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

Gastrointestinal (GI) motility disorders are frequent in patients with Parkinson's disease, manifesting mainly as dysphagia, disorders of gastric emptying and constipation. The most likely causes of these disorders are cerebral degeneration and degeneration of the myenteric plexus. Although the effect of antiparkinsonian medication is largely overestimated, it certainly has an influence and should be adapted accordingly in patients with GI motility disorders. In particular, anticholinergic drugs should be avoided, and anamnesis, clinical examination and, if necessary, diagnostic tests performed. Domperidone, a peripheral dopamine antagonist, is the drug of choice for motility disorders of the upper GI tract, although cisapride is an alternative. In the lower GI tract, conservative therapeutic options should be used in the first instance. The administration of cisapride leads to a marked temporary improvement in symptoms in lower GI disorders, while rare forms of anism (involuntary dystonic contraction of the anal sphincter) may be treated with botulinum toxin.
 ...
PMID:Gastrointestinal motility problems in patients with Parkinson's disease. Effects of antiparkinsonian treatment and guidelines for management. 910 86

Constipation is a common condition defined by less than three bowel movements per week. Often constipation is secondary to altered motility of the colon. Tests that measure colonic motility lead the clinician to appropriate therapy. Colonic transit measured with either radionuclides or radio-opaque markers determine whether the transit through the colon is truly slow, and then identify the potential region of the colon that impedes the movement of intraluminal contents. Patients with normal colonic transit do not require further evaluation of their colonic motor function. Colonic and anorectal manometry differentiate patients in to 3 groups: (1) functional anal outlet obstruction; (2) uncoordinated distal colonic phasic contractions, and (3) colonic inertia. Functional outlet obstruction may be treated successfully by increasing the water content of their stools and biofeedback. Antispasmodics including anticholinergics, nitrates and calcium channel blockers may decrease the functional obstruction caused by phasic colonic contractions. The prokinetics such as cisapride have successfully improved constipation due to colonic inertia, Parkinson's disease or spinal cord injury as well as idiopathic inertia. Occasionally patients with inertia may require colectomy with ileorectal anastomosis to treat severe constipation.
 ...
PMID:Role of colonic motility in guiding therapy in patients with constipation. 917 49

A total of 335 patients with early Parkinson's disease (PD) were enrolled in a multicenter, randomized, double-blind trial designed to assess the efficacy and safety of pramipexole. Entry was restricted to patients with idiopathic PD who were not receiving levodopa. Pramipexole was administered according to an ascending dose schedule up to 4.5 mg/d. During the 7-week dose-escalation phase, each subject was titrated to his or her maximally tolerated dose of study medication. This was followed by a 24-week period of maintenance therapy. The mean daily dose during the maintenance period was 3.8 mg. Pramipexole significantly reduced the severity of PD symptoms and signs compared with placebo, as measured by decreases in parts II (Activities of Daily Living) and III (Motor Examination) of the Unified Parkinson's Disease Rating Scale at week 24 compared with baseline (p < or = 0.0001). Differences between the active drug and placebo groups emerged at week 3 (1.5 mg/d) in the ascending-dose interval and persisted throughout the maintenance phase (p < or = 0.0001). The majority of patients completed the study (pramipexole 83%, placebo 80%). In the assessment of adverse events, nausea, insomnia, constipation, somnolence, and visual hallucinations occurred more frequently in the pramipexole treatment group compared with placebo patients. No clinically significant changes were noted in blood pressure or pulse rate. Overall, these results indicate that pramipexole is safe and effective in the treatment of early PD.
 ...
PMID:Efficacy of pramipexole, a novel dopamine agonist, as monotherapy in mild to moderate Parkinson's disease. The Pramipexole Study Group. 930 31

A parkinsonian patient with severe outlet-type constipation was treated with injection of botulinum toxin into the puborectalis muscle. A total of 30 units (Botox) was injected in two sites. Resting anal pressure, maximum voluntary contraction, and pressure on straining were evaluated before treatment and 4, 8, 12, and 16 weeks afterward. Pressure values declined following treatment, the decline of pressure on straining ending by week 12. Proctography performed 8 weeks after treatment showed improvement in the anorectal angle and evacuation of barium paste. The clinical benefit lasted for approximately 12 weeks. The present data show that botulinum toxin is a promising tool for treating outlet-type constipation in Parkinson's disease.
 ...
PMID:Severe constipation in Parkinson's disease relieved by botulinum toxin. 938 63

We evaluated the reliability of patient history and the effect of psyllium on symptoms and colorectal function in 12 patients with Parkinson's disease (PD) and constipation. In all but two, constipation anteceded the development of parkinsonian symptoms. A comparison with prospectively obtained stool diaries confirmed the patients' reported constipation in 7 of the 12 patients. Those patients with confirmed constipation had lower stool weights and reported more straining at stool. Measures of colonic and anorectal function were similar in those who were truly constipated and those who were not. Among those PD subjects with confirmed constipation, psyllium increased stool frequency and weight but did not alter colonic transit or anorectal function. We conclude that prospectively obtained stool diaries should be employed to confirm constipation in PD and that psyllium produces both subjective and objective improvements in constipation related to PD.
 ...
PMID:Constipation in Parkinson's disease: objective assessment and response to psyllium. 939 19

This study investigated whether domperidone could improve gastrointestinal symptoms in patients with Parkinson's disease who were receiving levodopa therapy. A total of 11 patients were studied. Following a baseline gastric emptying test, patients were treated with a starting dose of domperidone 20 mg p.o. q.i.d. A follow-up gastric emptying test was repeated at least 4 months after starting domperidone therapy. At the beginning and at each 3-month follow-up visit, symptoms of nausea, vomiting, anorexia, abdominal bloating, heartburn, regurgitation, dysphagia, and constipation were evaluated and scored on a scale of 0-3. The overall mean follow-up period was 3 years. Compared with their baseline evaluation, patients experienced a significant improvement in all symptoms (p < 0.05) except dysphagia and constipation. Gastric emptying of an isotope-labeled solid meal was significantly faster, with a baseline result of 60.2 +/- 6.4% retention of isotope 2 h after the meal compared with 37.0 +/- 2.2% retention during domperidone therapy (p < 0.05). Patients' global assessment of Parkinson's disease remained stable or improved. Serum prolactin was elevated in all patients after domperidone therapy (p < 0.05). Domperidone therapy significantly reduces upper gastrointestinal symptoms and accelerates gastric emptying of a solid meal, but does not interfere with response to antiparkinsonism treatment.
 ...
PMID:Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with Parkinson's disease. 939 20

Selegiline (deprenyl), a selective, irreversible inhibitor of monoamine oxidase type B (MAO-B) is widely used in the treatment of Parkinson's disease. As the first MAO-B inhibitor approved for the treatment of Parkinson's disease, concerns were raised about the safety of the drug based on the adverse effect profiles of older, nonselective MAO inhibitors. Unlike the nonselective MAO inhibitors, selegiline does not significantly potentiate tyramine-induced hypertension (the 'cheese effect') at the dosages (5 to 10 mg daily) used for the treatment of Parkinson's disease. Selegiline has been well tolerated when given alone. The most frequent adverse events seen during monotherapy have been insomnia, nausea, benign cardiac arrhythmias, dizziness and headache. When combined with levodopa, selegiline can potentiate the typical adverse effects of levodopa, if the dose of levodopa is not reduced sufficiently. Thus, the most common adverse effects associated with this combination are nausea, dizziness, fatigue, constipation and insomnia. At the later stages of Parkinson's disease when fluctuations in disability occur, peak dose dyskinesias, psychiatric complications like hallucinations and insomnia, and orthostatic hypotension are further potentiated by selegiline. Mortality was recently reported to be increased when selegiline and levodopa were given together in comparison with treatment with levodopa alone, but a large meta-analysis of 5 long term studies and 4 separate studies did not support this conclusion. Selegiline seems to be generally well tolerated in combination with other drugs. However, when pethidine (meperidine) has been given to patients who are receiving selegiline therapy, severe adverse effects have been reported. Thus, the concomitant use of these drugs is not recommended. A low tyramine diet is recommended if selegiline is used together with nonselective MAO inhibitors or the selective, reversible MAO-A inhibitor, moclobemide. Several adverse effects have been reported when fluoxetine and selegiline have been used together. A recent survey revealed that the incidence of a true serotonin syndrome is, however, very low with this combination. Concomitant use of selegiline and other selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) like citalopram, which have generally less interactions than fluoxetine, seems to be well tolerated. Nevertheless, caution is advised when combining a SSRI or a tricyclic antidepressant and selegiline.
 ...
PMID:Safety of selegiline (deprenyl) in the treatment of Parkinson's disease. 967 55

Constipation is very common in Parkinson's disease. It is still not known whether constipation is due to a slow transit of the colon or an outlet obstruction. We examined 25 patients (11 women, 14 men, mean age 62 years) with newly diagnosed idiopathic Parkinson's disease. All patients had typical clinical symptoms (with an average score of 11.4 points on the Webster scale); the diagnosis was confirmed by 18F-Dopa-PET. In all patients the colon transit time was measured with radioopaque markers. Pudendal nerve lesions were excluded by neurography of the pudendal nerve. Electromyography of the external anal sphincter was performed with concentric needle electrodes in the right and left lateral position. Colon transit time in the patients averaged 3.7 days, with pathologically prolonged transit (> 4 days) in 6 patients (24%). Four patients (16%) showed mild neurogenic changes on sphincter EMG (16%). In three other cases (12%) long duration and large amplitude of motor unit action potentials (MUAPs), and a reduced interference pattern during maximal voluntary effort indicated a severe neurogenic lesion. One patient presented with involuntary contractions of the external anal sphincter at rest, which increased during strain (anism).
 ...
PMID:Defecatory disorders in de novo Parkinsonians--colonic transit and electromyogram of the external anal sphincter. 978 72

Prevalence of chronic constipation is around 3% in youth, 8% in middle age, and 20% in the elderly, respectively. There are three etiologic groups: 1. Diet poor in fibre. Most constipated persons, however, do not eat less fibre than controls. 2. Organic diseases accompanied by constipation such as autonomous neuropathies (e.g. in diabetes), endocrine disorders, and neurologic diseases (e.g. Parkinsons disease). 3. Functional outlet obstruction. This may be due to disturbed sphincter function, internal rectal prolapse, or rectocele. The basic treatment of all forms of constipation consists in a diet rich in fibre. In selected cases of functional outlet obstruction, surgery may be successful. Otherwise, treatment with laxatives is justified.
 ...
PMID:[Diagnosis and therapy of constipation]. 988 Oct 37

Patients who seek medical care for constipation present challenges which may involve communication problems, difficulties in diagnosis, lack of optimal therapy, uncorrectable underlying disorders, or psychiatric issues which complicated management. This review describes some of these challenges, and presents management approaches that may increase the likelihood of satisfactory treatment outcomes. Situations which are reviewed include the diagnostic evaluation of the new patient with constipation; syndromes of uncertain pathophysiology including irritable bowel syndrome, slow transit constipation, and pelvic floor dysfunction; constipation associated with neurologic disorders including spinal cord injury, Parkinson's disease, and multiple sclerosis; and psychiatric issues which complicate the management of constipation, including recognition of associated psychiatric diseases, unusual attitudes toward bowel function, eating disorders, and referral for psychiatric care.
 ...
PMID:Challenging problems presenting as constipation. 1008 34


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>