1
|
Dorogan M, Namballa HK, Harding WW. Natural Product-Inspired Dopamine Receptor Ligands. J Med Chem 2024. [PMID: 39038276 DOI: 10.1021/acs.jmedchem.4c00537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Due to their evolutionary bias as ligands for biologically relevant drug targets, natural products offer a unique opportunity as lead compounds in drug discovery. Given the involvement of dopamine receptors in various physiological and behavioral functions, they are linked to numerous diseases and disorders such as Parkinson's disease, schizophrenia, and substance use disorders. Consequently, ligands targeting dopamine receptors hold considerable therapeutic and investigative promise. As this perspective will highlight, dopamine receptor targeting natural products play a pivotal role as scaffolds with unique and beneficial pharmacological properties, allowing for natural product-inspired drug design and lead optimization. As such, dopamine receptor targeting natural products still have untapped potential to aid in the treatment of disorders and diseases related to central nervous system (CNS) and peripheral nervous system (PNS) dysfunction.
Collapse
Affiliation(s)
- Michael Dorogan
- Department of Chemistry, Hunter College, City University of New York, 695 Park Avenue, New York, New York 10065, United States
| | - Hari K Namballa
- Department of Chemistry, Hunter College, City University of New York, 695 Park Avenue, New York, New York 10065, United States
| | - Wayne W Harding
- Department of Chemistry, Hunter College, City University of New York, 695 Park Avenue, New York, New York 10065, United States
- Program in Biochemistry, CUNY Graduate Center, 365 Fifth Avenue, New York, New York 10016, United States
- Program in Chemistry, CUNY Graduate Center, 365 Fifth Avenue, New York, New York 10016, United States
| |
Collapse
|
2
|
Phokaewvarangkul O, Kantachadvanich N, Buranasrikul V, Sanyawut K, Phumphid S, Anan C, Bhidayasiri R. Integrating technology into a successful apomorphine delivery program in Thailand: a 10-year journey of achievements with a five-motto concept. Front Neurol 2024; 15:1379459. [PMID: 38645746 PMCID: PMC11026563 DOI: 10.3389/fneur.2024.1379459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Apomorphine, a potent dopamine agonist, is a therapeutic option for patients with Parkinson's disease and motor fluctuations. However, the adoption of and adherence to this therapy have been limited by the need for complex delivery devices and specialized care as well as resource consumption, posing challenges for new physicians. Thailand is a unique example of a developing nation that has successfully implemented and continued the use of this therapy by employing cooperative technology that has dramatically enhanced apomorphine delivery services. Methods Establishing apomorphine delivery services requires significant resources and step-by-step solutions. We began our services by implementing various strategies in three chronological stages: the initial stage (2013-2015), intermediate stage (2016-2019), and current stage (2020-present), each presenting unique challenges. Together, we also implemented a proposed set of five mottos to strengthen our apomorphine delivery service. Using additive technology, we developed a patient registry platform that combined electronic data acquisition, video and remote monitoring using wearable sensors, and in-house mobile applications to support our service. Results At the initial stage, we assembled a team to enhance the efficacy and confirm the safety of apomorphine treatment in our hospital. At the intermediate stage, we expanded our apomorphine delivery services beyond just the patients at our hospital. We supported other hospitals in Thailand in setting up their own apomorphine services by educating both physicians and nurses regarding apomorphine therapy. With this educational undertaking, increased apomorphine-related knowledge among medical professionals, and a greater number of hospitals providing apomorphine services, an increasing number of patients were administered apomorphine in subsequent years. Currently, we are providing effective apomorphine delivery to improve patient outcomes and are seamlessly integrating technology into clinical practice. Incorporating integrative technologies in our apomorphine delivery program yielded positive results in data collection and support throughout patient care, in tracking patients' statuses, in the long-term use of this treatment, and in increasing medication adherence rates. Conclusion This perspective paper describes how technology can help provide supportive healthcare services in resource-constrained environments, such as in Thailand, offering a step-by-step approach to overcoming several limitations. The valuable insights from our 10-year journey in successfully integrating technology into apomorphine delivery services can benefit new physicians seeking to replicate our success.
Collapse
Affiliation(s)
- Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nithinan Kantachadvanich
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vijittra Buranasrikul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kanyawat Sanyawut
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Science of Thailand, Bangkok, Thailand
| |
Collapse
|
3
|
Girmaw F. Review on allosteric modulators of dopamine receptors so far. Health Sci Rep 2024; 7:e1984. [PMID: 38505681 PMCID: PMC10948587 DOI: 10.1002/hsr2.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024] Open
Abstract
Background Contemporary research is predominantly directed towards allosteric modulators, a class of compounds designed to interact with specific sites distinct from the orthosteric site on G protein-coupled receptors. These allosteric modulators play a pivotal role in influencing diverse pharmacological effects, such as agonism/inverse agonism, efficacy modulation, and affinity modulation. One particularly intriguing aspect is the demonstrated capacity of allosteric modulation to enhance drug selectivity for therapeutic purposes, potentially leading to a reduction in serious side effects associated with traditional approaches. Allosteric ligands, a majority of which fall into the categories of negative allosteric modulators or positive allosteric modulators, exhibit the unique ability to either diminish or enhance the effects of endogenous ligands. Negative allosteric modulators weaken the response, while positive allosteric modulators intensify it. Additionally, silent allosteric modulators represent a distinct class that neither activates nor blocks the effects of endogenous ligands, adding complexity to the spectrum of allosteric modulation. In the broader context of central nervous system disorders, allosteric modulation takes center stage, particularly in the realm of dopamine receptors specifically, D1, D2, and D3 receptors. These receptors hold immense therapeutic potential for a range of conditions spanning neurodegenerative disorders to neurobehavioral and psychiatric disorders. The intricate modulation of dopamine receptors through allosteric mechanisms offers a nuanced and versatile approach to drug development. As research endeavors continue to unfold, the exploration of allosteric modulation stands as a promising frontier, holding the potential to reshape the landscape of drug discovery and therapeutic interventions in the field of neurology and psychiatry.
Collapse
Affiliation(s)
- Fentaw Girmaw
- Department of Pharmacy, College of Health ScienceWoldia UniversityWoldiaEthiopia
| |
Collapse
|
4
|
Moes HR, Henriksen T, Sławek J, Phokaewvarangkul O, Buskens E, van Laar T. Tools and criteria to select patients with advanced Parkinson's disease for device-aided therapies: a narrative review. J Neural Transm (Vienna) 2023; 130:1359-1377. [PMID: 37500937 PMCID: PMC10645650 DOI: 10.1007/s00702-023-02656-z] [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] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/29/2023]
Abstract
This article provides an overview of the various screening and selection tools which have been developed over the past 25 years to identify patients with Parkinson's disease (PD) possibly eligible for device-aided therapies (DATs). For the available screening tools, we describe the target therapies (subtypes of DAT), development methods, validation data, and their use in clinical practice. In addition, the historical background and potential utility of these screening tools are discussed. The challenges in developing and validating these tools are also addressed, taking into account the differences in population, the local health care organization, and resource availability.
Collapse
Affiliation(s)
- Harmen R Moes
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands
| | - Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jarosław Sławek
- Department of Neurology, St Adalbert Hospital Copernicus, Gdansk, Poland
- Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands.
| |
Collapse
|
5
|
Pirtošek Z, Leta V, Jenner P, Vérin M. Should continuous dopaminergic stimulation be a standard of care in advanced Parkinson's disease? J Neural Transm (Vienna) 2023; 130:1395-1404. [PMID: 37930456 DOI: 10.1007/s00702-023-02708-4] [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] [Received: 08/09/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
The standard of care is a term that refers to the level of care, skill, and treatment that a healthcare provider should offer to a patient based on the current scientific evidence and the level of medical knowledge available in the field. For Parkinson's disease (PD), the standard care is mostly considered to be oral treatment with dopaminergic drugs, particularly levodopa which remains the 'gold standard'. However, effective management with levodopa during the later stages of the disease becomes increasingly challenging due to the ongoing neurodegenerative process, the consequences of its pulsatile dopaminergic stimulation, and the gastrointestinal barriers to effective drug absorption. As a result, the concept of applying continuous dopaminergic stimulation has emerged with infusion therapies (continuous subcutaneous apomorphine, levodopa-carbidopa intestinal gel, and levodopa-entacapone-carbidopa intestinal gel infusion). These therapies seek to provide continuous stimulation of striatal dopamine receptors that is efficient not only in alleviating clinical symptoms, but also in delaying, reducing, and possibly preventing the onset of levodopa-related motor (fluctuations, dyskinesia) and non-motor complications; and they are also associated with clinically relevant side effects. Clinical studies and real-life experience support the notion that infusion therapies should be accepted as part of the standard of care for patients with advanced PD who have refractory, severe, and disabling motor complications that affect their quality of life. However, they should be considered based on the needs of individualized patients and the access to these advanced therapies needs to be made more accessible to the general PD population.
Collapse
Affiliation(s)
- Z Pirtošek
- Department of Neurology University Medical Centre and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - V Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto, Neurologico Carlo Besta Milan, Milan, Italy
| | - P Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 1UL, UK
| | - M Vérin
- Institut Des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior and Basal Ganglia Research Unit, CIC-IT INSERM 1414, University of Rennes, Rennes, France
- Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France
| |
Collapse
|
6
|
van Laar T, Chaudhuri KR, Antonini A, Henriksen T, Trošt M. Infusion Therapies in the Treatment of Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:641-657. [PMID: 37334617 PMCID: PMC10473148 DOI: 10.3233/jpd-225112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/20/2023]
Abstract
Oral levodopa is the gold-standard therapy for treating Parkinson's disease (PD) but after a few years of treatment the therapeutic window narrows, and patients often experience various treatment-related complications. Patients in this advanced PD stage may benefit from alternative therapy, such as continuous intrajejunal delivery of levodopa-carbidopa intestinal gel (LCIG; or carbidopa-levodopa enteral suspension), continuous intrajejunal delivery of levodopa-carbidopa-entacapone intestinal gel, or continuous subcutaneous apomorphine infusion. Consideration and initiation of infusion therapies in advanced PD are suggested before the onset of major disability. The present review summarizes clinical evidence for infusion therapy in advanced PD management, discusses available screening tools for advanced PD, and provides considerations around optimal use of infusion therapy.
Collapse
Affiliation(s)
- Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - K. Ray Chaudhuri
- Parkinson’s Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Psychology & Neuroscience, King’s College Institute of Psychiatry, London, UK
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, Padua University, Padua, Italy
| | - Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | - Maja Trošt
- Department of Neurology, University Medical Centre Ljubljana, Slovenia, Faculty of Medicine, University of Ljubljana, Slovenia
| |
Collapse
|
7
|
Latif K, Ullah A, Shkodina AD, Boiko DI, Rafique Z, Alghamdi BS, Alfaleh MA, Ashraf GM. Drug reprofiling history and potential therapies against Parkinson’s disease. Front Pharmacol 2022; 13:1028356. [PMID: 36386233 PMCID: PMC9643740 DOI: 10.3389/fphar.2022.1028356] [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: 08/26/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Given the high whittling down rates, high costs, and moderate pace of new medication, revelation, and improvement, repurposing “old” drugs to treat typical and uncommon illnesses is progressively becoming an appealing proposition. Drug repurposing is the way toward utilizing existing medications in treating diseases other than the purposes they were initially designed for. Faced with scientific and economic challenges, the prospect of discovering new medication indications is enticing to the pharmaceutical sector. Medication repurposing can be used at various stages of drug development, although it has shown to be most promising when the drug has previously been tested for safety. We describe strategies of drug repurposing for Parkinson’s disease, which is a neurodegenerative condition that primarily affects dopaminergic neurons in the substantia nigra. We also discuss the obstacles faced by the repurposing community and suggest new approaches to solve these challenges so that medicine repurposing can reach its full potential.
Collapse
Affiliation(s)
- Komal Latif
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Aman Ullah
- Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millet University, Islamabad, Pakistan
| | - Anastasiia D. Shkodina
- Department of Neurological Diseases, Poltava State Medical University, Poltava, Ukraine
- Municipal Enterprise “1 City Clinical Hospital of Poltava City Council”, Poltava, Ukraine
- *Correspondence: Ghulam Md. Ashraf, ; Anastasiia D. Shkodina,
| | - Dmytro I. Boiko
- Department of Psychiatry, Narcology and Medical Psychology, Poltava State Medical University, Poltava, Ukraine
| | - Zakia Rafique
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Badrah S. Alghamdi
- Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- King Fahd Center for Medical Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed A. Alfaleh
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Vaccines and Immunotherapy, King Fahd Center for Medical Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghulam Md. Ashraf
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Ghulam Md. Ashraf, ; Anastasiia D. Shkodina,
| |
Collapse
|
8
|
Closing the loop for patients with Parkinson disease: where are we? Nat Rev Neurol 2022; 18:497-507. [PMID: 35681103 DOI: 10.1038/s41582-022-00674-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Although levodopa remains the most efficacious symptomatic therapy for Parkinson disease (PD), management of levodopa treatment during the advanced stages of the disease is extremely challenging. This difficulty is a result of levodopa's short half-life, a progressive narrowing of the therapeutic window, and major inter-patient and intra-patient variations in the dose-response relationship. Therefore, a suitable alternative to repeated oral administration of levodopa is being sought. Recent research efforts have focused on the development of novel levodopa delivery strategies and wearable physical sensors that track symptoms and disease progression. However, the need for methods to monitor the levels of levodopa present in the body in real time has been overlooked. Advances in chemical sensor technology mean that the development of wearable and mobile biosensors for continuous or frequent levodopa measurements is now possible. Such levodopa monitoring could help to deliver personalized and timely medication dosing to alleviate treatment-related fluctuations in the symptoms of PD. Therefore, with the aim of optimizing therapeutic management of PD and improving the quality of life of patients, we share our vision of a future closed-loop autonomous wearable 'sense-and-act' system. This system consists of a network of physical and chemical sensors coupled with a levodopa delivery device and is guided by effective big data fusion algorithms and machine learning methods.
Collapse
|
9
|
Antonini A, Pahwa R, Odin P, Isaacson SH, Merola A, Wang L, Kandukuri PL, Alobaidi A, Yan CH, Bao Y, Zadikoff C, Parra JC, Bergmann L, Chaudhuri KR. Comparative Effectiveness of Device-Aided Therapies on Quality of Life and Off-Time in Advanced Parkinson's Disease: A Systematic Review and Bayesian Network Meta-analysis. CNS Drugs 2022; 36:1269-1283. [PMID: 36414908 PMCID: PMC9712309 DOI: 10.1007/s40263-022-00963-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Research comparing levodopa/carbidopa intestinal gel (LCIG), deep brain stimulation (DBS), and continuous subcutaneous apomorphine infusion (CSAI) for advanced Parkinson's disease (PD) is lacking. This network meta-analysis (NMA) assessed the comparative effectiveness of LCIG, DBS, CSAI and best medical therapy (BMT) in reducing off-time and improving quality of life (QoL) in patients with advanced PD. METHODS A systematic literature review was conducted for randomized controlled trials (RCTs), observational and interventional studies from January 2003 to September 2019. Data extracted at baseline and 6 months were off-time, as reported by diary or Unified Parkinson's Disease Rating Scale Part IV item 39, and QoL, as reported by Parkinson's Disease Questionnaire (PDQ-39/PDQ-8). Bayesian NMA was performed to estimate pooled treatment effect sizes and to rank treatments in order of effectiveness. RESULTS A total of 22 studies fulfilled the inclusion criteria (n = 2063 patients): four RCTs, and 16 single-armed, one 2-armed and one 3-armed prospective studies. Baseline mean age was between 55.5-70.9 years, duration of PD was 9.1-15.3 years, off-time ranged from 5.4 to 8.7 h/day in 9 studies, and PDQ scores ranged from 28.8 to 67.0 in 19 studies. Levodopa/carbidopa intestinal gel and DBS demonstrated significantly greater improvement in off-time and QoL at 6 months compared with CSAI and BMT (p < 0.05). There was no significant difference in the effects of LCIG and DBS, but DBS was ranked first for reduction in off-time, and LCIG was ranked first for improvement in QoL. CONCLUSIONS This NMA found that LCIG and DBS were associated with superior improvement in off-time and PD-related QoL compared with CSAI and BMT at 6 months after treatment initiation. This comparative effectiveness research may assist providers, patients, and caregivers in the selection of the optimal device-aided therapy.
Collapse
Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, Study Center for Neurodegeneration (CESNE), University of Padova, 35128, Padua, Italy.
| | - Rajesh Pahwa
- Medical Center, University of Kansas, Kansas City, KS USA
| | - Per Odin
- University of Lund, Lund, Sweden
| | | | - Aristide Merola
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Lin Wang
- AbbVie Inc., North Chicago, IL USA ,Johns Hopkins School of Public Health, Baltimore, MD USA
| | | | - Ali Alobaidi
- AbbVie Inc., North Chicago, IL USA ,University of Illinois at Chicago, Chicago, IL USA
| | - Connie H. Yan
- AbbVie Inc., North Chicago, IL USA ,University of Illinois at Chicago, Chicago, IL USA
| | | | | | | | | | - K. Ray Chaudhuri
- King’s College and Parkinson Foundation Centre of Excellence, Kings College Hospital London, London, UK
| |
Collapse
|
10
|
Santos-García D, Catalán M, Puente V, Valldeoriola F, Regidor I, Mir P, Matías-Arbelo J, Parra J, Grandas F. Uso de la infusión intestinal continua de levodopa-carbidopa en pacientes con enfermedad de Parkinson avanzada en España. Subanálisis por comunidades autónomas. Neurologia 2021; 36:101-111. [DOI: 10.1016/j.nrl.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022] Open
|
11
|
Santos-García D, Catalán M, Puente V, Valldeoriola F, Regidor I, Mir P, Matías-Arbelo J, Parra J, Grandas F. Continuous intestinal infusion of levodopa–carbidopa in patients with advanced Parkinson's disease in Spain: Subanalysis by autonomous community. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
12
|
Niemann N, Billnitzer A, Jankovic J. Parkinson's disease and skin. Parkinsonism Relat Disord 2020; 82:61-76. [PMID: 33248395 DOI: 10.1016/j.parkreldis.2020.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/18/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's disease is associated with a variety of dermatologic disorders and the study of skin may provide insights into pathophysiological mechanisms underlying this common neurodegenerative disorder. Skin disorders in patients with Parkinson's disease can be divided into two major groups: 1) non-iatrogenic disorders, including melanoma, seborrheic dermatitis, sweating disorders, bullous pemphigoid, and rosacea, and 2) iatrogenic disorders related either to systemic side effects of antiparkinsonian medications or to the delivery system of antiparkinsonian therapy, including primarily carbidopa/levodopa, rotigotine and other dopamine agonists, amantadine, catechol-O-methyl transferase inhibitors, subcutaneous apomorphine, levodopa/carbidopa intestinal gel, and deep brain stimulation. Recent advances in our understanding of the role of α-synuclein in peripheral tissues, including the skin, and research based on induced pluripotent stem cells derived from skin fibroblasts have made skin an important target for the study of Parkinson's disease pathogenesis, drug discovery, novel stem cell therapies, and diagnostics.
Collapse
Affiliation(s)
- Nicki Niemann
- Muhammad Ali Parkinson Center, Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA.
| | - Andrew Billnitzer
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
13
|
Long-term Apomorphine Infusion Users Versus Short-term Users: An International Dual-center Analysis of the Reasons for Discontinuing Therapy. Clin Neuropharmacol 2020; 42:172-178. [PMID: 31567642 DOI: 10.1097/wnf.0000000000000361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A retrospective analysis at 2 specialist centers was undertaken to determine the long-term efficacy of subcutaneous apomorphine infusion (APO), rates and reasons for discontinuation, and factors that might contribute to discontinuation. METHODS Demographics, clinical outcomes data, and reasons for discontinuation were collected for patients treated with APO at Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Bangkok, Thailand (n = 36) and Fundacion Jimemez Diaz Universidad Autonoma de Madrid, Spain (n = 16). RESULTS There were 19 (52.7%) patients in the Thai cohort and 10 (62.5%) patients in the Spanish cohort who discontinued treatment within around 6 months of initiation, most commonly due to skin nodules (Thai cohort) and perceived lack of efficacy (Spanish cohort). Those who continued APO tended to stay on treatment. In both cohorts, APO resulted in significant reductions in Unified Parkinson's Disease Rating Scale 3 motor scores, daily OFF time, and levodopa-equivalent dose in patients who subsequently stopped therapy, suggesting APO is clinically effective even when "lack of efficacy" is stated as a reason for discontinuing. Daily OFF hours after APO therapy was found to be a significant predictive factor for APO discontinuation with an odds ratio of 5.952 (P = 0.040). The cutoff point that determined APO discontinuation was calculated to be 1.75 or more OFF hours (sensitivity, 84.6%; specificity, 63.2%). CONCLUSIONS Apomorphine infusion is a minimally invasive therapy and therefore very easy to discontinue if difficulties arise. This fact might explain the high dropout rate of this technique. Successful long-term adherence to APO therapy requires a multidisciplinary health care team approach including regular patient follow-up and assessment and prompt resolution of queries and concerns.
Collapse
|
14
|
Regidor I, Santos-García D, Catalán MJ, Puente V, Valldeoriola F, Grandas F, Mir P, Parra JC, Arbelo JM. Impact of Disease Duration in Effectiveness of Treatment with Levodopa-Carbidopa Intestinal Gel and Factors Leading to Discontinuation. JOURNAL OF PARKINSONS DISEASE 2019; 9:173-182. [DOI: 10.3233/jpd-181324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Ignacio Regidor
- Functional Neurosurgery Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Diego Santos-García
- Department of Internal Medicine, Neurology Section, Hospital Arquitecto Marcide, Complejo Hospitalario Universitario de Ferrol (CHUF), A Coruña, Spain
| | - Mar;ıa José Catalán
- Department of Neurology, Movement Disorders Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Vıctor Puente
- Department of Neurology, Movement Disorders Unit, Parc de salut Mar, Institut Hospital del Mar d’investigacions Mèdicas, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Francisco Grandas
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Mir
- Department of Neurology, Movement Disorders Unit, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - José Matías Arbelo
- Department of Neurology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
15
|
Hall A, Provins L, Valade A. Novel Strategies To Activate the Dopamine D 1 Receptor: Recent Advances in Orthosteric Agonism and Positive Allosteric Modulation. J Med Chem 2018; 62:128-140. [PMID: 30525590 DOI: 10.1021/acs.jmedchem.8b01767] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The five dopamine receptor subtypes (D1-5) are activated by the endogenous catecholamine dopamine. Sustained research has sought to identify selective ligands for receptor subtypes. In particular, activation of the D1 receptor has attracted attention due to its promising role in neurological diseases. Initial attempts to identify agonists yielded catechol derivatives, mimicking dopamine, with suboptimal DMPK parameters and low selectivity over the D5 subtype. However, more recent efforts to identify ligands capable of activating the D1 receptor have made substantial progress with the identification of non-catechol agonists with suitable properties to progress to clinical studies. In addition, several research groups have identified positive allosteric modulators that offer new potential. Furthermore, structural studies have surprisingly uncovered two potential allosteric binding sites, the most characterized of which appears to be on intracellular loop 2 (ICL2). This review highlights the recent progress in the field, covering both orthosteric and allosteric modes of activation, discusses the elucidation of the allosteric binding sites, and summarizes the clinical development status of various compounds.
Collapse
Affiliation(s)
- Adrian Hall
- UCB Pharma , Avenue de l'Industrie , Braine-L'Alleud 1420 , Belgium
| | - Laurent Provins
- UCB Pharma , Avenue de l'Industrie , Braine-L'Alleud 1420 , Belgium
| | - Anne Valade
- UCB Pharma , Avenue de l'Industrie , Braine-L'Alleud 1420 , Belgium
| |
Collapse
|
16
|
Antonini A, Stoessl AJ, Kleinman LS, Skalicky AM, Marshall TS, Sail KR, Onuk K, Odin PLA. Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson's disease: a multi-country Delphi-panel approach. Curr Med Res Opin 2018; 34:2063-2073. [PMID: 30016901 DOI: 10.1080/03007995.2018.1502165] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Lack of a global consensus on the definition of advanced Parkinson's disease (APD) and considerations for timing of device-aided therapies may result in heterogeneity in care. OBJECTIVES To reach consensus among movement disorder specialists regarding key patient characteristics indicating transition to APD and guiding appropriate use of device-aided therapies in the management of PD symptoms. METHODS A Delphi-panel approach was utilized to synthesize opinions of movement disorder specialists and build consensus. RESULTS A panel was comprised of movement disorder specialists from 10 European countries with extensive experience of treating PD patients (mean =24.8 ± 7.2 years). Consensus on indicators of suspected APD and eligibility for device-aided therapies were based on motor symptoms, non-motor symptoms, and functional impairments. Key indicators of APD included: (i) motor-moderate troublesome motor fluctuations, ≥1 h of troublesome dyskinesia/day, ≥2 h "off" symptoms/day, and ≥5-times oral levodopa doses/day; (ii) non-motor-mild dementia, and non-transitory troublesome hallucinations; (iii) functional impairment-repeated falls despite optimal treatment, and difficulty with activities of daily living. Patients with good levodopa response, good cognition, and <70 years of age were deemed as good candidates for all three device-aided therapies. Patients with troublesome dyskinesia were considered good candidates for both levodopa-carbidopa intestinal gel and Deep Brain Stimulation (DBS). PD patients with levodopa-resistant tremor were considered good candidates for DBS. CONCLUSION Identifying patients progressing to APD and suitable for device-aided therapies will enable general neurologists to assess the need for referral to movement disorder specialists and improve the quality of care and patient outcomes.
Collapse
Affiliation(s)
- Angelo Antonini
- a Department of Neuroscience , University of Padua , Padova , Italy
| | - A Jon Stoessl
- b Pacific Parkinson's Research Centre , Vancouver , BC , Canada
| | | | | | | | | | | | - Per Lars Anders Odin
- e Department of Neurology , Lund University, Skåne University Hospital , Lund Sweden
- f Klinikum-Bremerhaven , Bremerhaven , Germany
| |
Collapse
|
17
|
Apomorphine and levodopa infusion for motor fluctuations and dyskinesia in advanced Parkinson disease. J Neural Transm (Vienna) 2018; 125:1131-1135. [DOI: 10.1007/s00702-018-1906-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/09/2018] [Indexed: 12/14/2022]
|
18
|
Antonini A, Moro E, Godeiro C, Reichmann H. Medical and surgical management of advanced Parkinson's disease. Mov Disord 2018; 33:900-908. [DOI: 10.1002/mds.27340] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/07/2018] [Accepted: 01/19/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Angelo Antonini
- Department of Neuroscience; University of Padua; Padua Italy
| | - Elena Moro
- Division of Neurology, CHU of Grenoble; Grenoble Alpes University; Grenoble France
| | - Clecio Godeiro
- Division of Neurology, CHU of Grenoble; Grenoble Alpes University; Grenoble France
- Division of Neurology; Federal University of Rio Grande do Norte; Natal Brazil
| | - Heinz Reichmann
- Department of Neurology; Dresden University of Technology; Dresden Germany
| |
Collapse
|
19
|
Catalán MJ, Antonini A, Calopa M, Băjenaru O, de Fábregues O, Mínguez-Castellanos A, Odin P, García-Moreno JM, Pedersen SW, Pirtošek Z, Kulisevsky J. Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence? eNeurologicalSci 2017; 8:44-53. [PMID: 29260038 PMCID: PMC5730910 DOI: 10.1016/j.ensci.2017.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023] Open
Abstract
Advanced Parkinson's disease (APD) is characterized by increased functional disability, caused by motor complications, the presence of axial symptoms, and emergent disease- and drug-related non-motor symptoms. One of the advanced therapies available is intrajejunal infusion of levodopa/carbidopa intestinal gel (LCIG); however, patient selection for this treatment is sometimes difficult, particularly because of overlapping indications with other alternatives. In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment), a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.
Collapse
Key Words
- APD, Advanced Parkinson's disease
- DBS, Deep brain stimulation
- Duodopa
- ICD, Impulse control disorders
- Intrajejunal infusion of levodopa/carbidopa intestinal gel
- LCIG, Levodopa-carbidopa intestinal gel
- Motor symptoms
- NMS, Non-motor symptoms
- NMSS, Non-motor symptoms scale
- Non-motor symptoms
- PD, Parkinson's disease
- PDSS, Parkinson's disease sleep scale
- PEG, Percutaneous endoscopic gastrostomy
- Parkinson's disease
- QoL, Quality of life
- Quality of life
Collapse
Affiliation(s)
- Maria José Catalán
- Parkinson and Movement Disorders Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences, IRCCS Hospital San Camillo, Venice, Italy
| | | | - Ovidiu Băjenaru
- University of Medicine and Pharmacy "Carol Davila" Bucharest - University Emergency Hospital, Department of Neurology, Bucharest, Romania
| | - Oriol de Fábregues
- Vall d'Hebron University Hospital, Neurology Service, Movement Disorders Unit, Autonomous University of Barcelona, Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Adolfo Mínguez-Castellanos
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación Biosanitaria "ibs. Granada,", Granada, Spain
| | - Per Odin
- Skåne University Hospital, Lund University, Lund, Sweden.,Klinikum-Bremerhaven, Bremerhaven, Germany
| | | | | | | | - Jaime Kulisevsky
- Hospital Santa Creu i Sant Pau, Ciberned, Universitat Autònoma de Barcelona, Universitat Oberta de Catalunya, Barcelona, Spain
| |
Collapse
|
20
|
Lowin J, Sail K, Baj R, Jalundhwala YJ, Marshall TS, Konwea H, Chaudhuri KR. The cost-effectiveness of levodopa/carbidopa intestinal gel compared to standard care in advanced Parkinson's disease. J Med Econ 2017; 20:1207-1215. [PMID: 28895769 DOI: 10.1080/13696998.2017.1379411] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is an incurable, progressive neurological condition, with symptoms impacting movement, walking, and posture that eventually become severely disabling. Advanced PD (aPD) has a significant impact on quality-of-life (QoL) for patients and their caregivers/families. Levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of advanced levodopa-responsive PD with severe motor fluctuations and hyper-/dyskinesia when available combinations of therapy have not given satisfactory results. AIMS To determine the cost-effectiveness of LCIG vs standard of care (SoC) for the treatment of aPD patients. METHODS A Markov model was used to evaluate LCIG vs SoC in a hypothetical cohort of 100 aPD patients with severe motor fluctuations from an Irish healthcare perspective. Model health states were defined by Hoehn & Yahr (H&Y) scale-combined with amount of time in OFF-time-and death. SoC comprised of standard oral therapy ± subcutaneous apomorphine infusion and standard follow-up visits. Clinical efficacy, utilities, and transition probabilities were derived from published studies. Resource use was estimated from individual patient-level data from Adelphi 2012 UK dataset, using Irish costs, where possible. Time horizon was 20 years. Costs and outcomes were discounted at 4%. Both one-way and probabilistic sensitivity analyses were conducted. RESULTS The incremental cost-effectiveness ratio for LCIG vs SOC was €26,944/quality adjusted life year (QALY) (total costs and QALYs for LCIG vs SoC: €537,687 vs €514,037 and 4.37 vs 3.49, respectively). LCIG is cost-effective at a payer threshold of €45,000. The model was most sensitive to health state costs. CONCLUSION LCIG is a cost-effective treatment option compared with SoC in patients with aPD.
Collapse
Affiliation(s)
| | | | | | | | | | | | - K R Chaudhuri
- d National Parkinson Foundation Centre of Excellence, King's College Hospital and King's College London , London , UK
- e University Hospital Lewisham , London , UK
| |
Collapse
|
21
|
Salazar G, Martín J, Fragoso M, Font M. Continuous infusion of apomorphine in patients with advanced Parkinson's disease and different degrees of functional disability. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
22
|
Salazar G, Martín J, Fragoso M, Font M. Apomorfina en bomba de perfusión continua en pacientes con enfermedad de Parkinson avanzada con diferente grado de afectación funcional. Neurologia 2017; 32:407-410. [DOI: 10.1016/j.nrl.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 12/01/2022] Open
|
23
|
Levodopa/carbidopa intestinal gel (LCIG) infusion as mono- or combination therapy. J Neural Transm (Vienna) 2017; 124:1005-1013. [PMID: 28229223 DOI: 10.1007/s00702-017-1698-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/14/2017] [Indexed: 01/16/2023]
Abstract
Levodopa/carbidopa intestinal gel (LCIG) infusion is an effective escalating therapy in patients with Parkinson disease (PD) suffering from motor fluctuations and dyskinesia. Levodopa/carbidopa given continuously as infusion provides an optimized application of the most effective and best tolerable antiparkinsonian drug. It has been proven to have a superior motor effect compared with oral levodopa and to improve also non-motor symptoms. However, invasiveness, discomfort resulting from carrying an external device, and side effects associated with the way of administration limit its application in PD patients. At present, there are no guidelines that delineate to which patients LCIG should be offered as monotherapy, in combination with oral and/or transdermal medication, or as additional therapy to deep brain stimulation (DBS). Based on clinical studies, we propose an expert consensus for neurologists addressing the question when LCIG therapy should be recommended and in which cases LCIG infusion is suggested in combination with other antiparkinsonian drugs and/or DBS. We describe how LCIG should be initiated and what we consider necessary for clinical follow-up. We suggest an algorithm facilitating decision-making with respect to the currently available invasive PD therapies, namely infusion with subcutaneous apomorphine, LCIG, and DBS.
Collapse
|
24
|
Skorvanek M, Bhatia KP. The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues. Mov Disord Clin Pract 2017; 4:21-31. [PMID: 30363435 PMCID: PMC6174479 DOI: 10.1002/mdc3.12425] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) and the skin are related in a number of ways, including clinical abnormalities of the disease itself and skin-related side effects of dopaminergic medication, pumps, and surgical therapies. Recent advances in understanding the role of α-synuclein suggest skin biopsies as a potential diagnostic or even a premotor marker of PD. METHODS The PubMed database was searched for publications up to October 2015, and the current evidence on skin-related issues in PD was comprehensively summarized. RESULTS The evidence was summarized on the prevalence, etiology, and management of seborrheic dermatitis, sweating dysfunctions, bullous pemphigoid, and malignant melanoma, as well as therapy-related skin disorders, especially those observed in amantadine, rotigotine, apomorphine, and levodopa/carbidopa intestinal gel therapies and deep-brain stimulation. Skin biopsies evaluating the presence of α-synuclein, the density and morphology of cutaneous nerves, and skin fibroblast functions also are discussed. CONCLUSIONS Skin disorders are a common manifestation of PD. However, the exact pathophysiology and prevalence of these disorders are not well understood, and more systematic research is needed in this regard. Peripheral tissue biopsies as a diagnostic marker of PD are an exciting avenue in future PD research, although multiple caveats and pending issues need to be solved before they can be used in routine clinical practice.
Collapse
Affiliation(s)
- Matej Skorvanek
- Department of NeurologyP. J. Safarik UniversityKosiceSlovakia
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovakia
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| |
Collapse
|
25
|
Pérez-López C, Samà A, Rodríguez-Martín D, Català A, Cabestany J, Moreno-Arostegui JM, de Mingo E, Rodríguez-Molinero A. Assessing Motor Fluctuations in Parkinson's Disease Patients Based on a Single Inertial Sensor. SENSORS (BASEL, SWITZERLAND) 2016; 16:E2132. [PMID: 27983675 PMCID: PMC5191112 DOI: 10.3390/s16122132] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/27/2016] [Accepted: 12/10/2016] [Indexed: 01/23/2023]
Abstract
Altered movement control is typically the first noticeable symptom manifested by Parkinson's disease (PD) patients. Once under treatment, the effect of the medication is very patent and patients often recover correct movement control over several hours. Nonetheless, as the disease advances, patients present motor complications. Obtaining precise information on the long-term evolution of these motor complications and their short-term fluctuations is crucial to provide optimal therapy to PD patients and to properly measure the outcome of clinical trials. This paper presents an algorithm based on the accelerometer signals provided by a waist sensor that has been validated in the automatic assessment of patient's motor fluctuations (ON and OFF motor states) during their activities of daily living. A total of 15 patients have participated in the experiments in ambulatory conditions during 1 to 3 days. The state recognised by the algorithm and the motor state annotated by patients in standard diaries are contrasted. Results show that the average specificity and sensitivity are higher than 90%, while their values are higher than 80% of all patients, thereby showing that PD motor status is able to be monitored through a single sensor during daily life of patients in a precise and objective way.
Collapse
Affiliation(s)
- Carlos Pérez-López
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Albert Samà
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Daniel Rodríguez-Martín
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Andreu Català
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Joan Cabestany
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Juan Manuel Moreno-Arostegui
- Technical Research Centre for Dependency Care and Autonomous Living, CETPD, Universitat Politècnica de Catalunya, Barcelona Tech., Rambla de l'Exposició 59-69, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Eva de Mingo
- Clinical Research Unit, Consorci Sanitari del Garraf (Fundación Sant Antoni Abat ), Carrer de Sant Josep, 21-23, Vilanova i la Geltrú 08800, Barcelona, Spain.
| | - Alejandro Rodríguez-Molinero
- Clinical Research Unit, Consorci Sanitari del Garraf (Fundación Sant Antoni Abat ), Carrer de Sant Josep, 21-23, Vilanova i la Geltrú 08800, Barcelona, Spain.
| |
Collapse
|
26
|
De Rosa A, Tessitore A, Bilo L, Peluso S, De Michele G. Infusion treatments and deep brain stimulation in Parkinson's Disease: The role of nursing. Geriatr Nurs 2016; 37:434-439. [PMID: 27444659 DOI: 10.1016/j.gerinurse.2016.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/27/2022]
Abstract
Parkinson's Disease (PD) represents one of the most common neurodegenerative disorders in the elderly. PD is caused by a loss of dopaminergic cells in the substantia nigra pars compacta. The motor cardinal signs include a resting tremor, bradykinesia, rigidity and postural reflex impairment. Although levodopa represents the gold standard also in the advanced stage of the disease, over the years most patients develop disabling motor fluctuations, dyskinesias, and non-motor complications, which are difficult to manage. At this stage, more complex treatment approaches, such as infusion therapies (subcutaneous apomorphine and intraduodenal levodopa) and deep brain stimulation of the subthalamic nucleus or the globus pallidus internus should be considered. All three procedures require careful selection and good compliance of candidate patients. In particular, infusional therapies need adequate training both of caregivers and nursing staff in order to assist clinicians in the management of patients in the complicated stages of disease.
Collapse
Affiliation(s)
- Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, via Pansini 5, 80131 Naples, Italy.
| | - Alessandro Tessitore
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - Leonilda Bilo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, via Pansini 5, 80131 Naples, Italy
| | - Silvio Peluso
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, via Pansini 5, 80131 Naples, Italy
| | - Giuseppe De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, via Pansini 5, 80131 Naples, Italy
| |
Collapse
|
27
|
Pérez-López C, Samà A, Rodríguez-Martín D, Moreno-Aróstegui JM, Cabestany J, Bayes A, Mestre B, Alcaine S, Quispe P, Laighin GÓ, Sweeney D, Quinlan LR, Counihan TJ, Browne P, Annicchiarico R, Costa A, Lewy H, Rodríguez-Molinero A. Dopaminergic-induced dyskinesia assessment based on a single belt-worn accelerometer. Artif Intell Med 2016; 67:47-56. [PMID: 26831150 DOI: 10.1016/j.artmed.2016.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/01/2016] [Accepted: 01/05/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND After several years of treatment, patients with Parkinson's disease (PD) tend to have, as a side effect of the medication, dyskinesias. Close monitoring may benefit patients by enabling doctors to tailor a personalised medication regimen. Moreover, dyskinesia monitoring can help neurologists make more informed decisions in patient's care. OBJECTIVE To design and validate an algorithm able to be embedded into a system that PD patients could wear during their activities of daily living with the purpose of registering the occurrence of dyskinesia in real conditions. MATERIALS AND METHODS Data from an accelerometer positioned in the waist are collected at the patient's home and are annotated by experienced clinicians. Data collection is divided into two parts: a main database gathered from 92 patients used to partially train and to evaluate the algorithms based on a leave-one-out approach and, on the other hand, a second database from 10 patients which have been used to also train a part of the detection algorithm. RESULTS Results show that, depending on the severity and location of dyskinesia, specificities and sensitivities higher than 90% are achieved using a leave-one-out methodology. Although mild dyskinesias presented on the limbs are detected with 95% specificity and 39% sensitivity, the most important types of dyskinesia (any strong dyskinesia and trunk mild dyskinesia) are assessed with 95% specificity and 93% sensitivity. CONCLUSION The presented algorithmic method and wearable device have been successfully validated in monitoring the occurrence of strong dyskinesias and mild trunk dyskinesias during activities of daily living.
Collapse
Affiliation(s)
- Carlos Pérez-López
- Centro de Estudios para la Dependencia y la vida Autónoma (CETpD), Universitat Politècnica de Catalunya (UPC), Rambla de l'Exposició, 59, 08800 Vilanova i la Geltrú, Barcelona, Spain.
| | - Albert Samà
- Centro de Estudios para la Dependencia y la vida Autónoma (CETpD), Universitat Politècnica de Catalunya (UPC), Rambla de l'Exposició, 59, 08800 Vilanova i la Geltrú, Barcelona, Spain
| | - Daniel Rodríguez-Martín
- Centro de Estudios para la Dependencia y la vida Autónoma (CETpD), Universitat Politècnica de Catalunya (UPC), Rambla de l'Exposició, 59, 08800 Vilanova i la Geltrú, Barcelona, Spain
| | - Juan Manuel Moreno-Aróstegui
- Centro de Estudios para la Dependencia y la vida Autónoma (CETpD), Universitat Politècnica de Catalunya (UPC), Rambla de l'Exposició, 59, 08800 Vilanova i la Geltrú, Barcelona, Spain
| | - Joan Cabestany
- Centro de Estudios para la Dependencia y la vida Autónoma (CETpD), Universitat Politècnica de Catalunya (UPC), Rambla de l'Exposició, 59, 08800 Vilanova i la Geltrú, Barcelona, Spain
| | - Angels Bayes
- UParkinson, Passeig Bonanova 26, Barcelona 08022, Spain
| | - Berta Mestre
- UParkinson, Passeig Bonanova 26, Barcelona 08022, Spain
| | | | - Paola Quispe
- UParkinson, Passeig Bonanova 26, Barcelona 08022, Spain
| | - Gearóid Ó Laighin
- Electrical & Electronic Engineering, School of Engineering & Informatics National University Galway (NUIG), University Rd, Galway, Ireland
| | - Dean Sweeney
- Electrical & Electronic Engineering, School of Engineering & Informatics National University Galway (NUIG), University Rd, Galway, Ireland
| | - Leo R Quinlan
- Physiology, School of Medicine National University Galway (NUIG), University Rd, Galway, Ireland
| | - Timothy J Counihan
- School of Medicine, National University Galway (NUIG), University Rd, Galway, Ireland
| | - Patrick Browne
- School of Medicine, National University Galway (NUIG), University Rd, Galway, Ireland
| | | | - Alberto Costa
- Fondazione Santa Lucia, Via Ardeatina, 306, Rome 00142, Italy; Niccolò Cusano University, via Don Carlo Gnocchi, 3, Rome 00166, Italy
| | - Hadas Lewy
- Maccabi Healthcare Services, Hamered Street 27, Tel-Aviv 68125, Israel
| | - Alejandro Rodríguez-Molinero
- Electrical & Electronic Engineering, School of Engineering & Informatics National University Galway (NUIG), University Rd, Galway, Ireland
| |
Collapse
|
28
|
Băjenaru O, Ene A, Popescu BO, Szász JA, Sabău M, Mureşan DF, Perju-Dumbrava L, Popescu CD, Constantinescu A, Buraga I, Simu M. The effect of levodopa-carbidopa intestinal gel infusion long-term therapy on motor complications in advanced Parkinson's disease: a multicenter Romanian experience. J Neural Transm (Vienna) 2015; 123:407-14. [PMID: 26699635 PMCID: PMC4805768 DOI: 10.1007/s00702-015-1496-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022]
Abstract
Chronic treatment with oral levodopa is associated with an increased frequency of motor complications in the late stages of Parkinson’s disease (PD). Continuous administration of levodopa–carbidopa intestinal gel (LCIG—Duodopa®, Abbott Laboratories), which has been available in Romania since 2009, represents an option for treating patients with advanced PD. Our primary objective was to report changes in motor complications after initiation of LCIG therapy. The secondary objectives were as follows: to determine the impact of LCIG therapy on the daily levodopa dose variation before/and after LCIG, to collect patient self-assessments of quality of life (QoL), and to study the overall tolerability and safety of LCIG administration. A retrospective analysis (2009–2013) of LCIG therapy and the experience in nine neurology centers in Romania was performed. The impact of LCIG therapy was evaluated by analyzing changes in motor fluctuations, dyskinesia and the patients’ QoL after initiating therapy. The safety of LCIG therapy was estimated by noting agent-related adverse events (AEs) and medical device-related AEs. In the 113 patients included, we observed a significant improvement in PD symptoms after initiation of LCIG therapy. The “on” period increased, with a mean value of 6.14 h, and the dyskinesia period was reduced, with a mean value of 29.4 %. The quantified non-motor symptoms subsided. The patients exhibited significant improvements in QoL scores. There were few AEs and few cases of LCIG therapy discontinuation. LCIG is an important and available therapeutic option for managing patients with advanced PD.
Collapse
Affiliation(s)
- O Băjenaru
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, University Emergency Hospital Bucharest, 169 Splaiul Independentei, Sector 5, Bucharest, Romania
| | - A Ene
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, University Emergency Hospital Bucharest, 169 Splaiul Independentei, Sector 5, Bucharest, Romania
| | - B O Popescu
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, Colentina Hospital, 19-21 Stefan cel Mare Street, Sector 2, 020125, Bucharest, Romania
| | - J A Szász
- Department of Neurology, University of Medicine and Pharmacy Targu Mures, 38 Gh Marinescu Street, 540139, Targu Mures, Mures, Romania
| | - M Sabău
- Department of Neurology, Emergency Clinical Hospital Oradea, 65 Gh Doja Street, 410169, Oradea, Bihor, Romania
| | - D F Mureşan
- Department of Neurology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Cluj County Hospital, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - L Perju-Dumbrava
- Department of Neurology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Cluj County Hospital, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - C D Popescu
- Neurology Rehabilitation Department, University of Medicine and Pharmacy "Gr. T. Popa" Iasi, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661, Iasi, Romania
| | - A Constantinescu
- Neurology Rehabilitation Department, University of Medicine and Pharmacy "Gr. T. Popa" Iasi, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661, Iasi, Romania
| | - I Buraga
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, Colentina Hospital, 19-21 Stefan cel Mare Street, Sector 2, 020125, Bucharest, Romania
| | - M Simu
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes," Timisoara County Hospital, 10 Iosif Bulbuca Street, 300736, Timisoara, Timis, Romania.
| |
Collapse
|
29
|
Krüger R, Hilker R, Winkler C, Lorrain M, Hahne M, Redecker C, Lingor P, Jost WH. Advanced stages of PD: interventional therapies and related patient-centered care. J Neural Transm (Vienna) 2015; 123:31-43. [PMID: 26138439 DOI: 10.1007/s00702-015-1418-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/22/2015] [Indexed: 11/24/2022]
Abstract
During the last decades, symptomatic treatment of motor symptoms of Parkinson's disease (PD) improved continuously and is reflected by long-range independency of the patient during the disease course. However, advanced stages of PD still represent an important challenge to patients, caregivers and treating physicians. In patients with advanced PD, interventional therapy strategies are increasingly applied. These device-related treatment strategies using pump-based continuous dopaminergic stimulation (CDS) or deep brain stimulation (DBS) opened new treatment options especially if motor complications predominate. Well-designed clinical studies on these interventional therapeutic approaches provided class 1 evidence for the efficacy of DBS and CDS in advanced PD and opened new perspectives for their use in earlier disease stages also. Therefore, careful selection of patients amenable to the (semi)invasive therapy options becomes more and more important and requires an interdisciplinary setting that accounts for (i) optimal patient information and awareness, (ii) selection of best individual treatment modality, (iii) training of relatives and caregivers, (iv) management of complications, and (v) follow-up care. Here, we address these topics by summarizing current state-of-the-art in patient selection, providing specificities of treatment options and troubleshooting, and defining steps towards an optimized patient-centered care. Interventional therapies pioneer in the area of individualized treatment approaches for PD, and may be complemented in the future by biomarker-based improved stratification and by closed-loop systems for adaptive therapeutic strategies. In the present review, we summarize the proceedings of an Expert Workshop on Parkinson's disease held on November 22, 2014 in Frankfurt, Germany.
Collapse
Affiliation(s)
- Rejko Krüger
- Clinical and Experimental Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg. .,Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
| | - Rüdiger Hilker
- Department of Neurology, Klinikum Vest, Recklinghausen/Marl, Germany
| | - Christian Winkler
- Department of Neurology, Lindenbrunn Hospital, Lindenbrunn 1, 31863, Coppenbrügge, Germany.,Department of Neurology, University Hospital Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | | | - Matthias Hahne
- Clinic of Neurology Bad Neustadt, Academic Teaching Hospital of the University Marburg, 97616, Bad Neustadt, Germany
| | - Christoph Redecker
- Hans-Berger-Department of Neurology, Jena University Hospital, Jena, Germany
| | - Paul Lingor
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | | |
Collapse
|
30
|
Ojo OO, Fernandez HH. Levodopa/carbidopa intestinal gel: an effective formulation for the management of advanced Parkinson's disease. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY With disease progression, almost all Parkinson's disease (PD) patients eventually experience motor fluctuations, often posing a significant challenge for patients and caregivers. Majority of these patients end up with complex medication regimens resulting in increased incidence of adverse effects and a poorer quality of life. Treatment options for advanced PD remain limited; thus, providing the optimal treatment for this growing subpopulation of patients continues to be the focus of many drug development efforts. While deep brain stimulation is considered the most significant therapeutic advancement for advanced PD, it remains an expensive and invasive procedure, with its own risks and complications, which limits global applicability to a wider PD population. Levodopa/carbidopa intestinal gel is one option that may offer a therapeutic benefit as significant as that of deep brain stimulation, and to a broader spectrum of PD patients. This article reviews the pharmacological properties, efficacy, safety and tolerability of levodopa/carbidopa intestinal gel in PD.
Collapse
Affiliation(s)
- Oluwadamilola O Ojo
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Neurology Unit, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| |
Collapse
|
31
|
Picciolini S, Castagnetti N, Vanna R, Mehn D, Bedoni M, Gramatica F, Villani M, Calestani D, Pavesi M, Lazzarini L, Zappettini A, Morasso C. Branched gold nanoparticles on ZnO 3D architecture as biomedical SERS sensors. RSC Adv 2015. [DOI: 10.1039/c5ra13280k] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We present a new 3D surface-enhanced Raman spectroscopy substrate made of branched gold nanoparticles supported on ZnO tetrapods that was proved to be effective in different biomedical application such as drug detection and cancer cells analysis.
Collapse
Affiliation(s)
- S. Picciolini
- LABION – Laboratory of Nanomedicine and Clinical Biophotonics
- Fondazione Don Carlo Gnocchi ONLUS
- Milan
- Italy
| | | | - R. Vanna
- LABION – Laboratory of Nanomedicine and Clinical Biophotonics
- Fondazione Don Carlo Gnocchi ONLUS
- Milan
- Italy
| | - D. Mehn
- LABION – Laboratory of Nanomedicine and Clinical Biophotonics
- Fondazione Don Carlo Gnocchi ONLUS
- Milan
- Italy
| | - M. Bedoni
- LABION – Laboratory of Nanomedicine and Clinical Biophotonics
- Fondazione Don Carlo Gnocchi ONLUS
- Milan
- Italy
| | - F. Gramatica
- LABION – Laboratory of Nanomedicine and Clinical Biophotonics
- Fondazione Don Carlo Gnocchi ONLUS
- Milan
- Italy
| | | | | | - M. Pavesi
- Parma University
- Phys. Dept
- Parma
- Italy
| | | | | | - C. Morasso
- LABION – Laboratory of Nanomedicine and Clinical Biophotonics
- Fondazione Don Carlo Gnocchi ONLUS
- Milan
- Italy
| |
Collapse
|
32
|
Fuxe K, Guidolin D, Agnati LF, Borroto-Escuela DO. Dopamine heteroreceptor complexes as therapeutic targets in Parkinson's disease. Expert Opin Ther Targets 2014; 19:377-98. [PMID: 25486101 DOI: 10.1517/14728222.2014.981529] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Several types of D2R and D1R heteroreceptor complexes were discovered in the indirect and direct pathways of the striatum, respectively. The hypothesis is given that changes in the function of the dopamine heteroreceptor complexes may help us understand the molecular mechanisms underlying the motor complications of long-term therapy in Parkinson's disease (PD) with l-DOPA and dopamine receptor agonists. AREAS COVERED In the indirect pathway, the potential role of the A2AR-D2R, A2AR-D2R-mGluR5 and D2R-NMDAR heteroreceptor complexes in PD are covered and in the direct pathway, the D1R-D3R, A1R-D1R, D1R-NMDAR and putative A1R-D1R-D3R heteroreceptor complexes. EXPERT OPINION One explanation for the more powerful ability of l-DOPA treatment versus treatment with the partial dopamine receptor agonist/antagonist activity to induce dyskinesias, may be that dopamine formed from l-DOPA acts as a full agonist. The field of D1R and D2R heteroreceptor complexes in the CNS opens up a new understanding of the wearing off of the antiparkinson actions of l-DOPA and dopamine receptor agonists and the production of l-DOPA-induced dyskinesias. It can involve a reorganization of the D1R and D2R heteroreceptor complexes and a disbalance of the D1R and D2R homomers versus non-dopamine receptor homomers in the direct and indirect pathways.
Collapse
Affiliation(s)
- Kjell Fuxe
- Karolinska Institutet, Department of Neuroscience , Retzius väg 8, 17177 Stockholm , Sweden +46 852 487 077 ; +46 8 315 721 ;
| | | | | | | |
Collapse
|
33
|
Efficacy and safety of Tai Chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2014; 9:e99377. [PMID: 24927169 PMCID: PMC4057148 DOI: 10.1371/journal.pone.0099377] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background and Objective In Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi is beneficial for many illnesses, its efficacy for PD remains uncertain. The purpose of this review was to evaluate the efficacy and safety of Tai Chi for PD. Methods Randomized controlled trials (RCTs) of Tai Chi for PD were electronically searched by the end of December 2013 and identified by two independent reviewers. The tool from the Cochrane Handbook 5.1 was used to assess the risk of bias. A standard meta-analysis was performed using RevMan 5.2 software. Results Ten trials with PD of mild-to-moderate severity were included in the review, and nine trials (n = 409) were included in the meta-analysis. The risk of bias was generally high in the blinding of participants and personnel. Improvements in the Unified Parkinson's Disease Rating Scale Part III (mean difference (MD) −4.34, 95% confidence interval (CI) −6.67–−2.01), Berg Balance Scale (MD: 4.25, 95% CI: 2.83–5.66), functional reach test (MD: 3.89, 95% CI: 1.73–6.04), Timed Up and Go test (MD: −0.75, 95% CI: −1.30–−0.21), stride length (standardized MD: 0.56, 95% CI: 0.03–1.09), health-related quality of life (standardized MD: −1.10, 95% CI: −1.81–−0.39) and reduction of falls were greater after interventions with Tai Chi plus medication. Satisfaction and safety were high. Intervention with Tai Chi alone was more effective for only a few balance and mobility outcomes. Conclusions Tai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed. PROSPERO registration number CRD42013004989.
Collapse
|
34
|
Wenzel K, Homann CN, Fabbrini G, Colosimo C. The role of subcutaneous infusion of apomorphine in Parkinson’s disease. Expert Rev Neurother 2014; 14:833-43. [DOI: 10.1586/14737175.2014.928202] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
35
|
Dézsi L, Vécsei L. Clinical implications of irregular ADMET properties with levodopa and other antiparkinson's drugs. Expert Opin Drug Metab Toxicol 2014; 10:409-24. [DOI: 10.1517/17425255.2014.878702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
36
|
Wright BA, Waters CH. Continuous dopaminergic delivery to minimize motor complications in Parkinson’s disease. Expert Rev Neurother 2014; 13:719-29. [DOI: 10.1586/ern.13.47] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
37
|
Sensi M, Preda F, Trevisani L, Contini E, Gragnaniello D, Capone JG, Sette E, Golfre-Andreasi N, Tugnoli V, Tola MR, Quatrale R. Emerging issues on selection criteria of levodopa carbidopa infusion therapy: considerations on outcome of 28 consecutive patients. J Neural Transm (Vienna) 2014; 121:633-42. [DOI: 10.1007/s00702-013-1153-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/25/2013] [Indexed: 11/28/2022]
|
38
|
Olanow CW, Schapira AHV. Therapeutic prospects for Parkinson disease. Ann Neurol 2013; 74:337-47. [PMID: 24038341 DOI: 10.1002/ana.24011] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 08/09/2013] [Accepted: 08/12/2001] [Indexed: 12/11/2022]
Abstract
Dopaminergic therapies such as levodopa have provided benefit for millions of patients with Parkinson's disease (PD) and revolutionized the treatment of this disorder. However patients continue to experience disability despite the best of modern treatment. Dopaminergic and surgical therapies are associated with potentially serious side effects. Non-motor and non-dopaminergic features such as freezing, falling, and dementia are not adequately controlled with available medications and represent the major source of disability for advanced patients. And, the disease continues to relentlessly progress. Major therapeutic unmet needs include a dopaminergic therapy that is not associated with serious side effects, a therapy that addresses the non-motor and non-dopaminergic features of the disease, and a disease-modifying therapy that slows or stops disease progression. This review will consider current attempts to address these issues and the obstacles that must be overcome in order to develop more effective therapies for PD.
Collapse
Affiliation(s)
- C Warren Olanow
- Departments of Neurology and Neuroscience, Mount Sinai School of Medicine, New York, NY
| | | |
Collapse
|
39
|
Advanced Parkinson's disease: Clinical characteristics and treatment. Part II. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2013.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
40
|
Enfermedad de Parkinson avanzada. Características clínicas y tratamiento. Parte II. Neurologia 2013; 28:558-83. [DOI: 10.1016/j.nrl.2013.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/16/2013] [Accepted: 05/02/2013] [Indexed: 01/24/2023] Open
|
41
|
Jenner P. Wearing Off, Dyskinesia, and the Use of Continuous Drug Delivery in Parkinson's Disease. Neurol Clin 2013; 31:S17-35. [DOI: 10.1016/j.ncl.2013.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
42
|
Kaminioti AN, Nikitas GT, Terlis AK, Manolis AG, Thomaides T, Panousopoulou AN. Ventricular bigeminy after subcutaneous administration of apomorphine in a patient with refractory Parkinson's disease: a case report. J Mov Disord 2013; 6:9-12. [PMID: 24868418 PMCID: PMC4027651 DOI: 10.14802/jmd.13002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/15/2013] [Indexed: 11/24/2022] Open
Abstract
Apomorphine is a well established treatment for the management of sudden, unexpected and refractory levodopa-induced “off” states in fluctuating Parkinson’s disease either as bolus injections or as continuous infusions. Incidents of atrial fibrillation associated with the administration of the drug have been reported in the past but no incidents of ventricular arrhythmias. We report a case of ventricular bigeminy recorded in a female patient after the administration of apomorphine.
Collapse
|
43
|
Abstract
Parkinson's disease (PD) is one of the most frequent neurological diseases. Despite the modern imaging and nuclear techniques which help to diagnose it in a very early stage and lead to a better discrimination of similar diseases, PD has remained a clinical diagnosis. The increasing number of available treatment options makes the disease management often complicated even when the presence of PD seems undoubted. In addition, nonmotor symptoms and side effects of some therapies constitute some pitfalls already in the preclinical state or at the beginnings of the disease, especially with the progressive effect on patients. Therefore, this review aimed to summarize study results and depict recommended medical treatments for the most common motor and nonmotor symptoms in PD. Additionally, emerging new therapeutic options such as continuous pump therapies, eg, with apomorphine or parenteral levodopa, or the implantation of electrodes for deep brain stimulation were also considered.
Collapse
Affiliation(s)
- David J Pedrosa
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
44
|
Levodopa-carbidopa intestinal gel in advanced Parkinson's disease open-label study: interim results. Parkinsonism Relat Disord 2013; 19:339-45. [PMID: 23287001 DOI: 10.1016/j.parkreldis.2012.11.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/12/2012] [Accepted: 11/29/2012] [Indexed: 11/21/2022]
Abstract
Levodopa-carbidopa intestinal gel (LCIG) delivered continuously via percutaneous endoscopic gastrojejunostomy (PEG-J) tube has been reported, mainly in small open-label studies, to significantly alleviate motor complications in Parkinson's disease (PD). A prospective open-label, 54-week, international study of LCIG is ongoing in advanced PD patients experiencing motor fluctuations despite optimized pharmacologic therapy. Pre-planned interim analyses were conducted on all enrolled patients (n = 192) who had their PEG-J tube inserted at least 12 weeks before data cutoff (July 30, 2010). Outcomes include the 24-h patient diary of motor fluctuations, Unified Parkinson's Disease Rating Scale (UPDRS), Clinical Global Impression-Improvement (CGI-I), Parkinson's Disease Questionnaire (PDQ-39), and safety evaluations. Patients (average PD duration 12.4 yrs) were taking at least one PD medication at baseline. The mean (±SD) exposure to LCIG was 256.7 (±126.0) days. Baseline mean "Off" time was 6.7 h/day. "Off" time was reduced by a mean of 3.9 (±3.2) h/day and "On" time without troublesome dyskinesia was increased by 4.6 (±3.5) h/day at Week 12 compared to baseline. For the 168 patients (87.5%) reporting any adverse event (AE), the most common were abdominal pain (30.7%), complication of device insertion (21.4%), and procedural pain (17.7%). Serious AEs occurred in 60 (31.3%) patients. Twenty-four (12.5%) patients discontinued, including 14 (7.3%) due to AEs. Four (2.1%) patients died (none deemed related to LCIG). Interim results from this advanced PD cohort demonstrate that LCIG produced meaningful clinical improvements. LCIG was generally well-tolerated; however, device and procedural complications, while generally of mild severity, were common.
Collapse
|
45
|
Nyholm D, Odin P, Johansson A, Chatamra K, Locke C, Dutta S, Othman AA. Pharmacokinetics of levodopa, carbidopa, and 3-O-methyldopa following 16-hour jejunal infusion of levodopa-carbidopa intestinal gel in advanced Parkinson's disease patients. AAPS JOURNAL 2012; 15:316-23. [PMID: 23229334 DOI: 10.1208/s12248-012-9439-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/05/2012] [Indexed: 11/30/2022]
Abstract
Motor complications of Parkinson's disease (PD) are a consequence of pulsatile dopaminergic stimulation from standard oral levodopa therapy. Levodopa-carbidopa intestinal gel (LCIG) is infused continuously via an intrajejunal percutaneous gastrostomy tube. This was the first study designed to characterize the full pharmacokinetic profiles of levodopa, carbidopa, and levodopa metabolite, 3-O-methyldopa (3-OMD) with 16-h LCIG infusion. Nineteen advanced PD patients (mean age, 65 years) who were on LCIG therapy for ≥30 days were enrolled. Patients received their individualized LCIG infusion doses, and serial pharmacokinetic samples were collected. Eighteen patients completed the study; 19 were assessed for safety. Mean (SD) total levodopa and carbidopa doses were 1,580 (403) and 395 (101) mg, respectively. Mean (SD) C(avg) (μg/mL) were 2.9 (0.84) for levodopa, 17.1 (4.99) for 3-OMD, and 0.22 (0.08) for carbidopa. The degree of fluctuation [defined as (C(max)-C(min))/C(avg)] in levodopa, 3-OMD, and carbidopa plasma concentrations was very low (0.52, 0.21, and 0.96, respectively) during hours 2-16 of infusion. Accordingly, the within-subject coefficients of variation in levodopa, 3-OMD, and carbidopa concentrations were low (13%, 6%, and 19%, respectively). Three patients (16%) reported ≥1 treatment-emergent adverse event; none were considered severe. Continuous intrajejunal LCIG infusion maintained stable plasma levodopa levels over 16 h. Consistent exposure has been shown to reduce motor and nonmotor complications associated with oral medications. LCIG was well tolerated, consistent with previous reports.
Collapse
Affiliation(s)
- Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | | | | | | | | | | | | |
Collapse
|
46
|
Pilleri M, Koutsikos K, Antonini A. Is there room for new non-dopaminergic treatments in Parkinson’s disease? J Neural Transm (Vienna) 2012; 120:349-52. [DOI: 10.1007/s00702-012-0947-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/02/2012] [Indexed: 12/26/2022]
|
47
|
Abstract
In patients with Parkinson disease, pulsatile administration of dopaminergic drugs is associated with motor fluctuations and dyskinesias. By contrast, treatments that provide more continuous dopaminergic stimulation are associated with less intense motor complications. This can be achieved by using drugs with longer half-lives, delayed release formulations, and routes of administration that permit continuous delivery. The mechanisms by which different modes of dopaminergic treatment (pulsatile or continuous) determine the motor response are not fully understood. However, the use of experimental models of parkinsonism has helped understand the motor complications associated with pulsatile dopamine replacement. These studies have provided important insights into the biochemical and molecular changes in the basal ganglia in response to continuous stimulation. In addition, these models have facilitated the development of new treatments that may stabilize the motor response and the biochemical alterations in the basal ganglia to provide more efficient forms of continuous dopaminergic stimulation in patients with Parkinson disease.
Collapse
|
48
|
Gershanik O, Jenner P. Moving from continuous dopaminergic stimulation to continuous drug delivery in the treatment of Parkinson’s disease. Eur J Neurol 2012; 19:1502-8. [DOI: 10.1111/j.1468-1331.2011.03593.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
49
|
Smith Y, Wichmann T, Factor SA, DeLong MR. Parkinson's disease therapeutics: new developments and challenges since the introduction of levodopa. Neuropsychopharmacology 2012; 37:213-46. [PMID: 21956442 PMCID: PMC3238085 DOI: 10.1038/npp.2011.212] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 12/13/2022]
Abstract
The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.
Collapse
Affiliation(s)
- Yoland Smith
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30322, USA.
| | | | | | | |
Collapse
|
50
|
Maranis S, Tsouli S, Konitsiotis S. Treatment of motor symptoms in advanced Parkinson's disease: a practical approach. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1795-807. [PMID: 21645577 DOI: 10.1016/j.pnpbp.2011.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 03/29/2011] [Accepted: 05/23/2011] [Indexed: 12/28/2022]
Abstract
Patients with advanced Parkinson's disease (PD) are known to develop motor complications after a few years of levodopa (L-dopa) therapy. Motor fluctuations develop with increasing severity of the disease, owing to loss of dopaminergic neurons and loss of the buffering capacity of the neurons to fluctuating dopamine levels. Dyskinesias develop as a result of pulsatile stimulation of the receptors and alterations in neuronal firing patterns. L-dopa remains the gold standard medication for the treatment of patients with advanced PD. However, once motor complications on L-dopa therapy emerge, clinicians may add on other classes of antiparkinsonian drugs such as dopamine agonists, catechol-O-methyl transferase inhibitors (COMTIs) or monoamine oxidase type B inhibitors (MAOBIs). The individualisation of the treatment seems to be the key for the best approach of advanced PD patients. The present review provides the most important current clinical data in the pharmacological treatment of motor symptoms in advanced PD and provides the clinician a simple algorithm in order to determine the best suitable treatment to advanced parkinsonian patients.
Collapse
Affiliation(s)
- S Maranis
- Department of Neurology, University Hospital of Ioannina, Greece
| | | | | |
Collapse
|