Long-Term Efficacy of Controlled-Release Carbidopa/Levodopa in Patients with Advanced Parkinson s Disease*

Size: px
Start display at page:

Download "Long-Term Efficacy of Controlled-Release Carbidopa/Levodopa in Patients with Advanced Parkinson s Disease*"

Transcription

1 ANNALS O F CLINICAL AND LABORATORY SCIEN CE, Vol. 19, 6 Copyright 1989, Institute for Clinical Science, Inc. Long-Term Efficacy of Controlled-Release Carbidopa/Levodopa in Patients with Advanced Parkinson s Disease* MARGERY H. MARK, M.D. and JACOB I. SAGE, M.D. Department of Neurology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ ABSTRACT Twenty-one patients with Parkinson s disease and m otor fluctuations who completed a double-blind study comparing controlled-release carbidopa/levodopa (Sinemet CR4)* with standard Sinemet (SS) were evaluated one year following completion of the study. Five patients rem ained on CR4 alone; 16 continued on CR4 plus SS, and one also required addition of bromocriptine. Patients were significantly worse (p < 0.05) at one year compared with double-blind CR4 phase (DBCR) for nine param eters of the motor exam, six activities of daily living (ADL), Hoehn & Yahr staging, and physician s global assessment. Compared with baseline SS, patients were worse at one year for four points of the motor exam, two of m entation, behavior, and mood, and 11 param eters of ADL. Im provem ent at one year was noted for less action and postural trem or and decreased duration of dyskinesias for both comparison periods. There was elimination of early morning dystonia at one year over the DBCR period and more hours on without dyskinesias and fewer hours on with dyskinesias compared with baseline SS. Total levodopa dosage was not significantly changed over the year. These data suggest that, in long-term use, CR4 remains more efficacious than SS alone for Parkinson s patients experiencing m otor fluctuations, although disease progression continues despite optim al m edication. Introduction T he com bination of levodopa plus decarboxylase inhibitor has been the * Send reprint requests to: Margery H. Mark, M.D., Departm ent of Neurology, UMDNJ-Robert Wood Johnson Medical School, CN-19, New Brunswick, NJ * The new trademark name for Sinemet CR4 is now Sinemet CR. most effective treatm ent for Parkinson s disease for m ore than a decade. H ow ever, its long-term use frequently brings about a num ber of undesirable m otor fluctuations, including w earing off (end-of-dose d eterioration), on-off phenomena, peak-dose dyskinesias, and off dystonia.2,3'9,23 The appearance of these phenom ena have been correlated w ith flu ctu atio n s in plasm a levodopa /89/ $01.20 Institute for Clinical Science, Inc.

2 4 1 6 MARK AND SAGE concentration. 7,1014,23 24 New th era p eu tic objectives have thus been aim ed at m aintaining a steady plasma levodopa level to generate consistent m otor function. Im provem ent in motor fluctuations in some patients has been effected with in tra v e n o u s 27 and in tra d u o d e n a l29 30 levodopa infusions. Trials have b een undertaken of oral controlled-release preparations of benserazide/levodopa26 and of carbidopa/levodopa (Sinemet); the latter has undergone several generations of clinical trials, from CR-1 th ro u g h CR ,28 Some studies of the pharm acokinetics of the oral controlled-release drugs have correlated im provem ent in m otor fluctuations with s m o o th e r p la s m a le v e ls o f le v o dopa Most of the recent trials have studied Sinemet CR-4 (CR), a formulation of 50 mg carbidopa per mg levodopa in an erodable polymeric matrix, in comparis o n with standard Sinemet (SS). 1, Following th e com p letio n of a double-blind, crossover study, 28 patients in our trial were continued on open label CR, either w ith or w ithout additional SS or dopam ine agonist, acco rd in g to in d iv id u al n eed s. Results of the one-year follow-up of open label CR in 21 p atien ts are re p o rte d com pared with the results of the final week (week 8 ) of CR therapy during the double blind trial, as well as with the results of baseline SS. Patients and Methods Twenty-one (13 men, 8 women) of 24 p a tie n ts w ith m otor flu c tu a tio n s in advanced Parkinson s disease who completed a double-blind crossover study comparing CR with SS continued to take CR at th e conclusion of th e 24-w eek trial. Their mean age was 64.9 years (age range 51 to 78 years), mean duration of disease 11.1 years (range 4 to 19 years), and m ean duration of fluctuations 5.9 years (range 2 to 17 years). R e q u ire m ents for entry into the initial study included wearing-off of dose, on-off phenom enon, dose-related dyskinesias, or freezing d esp ite optim al levodopa therapy, and a SS dosing schedule of at least four tim es per day. O f the three patients who w ere not included in the long-term study, one chose to drop out of the study and return to SS alone as she found no fu rth e r clinical b en efit nor increased convenience; one was lost to follow-up; and the third, although still on CR at night, is currently being m aintain ed on an in trad u o d en al levodopa pum p and was therefore excluded from the calculations. Results of patient evaluations in the final week of the initial eight-week doub le-b lin d CR p erio d w ere com pared with the data from the one year point. Patients w ere evaluated using the Unified Parkinson s Disease Scale (UPDS)8 m easu rin g su b jectiv e p a ra m e te rs of m entation, behavior, and mood, activities of daily living (ADL) for both on and off states, and com plications of therapy. Extrapyram idal m otor examination was graded on a 0 to 4 scale (0 = no disability, 4 = maximum disability). Also included in the routine evaluation was th e H o e h n & Yahr s ta g in g, 8-15 th e Schwab & England Activities of Daily Living scale for on and off states, 8 and total levodopa dosage. The patients were also asked to record a 24-hour diary twice a week, rating each hour as asleep, on without dyskinesias, on with dyskinesias, or off. For those hours that included m ore than one of these four d e s c rip tio n s, th e sin g le ra tin g th a t reflected the greatest part of the hour was recorded. At the end of each period, the examiners graded the patients for severity of illness. A full listing of all p a r a m e t e r s h a s b e e n p r e v io u s ly reported.28 Statistical analyses were based on all of the above information as obtained in the

3 LONG-TERM CONTROLLED-RELEASE SINEMET 417 final w eek of each p erio d. Statistical analyses w ere perfo rm ed by the chisquare test and S tudent s t-test. Results Twenty-one of the original 24 patients com pleting the double-blind study continued on open-label CR follow-up with evaluation at one year. The p atien ts s scores at the conclusion of the CR phase of the double-blind trial (DRCR) were re c o rd e d and c o m p a re d w ith th o se obtained at the one year visit. In table I are listed the statistically significant (p < ) p a ra m e te rs th a t w e re b e tte r (versus the same or worse) during the DRCR phase than at one year; in Table II are listed those that were improved one year later com pared w ith the initial DBCR period. TABLE I U nified P a rk in so n 's Disease Scale Param eters Worse a t One Year on CR N o. a t 1 Y r. Speech 8 2 Finger taps 8 1 Hand movements 9 2 Rapid alternating movements 9 2 of hands Foot agility 9 2 Arising from chair 8 2 Posture* Gait 9 3 Postural stability* 10 2 Activity of Daily Living Speech On 8 2 Handwriting Off 8 2 Cutting food and handling Off 8 2 utensils Dressing Off* 12 2 Hygiene Off# 14 0 Walking Off* Hoehn and Yahr Staging 6 1 Physician's global assessment All statistically significant at p < 0.05 except * p < and # p < CR = Sinemet CR T A B L E II U nified P ark in so n 's D isease Scale Param eters B e tte r a t One Year N o. a t 1 Y r. on CR Action and postural tremor* 6 0 Duration of dyskinesias* 9 1 Presence of early morning 5 0 dystonia Statistically significant at p < 0.05 except * p < CR = Sinemet CR Nine out of the 18 individual points of the m otor exam were significantly better d u rin g th e D B CR phase th an at one year. For seven of these param eters, the p value was < 0.05 and was b etter in 38.1 to 42.9 percent of patients on DBCR vs. 4.8 to 9.5 percent b e tte r at one year: speech, finger taps, hand m ovem ents, rapid alternating m ovem ents of hands, foot agility, arising from chair, and gait; for posture and postural stability, 52.4 percent and 47.6 percent, respectively, w ere b e tter on DBCR vs. 9.5 percent b e tte r at one year, w ith p < Although the m otor exam represents a brief point in the course of the day, the patients w ere largely evaluated in relative on phases for both periods, thus allowing a reasonably fair comparison. Activities of daily living dem onstrated a significant decline at one year for six p aram eters. In th e on phase, only speech was b e tte r on DBCR (38.1 p e r cent of patients) than at one year (9.5 percent). The other five items were all noted to be significantly better on DBCR in the off phase: handwriting and cutting food/handling utensils (both 38.1 p e rc e n t vs. 9.5 p e rc e n t, p < 0.05); dressing (57.1 percent vs. 9.5 percent, p < ); h y g ie n e (66.7 p e r c e n t of patients better on DBCR and none bette r at one year, w ith p < ); and walking (52.4 percen t vs. 9.5 percent, p < 0.01).

4 418 MARK AND SAGE At one year, six patients had a decline in their Hoehn & Yahr staging compared w ith only one showing im provem ent (p < 0.05). Both periods exhibited staging range of two to four; however, although the mean for DBCR was 2.7 and for one year 3.0, the total rating did not reveal a statistically significant difference. Patients were rated by examiners for global assessm ent of severity of illness compared with baseline (pre-study) Sinem et treatm ent. E leven patients (52.4 percent) w ere felt to be worse at one year vs. 4 (19.0 percent) who m aintained overall im provem ent; the difference is significant at p < T hree param eters exhibited im provem ent at one year compared with DBCR. On the motor examination, 28.6 percent of patien ts had red u c e d action or postural trem or of hands at one year; no p a tien ts w ere b e tte r on D BCR (p < 0.01). Two m easurem ents of com plications of therapy were better at one year than on DBCR: duration of dyskinesias (42.9 percent vs. 4.8 percent of patients, p < ) and presence of early morning dystonia (23.8 percent vs. 0, p < 0.05). Com pared with baseline SS, there was significant decline at one year for four points of the m otor exam: speech (1 0 patients better on SS vs. 0 at one year, p < 0.001), gait and postural stability (47.6 percent b e tte r on SS vs percent b e tte r at one year) and bradykinesia (38.1 p ercen t vs. 9.5 percent), with a p < There was a significant num ber of patients w ith m ore disability of m entation, behavior, and mood (thought disorder and m otivation/initiative) at one year than at baseline (p < 0.01). Eleven factors of ADL scoring were also better at baseline than at one year; they are listed in table III. Four evaluation param eters were better at one year compared with baseline SS (table IV). Action and postural trem or was significantly b e tter at one year for th e sam e n u m b er of p a tie n ts as the T A B L E III U nified P a rk in so n 's D isease Scale Param eters B e tter a t B aseline Over One Year B a s e l in e 1 Y r. Speech# 10 0 Gait 10 3 Postural stability 10 3 Bradykinesia 8 2 Mentation, Behavior, Mood Thought disorder* 7 0 Motivation/initiative* 9 2 Activities of Daily Living Speech On* 9 2 Handwriting On 8 1 Handwriting Off 8 2 Dressing On 8 2 Hygiene On 6 1 Falling On* 10 2 Falling Off* Freezing On 9 2 Freezing Off 9 3 Walking On 9 2 Walking Off 9 3 Statistically significant at p < 0.05 except * < and # < DBCR comparison. Also like the DBCR comparison, duration of dyskinesias was reduced at one year for 38.1 percent of patients com pared with 9.5 percent b ette r on SS. H ow ever, unlike DBCR, th ere was significant im provem ent at one year for 2 components of the 24 hour diary: m ore hours on without dyskinesias (66.7 percent) and fewer hours on w ith dyskinesias (for 52.4 p e rc e n t of patients) as opposed to 23.8 percent and 19.0 p e rc e n t, respectively, b e tte r at baseline. Previously, some im provem ent was re p o rte d w ith sh o rt-term data in 1 2 patients on com bination therapy with CR plus SS. 21,22 By the one year point, 16 of th e 21 p a tie n ts (76.2 p e rcen t) req u ired adjustm ent of m edication to com bination therapy with CR plus SS according to individual needs, one of whom also needed addition of brom o criptine, a direct-acting dopam ine ago-

5 LONG-TERM CONTROLLED-RELEASE SINEMET T A B L E IV U nified P ark in so n 's D isease Scale Param eters B etter a t One Year Over B aseline 1 Y r. B a s e l in e Action and postural tremor* 6 0 Duration of Dyskinesias 8 2 Hours "On" Without Dyskinesias 14 5 Hours "On" With Dyskinesias All statistically significant at p < 0.05 except * p < nist; the rem aining five patients continued on CR alone. N ine patients took alternating doses of SS and CR while seven took their SS doses simultaneously with CR. Eleven patients added SS as a m orning booster to circum vent the slow onset and loss of the morning kickin - that has been commonly noted with CR usage. 1,5,12,13,28 Three patients took afternoon or late night SS boosters to com bat short, predictable offs occurring at those times, but none needed the addition in the morning. Three people required SS doses in betw een each CR dose throughout the day; seven others took a SS tab le t w ith each CR dose, including the one patient on bromocriptine. In two other patients, disturbing dyskinesias on CR caused a return to SS alone for most of the day with CR used only in the evenings. Total daily am ount of levodopa (CR with or without addition of SS) was not significantly changed betw een treatm ent p erio d s, w ith a m ean of mg (± SD) at b aseline, mg (±722.8 SD) on DBCR and mg (±733.9 SD) at one year. No adverse effects w ere reported at one year on CR beyond those complications of therapy already experienced on SS. T here w ere no statistically or clinically significant changes in m entation, behavior, and mood, num ber of hours asleep, on w ithout dyskinesias, on w ith dyskinesias, or off for the one year/dbcr comparison, nor changes in the Schwab and England scale for either comparison group. Discussion At one year, nine param eters of the m otor exam ination and six activities of daily living dem onstrated a significant decline compared with the D üc R phase (table I). On the m otor exam, the regression is seen particu larly for postural reflexes and coordinated movements of the extremities; on ADL, five of the six occurred in the off phase. F urther, H oehn & Yahr staging and physician s global assessment also deteriorated after one year. In addition, th ere was significant decline in 11 param eters of ADL, two of m entation, behavior, and mood, and four of the m otor exam at one year over baseline SS (table III). These data are indicative of the fact that, despite optim al adjustm ent of levodopa tre a t m e n t, P a rk in so n s is a p ro g re ssiv e degenerative disease. Long-term therapy with CR (with and w ithout com bination w ith SS and/or dopam ine agonist) confirms the earlier finding in short-term, open label trial of CR with SS21,22 that duration of dyskinesias is reduced (table II). Recause of the h ig h er plasm a levodopa levels m aintained by CR therapy, 11 reduction in the total CR dose w ith com pensatory addition of small am ounts of short-onset, short-duration SS may decrease dyskinesias w ithout increasing the am ount of off tim e. 22 However, as two of the nine patients reporting reduced duration of dyskinesias w ere not on com bination therapy, one may speculate that m aintenance of dose in the face of progression of disease, and therefore increasing levodopa requirem ent, may result in shorter

6 420 MARK AND SAGE d u ra tio n of d y sk in e sias. Also, five p atien ts re p o rte d abatem en t of early morning dystonia at one year; one explanation for this occurrence is that long duration of a nighttim e CR dose may m aintain a plasm a levodopa level by morning that is sufficient to prevent this usually off phenom enon from d ev eloping. Previous reports of short-term open label5,12 and double-blind studies117'20 28 of CR com pared w ith SS have dem onstrated im provem ent in total daily on time on CR. Two long-term studies have been reported 613 comparing CR at one year w ith baseline SS; both noted significant im provem ent in on tim e over baseline. W hen our one year data are com pared w ith both baseline and the d o u b le -b lin d SS p h a se, sig n ifican t im provem ent (p < 0.05) is m aintained for reduced duration of dyskinesias and num ber of hours on with dyskinesias, and in creased n u m b er of hours on w ithout dyskinesias (table IV), suggesting that, even with long-term use of CR, there is still enhanced efficacy over SS alone. Although one short-term study17 has suggested that elderly men may benefit most from CR, the current authors were unable to identify any predictive factors for patients who may respond maximally to CR in our short-term trials, 22,28 and this observation is repeated in long-term follow-up. There was great variability of age, sex, severity of illness, duration of disease and flu ctu atio n s, n u m b er of doses and tablets of CR and SS, and total mg of levodopa. Each patient continued to re q u ire ad ju stm en t of m edication according to specific individual needs. Based on the findings in a long-term, open label trial of CR therapy (with or without addition of SS and/or dopamine agonist), it appears that use of CR for patients experiencing the m otor fluctuations associated with long-term levodopa treatm ent remains more efficacious after one year than use of SS alone. However, it also appears that the progression of Parkinson s disease continues despite optim al m edication. Acknowledgments The authors gratefully acknowledge the assistance of Mary Bergen, R.N., Ms. Michele Fabriele, and Ms. Vanessa Patterson. Funds and drugs for this study were provided by Merck Sharp and Dohme, W est Point, PA. References 1. A h l s k o g, J. E., M u e n t e r, M. D., M c M a n is, P. G., Be l l, G. N., and Ba iley, P. A.: Controlled-release Sinemet (CR-4): A double-blind crossover study in patients with fluctuating Parkinson s disease. Mayo Clin. Proc. 63: , Bah bea u, A. : Long-term appraisal of levodopa therapy (and panel discussion). Neurology 22 Suppl:22 37, Ba r b e a u, A.: Long-term side-effects of levodopa. Lancet 1:395, C e d a r b a u m, J. M., B r e c k, L., K u tt, H., and M c D o w e l l, F. H.: C ontrolled-release levodopa/carbidopa. I. Sinemet CR3 treatm ent of response fluctuations in Parkinson s disease. Neurology 37: , C e d a r b a u m, J. M., B r e c k, L., K u tt, H., and M c D o w e l l, F. H.: C ontrolled-release levodopa/carbidopa. II. Sinemet CR4 treatm ent of response fluctuations in Parkinson s disease. Neurology 37: , C e d a r b a u m, J. M., H oey, M., K u tt, H., and M c D o w e l l, F. H.: Results of long-term treatm ent with controlled-release levodopa/carbidopa. Ann. Neurol. 22:145, F a b b r in i, G., J u n c o s, J., M o u r a d ia n, M. M., Se r r a ti, C., and C h a se, T. N.: Levodopa pharmacokinetic mechanisms and motor fluctuations in Parkinson s disease. Ann. Neurol. 21: , F a h n, S. and E l t o n, R. L.: M embers of the UPDRS Development Committee. Unified Parkinson s disease rating scale. Recent Developments in Parkinson s Disease, voi II. Fahn, S., Marsden, C. D., Calne, D. B., and G o l d s t e in, M., eds. Florham Park, NJ, Macmillan Healthcare Information, 1987, pp , F a h n, S.: On-ofF phenomenon with levodopa therapy in parkinsonism. Neurology 24: , G a n c h e r, S. T., N u tt, J. G., and W o o d w a r d, W. R. : Peripheral pharmacokinetics of levodopa in untreated, stable, and fluctuating parkinsonian patients. Neurology 37: , G o e t z, C. G., C arvey, P. M., T a n n er, C. M., Sh annon, K. M., and Klawans, H. L.: Pharmacokinetic study of controlled release levo-

7 LONG-TERM CONTROLLED-RELEASE SINEMET 421 dopa/carbidopa (CR4-Sinemet) versus traditional Sinemet. Ann. Neurol. 22:170, G o e t z, C. G., T anner, C. M., K la wa ns, H. L., Sh a n n o n, K. M., an d C a r r o l l, V. S.: Parkinson s d isease a n d m o to r flu ctu atio n s: long-acting carb id o p a/lev o d o p a (C R -4-Sinem et). N eurology 37: , G o etz, C. G., T a n n er, C. M., Sh a n n o n, K. M., C a r r o l l, V. S., K l a w a n s, H. L., C arvey, P. M., a n d G illey, D.: C o n tro lle d -re le a se carb id o p a/lev o d o p a (C R 4-S inem et) in P ark in so n s disease p a tie n ts w ith a n d w ith o u t m o to r flu c tu a tions. N euro lo g y 3 8 : , H a r d ie, R. J., L e e s, A. J., and St e r n, G. M.: Pharmacokinetics of levodopa and motor fluctuations. Adv. Neurol. 45: , H o eh n, M. M., and Yahr, M. D.: Parkinsonism: Onset, progression, and mortality. Neurology 17: , H u tto n, J. T., D ip p e l, R. L., B ia n c h in e, J. R., St r a h l e n d o r f, H. K., and M ey e r, P. G.: Controlled-release carbidopa/levodopa in the treatment of parkinsonism. Clin. Neuropharmacol. 7: , H u tto n, J. T., M o r r is, J. L., Ro m a n, G. C., I m k e, S. C., and ELIAS, J. W.: Treatm ent of chronic Parkinson s disease w ith controlledrelease carbidopa/levodopa. Arch. N eurol. 45: , J u n c o s, J. L., F a b b r in i, G., M o u r a d ia n, M. M., and C h a se, T. N.: Controlled release levodopa-carbidopa (CR-5) in the management of parkinsonian m otor fluctuations. Arch. Neurol. 44: , J u n c o s, J. L., F a b b r in i, G., M o u r a d ia n, M. M., Ser r a ti, C., Ka sk, A. M., and C h a se, T. N.: Controlled release levodopa treatm ent of motor fluctuations in Parkinson s disease. J. Neurol. N eurosurg. Psychiatry 50: , L ieberm an, A. N., M iller, E., G opinathan, F., and N e o p h y t id e s, A.: A comparison of controlled release Sinemet 50/200 mg with standard Sinemet 25/100 mg in Parkinson s disease. Ann. Neurol. 2:173, M ark, M. H. and Sa g e, J. I.: C ontrolled-release carbidopa/levodopa (Sinemet) in combination with standard Sinemet therapy in advanced Parkinson s disease. Neurology 38 (Suppl 1):330, M ark, M. H. and Sa g e, J. I.: Controlled-release carbidopa/levodopa (Sinemet) in combination with standard Sinemet therapy in advanced Parkinson s disease. Ann. C lin. Lab. Sci. J9: , M a r s d e n, C. D. and Pa r k e s, J. D.: On-off effects in patients with Parkinson s disease on chronic levodopa therapy. Lancet 1: , M en a, M. A., M urad a s, V., Bazan, E., R e ir iz, J., and DE Ye b e n e s, J. G.: Pharmacokinetics of 1-DOPA in patients with Parkinson s disease. Adv. Neurol. 45: , N u tt, J. G., W o o d w a r d, W. R., and C a rter, J. H.: Clinical and biochemical studies with controlled-release levodopa/carbidopa. Neurology 36: , P o e w e, W. H., L e e s, A. J., and St e r n, G. M.: Treatment of motor fluctuations in Parkinson s disease with an oral sustained-release preparation of L-dopa: clinical and pharmacokinetic observations. Clin. Neuropharmacol. 9: , Q u in n, N., M a r sd en, C. D., and Pa rkes, J. D.: Complicated response fluctuations in Parkinson s disease: response to intravenous infusion of levodopa. Lancet 2: , Sa g e, J. I. and M a rk, M. H.: Comparison of controlled-release Sinemet (CR-4) and standard Sinemet (25/100) in advanced Parkinson s disease: a double-blind, crossover study. Clin. Neuropharmocol. 11: , Sa g e, J. I., Sc h u h, L., H e ik k il a, R. E., and D u v o isin, R. C.: Continuous 24-duodenal infusions of levodopa: plasma concentrations and motor fluctuations in Parkinson s disease. Clin. Neuropharmacol. 11:36-44, Sc h u h, L., Sa g e, J. I., H e ik k il a, R. E., and D u v o is in, R. C.: Continuous intraduodenal infusions of levodopa (LD) produce steady plasma LD levels which correlate with improvem ent of motor fluctuations in parkinsonian patients. Neurology 7:277, 1987.

Controlled-Release Carbidopa-Levodopa (Sinemet) in Combination with Standard Sinemet in Advanced Parkinson s Disease

Controlled-Release Carbidopa-Levodopa (Sinemet) in Combination with Standard Sinemet in Advanced Parkinson s Disease ANNALS O F CLINICAL AND LABORATORY SCIEN CE, Vol. 19, No. 2 Copyright 1989, Institute for Clinical Science, Inc. Controlled-Release Carbidopa-Levodopa (Sinemet) in Combination with Standard Sinemet in

More information

Sensitivity of Serum Fructosamine in Short Term Glycemic Control

Sensitivity of Serum Fructosamine in Short Term Glycemic Control A N N A L S O F C L IN IC A L A N D L A B O R A T O R Y S C IE N C E, Vol. 19, N o. 2 Copyright 1989, Institute for Clinical Science, Inc. Sensitivity of Serum Fructosamine in Short Term Glycemic Control

More information

A double-blind crossover comparison of Sinemet CR4 and standard Sinemet 25/100 in patients with Parkinson's disease and fluctuating motor performance

A double-blind crossover comparison of Sinemet CR4 and standard Sinemet 25/100 in patients with Parkinson's disease and fluctuating motor performance Journal ofneurology, Neurosurgery, and Psychiatry 1989;52:27-212 A double-blind crossover comparison of Sinemet CR4 and standard Sinemet 25/1 in patients with Parkinson's disease and fluctuating motor

More information

Form B3L: UPDRS Part III Motor Examination 1

Form B3L: UPDRS Part III Motor Examination 1 Initial Visit Packet NACC Uniform Data Set (UDS) LBD MODULE Form B3L: UPDRS Part III Motor Examination 1 ADC name: Subject ID: Form date: / / Visit #: Examiner s initials: INSTRUCTIONS: This form is to

More information

Reemergence of the International Normalized Ratio for the Standardization of Prothrombin Time*

Reemergence of the International Normalized Ratio for the Standardization of Prothrombin Time* ANNALS O F CLINICAL AND LABORATORY SCIEN CE, Vol. 23, No. 3 Copyright 1993, Institute for Clinical Science, Inc. Reemergence of the International Normalized Ratio for the Standardization of Prothrombin

More information

Continuous dopaminergic stimulation

Continuous dopaminergic stimulation Continuous dopaminergic stimulation Angelo Antonini Milan, Italy GPSRC CNS 172 173 0709 RTG 1 As PD progresses patient mobility becomes increasingly dependent on bioavailability of peripheral levodopa

More information

Re-Submission. Scottish Medicines Consortium. rasagiline 1mg tablet (Azilect ) (No. 255/06) Lundbeck Ltd / Teva Pharmaceuticals Ltd.

Re-Submission. Scottish Medicines Consortium. rasagiline 1mg tablet (Azilect ) (No. 255/06) Lundbeck Ltd / Teva Pharmaceuticals Ltd. Scottish Medicines Consortium Re-Submission rasagiline 1mg tablet (Azilect ) (No. 255/06) Lundbeck Ltd / Teva Pharmaceuticals Ltd 10 November 2006 The Scottish Medicines Consortium (SMC) has completed

More information

Parkinson s Disease. Sirilak yimcharoen

Parkinson s Disease. Sirilak yimcharoen Parkinson s Disease Sirilak yimcharoen EPIDEMIOLOGY ~1% of people over 55 years Age range 35 85 years peak age of onset is in the early 60s ~5% of cases characterized by an earlier age of onset (typically

More information

Optimizing Clinical Communication in Parkinson s Disease:

Optimizing Clinical Communication in Parkinson s Disease: Optimizing Clinical Communication in Parkinson s Disease:,Strategies for improving communication between you and your neurologist PFNCA Symposium March 25, 2017 Pritha Ghosh, MD Assistant Professor of

More information

Thyroid Screening in the Newborn: Utah Experience

Thyroid Screening in the Newborn: Utah Experience ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 13, No. 1 Copyright 1983, Institute for Clinical Science, Inc. Thyroid Screening in the Newborn: Utah Experience BRUCE A. BUEHLER. M.D.,* MELVIN J. GORTATOUSKI,

More information

LONG DIALYSIS SESSIONS (DAILY, NOCTURNAL ETC) Ercan Ok, Izm ir, Turkey. Chair: Mustafa Arici, Ankara, Turkey Bernard Canaud, Montpellier, France

LONG DIALYSIS SESSIONS (DAILY, NOCTURNAL ETC) Ercan Ok, Izm ir, Turkey. Chair: Mustafa Arici, Ankara, Turkey Bernard Canaud, Montpellier, France LONG DIALYSIS SESSIONS (DAILY, NOCTURNAL ETC) Ercan Ok, Izm ir, Turkey Chair: Mustafa Arici, Ankara, Turkey Bernard Canaud, Montpellier, France Prof Ercan Ok Divis ion of N ephrology E ge U nivers ity

More information

Unified Parkinson Disease Rating Scale (UPDRS)

Unified Parkinson Disease Rating Scale (UPDRS) Unified Parkinson Disease Rating Scale (UPDRS) The UPDRS is a rating tool to follow the longitudinal course of Parkinson's Disease. It is made up of the 1)Mentation, Behavior, and Mood, 2)ADL and 3)Motor

More information

Clinical Trial of Young Red Blood Cells Prepared by Apheresis

Clinical Trial of Young Red Blood Cells Prepared by Apheresis ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 16, No. 6 Copyright 1986, Institute for Clinical Science, Inc. Clinical Trial of Young Red Blood Cells Prepared by Apheresis PATRICIA PISCIOTTO, M.D.,* THOMAS

More information

The Use of Amantadine HCL in Clinical Practice: A Study of Old and New Indications

The Use of Amantadine HCL in Clinical Practice: A Study of Old and New Indications The Use of Amantadine HCL in Clinical Practice: A Study of Old and New Indications Carlos Singer, MD* Spiridon Papapetropoulos, MD, PhD* Gadith Uzcategui, BA Lydia Vela, MD * Department of Neurology, University

More information

E levated Prolactin Level in Prostates with Latent Carcinoma

E levated Prolactin Level in Prostates with Latent Carcinoma ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 17, No. 3 Copyright 1987, Institute for Clinical Science, Inc. E levated Prolactin Level in Prostates with Latent Carcinoma RYUICHI YATANI, M.D.,* ITSUO

More information

BORDEAUX MDS WINTER SCHOOL FOR YOUNG

BORDEAUX MDS WINTER SCHOOL FOR YOUNG BORDEAUX MDS WINTER SCHOOL FOR YOUNG NEUROLOGISTS INFUSION THERAPIES IN PARKINSON S DISEASE Apomorphine, T. Henriksen Tove Henriksen, MD MDS Clinic University Hospital of Bispebjerg, Copenhagen MOTOR FLUCTUATIONS

More information

Advanced Therapies for Motor Symptoms in PD. Matthew Boyce MD

Advanced Therapies for Motor Symptoms in PD. Matthew Boyce MD Advanced Therapies for Motor Symptoms in PD Matthew Boyce MD Medtronic Education Teva Speakers Bureau Acadia Speakers Bureau Disclosures Discuss issues in advanced PD Adjunct therapies to levo-dopa Newer

More information

Parkinson s Disease Current Treatment Options

Parkinson s Disease Current Treatment Options Parkinson s Disease Current Treatment Options Daniel Kassicieh, D.O., FAAN Sarasota Neurology, P.A. PD: A Chronic Neurodegenerative Ds. 1 Million in USA Epidemiology 50,000 New Cases per Year Majority

More information

Update in the Management of Parkinson s Disease

Update in the Management of Parkinson s Disease Update in the Management of Parkinson s Disease What s standard? What s new? What s coming? Bruno V. Gallo, M.D. Assistant Professor of Neurology, FIU Wertheim College of Medicine Director, Parkinson &

More information

Parkinson s disease Therapeutic strategies. Surat Tanprawate, MD Division of Neurology University of Chiang Mai

Parkinson s disease Therapeutic strategies. Surat Tanprawate, MD Division of Neurology University of Chiang Mai Parkinson s disease Therapeutic strategies Surat Tanprawate, MD Division of Neurology University of Chiang Mai 1 Scope Modality of treatment Pathophysiology of PD and dopamine metabolism Drugs Are there

More information

U n i f i e d P a r k i n s o n s D i s e a s e R a t i n g S c a l e ( U P D R S )

U n i f i e d P a r k i n s o n s D i s e a s e R a t i n g S c a l e ( U P D R S ) Patient last name:................................. Date of birth:.... /.... /........ Patient first name:................................. Date:.... /.... /........ U n i f i e d P a r k i n s o n s D

More information

Medication Management & Strategies When the levodopa honeymoon is over

Medication Management & Strategies When the levodopa honeymoon is over Medication Management & Strategies When the levodopa honeymoon is over Eric J Pappert, MD Parkinson s Disease & Movement Disorders Center Neurology Associates Medication Options in Parkinson s Carbidopa/Levodopa

More information

Freezing of gait in patients with advanced Parkinson s disease

Freezing of gait in patients with advanced Parkinson s disease J Neural Transm (2001) 108: 53 61 Freezing of gait in patients with advanced Parkinson s disease N. Giladi, T. A. Treves, E. S. Simon, H. Shabtai, Y. Orlov, B. Kandinov, D. Paleacu, and A. D. Korczyn Movement

More information

Communicating About OFF Episodes With Your Doctor

Communicating About OFF Episodes With Your Doctor Communicating About OFF Episodes With Your Doctor Early in Parkinson s disease (PD), treatment with levodopa and other anti-pd drugs provides continuous benefit. As the disease progresses, however, symptom

More information

Apathy, fatigue and quality of life in patients with Parkinson's disease Skorvanek, Matej

Apathy, fatigue and quality of life in patients with Parkinson's disease Skorvanek, Matej University of Groningen Apathy, fatigue and quality of life in patients with Parkinson's disease Skorvanek, Matej IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if

More information

Switching from pergolide to pramipexole in patients with Parkinson s disease

Switching from pergolide to pramipexole in patients with Parkinson s disease J Neural Transm (2001) Switching 108: 63 70 from pergolide to pramipexole in PD 63 Switching from pergolide to pramipexole in patients with Parkinson s disease P. A. Hanna 1,2, L. Ratkos 2, W. G. Ondo

More information

parts of the gastrointenstinal tract. At the end of April 2008, it was temporarily withdrawn from the US Market because of problems related to

parts of the gastrointenstinal tract. At the end of April 2008, it was temporarily withdrawn from the US Market because of problems related to parts of the gastrointenstinal tract. At the end of April 2008, it was temporarily withdrawn from the US Market because of problems related to crystallization of the drug, which caused unreliable drug

More information

BORDEAUX MDS WINTER SCHOOL FOR YOUNG

BORDEAUX MDS WINTER SCHOOL FOR YOUNG BORDEAUX MDS WINTER SCHOOL FOR YOUNG NEUROLOGISTS HOW TO EVALUATE MOTOR COMPLICATIONS IN PARKINSON'S DISEASE T. Henriksen Tove Henriksen, MD MDS Clinic University Hospital of Bispebjerg, Copenhagen MOTOR

More information

Best Medical Treatments for Parkinson s disease

Best Medical Treatments for Parkinson s disease Best Medical Treatments for Parkinson s disease Bernadette Schöneburg, M.D. June 20 th, 2015 What is Parkinson s Disease (PD)? Progressive neurologic disorder that results from the loss of specific cells

More information

European Commission approves ONGENTYS (opicapone) a novel treatment for Parkinson s disease patients with motor fluctuations

European Commission approves ONGENTYS (opicapone) a novel treatment for Parkinson s disease patients with motor fluctuations July 6, 2016 European Commission approves ONGENTYS (opicapone) a novel treatment for Parkinson s disease patients with motor fluctuations Porto, 5 July 2016 BIAL announced that the medicinal product ONGENTYS

More information

Enhanced Primary Care Pathway: Parkinson s Disease

Enhanced Primary Care Pathway: Parkinson s Disease Enhanced Primary Care Pathway: Parkinson s Disease 1. Focused summary of PD relevant to primary care Parkinson s Disease (PD) and Essential tremor (ET) are two of the most common movement disorders encountered

More information

Screening Hospitalized Injured Drivers and Other Trauma Victims for Alcoholism Using Two Questions

Screening Hospitalized Injured Drivers and Other Trauma Victims for Alcoholism Using Two Questions Screening Hospitalized Injured Drivers and Other Trauma Victims for Alcoholism Using Two Questions C arl A. S o d e r str o m, M.D.,1 P a tricia C. D isc h in g e r, P h.d.,2 G ord on S. S m ith, M.D.3

More information

TRANSPARENCY COMMITTEE OPINION. 18 March 2009

TRANSPARENCY COMMITTEE OPINION. 18 March 2009 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 18 March 2009 REQUIP LP 2 mg extended-release tablet Box of 21 tablets (CIP: 379 214-8) Box of 28 tablets (CIP: 379

More information

The catechol-o-methyltransferase (COMT) inhibitor entacapone enhances the pharmacokinetic and clinical response to Sinemet CR in Parkinson s disease

The catechol-o-methyltransferase (COMT) inhibitor entacapone enhances the pharmacokinetic and clinical response to Sinemet CR in Parkinson s disease J Neurol Neurosurg Psychiatry 2;68:589 594 589 Department of Neurology, Imperial College, School of Medicine, Hammersmith Hospital, London, UK P Piccini D J Brooks N Pavese Research Centre, Orion Pharma,

More information

Issues for Patient Discussion

Issues for Patient Discussion onmotor complications radykinesia Screening Tools asked PD micrographia eurodegeneration Designed for Use by Family Practitioners remor on-off opamine agonists tiffness depression ostural instability wearing

More information

Optimizing levodopa therapy for Parkinson s disease with levodopa/carbidopa/entacapone: implications from a clinical and patient perspective

Optimizing levodopa therapy for Parkinson s disease with levodopa/carbidopa/entacapone: implications from a clinical and patient perspective EXPERT OPINION Optimizing levodopa therapy for Parkinson s disease with levodopa/carbidopa/entacapone: implications from a clinical and patient perspective David J Brooks Division of Neuroscience, Faculty

More information

HLA Alloimmunization with Leukocyte Concentrates from HLA-matched and HLA-non-m atched Donors in Patients with H unter s Syndrom e*

HLA Alloimmunization with Leukocyte Concentrates from HLA-matched and HLA-non-m atched Donors in Patients with H unter s Syndrom e* ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 15, No. 5 Copyright 1985, Institute for Clinical Science, Inc. HLA Alloimmunization with Leukocyte Concentrates from HLA-matched and HLA-non-m atched Donors

More information

10th Medicine Review Course st July Prakash Kumar

10th Medicine Review Course st July Prakash Kumar 10th Medicine Review Course 2018 21 st July 2018 Drug Therapy for Parkinson's disease Prakash Kumar National Neuroscience Institute Singapore General Hospital Sengkang General Hospital Singhealth Duke-NUS

More information

Overview. Overview. Parkinson s disease. Secondary Parkinsonism. Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits

Overview. Overview. Parkinson s disease. Secondary Parkinsonism. Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits Overview Overview Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits The differential diagnosis of Parkinson s disease Primary vs. Secondary Parkinsonism Proteinopathies:

More information

Motor Fluctuations in Parkinson s Disease

Motor Fluctuations in Parkinson s Disease Motor Fluctuations in Parkinson s Disease Saeed Bohlega, MD, FRCPC Senior Distinguished Consultant Department of Neurosciences King Faisal Specialist Hospital & Research Centre Outline Type of fluctuations

More information

Motor Fluctuations Stephen Grill, MD, PHD Parkinson s and Movement Disorders Center of Maryland and Johns Hopkins University

Motor Fluctuations Stephen Grill, MD, PHD Parkinson s and Movement Disorders Center of Maryland and Johns Hopkins University Motor Fluctuations Stephen Grill, MD, PHD Parkinson s and Movement Disorders Center of Maryland and Johns Hopkins University I have no financial interest with any entity producing marketing, re-selling,

More information

Health related quality of life in Parkinson s disease: a prospective longitudinal study

Health related quality of life in Parkinson s disease: a prospective longitudinal study 584 Department of Neurology, Central Hospital of Rogaland, Postbox 8100, N-4003 Stavanger, Norway K H Karlsen E Tandberg J P Larsen Department of Psychiatry D Årsland Correspondence to: Professor Jan P

More information

H yperglycem ic M acrocytosis in Electronically D eterm ined M ean Corpuscular Volume

H yperglycem ic M acrocytosis in Electronically D eterm ined M ean Corpuscular Volume ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 15, No. 4 Copyright 1985, Institute for Clinical Science, Inc. H yperglycem ic M acrocytosis in Electronically D eterm ined M ean Corpuscular Volume Use

More information

Objectives. Emerging Treatments in Parkinson s s Disease. Pathology. As Parkinson s progresses it eventually affects large portions of the brain.

Objectives. Emerging Treatments in Parkinson s s Disease. Pathology. As Parkinson s progresses it eventually affects large portions of the brain. Objectives Emerging Treatments in Parkinson s s Disease 1) Describe recent developments in the therapies for Parkinson s Disease Jeff Kraakevik MD Assistant Professor OHSU/Portland VAMC Parkinson s Center

More information

What is the best medical therapy for early Parkinson's disease? Medications Commonly Used for Parkinson's Disease

What is the best medical therapy for early Parkinson's disease? Medications Commonly Used for Parkinson's Disease FPIN's Clinical Inquiries Treatment of Early Parkinson's Disease Clinical Question What is the best medical therapy for early Parkinson's disease? Evidence-Based Answer Treatment of early Parkinson's disease

More information

REFERENCE CODE GDHC391DFR PUBLICAT ION DATE M ARCH 2014 DUODOPA (PARKINSON S DISEASE) - FORECAST AND MARKET ANALYSIS TO 2022

REFERENCE CODE GDHC391DFR PUBLICAT ION DATE M ARCH 2014 DUODOPA (PARKINSON S DISEASE) - FORECAST AND MARKET ANALYSIS TO 2022 REFERENCE CODE GDHC391DFR PUBLICAT ION DATE M ARCH 2014 DUODOPA (PARKINSON S DISEASE) - Executive Summary The table below provides a summary of the key metrics for Duodopa in the 8MM Parkinson s Disease

More information

Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B.

Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B. UvA-DARE (Digital Academic Repository) Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B. Link to publication Citation for published version (APA): Post, B. (2009). Clinimetrics,

More information

Surgical Management of Parkinson s Disease

Surgical Management of Parkinson s Disease Surgical Management of Parkinson s Disease Shyamal H. Mehta MD, PhD Assistant Professor of Neurology, Movement Disorders Division Mayo Clinic College of Medicine Mayo Clinic, Arizona 2016 MFMER slide-1

More information

PARKINSON S DISEASE. Nigrostriatal Dopaminergic Neurons 5/11/16 CARDINAL FEATURES OF PARKINSON S DISEASE. Parkinson s disease

PARKINSON S DISEASE. Nigrostriatal Dopaminergic Neurons 5/11/16 CARDINAL FEATURES OF PARKINSON S DISEASE. Parkinson s disease 5/11/16 PARKINSON S DISEASE Parkinson s disease Prevalence increases with age (starts 40s60s) Seen in all ethnic groups, M:F about 1.5:1 Second most common neurodegenerative disease Genetics role greater

More information

Effects of Alcohol on Visual, Cognitive & Motor Performances Related to a Complex Manual Control Task

Effects of Alcohol on Visual, Cognitive & Motor Performances Related to a Complex Manual Control Task Effects of Alcohol on Visual, Cognitive & Motor Performances Related to a Complex Manual Control Task R obert S. K ennedy*, Janet J. Turnage*, D eborah L. H arm ** and Julie M. Drexler*** *Essex Corporation,

More information

Apomorphine for the treatment of refractory motor fluctuations in late stage Parkinson's disease : an old drug revisited

Apomorphine for the treatment of refractory motor fluctuations in late stage Parkinson's disease : an old drug revisited Pérez Lloret, Santiago Apomorphine for the treatment of refractory motor fluctuations in late stage Parkinson's disease : an old drug revisited Preprint del documento publicado en European Journal of Neurology,

More information

III./3.1. Movement disorders with akinetic rigid symptoms

III./3.1. Movement disorders with akinetic rigid symptoms III./3.1. Movement disorders with akinetic rigid symptoms III./3.1.1. Parkinson s disease Parkinson s disease (PD) is the second most common neurodegenerative disorder worldwide after Alzheimer s disease.

More information

REFERENCE CODE GDHC395DFR PUBLICAT ION DATE M ARCH 2014 APOKYN (PARKINSON S DISEASE) - FORECAST AND MARKET ANALYSIS TO 2022

REFERENCE CODE GDHC395DFR PUBLICAT ION DATE M ARCH 2014 APOKYN (PARKINSON S DISEASE) - FORECAST AND MARKET ANALYSIS TO 2022 REFERENCE CODE GDHC395DFR PUBLICAT ION DATE M ARCH 2014 APOKYN (PARKINSON S DISEASE) - Executive Summary The table below provides a summary of the key metrics for Apokyn in the 8MM Parkinson s Disease

More information

Measuring symptom change in patients with Parkinson s disease

Measuring symptom change in patients with Parkinson s disease Age and Ageing 2000; 29: 41 45 2000, British Geriatrics Society Measuring symptom change in patients with Parkinson s disease JOHN E. HARRISON, SARAH PRESTON 1,STAVIA B. BLUNT 1 CeNeS Ltd, Compass House,

More information

Anticholinergic withdrawal and benzhexol treatment

Anticholinergic withdrawal and benzhexol treatment Journal of Neurology, Neurosurgery, and Psychiatry, 1973, 36, 936-941 Anticholinergic withdrawal and benzhexol treatment in Parkion's disease P. M. HORROCKS, D. J. VICARY, J. E. REES, J. D. PARKES, AND

More information

Viscoelastic Measurement of Clot Formation: A New Test of Platelet Function

Viscoelastic Measurement of Clot Formation: A New Test of Platelet Function ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 13, No. 2 Copyright 1983, Institute for Clinical Science, Inc. Viscoelastic Measurement of Clot Formation: A New Test of Platelet Function ABDUS SALEEM,

More information

Individual Study Table Referring to Part of Dossier: Volume: Page:

Individual Study Table Referring to Part of Dossier: Volume: Page: Synopsis Abbott Laboratories Name of Study Drug: DUODOPA Intestinal Gel Name of Active Ingredient: Levodopa-carbidopa Individual Study Table Referring to Part of Dossier: Volume: Page: (For National Authority

More information

Progestin-only methods Type or dose of progestagen

Progestin-only methods Type or dose of progestagen Progestin-only contraception and beneficial effects on migraine Conflicts of interest A d v ise r a n d le ctu re r fo r E X E LT IS Le ctu re s a n d A d v iso ry b o a rd s B aye r Le ctu re s a n d

More information

Parkinson s Disease Update. Presented by Joanna O Leary, MD Movement disorder neurologist Providence St. Vincent s

Parkinson s Disease Update. Presented by Joanna O Leary, MD Movement disorder neurologist Providence St. Vincent s Parkinson s Disease Update Presented by Joanna O Leary, MD Movement disorder neurologist Providence St. Vincent s What is a movement disorder? Neurological disorders that affect ability to move by causing

More information

What contributes to quality of life in patients with Parkinson s disease?

What contributes to quality of life in patients with Parkinson s disease? 308 Department of Neurology, Institute of Neurology, Queen Square, London WC1N 3BG, UK A Schrag M Jahanshahi N Quinn Correspondence to: Professor NP Quinn n.quinn@ion.ucl.ac.uk Received 2 Sepyember 1999

More information

Cost effectiveness analysis of dopamine agonists in the treatment of Parkinson's disease in Japan Shimbo T, Hira K, Takemura M, Fukui T

Cost effectiveness analysis of dopamine agonists in the treatment of Parkinson's disease in Japan Shimbo T, Hira K, Takemura M, Fukui T Cost effectiveness analysis of dopamine agonists in the treatment of Parkinson's disease in Japan Shimbo T, Hira K, Takemura M, Fukui T Record Status This is a critical abstract of an economic evaluation

More information

Parkinson s Disease medications

Parkinson s Disease medications Parkinson s Disease medications In correlation to the Unified Parkinson s disease rating scale Ayaan Mohamed Degree Thesis in Pharmacy 15 ECTS Bachelor s Level Report passed: Spring 2017 Supervisor: Miles

More information

REFERENCE CODE GDHC401DFR PUBLICAT ION DATE M ARCH 2014 RYTARY/IPX066 (PARKINSON S DISEASE) - FORECAST AND MARKET ANALYSIS TO 2022

REFERENCE CODE GDHC401DFR PUBLICAT ION DATE M ARCH 2014 RYTARY/IPX066 (PARKINSON S DISEASE) - FORECAST AND MARKET ANALYSIS TO 2022 REFERENCE CODE GDHC401DFR PUBLICAT ION DATE M ARCH 2014 RYTARY/IPX066 (PARKINSON S DISEASE) - Executive Summary The table below summarizes the key metrics for Rytary/IPX066 in the 8MM Parkinson s disease

More information

Parkinson s Disease in 60 minutes. Dr. Claire Hinnell Movement Disorder Neurologist Director Movement Disorder Clinic JPOCSC

Parkinson s Disease in 60 minutes. Dr. Claire Hinnell Movement Disorder Neurologist Director Movement Disorder Clinic JPOCSC Parkinson s Disease in 60 minutes Dr. Claire Hinnell Movement Disorder Neurologist Director Movement Disorder Clinic JPOCSC S Plan of attack S What causes Parkinson s disease brief S Symptoms/Diagnostic

More information

Parkinson s Disease in the Elderly A Physicians perspective. Dr John Coyle

Parkinson s Disease in the Elderly A Physicians perspective. Dr John Coyle Parkinson s Disease in the Elderly A Physicians perspective Dr John Coyle Overview Introduction Epidemiology and aetiology Pathogenesis Diagnosis and clinical features Treatment Psychological issues/ non

More information

Welcome and Introductions

Welcome and Introductions Parkinson s Disease Spotlight on Treatment Advances Tuesday, January 26, 2016 Welcome and Introductions Stephanie Paul Vice President Development and Marketing American Parkinson Disease Association 1

More information

IMPACT OF PATIENT DIARY FORMAT ON QUALITY OF LIFE OUTCOMES IN PEOPLE WITH PARKINSON S DISEASE

IMPACT OF PATIENT DIARY FORMAT ON QUALITY OF LIFE OUTCOMES IN PEOPLE WITH PARKINSON S DISEASE Health Research Associates, inc. IMPACT OF PATIENT DIARY FORMAT ON QUALITY OF LIFE OUTCOMES IN PEOPLE WITH PARKINSON S DISEASE I. Budhiarso 1, D. Bushnell 1, M. Martin 1, and T. Hogan 2 1 Health Research

More information

Evaluation of Parkinson s Patients and Primary Care Providers

Evaluation of Parkinson s Patients and Primary Care Providers Evaluation of Parkinson s Patients and Primary Care Providers 2018 Movement Disorders Half Day Symposium Elise Anderson MD Medical Co-Director, PBSI Movement Disorders 6/28/2018 1 Disclosures GE Speaker,

More information

Problems with Outliers in Breath Alcohol Testing

Problems with Outliers in Breath Alcohol Testing Problems with Outliers in Breath Alcohol Testing Jo c h e n W ilske Blood alcohol concentration (BAC) and impairment o f driving skills are related so closely, that statutory drink-drive limits are accepted

More information

Date of Referral: Enhanced Primary Care Pathway: Parkinson s Disease

Date of Referral: Enhanced Primary Care Pathway: Parkinson s Disease Specialist LINK Linking Physicians CALGARY AND AREA Patient Name: Date of Birth: Calgary RHRN: PHN / ULI: Date of Referral: Referring MD: Fax: Today s Date: CONFIRMATION: TRIAGE CATEGORY: REFERRAL STATUS:

More information

Whole Blood Viscosity in Beta Thalassemia Minor

Whole Blood Viscosity in Beta Thalassemia Minor ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 22, No. 4 Copyright 1992, Institute for Clinical Science, Inc. Whole Blood Viscosity in Beta Thalassemia Minor JAMES P. CROWLEY, M.D.t, JACLYN B. M ETZGER,

More information

Clinical Policy: Safinamide (Xadago) Reference Number: CP.CPA.308 Effective Date: Last Review Date: Line of Business: Commercial

Clinical Policy: Safinamide (Xadago) Reference Number: CP.CPA.308 Effective Date: Last Review Date: Line of Business: Commercial Clinical Policy: Safinamide (Xadago) Reference Number: CP.CPA.308 Effective Date: 05.16.17 Last Review Date: 08.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy

More information

Original Articles. Calne, resting tremor. Mortimer, Pirozzolo, Hansch, & Webster, postural disturbance III

Original Articles. Calne, resting tremor. Mortimer, Pirozzolo, Hansch, & Webster, postural disturbance III 2004 97-106 Original Articles 1 2 3 1 1 2 3 47 22 III I II muscular rigidity postural disturbance resting tremor bradykinesia Calne, 2001 Mortimer, Pirozzolo, Hansch, & Webster, 1982 Tel: 02-23627076 E-mail:

More information

Do Botulinum Toxin Injections Improve the Freezing of Gait (FOG) Episodes Experienced by Parkinson s Disease (PD) Patients?

Do Botulinum Toxin Injections Improve the Freezing of Gait (FOG) Episodes Experienced by Parkinson s Disease (PD) Patients? Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2016 Do Botulinum Toxin Injections Improve

More information

PARKINSON S MEDICATION

PARKINSON S MEDICATION PARKINSON S MEDICATION History 1940 50 s Neurosurgeons operated on basal ganglia. Improved symptoms. 12% mortality 1960 s: Researchers identified low levels of dopamine caused Parkinson s leading to development

More information

The symptoms of the Parkinson s disease may vary from person to person. The symptoms might include the following:

The symptoms of the Parkinson s disease may vary from person to person. The symptoms might include the following: 1 PARKINSON S DISEASE Parkinson's disease is a long term disease related to the central nervous system that mainly affects the motor system, resulting in the loss of dopamine, which helps in producing

More information

EMERGING TREATMENTS FOR PARKINSON S DISEASE

EMERGING TREATMENTS FOR PARKINSON S DISEASE EMERGING TREATMENTS FOR PARKINSON S DISEASE Katerina Markopoulou, MD, PhD Director Neurodegenerative Diseases Program Department of Neurology NorthShore University HealthSystem Clinical Assistant Professor

More information

CENTENE PHARMACY AND THERAPEUTICS NEW DRUG REVIEW 3Q17 July August

CENTENE PHARMACY AND THERAPEUTICS NEW DRUG REVIEW 3Q17 July August BRAND NAME Xadago GENERIC NAME Safinamide MANUFACTURER Newron Pharmaceuticals SpA holds license; granted approval. US WorldMeds, LLC exclusive licensee and distributor in the U.S. DATE OF APPROVAL March

More information

SPOTLIGHT ON MOVEMENT FUNCTION: COPING WITH ON/OFF PERIODS WELCOME AND INTRODUCTIONS

SPOTLIGHT ON MOVEMENT FUNCTION: COPING WITH ON/OFF PERIODS WELCOME AND INTRODUCTIONS PARKINSON S DISEASE SPOTLIGHT ON MOVEMENT FUNCTION: COPING WITH ON/OFF PERIODS THURSDAY, MAY 11, 2017 WELCOME AND INTRODUCTIONS Stephanie Paul Vice President Development and Marketing American Parkinson

More information

Deep Brain Stimulation: Patient selection

Deep Brain Stimulation: Patient selection Deep Brain Stimulation: Patient selection Halim Fadil, MD Movement Disorders Neurologist Kane Hall Barry Neurology Bedford/Keller, TX 1991: Thalamic (Vim) DBS for tremor Benabid AL, et al. Lancet. 1991;337(8738):403-406.

More information

The Parkinson s Disease Composite Scale

The Parkinson s Disease Composite Scale The Parkinson s Disease Composite Scale Motor symptoms Bradykinesia: (Total of finger tapping, alternating hand movements, legs agility, total impression of body bradykinesia) Mild 1 Minimal slowness,

More information

Safinamide: un farmaco innovativo con un duplice meccanismo d azione

Safinamide: un farmaco innovativo con un duplice meccanismo d azione Safinamide: un farmaco innovativo con un duplice meccanismo d azione AINAT Sardegna Cagliari, 26 novembre 2016 Carlo Cattaneo Corporate Medical Advisor CNS & Rare Diseases Reichmann H. et al., European

More information

Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease

Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease Articles CME VIDEO Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease D. Nyholm, MD, PhD; A.I.M. Nilsson Remahl, MD, PhD; N. Dizdar, MD, PhD; R. Constantinescu, MD;

More information

Understanding Parkinson s Disease Important information for you and your loved ones

Understanding Parkinson s Disease Important information for you and your loved ones Patient Education Understanding Parkinson s Disease Important information for you and your loved ones This handout explains the signs, symptoms, and possible treatments of Parkinson s disease. Parkinson

More information

Basal ganglia motor circuit

Basal ganglia motor circuit Parkinson s Disease Basal ganglia motor circuit 1 Direct pathway (gas pedal) 2 Indirect pathway (brake) To release or augment the tonic inhibition of GPi on thalamus Direct pathway There is a tonic inhibition

More information

A major aim in the management of advanced Parkinson s

A major aim in the management of advanced Parkinson s 396 PAPER Use and interpretation of on/off diaries in Parkinson s disease J Reimer, M Grabowski, O Lindvall, P Hagell... See end of article for authors affiliations... Correspondence to: Peter Hagell,

More information

Literature Scan: Anti-Parkinson s Agents

Literature Scan: Anti-Parkinson s Agents Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119

More information

The Effectiveness of ASAP Education and Rehabilitation Programs

The Effectiveness of ASAP Education and Rehabilitation Programs The Effectiveness of ASAP Education and Rehabilitation Programs James L. Nichols 1 EDUCATIONAL PROGRAMS B ackground and D escription Educational programs for convicted drinking drivers have recently received

More information

home environments of patients

home environments of patients A mobile-based system can assess Parkinson s disease symptoms from home environments of patients Treatment of Parkinson s disease involves major challenges like the large within- and between-patient variability

More information

REFERENCE CODE GDHC397DFR PUBLICAT ION DATE M ARCH 2014 NOURIAST (PARKINSON S DISEASE) - FORECAST AND MARKET ANALYSIS TO 2022

REFERENCE CODE GDHC397DFR PUBLICAT ION DATE M ARCH 2014 NOURIAST (PARKINSON S DISEASE) - FORECAST AND MARKET ANALYSIS TO 2022 REFERENCE CODE GDHC397DFR PUBLICAT ION DATE M ARCH 2014 NOURIAST (PARKINSON S DISEASE) - Executive Summary The table below provides a summary of the key metrics for Nouriast in the 8MM Parkinson s Disease

More information

Drug Management of Parkinsonism. By Prof. Mohammad Saleh M. Hassan PhD. (Pharma); MSc. (Ped.); MHPE (Ed.)

Drug Management of Parkinsonism. By Prof. Mohammad Saleh M. Hassan PhD. (Pharma); MSc. (Ped.); MHPE (Ed.) Drug Management of Parkinsonism By Prof. Mohammad Saleh M. Hassan PhD. (Pharma); MSc. (Ped.); MHPE (Ed.) Drug management of Parkinsonism Levodopa Ergot derivatives noamine Oxidaes Inhibitors Catechol-Omethyl

More information

Can Tango Help Improve Quality of Life for Patients with Parkinson s Disease?

Can Tango Help Improve Quality of Life for Patients with Parkinson s Disease? Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2018 Can Tango Help Improve Quality of Life

More information

Drugs used in Parkinsonism

Drugs used in Parkinsonism Drugs used in Parkinsonism قادة فريق علم األدوية : لي التميمي & عبدالرحمن ذكري الشكر موصول ألعضاء الفريق املتميزين : جومانة القحطاني ندى الصومالي روان سعد القحطاني pharma436@outlook.com @pharma436 Your

More information

Pharmacologic Treatment of Parkinson s Disease. Nicholas J. Silvestri, M.D. Assistant Professor of Neurology

Pharmacologic Treatment of Parkinson s Disease. Nicholas J. Silvestri, M.D. Assistant Professor of Neurology + Pharmacologic Treatment of Parkinson s Disease Nicholas J. Silvestri, M.D. Assistant Professor of Neurology + Overview n Brief review of Parkinson s disease (PD) n Clinical manifestations n Pathophysiology

More information

Unified Parkinson's Disease Rating Scale UPDRS

Unified Parkinson's Disease Rating Scale UPDRS Unified Parkinson's Disease Rating Scale Questionnaire Supplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials Prepared by CDISC and National Institute of Neurological

More information

Motor symptoms: Tremor: Score (total of four limbs) Absent 0 Symptom not present

Motor symptoms: Tremor: Score (total of four limbs) Absent 0 Symptom not present Motor symptoms: Bradykinesia: (total of finger tapping, alternating hand, movements, legs agility, total impression of body bradykinesia) Mild 1 Minimal slowness, giving movement a deliberate character;

More information

CRITICALLY APPRAISED PAPER (CAP)

CRITICALLY APPRAISED PAPER (CAP) CRITICALLY APPRAISED PAPER (CAP) Holmes, J. D., Gu, M. L., Johnson, A. M., & Jenkins, M. E. (2013). The effects of a home-based virtual reality rehabilitation program on balance among individuals with

More information

Clinically Meaningful Endpoints

Clinically Meaningful Endpoints Clinically Meaningful Endpoints Claire Henchcliffe MD DPhil FAAN FANA Associate Professor of Neurology Director, Weill Cornell Parkinson s Disease & Movement Disorders Institute Vice Chair for Clinical

More information

Faculty. Joseph Friedman, MD

Faculty. Joseph Friedman, MD Faculty Claire Henchcliffe, MD, DPhil Associate Professor of Neurology Weill Cornell Medical College Associate Attending Neurologist New York-Presbyterian Hospital Director of the Parkinson s Institute

More information