Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Previous short-term studies have shown that the dopamine agonist pergolide improves control of Parkinson's disease when used in conjunction with carbidopa-levodopa (Sinemet). We assessed the long-term outcome (2 1/2- to 3-year follow-up) in patients with Parkinson's disease who participated in our previous pergolide double-blind trial and were subsequently switched to open-label pergolide therapy. Of 41 evaluable patients who began pergolide therapy, 10 (24%) experienced sustained substantial benefit that persisted to the end of this investigation. A total of 23 patients (56%) remained on pergolide therapy and, as a group, had considerable improvement over baseline at 2 1/2 to 3 years on the basis of several measurements of efficacy. A tendency toward deterioration could be reversed in many patients by larger or more frequent doses of carbidopa-levodopa; nevertheless, all but four patients were still taking the same dose or less of carbidopa-levodopa at the end of this study as at the onset. Patients with the best initial response to pergolide seemed most likely to experience long-term benefit. Confusion and hallucinations were the side effects most likely to necessitate discontinuation of pergolide. Symptoms suggestive of dose-related angina pectoris occurred in four patients in the open-label phase and two patients in the earlier double-blind phase (13% of patients who started pergolide therapy); these symptoms were easily controlled by dose reduction or discontinuation of pergolide, without sequelae. Dose-related leukopenia developed in one patient.
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PMID:Pergolide: long-term use in Parkinson's disease. 305 Mar 1

On-off fluctuations in longstanding Parkinson's disease initially respond well to a combined drug regime of Levodopa with direct dopamine agonists and L-deprenyl. L-Dopa infusions are efficient, but not applicable for longer use. S.c.-Lisuride-infusions reduce markedly motor-response fluctuations, dystonias and hyperkinesias, but bear the risk of inducing confusion or even psychosis. In patients with coexisting response fluctuations and psychiatric disturbances a therapeutic approach is outlined to preserve still some favourable effects on motor performance avoiding severe psychosis. Side-effects and possible complications of that therapy are discussed as are some further indications for the clinical use of Lisuride in akinetic crisis, the neuroleptic malignant syndrome and in dyskinesias.
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PMID:Chronic s.c. lisuride in Parkinson's disease--motor-performance and avoidance of psychiatric side effects. 316 38

Neuroleptic malignant syndrome is an uncommon, occasionally lethal reaction to drug therapy. Patients taking neuroleptic medication are usually the victims of this complex disorder, but others, such as patients with Parkinson's disease, are also at risk. The classic presentation includes autonomic instability, rigidity, hyperthermia, confusion and other neurologic symptoms. Family physicians may be the first to see these patients and must be able to make the diagnosis quickly to avoid delay in treatment.
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PMID:Neuroleptic malignant syndrome. 318 25

Budipine, a new 4,4-diphenylpiperidine derivative, and placebo were administered three times daily to 31 patients with Parkinson's disease over a period of 12 weeks. All patients in the two treatment groups received levodopa (plus benserazide) at an optimum and constant dose for at least 2 months before the start of the study and throughout the trial. The additional administration of budipine (daily dose 60 mg) was excellently tolerated by 14 patients, while 2 patients left the study because of mental confusion at an early stage of the trial. The budipine group showed a 22% improvement on the Columbia Rating Scale (median score). Compared with the placebo group (4% improvement), there was a highly significant difference (P less than 0.01, one-tailed test). Of the three main symptoms of Parkinson's disease, the best effect was seen on tremor, and less pronounced effects on bradykinesia and rigidity. Owing to its long half-life (31 h) with little plasma level fluctuations, budipine appears to be an effective agent in the treatment of Parkinson's disease.
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PMID:Adjuvant treatment of Parksinson's disease with budipine: a double-blind trial versus placebo. 330 21

Twenty-eight cases of mirror writing were seen during a period of three and a half years. These consisted of 12 patients with essential tremor, nine with Parkinson's disease, three with spino-cerebellar degeneration and four other cases. There were no cases of hemiparesis, aphasia, apraxia, agnosia or confusion. Fragmentary reversals were excluded from this study. Since essential tremor, Parkinsonian tremor and cerebellar tremor can be abolished by a stereotaxic produce applied to the thalamus, a common neural pathway via the thalamic nuclei may exist in these disorders. The existence is therefore proposed of some neural mechanism that controls the higher cerebral function of writing via the thalamus.
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PMID:The aetiology of mirror writing: a new hypothesis. 343 91

The parkinsonism that occurs in some patients with olivopontocerebellar atrophy (OPCA) can cause diagnostic confusion with idiopathic Parkinson's disease (IPD). The response to levodopa is usually a distinguishing feature, the OPCAs either failing to benefit or losing efficacy relatively quickly. A fluctuating response to levodopa in those OPCA patients who do benefit has not been emphasized in the literature previously. Reported here are three patients with presumed OPCA, dominated by parkinsonian features, who eventually developed typical fluctuations with morning akinesia, wearing off, and periodic lack of response related to meals. These fluctuations were a major source of disability and an important reason for diagnostic confusion with IPD. The possible mechanisms of these fluctuations are discussed.
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PMID:Levodopa dose-related fluctuations in presumed olivopontocerebellar atrophy. 350 41

Two patients with Parkinson's disease presented with unprovoked, abrupt onset of hallucinations, confusion and the simultaneous worsening of parkinsonian symptoms. This clinical syndrome appears to be a rare complication of dopaminergic therapy since improvement occurred gradually with reduction of Sinemet dosage.
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PMID:Sudden onset of confusion with severe exacerbation of parkinsonism during levodopa therapy. 350 49

Low-dose bromocriptine therapy and low-dose levodopa-carbidopa therapy are being compared in a double-blind study over a five-year period as treatment for newly-diagnosed patients with Parkinson's disease. Ninety-four patients had entered the study by January 1986 and of these, 50 had been followed for six months or more. Preliminary results confirm that many patients with Parkinson's disease can be managed satisfactorily in the early stages of the disease with low-dose therapy. Three patients, all of whom were receiving levodopa-carbidopa therapy, developed dyskinesia. Twelve patients who had received bromocriptine had an inadequate response or developed confusion or postural hypotension. Of these patients, six had a poor response to subsequent levodopa-carbidopa therapy. While the initial improvement that results from low-dose bromocriptine therapy and low-dose levodopa-carbidopa therapy is less than one would expect with conventional doses of these agents, it is hoped that this approach will reduce the incidence of long-term side-effects such as dyskinesia and fluctuations.
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PMID:The Sydney multicentre study of Parkinson's disease. The first 18 months. 355 78

Falling occurs more often in patients with Parkinson's disease when there is inadequate--not excessive--effect of the antiparkinsonian agent. Thus, falling may be evidence of a need for increased dosage. Of PD patients participating in a study, 60% reported experiencing hallucinations, confusion, vivid dreams, or nightmares. Confusion (34%) was the most commonly reported mental complaint; 27% reported vivid dreams; 26%, hallucinations; and 20%, nightmares.
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PMID:Avoiding mental changes and falls in older Parkinson's patients. 373 9

Long-term management of patients with Parkinson's disease includes close monitoring and frequent dose adjustment. In a small selected group of patients, complete withdrawal of L-dopa (drug holiday) and slow reintroduction of lower doses of this drug assured continued benefit for six to 24 months. We studied 45 drug holidays in 45 patients with idiopathic Parkinson's disease. Average preholiday L-dopa dose was 2,970 mg/d; at 24 months, it was 263 mg/d. The drug holiday resulted in reduced adverse drug effects (dyskinesias, "on-off" phenomenon, hallucinations, and confusion), and improved functional ratings at one, six, 12, and 24 months after the drug holiday.
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PMID:Parkinson's disease: follow-up after "drug holiday". 379 59


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