tool for monitoring peripheral sympathetic dysfunction in PD and optimizing therapy.
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Affiliation(s)
- Camilla Rocchi
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | | | | | | | | | | | - Benedetta Lauretti
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | | | - Enrica Olivola
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Stefani
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Fondazione S. Lucia, Rome, Italy
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9
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Orthostatic hypotension in patients with Parkinson's disease and atypical parkinsonism. PARKINSONS DISEASE 2014; 2014:475854. [PMID: 24634790 PMCID: PMC3929346 DOI: 10.1155/2014/475854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/11/2013] [Indexed: 12/23/2022]
Abstract
Orthostatic hypotension (OH) is one of the commonly occurring nonmotor symptoms in patients with idiopathic Parkinson's disease (IPD) and atypical parkinsonism (AP). We aimed to review current evidences on epidemiology, diagnosis, treatment, and prognosis of OH in patients with IPD and AP. Major electronic medical databases were assessed including PubMed/MEDLINE and Embase up to February 2013. English-written original or review articles with keywords such as "Parkinson's disease," "atypical parkinsonism," and "orthostatic hypotension" were searched for relevant evidences. We addressed different issues such as OH definition, epidemiologic characteristics, pathophysiology, testing and diagnosis, risk factors for symptomatic OH, OH as an early sign of IPD, prognosis, and treatment options of OH in parkinsonian syndromes. Symptomatic OH is present in up to 30% of IPD, 80% of multiple system atrophy (MSA), and 27% of other AP patients. OH may herald the onset of PD before cardinal motor symptoms and our review emphasises the importance of its timely diagnosis (even as one preclinical marker) and multifactorial treatment, starting with patient education and lifestyle approach. Advancing age, male sex, disease severity, and duration and subtype of motor symptoms are predisposing factors. OH increases the risk of falls, which affects the quality of life in PD patients.
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10
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Elkins G, Sliwinski J, Bowers J, Encarnacion E. Feasibility of clinical hypnosis for the treatment of Parkinson's disease: a case study. Int J Clin Exp Hypn 2013; 61:172-82. [PMID: 23427841 PMCID: PMC3600366 DOI: 10.1080/00207144.2013.753829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parkinson's disease is a severe neurodegenerative disorder with a prevalence rate of approximately 1.6% in elderly Americans. This case study reports on a 51-year-old male Parkinson's patient who received 3 weekly sessions of a hypnosis intervention, as well as instruction in self-hypnosis. Actigraphy was used to assess rest-tremor severity. Results revealed a 94% reduction in rest tremors following treatment. Self-reported levels of anxiety, depression, sleep quality, pain, stiffness, libido, and quality of life also showed improvements. The patient reported a high level of satisfaction with treatment. These findings suggest clinical hypnosis is potentially feasible and beneficial treatment for some Parkinson's symptoms. Further investigation with diverse samples and an ambulatory monitoring device is warranted.
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Affiliation(s)
- Gary Elkins
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76798, USA.
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11
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Abstract
Autonomic nervous system (ANS) modulates the function of all body organs through both parasympathetic and sympathetic fibers. Orthostatic hypotension is frequently observed in the course of central nervous system diseases including cortical (stroke, epilepsy, dementias), neurodegenerative (Parkinson's disease, multisystem atrophies) and spinal cord diseases. In some cases, the mechanism of orthostatic hypotension associated with central nervous system diseases involves a dysfunction of peripheral ANS fibers.
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12
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Bar-Am O, Gross A, Friedman R, Finberg JPM. Cardiovascular baroreceptor activity and selective inhibition of monoamine oxidase. Eur J Pharmacol 2012; 683:226-30. [PMID: 22465184 DOI: 10.1016/j.ejphar.2012.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 03/07/2012] [Accepted: 03/09/2012] [Indexed: 11/30/2022]
Abstract
Cardiovascular baroreceptor responsiveness of conscious rats treated with selective inhibitors of monoamine oxidase (MAO) types A and B was determined by measurement of blood pressure (BP) and heart rate (HR) responses to intravenous injection of phenylephrine and sodium nitroprusside. Treatment with selegiline (1 or 5 mg/kg p.o. daily for 7 days) did not significantly modify resting levels of BP and HR, lower or upper HR plateau levels, or HR/BP gain. Treatment with clorgyline (2 mg/kg p.o. daily for 7 days) increased HR/BP gain but also did not modify resting BP or HR, or lower and upper plateau levels of HR. The results are compatible with an effect of MAO-A inhibition to modify monoamine levels in medullary areas participating in CNS control of blood pressure.
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Affiliation(s)
- Orit Bar-Am
- Dept of Molecular Pharmacology, Rappaport Faculty of Medicine, Technion, POB 9649, Haifa 31096, Israel
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13
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Tysnes OB, Müller B, Larsen JP. Are dysautonomic and sensory symptoms present in early Parkinson's disease? Acta Neurol Scand 2011:72-7. [PMID: 20586740 DOI: 10.1111/j.1600-0404.2010.01380.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Parkinson's disease (PD) occurs with an annual incidence of 13/100.000, is slightly more frequent in men and is characterized by the motor symptoms tremor, rigidity, bradykinesia and postural instability. In addition, non-motor symptoms have been increasingly connected to the disease although already described in James Parkinson's 'Essay on the shaking palsy' from 1817. The motor symptoms in PD are related to the degeneration of dopaminergic cells in the substantia nigra (SN). These symptoms respond well to dopaminergic substitution. It is much more unclear whether non-motor symptoms like dysautonomia, insomnia, day-time sleepiness, fatigue, pain and neuropsychiatric symptoms respond to levodopa. Autonomic symptoms include dizziness because of orthostatic hypotension, constipation, nausea, voiding symptoms and increased sweating. Such symptoms as well as sensory symptoms like hyposmia and pain are very frequently reported in PD and seem to occur early in the disease process. Braak proposed a sequential model of neuropathology in PD starting with affection of the olfactory bulb and the autonomic innervation of the heart and gut. Affection of SN is seen from Braak stage 3, and limbic and cortical structures are affected in the later stages of the disease. Currently, the evidence for sensory and autonomic involvement in PD is reviewed with special focus on the early phase of the disease.
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Affiliation(s)
- O-B Tysnes
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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14
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Finberg JPM, Gillman K. Selective inhibitors of monoamine oxidase type B and the "cheese effect". INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011; 100:169-90. [PMID: 21971008 DOI: 10.1016/b978-0-12-386467-3.00009-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Potentiation of the cardiovascular and other effects of dietary tyramine by monoamine oxidase (MAO) inhibitors (cheese effect) has been a major limitation to clinical use of these drugs. The discovery that MAO exists in two distinct isoforms, MAO-A and MAO-B, together with the development of selective inhibitors of each isoform, enabled the understanding that selective inhibition of MAO-A, or inhibition of both isoforms, will cause cheese effect, but selective inhibition of MAO-B can be elicited without dangerous pressor reaction. This development has permitted the introduction of selective MAO-B inhibitors to clinical medicine for treatment of Parkinson's disease. This review describes the basic mechanisms involved in cheese effect, as well as providing information on tyramine levels in a variety of foodstuff, and surveys clinical information from tyramine pressor testing with the selective MAO-B inhibitors, selegiline and rasagiline.
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Affiliation(s)
- John P M Finberg
- Department of Molecular Pharmacology, Rappaport Faculty of Medicine, Technion, Haifa, Israel
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15
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Abstract
Clinical symptoms in Parkinson's disease (PD) comprise both motor and non-motor symptoms. In this disease, synucleinopathic-induced, nigral dopamine deficiency-related dysfunction of the basal ganglia is held responsible for the characteristic levodopa-responsive motor signs and symptoms (bradykinesia, hypokinesia, rigidity), known as parkinsonism and essential for clinical diagnosis in PD, as well as subtle motivational and cognitive dysfunctions. Some motor symptoms, such as tremor and postural instability, and most non-motor symptoms, however, are not fully levodopa-responsive, and suggested to manifest extranigral pathology. These symptoms include autonomic, sleep, sensory and neuropsychiatric symptoms, which in some cases may precede the first signs of motor parkinsonism, closely correlating with the progression of Lewy body pathology in PD. The recognition and treatment of these mostly under-recognized and under-treated symptoms is important, as these symptoms might have more impact on the quality of life in PD patients as compared to motor parkinsonism. On top of this, recognition of these manifestations in the prodromal phase of motor PD is critical to early diagnosis and treatment, as disease-modifying drugs, once identified, should be initiated as soon as possible, preferably in this premotor phase of the disease. On top of this, (non)motor extranigral symptoms in PD might also be of iatrogenic origin, whether directly as indirectly. During conventional, oral, dopaminomimetic treatment, the progressive loss of striatal dopaminergic nerve endings with the loss of cerebral dopamine storage capacity, renders the cerebral dopamine level fully dependent of the plasma levodopa levels, thus changing dopaminergic receptor stimulation from continuous to a more pulsatile pattern. Supposedly due to this process, neuroplastic changes in (sub)cortical dopaminergic pathways might cause therapeutic response fluctuations: motor and nonmotor fluctuations with anxiety- and panic-attacks and/or mood swings, dyskinesias and punding. Finally, dopaminomimetic pharmacotherapy may also induce extranigral non-motor drug-related direct adverse effects, such as impulse control disorders. In this article, non-motor signs and symptoms of extranigral PD-related pathology will be discussed, as well as the (suggested) criteria for diagnosis and treatment. Of course, also the recognition of the signs and symptoms of the prodromal (premotor) phase, suggestive for the presence of the PD, will be discussed. Iatrogenic non-motor symptoms, though, will not be further discussed.
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Affiliation(s)
- Erik Ch Wolters
- Neuroscience Campus Amsterdam, Dept. of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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Reichmann H, Ziemssen T. Treatment strategies for nonmotor manifestations of Parkinson's disease. Expert Opin Pharmacother 2009; 10:773-84. [DOI: 10.1517/14656560902811605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Truong DD, Bhidayasiri R, Wolters E. Management of non-motor symptoms in advanced Parkinson disease. J Neurol Sci 2008; 266:216-28. [PMID: 17804018 DOI: 10.1016/j.jns.2007.08.015] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Progress in pharmacology has markedly improved the treatment of early Parkinson's disease. The management of advanced Parkinson's symptoms, however, remains a challenge. These symptoms are divided into motor and non-motor symptoms. Non-motor symptoms may appear early or late in the disease and sometimes even before the onset of the first motor symptoms confirming the diagnosis. The spectrum of non-motor symptoms encompasses autonomic dysfunctions, sleep disorders, mood disorders, impulse control disorders, cognitive dysfunction, dementia, paranoia and hallucinations. They are often less appreciated than motor symptoms but are important sources of disability for many PD patients. This review describes these non-motor symptoms and their managements.
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Affiliation(s)
- Daniel D Truong
- The Parkinson's and Movement Disorder Institute, 9940 Talbert Avenue, Fountain Valley, CA 92708, USA.
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Fernandez HH, Chen JJ. Monoamine Oxidase-B Inhibition in the Treatment of Parkinson's Disease. Pharmacotherapy 2007; 27:174S-185S. [DOI: 10.1592/phco.27.12part2.174s] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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