Parkinson's Disease

MDNG Psychiatry, September 2010, Volume 9, Issue 3

Medical Websites

Cleveland Clinic - Parkinson’s Disease

Patrick J. Sweeney, MD, Department of Neurology, Cleveland Clinic, authored the extensive information located here. He covers the definition of Parkinson’s disease, its prevalence, pathophysiology, signs and symptoms, diagnosis, therapy, and outcomes in a fully referenced review, complete with five helpful tables and a link to an algorithm for the management of Parkinson’s disease, which originally appeared in Neurology.

Link Code: pn123120

www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/parkinsons-disease/

National Parkinson Foundation — Professionals

In keeping with its goal to “improve the quality of Parkinson's care through research, education and outreach” and belief that “by working together, we can improve the quality of care for every person diagnosed with Parkinson's disease,” NPF provides this collection of resources and tools to help keep you and your patients informed. Here, you can read the most recent white papers from NPF, learn about educational opportunities, and read the latest blog posts in the field of neurology and Parkinson’s disease. Be sure to check out the resources section, which houses conference information, diagnostic and referral guides, screening instruments, and downloadable posters from the 2009 annual Center Leadership Conference.

Link Code: pn123121

www.parkinson.org/professionals.aspx

The Educated PatientTM

NINDS Deep Brain Stimulation for Parkinson's Disease Information Page

Find a detailed description ofdeep brain stimulation (DBS), a “surgical procedure used to treat a variety of disabling neurological symptoms-most commonly the debilitating symptoms of Parkinson's disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems” at this site from the National Institute of Neurological Disorders and Stroke. Offered in outlined format are a description of the procedure, treatment, prognosis of patients who’ve received it, and research being conducted. Links to clinical trials currently recruiting patients with this and similar disorders, journal abstracts, and press releases dealing with this condition can be found on the left sidebar of this site.

Link Code: pn123220

www.ninds.nih.gov/disorders/deep_brain_stimulation/deep_brain_stimulation.htm

Parkinson’s Disease Resource Center

Direct patients to this site to access recent news articles about Parkinson’s disease (PD), in addition to a resource directory, forums, and chats to connect with patients who also suffer from PD; to post comments, registration is required (no charge). Patients who visit the site will be able to access a variety of videos reviewing PD topics, from current treatments and overcoming disabilities to device therapy and caregiving.

Link Code:pn123221

www.healingwell.com/parkinsons

eAbstracts

The Impact of Left Prefrontal Repetitive Transcranial Magnetic Stimulation on Depression in Parkinson's Disease: A Randomized, Double-blind, Placebo-controlled Study

Journal:Movement Disorders (August 24, 2010)

Authors:Pal E, Nagy F, Aschermannn Z, et al.

Purpose:To confirm the hypothesis that “repetitive transcranial magnetic stimulation (rTMS) seems to have an antidepressive effect on patients with Parkinson's disease (PD).”

Results:Although the authors suggest their results should be confirmed in studies looking at patients with PD who also have severe depression, they found that left dorsolateral prefrontal cortex rTMS had beneficial effects on depression in patients with PD for at least 30 days after treatment.

Link Code: pn123520

http://dx.doi.org/10.1002/mds.23270

Deep Brain Stimulation for Camptocormia in Dystonia and Parkinson's Disease

Journal:Journal of Neurology (August 28, 2010)

Authors:Capelle H, Schrader C, Blahak C, et al.

Purpose:To determine the effects of deep brain stimulation on camptocormia (bent spine syndrome), comparing primary dystonia to idiopathic Parkinson’s disease.

Results:Although GPi (globus pallidus pars interna) deep brain stimulation is effective in treating camptocormia in dystonia, “response of camptocormia to chronic STN [subthalamic nucleus] or GPi DBS in PD is more heterogenous. The latter may be due to a variety of causes and needs further clarification.”

Link Code: pn123521

http://dx.doi.org/10.1007/s00415-010-5695-0

Transcranial Doppler Monitoring in Parkinson's Disease: Cerebrovascular Compensation of Orthostatic Hypotension

Journal:Ultrasound in Medicine & Biology (August 30, 2010)

Authors:Haubrich C, Pies K, Dafotakis M, et al.

Purpose:To determine if “cerebral blood flow regulation explain[s] why orthostatic hypotension (OH) has often no accompanying symptoms” in patients with Parkinson’s disease.

Results: “Results showed a normal autoregulatory response to downward blood pressure shifts in PD. Moreover, orthostatic blood pressure instability is compensated equally sufficient in anterior and posterior parts of cerebral circulation. Whether in PD patients, OH becomes symptomatic rather seems to depend on blood pressure falling below the autoregulated range.”

Link Code: pn123522

http://dx.doi.org/10.1016/j.ultrasmedbio.2010.06.016

Clinical Trials

Parkinson'sResearch: The Organized Genetics Initiative (PROGENI)

Study Type:Observational

Age/Gender Requirement:Not Listed (male/female)

Sponsor:Indiana University School of Medicine

Purpose:To “study genetic and other risk factors that may be important in the development of Parkinson's disease.”

Link Code: pn123620

http://clinicaltrials.gov/ct2/show/NCT00086073?term=parkinson%27s&recr=Open&rank=19

PET Scanning in Parkinson's Disease

Study Type:Observational

Age/Gender Requirement:18 years (male/female)

Sponsor:National Institute of Mental Health

Purpose: To use in vivo PET scans to compare regional cerebral dopamine neurochemistry and blood flow between people with both familial and sporadic Parkinson’s disease, people with schizophrenia spectrum disorders, and “normal” volunteers.

Link Code: pn123621

http://clinicaltrials.gov/ct2/show/NCT00024622?term=parkinson%27s&recr=Open&rank=40

Transcranial Magnetic Stimulation in Parkinson's Disease

Study Type:Interventional

Age/Gender Requirement:

Sponsor:Beth Israel Deaconess Medical Center

Purpose: To determine if motor and mood symptoms can be improved with repetitive transcranial magnetic stimulation in patients with Parkinson’s disease.

Link Code: pn123622

http://clinicaltrials.gov/ct2/show/NCT01080794?term=parkinson%27s&recr=Open&rank=3

Online CME

The Future of Parkinson’s Disease: Diagnosis and Management

Credits:1.00

Fee:None

Expires:Not Listed

Multimedia:None

Complete this program to review neuroprotective treatment strategies for Parkinson’s disease, the neuroprotective effects of dopaminergic therapies that are currently available, emerging therapies for treating both motor and non-motor symptoms of Parkinson’s disease, drug delivery advances, the “unmet need for valid rating scales to identify early nonmotor symptoms of PD,” and potential biomarkers for aiding in early Parkinson’s disease diagnosis.

Link Code: pn123320

www.parkinsonsdiseasecme.com/cme-modules/future-of-parkinsons-disease

Strategies for Parkinson’s Disease Care: Evolving Approaches to Initial and Combination Therapy with Monoamine Oxidase Inhibitors

Credits:1.00

Fee:None

Expires: Not Listed

Multimedia:None

The mechanism of action of MAO-B inhibitors and why these agents are a good choice for initial monotherapy in patients with Parkinson’s disease; their role as adjunct therapy with levodopa in patients with advanced disease who experience motor fluctuations and dyskinesia; the differences in efficacy, safety, and tolerability profiles of rasagiline and selegiline; and the “potential neuroprotective effect of MAO-B inhibitors in animal models of PD” form the foci of this course.

Link Code: pn123321

www.parkinsonsdiseasecme.com/cme-modules/parkinsons-disease-care

Pharma Focus

Azilect (rasagiline)

eAbstracts

The Role of Rasagiline in the Treatment of Parkinson's Disease

Journal:Clinical Interventions in Aging (May 2010)

Authors:Leegwater-Kim J, Bortan E

Purpose:To review the safety, efficacy, and tolerability of rasagiline in the treatment of Parkinson’s disease.

Results:With greater potency than selegiline, rasagiline inhibits MAO-B through an advantageous once-daily dosing. Several studies have shown the efficacy of rasagiline as montherapy in early Parkinson’s disease and as adjunctive therapy in advanced disease. Both in vitro and in vivo study have demonstrated the neuroprotective effect of the agent. The recent ADAGIO trial “suggests a potential disease-modifying effect for rasagiline 1 mg/day.”

Link Code: pn123523

www.dovepress.com/the-role-of-rasagiline-in-the-treatment-of-parkinsonrsquos-disease-peer-reviewed-article-CIA

Clinical Trials

Change in Sense of Smell after Rasagiline Use in Parkinson's Patient

Study Type:Interventional

Age/Gender Requirement:≤ 75 years

Sponsor: The Parkinson's Institute

Purpose:To determine in treatment with rasagiline can improve sense of smell in patients with Parkinson’s disease, as no treatments have been proven to do so.

Link Code: pn123623

http://clinicaltrials.gov/ct2/show/NCT01007630?term=parkinson%27s rasagiline&recr=Open&rank=1

Effects of Azilect on Sleep Disturbances in Parkinson's Disease

Study Type:Interventional

Age/Gender Requirement:Not Listed (male/female)

Sponsor:Teva Pharmaceutical Industries

Purpose:To evaluate, in patients with a diagnosis of idiopathic Parkinson’s disease, the effect of 2 months of treatment with rasagiline on sleep disturbances.

Link Code: pn123624

http://clinicaltrials.gov/ct2/show/NCT01032486?term=parkinson%27s rasagiline&recr=Open&rank=2

From the HCPLive Network

The Immune System and Parkinson’s Disease

Researchers have discovered a link between Parkinson’s disease and common variants in immune system genes.

http://hcp.lv/blHip6

Nightmares Connected to Parkinson’s and Lewy Body Dementia

As if kicking, punching, and yelling while dreaming weren’t bad enough for those with REM sleep behavior disorder and those who share their bed, research shows that the disorder may be the initial manifestations of synucleinopathies, like Parkinson’s disease, multiple system atrophy, and dementia with Lewy bodies.

http://hcp.lv/cgOJTg

Nitric Oxide Linked to Parkinson’s, Alzheimer’s, and Huntington’s

Researchers have discovered that the untimely death of brain cells that characterize Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease can be traced back, in some cases, to the untimely transfer of nitric oxide (NO)—not to be confused with nitrous oxide—from one protein to another.

http://hcp.lv/9ZhoiO

Treating Parkinson's Disease: The Pharmacist's Role

Pharmacists are likely to see Parkinson's patients or their caregiver frequently because of the disease's slow and chronic course. Pharmacists need to e particularly vigilant about medication interactions and ensure doing changes are gradual.

http://hcp.lv/bMfeaf