PD Treatment Update from Movement Disorders Congress 2004

Subject: PD Treatment Update from Movement Disorders Congress 2004

Date: 7/19/2004

E-MOVE reports from the Eight International Congress of Parkinson’s Disease and Movement Disorders, Rome June 14-17, 2004. Page (S) and poster (P) numbers are from Movement Disorders 2004;19 (supplement 9)

Duodopa: Duodenal Infusion of Levodopa
Two studies report on the use of Duodopa, an intraduodenal infusion of levodopa/carbidopa in a gel suspension for PD patients with motor complications. In a randomized cross-over study, Duodopa was superior to conventional pharmacologic therapy in reduction of UPDRS and quality of life. Long-term follow-up indicated a low rate of device complications.

1. Enteral levodopa infusion as monotherapy is superior to conventional oral treatment of advanced Parkinson’s disease
D Nyholm, N Dizdar, IN Remahl, R Constantinescu, B Holmberg, R Jansson, SM Aquilonius, H Askmark

Twenty-four patients with motor complications were randomized to receive either conventional medical treatment (optimized individually for each patient) or Duodopa by intraduodenal infusion for three weeks, followed by crossover to the other treatment. Patients were videotaped every 30 minutes for 8 hours during treatment, and videos were rated by blinded investigators for “on” vs. “off” with or without dyskinesias. UPDRS and two quality-of-life scales were also administered.

Number of ratings in the on state without significant dyskinesias was 82% for conventional treatment vs. 100% for Duodopa (p<0.01). Finger tapping, hand movements, rising from a chair, gait, and bradykinesia were also improved. Median UPDRS was 53 on conventional treatment vs. 35 on Duodopa, and both QoL scores were more improved for Duodopa as well. Adverse events were similar between treatments.

2. Intraduodenal infusion of a gel suspension of levodopa/carbidopa, Duodopa®, in advanced Parkinson’s disease: Safety, tolerability, efficacy, dosage
D Nyholm, T Lewander, A Johansson, P LeWitt, C Lundqvist, SM Aquilonius
P496, S177

Fifty-two patients received Duodopa, primarily as monotherapy, for one year or more (average 4.1 years). Device complications occurred at a rate of 1.8 times per patient per year. These were primarily tube occlusions and dislocations. Side effect frequency and severity was similar to oral levodopa. Eighty-four percent of patients had “improved” or “much improved” motor fluctuations, and 50% had improved or much improved dyskinesias. No patients reported worsening as a result of therapy.

Zonisamide for Tremor
The potential of the anticonvulsant zonisamide as an adjunctive therapy in PD was examined in two studies, one versus trihexyphenidyl and the other versus placebo.

1. Effectiveness of zonisamide on parkinsonian tremor: A pilot cross-over study in comparison with trihexyphenidyl
I Nakanishi, Jkohmoto, H Miwa, T Kondo
P402, S147

Thirteen PD patients with tremor were randomized to 100 mg zonisamide or 1.5 mg trihexyphenidyl as adjunctive therapy for two weeks, followed by a two-week washout and crossover to the other treatment arm. Tremor improved significantly and equivalently in both groups. Trihexyphenidyl, but not zonisamide, caused improvement in UPDRS motor subscore after excluding tremor improvement. Zonisamide caused more drowsiness and nausea, while trihexyphenidyl caused more dry mouth.

2. Randomized, double-blind study of zonisamide with placebo in advanced Parkinson’s disease
M Muratta, K Hasegawa, I Kanazawa, Japan Zonisamide Study Group
P555, S198

One hundred thirty-six patients were randomized to receive zonisamide (at 50, 100, or 200 mg per day) or placebo as adjunctive therapy for 8 weeks. Low-dose zonisamide significantly improved UPDRS motor score vs placebo, while improvement from the other two doses just failed to reach significance. The authors report that zonisamide improved axial symptoms (neck rigidity, gait disturbance, postural instability) as well as limb rigidity.

Eradication of the ulcer-causing bacterium H. pylori improves levodopa pharmacokinetics, and a levodopa-containing seed powder provides fast symptoms relief, according to these two studies.

Long-term effects of Helicobacter pylori eradication on L-Dopa absorption in Parkinson’s disease patients
L Brusa, A Pietroiusti, M Pierantozzi, S Galati, E Fedele, P Stanzione
P1133, S387

Eradication of Helicobacter pylori improves levodopa pharmacokinetics, according to this study.

Twenty-five patients with H. pylori infection and unsatisfactory levodopa response received placebo followed by either H. pylori eradication therapy or antioxidant therapy with allopurinol. Pharmacokinetic, clinical, and histological response was gauged at 2 weeks and 3 months after treatment. Compared to placebo and allopurinol, eradication therapy increased levodopa C-max and area under the curve, with maximal benefits at 3 months, correlated with improvements in gastritis and duodenitis.

The authors suggest that testing for and treatment of infection in PD patients with motor fluctuations may be beneficial.

Mucuna pruriens in Parkinson’s disease: A double-blind clinical and pharmacological study
R Katzenschlager, A Evans, A Manson, PN Patsalos, N Ratnaraj, H Watt, L Timmermann, R Van de Giessen, AJ Lees
P710, S249

Levodopa-containing seed powder from Mucuna pruriens (cowhage, velvet bean, atmagupta) produces a rapid-onset symptomatic treatment for Parkinson’s disease, according to this study.

Eight patients with dyskinesias were randomized to receive either 200 mg levodopa or 15 or 30 mg M. pruriens followed by crossover. Onset of effect for the 30 mg dose was 34.6 minutes, vs. 68.5 minutes for levodopa (p = 0.021). Mean on time was 22% longer and area under the curve was 165% larger. No differences were seen in dyskinesias as assessed by two blinded video raters.

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

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