Parkinsonism: treatment of non-motor complications (AAN report)

Subject: Parkinsonism: treatment of non-motor complications (AAN report)

Date: 4/23/1999

Sildenafil citrate (Viagra) for the treatment of erectile dysfunction in men with Parkinson's disease
T Zesiewicz, R Hauser, M Helal
Neurology 1999;52(Suppl 2):A215

Viagra improves sexual function in men with erectile dysfunction in PD, according to this open-label study of ten patients. No changes were seen in UPDRS or Beck's Depression Inventory at doses up to 100 mg.

Quetiapine improves psychotic symptoms associated with Parkinson's disease
JL Juncos, L Arvanitis, D Sweitzer, P Yeung, RD Jewart, C Nemeroff
Neurology 1999;52(Suppl 2):A262

Quetiapine improves symptoms of drug-induced psychosis in PD without worsening parkinsonian symptoms, according to this open-label trial. Forty patients, including 19 on other antipsychotics, were treated with escalating doses of quetiapine. Assessment was performed with the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale, and the Modified Schwab & England ADL Scale. Improvements were seen in all measures, and were sustained over the one-year trial. ("Last observation carried forward" analysis was used for the 20 patients who did not complete the full year of
treatment). A transient improvement was seen in the UPDRS as well, possibly due to washout of other antipsychotics and consequent improvement in extrapyramidal symptoms.

This study was sponsored by Zeneca Pharmaceuticals

Quetiapine for the treatment of drug-induced psychosis in Parkinson's disease
JH Friedman, HH Fernandez, C Jacques, M Rosenfeld
Neurology 1999;52(Suppl 2):A215

Quetiapine is an effective treatment for drug-induced psychosis in PD, especially in drug-naive patients, according to this open-label study. Twenty of 24 drug-naive patients and 9 of 15 patients undergoing treatment with clozapine or olanzapine were successfully treated with quetiapine (mean dose of 40.6 mg/day), as measured on the BPRS and the Mini Mental Status Exam. The authors report, "Most of the crossover failures occurred in patients who were rapidly titrated with lesser overlap period."

Olanzapine treatment of parkinsonian patients with psychosis
NP Stover, JL Juncos
Neurology 1999;52(Suppl 2):A215

Olanzapine improves psychiatric symptoms but worsens motor symptoms in
parkinsonian patients, according to this six-month, open-label trial. Twenty-two patients, including three with probable PSP and 8 with PD-dementia, received olanzapine. Psychiatric symptoms improved in 12 patients, but 8 of these eventually ceased treatment within two months due to worsening of parkinsonian symptoms. Four patients remained on the drug at 5 mg/day.

Leg crossing compensates for sitting hypotension in autonomic failure
WP Cheshire
Neurology 1999;52(Suppl 2):A343

Crossing the legs at the knees while sitting can reduce orthostatic hypotension in patients with autonomic failure, according to this report. Twenty-five patients with autonomic failure (including patients with multiple system atrophy) had increased systolic and diastolic pressure increases during leg crossing of 10 and 5 mmHg, respectively, versus 3 and 2 mmHg in controls. The author notes, "Leg crossing may be worth recommending to AF patients who become symptomatic while sitting."

E-MOVE Editor: Richard Robinson, NASW, WE MOVE

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