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[PMID]:29345156
[Au] Autor:Svetel M; Tomic A; Kresojevic N; Kostic V
[Ad] Endereço:a Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine , University of Belgrade , Belgrade , Serbia.
[Ti] Título:Pharmacokinetic drug evaluation of opicapone for the treatment of Parkinson's disease.
[So] Source:Expert Opin Drug Metab Toxicol;14(3):353-360, 2018 Mar.
[Is] ISSN:1744-7607
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Opicapone (OPC) is a novel, potent, reversible, and purely peripheral third-generation COMT inhibitor, which provides an enhancement in levodopa (L-Dopa) availability. It represents adjunctive therapy for L-Dopa treated patients with PD and motor fluctuations. Areas covered: The purpose of this study was to evaluate pharmacokinetic of OPC for the treatment of PD. Expert commentary: Oral OPC exhibits linear, dose-dependent absorption. However, following concomitant ingestion of a high-fat, high-calorie meal, the maximum plasma concentration will be decreased. A once-daily bedtime administration of OPC 1 h after the last daily L-Dopa/AADCi, are considered to avoid any interaction during the L-Dopa absorption phase. There are no clinically relevant effects of age (in adults), renal impairment or race on the pharmacokinetics of OPC. OPC dose adjustment is not needed in patients with mild to moderate chronic hepatic impairment. Opicapone exhibits the lowest potential for cytotoxicity in comparison with other COMT inhibitors. It significantly decreases COMT activity, with half-life of COMT inhibition in human erythrocytes of 61.6 h and increases systemic exposure to L-Dopa. This provides an enhancement in L-Dopa availability that translates into clinical benefit for PD patients in terms of significant decrease of OFF periods and increase in ON-time without troublesome dyskinesia.
[Mh] Termos MeSH primário: Antiparkinsonianos/administração & dosagem
Oxidiazóis/administração & dosagem
Doença de Parkinson/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Animais
Antiparkinsonianos/efeitos adversos
Antiparkinsonianos/farmacocinética
Inibidores de Catecol O-Metiltransferase/administração & dosagem
Inibidores de Catecol O-Metiltransferase/farmacocinética
Relação Dose-Resposta a Droga
Quimioterapia Combinada
Interações Alimento-Droga
Meia-Vida
Seres Humanos
Levodopa/administração & dosagem
Levodopa/farmacocinética
Oxidiazóis/efeitos adversos
Oxidiazóis/farmacocinética
Doença de Parkinson/fisiopatologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antiparkinson Agents); 0 (Catechol O-Methyltransferase Inhibitors); 0 (Oxadiazoles); 46627O600J (Levodopa); Y5929UIJ5N (opicapone)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180119
[St] Status:MEDLINE
[do] DOI:10.1080/17425255.2018.1430138


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[PMID]:28452905
[Au] Autor:Regidor I; Benita V; Del Álamo de Pedro M; Ley L; Martinez Castrillo JC
[Ad] Endereço:*Unit of Functional Neurosurgery, †Service of Neurophysiology, ‡Service of Gastroenterology, §Service of Neurosurgery, and ∥Service of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
[Ti] Título:Duodenal Levodopa Infusion for Long-Term Deep Brain Stimulation-Refractory Symptoms in Advanced Parkinson Disease.
[So] Source:Clin Neuropharmacol;40(3):103-107, 2017 May/Jun.
[Is] ISSN:1537-162X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: This study assesses the effect of levodopa/carbidopa intestinal infusion gel (LCIIG) as an additional treatment in patients with advanced idiopathic Parkinson disease (PD) previously treated with deep brain stimulation (DBS). METHODS: Prospective study of advanced PD patients, satisfactorily treated with bilateral DBS of the subthalamic nucleus, who had developed refractory symptoms and LCIIG was added. Controls were advanced PD patients treated with LCIIG. Measurements included the Unified Parkinson Disease Rating Scale (UPDRS)-III and the UPDRS axial compound. RESULTS: There were 19 patients in the DBS-LCIIG therapy group and 21 in the control group. The DBS-LCIIG patients were younger and had disease duration longer than controls. The median time from DBS to gastrostomy was 7.8 years (range, 2-12 years). In both study groups, the mean scores of the UPDRS-III and UPDRS axial subscales improved significantly after LCIIG treatment (DBS-LCIIG group: UPDRS-III, 62.0 [15.7] vs 30.9 [12.1]; UPDRS axial, 24.7 [4.9] vs 10.2 [2.7]; P < 0.0005 for all comparisons). There were no differences in adverse events between the groups. In the follow-up of the DBS-LCIIG group. 5 patients discontinued DBS-LCIIG therapy and returned to DBS, 5 discontinued DBS and were maintained with LCIIG, and the remaining 9 continued with DBS-LCIIG therapy. Mean time until discontinuation in the double DBS-LCIIG group was 891 days. The main risk factors for discontinuation were age at the beginning of LCIIG and severity of the UPDRS axial subscale. CONCLUSIONS: Levodopa/carbidopa intestinal infusion gel therapy may be a valuable option in selected patients with advanced PD who develop refractory symptoms after long-term subthalamic nucleus-DBS.
[Mh] Termos MeSH primário: Antiparkinsonianos/administração & dosagem
Carbidopa/administração & dosagem
Estimulação Encefálica Profunda
Gastrostomia
Levodopa/administração & dosagem
Doença de Parkinson/tratamento farmacológico
Doença de Parkinson/terapia
Aceitação pelo Paciente de Cuidados de Saúde
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Antiparkinsonianos/efeitos adversos
Antiparkinsonianos/uso terapêutico
Carbidopa/efeitos adversos
Carbidopa/uso terapêutico
Terapia Combinada/efeitos adversos
Estimulação Encefálica Profunda/efeitos adversos
Combinação de Medicamentos
Duodeno
Feminino
Seguimentos
Gastrostomia/efeitos adversos
Géis
Seres Humanos
Intubação Gastrointestinal
Levodopa/efeitos adversos
Levodopa/uso terapêutico
Masculino
Meia-Idade
Doença de Parkinson/fisiopatologia
Pacientes Desistentes do Tratamento
Estudos Prospectivos
Índice de Gravidade de Doença
Espanha
Núcleo Subtalâmico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiparkinson Agents); 0 (Drug Combinations); 0 (Gels); 0 (carbidopa, levodopa drug combination); 46627O600J (Levodopa); MNX7R8C5VO (Carbidopa)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1097/WNF.0000000000000216


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[PMID]:28454042
[Au] Autor:Rajan R; Popa T; Quartarone A; Ghilardi MF; Kishore A
[Ad] Endereço:Comprehensive Care Center for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India. Electronic address: drrooparajan@gmail.com.
[Ti] Título:Cortical plasticity and levodopa-induced dyskinesias in Parkinson's disease: Connecting the dots in a multicomponent network.
[So] Source:Clin Neurophysiol;128(6):992-999, 2017 06.
[Is] ISSN:1872-8952
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Levodopa-induced dyskinesias are motor complications following long term dopaminergic therapy in Parkinson's disease (PD). Impaired brain plasticity resulting in the creation of aberrant motor maps intended to encode normal voluntary movement is proposed to result in the development of dyskinesias. Traditionally, the various nodes in the motor network like the striato-cortical and the cerebello-thalamic loops were thought to function independent of each other with little communication among them. Anatomical evidence from primates revealed the existence of reciprocal loops between the basal ganglia and the cerebellum providing an anatomical basis for communication between the motor network loops. Dyskinetic PD patients reveal impaired brain plasticity within the motor cortex which may be modulated by cortico-cortical, cerebello-cortical or striato-cortical connections. In this article, we review the evidence for altered plasticity in the multicomponent motor network in the context of levodopa induced dyskinesias in PD. Current evidence suggests a pivotal role for the cerebellum in the larger motor network with the ability to integrate sensorimotor information and independently influence multiple nodes in this network. Targeting the cerebellum seems to be a justified approach for future interventions aimed at attenuating levodopa-induced dyskinesias.
[Mh] Termos MeSH primário: Cerebelo/fisiopatologia
Conectoma
Discinesia Induzida por Medicamentos/fisiopatologia
Levodopa/uso terapêutico
Plasticidade Neuronal
Doença de Parkinson/fisiopatologia
[Mh] Termos MeSH secundário: Corpo Estriado/fisiopatologia
Discinesia Induzida por Medicamentos/etiologia
Seres Humanos
Levodopa/efeitos adversos
Córtex Motor/fisiopatologia
Doença de Parkinson/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
46627O600J (Levodopa)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:29390334
[Au] Autor:Lee HD; Chang MC
[Ad] Endereço:Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea.
[Ti] Título:Degeneration of the corticofugal tract from the secondary motor area in a Parkinson's disease patient with limb-kinetic apraxia: A case report.
[So] Source:Medicine (Baltimore);96(50):e9195, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: In this case report, we describe a Parkinson's disease (PD) patient with limb-kinetic apraxia (LKA) in whom degeneration of the corticofugal tract (CFT) from the supplementary motor area (SMA) was observed in diffusion tensor tractography (DTT). PATIENT CONCERNS: A 63-year-old woman presented with a loss of dexterity in both upper extremities, which indicated LKA, and typical PD-related symptoms, including a gait disturbance with a short step, resting tremor in both upper extremities, and rigidity, and these symptoms had been present for 2 years. The F-florinated-N-3-fluoropropyl-2-ß-carboxymethoxy-3-ß-(4-lodophenyl) nortropane positron emission tomography scanning findings were consistent with PD. Based on the clinical symptoms and imaging findings, we diagnosed the patient with PD. In a coin-rotation test that was used to evaluate the severity of the LKA, the patient's results significantly decreased compared to the results of the normal controls. DIAGNOSES: The DTT showed that the CFTs from the SMAs in both hemispheres were partially torn and thinned. The fractional anisotropy values and CFT volumes in both SMAs were >2 standard deviations lower than those of the normal controls. INTERVENTIONS: The patient was treated with an initial dose of 150/37.5 mg/day of levodopa/benserazide, and the dose was gradually increased to 400/100 mg/day. OUTCOMES: After treatment, although the bradykinesia, rigidity, and resting tremor of the patient significantly decreased, the dexterity of the patient's hands did not improve. LESSONS: These observations indicated degeneration of the CFTs from the SMAs in both hemispheres in the patient. This degeneration might have, at least in part, contributed to the patient's LKA. The results of this study suggest that CFT degeneration could be one of the pathological mechanisms underlying LKA in patients with PD.
[Mh] Termos MeSH primário: Córtex Motor/patologia
Doença de Parkinson/patologia
[Mh] Termos MeSH secundário: Anisotropia
Antiparkinsonianos/uso terapêutico
Benserazida/uso terapêutico
Imagem de Tensor de Difusão
Combinação de Medicamentos
Feminino
Seres Humanos
Levodopa/uso terapêutico
Meia-Idade
Córtex Motor/diagnóstico por imagem
Rigidez Muscular/diagnóstico por imagem
Rigidez Muscular/tratamento farmacológico
Rigidez Muscular/patologia
Atrofia Muscular Espinal/diagnóstico por imagem
Atrofia Muscular Espinal/tratamento farmacológico
Atrofia Muscular Espinal/patologia
Doença de Parkinson/diagnóstico por imagem
Doença de Parkinson/tratamento farmacológico
Tomografia por Emissão de Pósitrons
Tremor/diagnóstico por imagem
Tremor/tratamento farmacológico
Tremor/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiparkinson Agents); 0 (Drug Combinations); 0 (benserazide, levodopa drug combination); 46627O600J (Levodopa); 762OS3ZEJU (Benserazide)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009195


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[PMID]:28469105
[Au] Autor:Li SY; Wang YL; Liu WW; Lyu DJ; Wang F; Mao CJ; Yang YP; Hu LF; Liu CF
[Ad] Endereço:Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China.
[Ti] Título:Long-term Levodopa Treatment Accelerates the Circadian Rhythm Dysfunction in a 6-hydroxydopamine Rat Model of Parkinson's Disease.
[So] Source:Chin Med J (Engl);130(9):1085-1092, 2017 May 05.
[Is] ISSN:0366-6999
[Cp] País de publicação:China
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Parkinson's disease (PD) patients with long-term levodopa (L-DOPA) treatment are suffering from severe circadian dysfunction. However, it is hard to distinguish that the circadian disturbance in patients is due to the disease progression itself, or is affected by L-DOPA replacement therapy. This study was to investigate the role of L-DOPA on the circadian dysfunction in a rat model of PD. METHODS: The rat model of PD was constructed by a bilateral striatal injection with 6-hydroxydopamine (6-OHDA), followed by administration of saline or 25 mg/kg L-DOPA for 21 consecutive days. Rotarod test, footprint test, and open-field test were carried out to evaluate the motor function. Striatum, suprachiasmatic nucleus (SCN), liver, and plasma were collected at 6:00, 12:00, 18:00, and 24:00. Quantitative real-time polymerase chain reaction was used to examine the expression of clock genes. Enzyme-linked immunosorbent assay was used to determine the secretion level of cortisol and melatonin. High-performance liquid chromatography was used to measure the neurotransmitters. Analysis of variance was used for data analysis. RESULTS: L-DOPA alleviated the motor deficits induced by 6-OHDA lesions in the footprint and open-field test ( P < 0.01, P < 0.001, respectively). After L-DOPA treatment, Bmal1 decreased in the SCN compared with 6-OHDA group at 12:00 ( P < 0.01) and 24:00 ( P < 0.001). In the striatum, the expression of Bmal1, Rorα was lower than that in the 6-OHDA group at 18:00 (P < 0.05) and L-DOPA seemed to delay the peak of Per2 to 24:00. In liver, L-DOPA did not affect the rhythmicity and expression of these clock genes (P > 0.05). In addition, the cortisol secretion was increased (P > 0.05), but melatonin was further inhibited after L-DOPA treatment at 6:00 (P < 0.01). CONCLUSIONS: In the circadian system of advanced PD rat models, circadian dysfunction is not only contributed by the degeneration of the disease itself but also long-term L-DOPA therapy may further aggravate it.
[Mh] Termos MeSH primário: Ritmo Circadiano/efeitos dos fármacos
Levodopa/uso terapêutico
Oxidopamina/toxicidade
[Mh] Termos MeSH secundário: Animais
Western Blotting
Peso Corporal/efeitos dos fármacos
Ensaio de Imunoadsorção Enzimática
Imunofluorescência
Masculino
Ratos
Ratos Sprague-Dawley
Reação em Cadeia da Polimerase em Tempo Real
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
46627O600J (Levodopa); 8HW4YBZ748 (Oxidopamine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.4103/0366-6999.204920


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[PMID]:29250969
[Au] Autor:Szász JA; Constantin V; Fazakas PA; Blényesi E; Grieb LG; Balla A; Sárig M; Szegedi K; Bartha EN; Szatmári S
[Ad] Endereço:Neurológiai Tanszék (Department of Neurology), Marosvásárhelyi Orvosi és Gyógyszerészeti Egyetem (University of Medicine and Pharmacy of Tirgu Mures) 540081 Marosvásárhely (Tirgu Mures), Gral Ion Dumitrache u. 20/2, Románia.
[Ti] Título:[The role of selective monoamine oxidase B inhibitors in the therapeutic strategy of Parkinson's disease in the neurology clinics of Tirgu Mures County Emergency Clinical Hospital].
[Ti] Título:A szelektív monoaminoxidáz-B-gátlók helye a Parkinson-kór kezelési stratégiájában a marosvásárhelyi ideggyógyászati klinikák gyakorlatában..
[So] Source:Orv Hetil;158(51):2023-2028, 2017 Dec.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Ab] Resumo:INTRODUCTION: Selective monoamine oxidase B inhibitors have an accurate place in therapeutical strategy of Parkinsons's disease. In the early stages of the disease, especially in younger patients with milder symptoms, the introduction of levodopa substitution could be efficacious in delaying; in advanced stages they are mainly used to treat motor complications, as an adjunct to levodopa. AIM: The evaluation of therapeutical strategies used in the neurology clinics of Tirgu Mures County Emergency Clinical Hospital in order to define the role of monoamine oxidase B inhibitors. METHOD: This retrospective study includes all records of patients with Parkinson's disease hospitalized between 1 January 2003 and 31 December 2016. From the 2194 reports we used data focusing on the therapeutic recommendations. Regarding disease duration, we divided the patients in two groups: less than or equal to 5 years and more than 5 years. RESULTS: From the 1183 patients in first group, 243 received monoamine oxidase inhibitors: 12 as monotherapy, 52 together with dopamine agonists, in 61 cases combined with levodopa. In 118 cases monoamine oxidase inhibitors were combined with levodopa and dopamine agonists. From 582 cases whith Parkinson's disease for more than 5 years, 195 received monoamine oxidase B inhibitors (selegiline: 10 cases, rasagiline: 185 cases). In 429 cases we did not find accurate data regarding disease duration (selegiline: 5 cases, rasagiline: 93 cases). CONCLUSION: The use of monoamine oxidase B inhibitors was similar to those found in literature. The treating physicians should utilise more confidently the available therapeutical combinations. Orv Hetil. 2017; 158(51): 2023-2028.
[Mh] Termos MeSH primário: Antiparkinsonianos/uso terapêutico
Agonistas de Dopamina/uso terapêutico
Inibidores da Monoaminoxidase/uso terapêutico
Doença de Parkinson/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Instituições de Assistência Ambulatorial
Relação Dose-Resposta a Droga
Seres Humanos
Hungria
Levodopa/uso terapêutico
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiparkinson Agents); 0 (Dopamine Agonists); 0 (Monoamine Oxidase Inhibitors); 46627O600J (Levodopa)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1556/650.2017.30914


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[PMID]:27771287
[Au] Autor:Casula EP; Stampanoni Bassi M; Pellicciari MC; Ponzo V; Veniero D; Peppe A; Brusa L; Stanzione P; Caltagirone C; Stefani A; Koch G
[Ad] Endereço:Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy.
[Ti] Título:Subthalamic stimulation and levodopa modulate cortical reactivity in Parkinson's patients.
[So] Source:Parkinsonism Relat Disord;34:31-37, 2017 Jan.
[Is] ISSN:1873-5126
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The effects of deep brain stimulation of the subthalamic nucleus (DBS-STN) and L-dopa (LD) on cortical activity in Parkinson's disease (PD) are poorly understood. OBJECTIVES: By combining transcranial magnetic stimulation (TMS) and electroencephalography (EEG) we explored the effects of STN-DBS, either alone or in combination with L-Dopa (LD), on TMS-evoked cortical activity in a sample of implanted PD patients. METHODS: PD patients were tested in three clinical conditions: i) LD therapy with STN-DBS turned on (ON/ON condition); ii) without LD therapy with STN-DBS turned on (OFF/ON condition); iii) without LD therapy with STN-DBS turned off (OFF/OFF condition). TMS pulses were delivered over left M1 while simultaneously acquiring EEG. Eight age-matched healthy volunteers (HC) were tested as a control group. RESULTS: STN-DBS enhanced early global TMS-evoked activity (∼45-80ms) and high-alpha TMS-evoked oscillations (11-13 Hz) as compared to OFF/OFF condition, independently from concomitant LD therapy. LD intake (ON/ON condition) produced a further increase of late TMS-evoked activity (∼80-130ms) and beta TMS-evoked oscillations (13-30 Hz), as compared to OFF/OFF and OFF/ON conditions, that normalized reactivity as compared to HC range of values. CONCLUSIONS: Our data reveal that bilateral STN-DBS and LD therapy induce a modulation of specific cortical components and specific ranges of frequency. These findings demonstrate that STN-DBS and LD therapy may have synergistic effects on motor cortical activity.
[Mh] Termos MeSH primário: Córtex Cerebral/efeitos dos fármacos
Estimulação Encefálica Profunda
Levodopa/farmacologia
Levodopa/uso terapêutico
Doença de Parkinson/terapia
Núcleo Subtalâmico/fisiologia
[Mh] Termos MeSH secundário: Idoso
Antiparkinsonianos/farmacologia
Antiparkinsonianos/uso terapêutico
Mapeamento Encefálico
Estudos de Casos e Controles
Córtex Cerebral/fisiopatologia
Eletroencefalografia
Potenciais Evocados/efeitos dos fármacos
Potenciais Evocados/fisiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Doença de Parkinson/tratamento farmacológico
Doença de Parkinson/patologia
Índice de Gravidade de Doença
Análise Espectral
Estimulação Magnética Transcraniana
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiparkinson Agents); 46627O600J (Levodopa)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29241898
[Au] Autor:Marshall T; Pugh A; Fairchild A; Hass S
[Ad] Endereço:AbbVie, Inc., North Chicago, IL, USA. Electronic address: t.marshall@abbvie.com.
[Ti] Título:Patient Preferences for Device-Aided Treatments Indicated for Advanced Parkinson Disease.
[So] Source:Value Health;20(10):1383-1393, 2017 12.
[Is] ISSN:1524-4733
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Effective treatment for advanced Parkinson disease (PD) uncontrolled with oral medication includes device-aided therapies such as deep brain stimulation (DBS) and continuous levodopa-carbidopa infusion to the duodenum via a portable pump. OBJECTIVE: Our objective was to quantify patient preferences for attributes of these device-aided treatments. METHODS: We administered a Web-enabled survey to 401 patients in the United States. A discrete-choice experiment (DCE) was used to evaluate patients' willingness to accept tradeoffs among efficacy, tolerability, and convenience of alternative treatments. DCE data were analyzed using random-parameters logit. Best-worst scaling (BWS) was used to elicit the relative importance of device-specific attributes. Conditional logit was used to analyze the BWS data. We tested for differences in preferences among subgroups of patients. RESULTS: Improving ability to think clearly was twice as important as a 6-hour-per-day improvement in control of movement symptoms. After controlling for efficacy, treatment delivered via portable infusion pump was preferred over DBS, and both devices were preferred to oral therapy with poor symptom control. Patients were most concerned about device attributes relating to risk of stroke, difficulty thinking, and neurosurgery. Avoiding surgery to insert a wire in the brain was more important than avoiding surgery to insert a tube into the small intestine. Some differences in preferences among subgroups were statistically, but not qualitatively, significant. CONCLUSIONS: This study clarifies the patient perspective in therapeutic choices for advanced PD. These findings may help improve communication between patients and providers and also provide evidence on patient preferences to inform regulatory and access decisions.
[Mh] Termos MeSH primário: Antiparkinsonianos/administração & dosagem
Carbidopa/administração & dosagem
Estimulação Encefálica Profunda/métodos
Levodopa/administração & dosagem
Doença de Parkinson/terapia
Preferência do Paciente
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Comportamento de Escolha
Combinação de Medicamentos
Sistemas de Liberação de Medicamentos
Duodeno
Desenho de Equipamento
Feminino
Seres Humanos
Bombas de Infusão
Internet
Masculino
Meia-Idade
Doença de Parkinson/fisiopatologia
Doença de Parkinson/psicologia
Inquéritos e Questionários
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antiparkinson Agents); 0 (Drug Combinations); 0 (carbidopa, levodopa drug combination); 46627O600J (Levodopa); MNX7R8C5VO (Carbidopa)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:29180347
[Au] Autor:Liu H; Chen L; Zhang Z; Geng G; Chen W; Dong H; Chen L; Zhan S; Li T
[Ad] Endereço:College of Traditional Chinese Medicine, Jinan University, Guangzhou, China.
[Ti] Título:Effectiveness and safety of acupuncture combined with Madopar for Parkinson's disease: a systematic review with meta-analysis.
[So] Source:Acupunct Med;35(6):404-412, 2017 Dec.
[Is] ISSN:1759-9873
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the effectiveness and safety of acupuncture combined with Madopar for the treatment of Parkinson's disease (PD), compared to the use of Madopar alone. METHODS: A systematic search was carried out for randomised controlled trials (RCTs) of acupuncture and Madopar for the treatment of PD published between April 1995 and April 2015. The primary outcome was total effectiveness rate and secondary outcomes included Unified Parkinson's Disease Rating Scale (UPDRS) scores. Data were pooled and analysed with RevMan 5.3. Results were expressed as relative ratio (RR) with 95% confidence interval (CIs). RESULTS: Finally, 11 RCTs with 831 subjects were included. Meta-analyses showed that acupuncture combined with Madopar for the treatment of PD can significantly improve the clinical effectiveness compared with Madopar alone (RR=1.28, 95% CI 1.18 to 1.38, P<0.001). It was also found that acupuncture combined with Madopar significantly improved the UPDRS II (SMD=-1.00, 95% CI -1.71 to -0.29, P=0.006) and UPDRS I-IV total summed scores (SMD=-1.15, 95% CI -1.63 to -0.67, P<0.001) but not UPDRS I (SMD=-0.37, 95% CI -0.77 to 0.02, P=0.06), UPDRS III (SMD=-0.93, 95% CI -2.28 to 0.41, P=0.17) or UPDRS IV (SMD=-0.78, 95% CI -2.24 to 0.68, P=0.30) scores. Accordingly, acupuncture combined with Madopar appeared to have a positive effect on activities of daily life and the general condition of patients with PD, but was not better than Madopar alone for the treatment of mental activity, behaviour, mood and motor disability. In the safety evaluation, it was found that acupuncture combined with Madopar was associated with significantly fewer adverse effects including gastrointestinal reactions (RR=0.38, 95% CI 0.23 to 0.65, P<0.001), on-off phenomena (RR=0.27, 95% CI 0.11 to 0.66, P=0.004) and mental disorders (RR=0.24, 95% CI 0.06 to 0.92, P=0.04) but did not significantly reduce dyskinesia (RR=0.64, 95% CI 0.35 to 1.16, P=0.14). CONCLUSION: Acupuncture combined with Madopar appears, to some extent, to improve clinical effectiveness and safety in the treatment of PD, compared with Madopar alone. This conclusion must be considered cautiously, given the quality of most of the studies included was low. Therefore, more high-quality, multicentre, prospective, RCTs with large sample sizes are needed to further clarify the effect of acupuncture combined with Madopar for PD.
[Mh] Termos MeSH primário: Terapia por Acupuntura/mortalidade
Benserazida/uso terapêutico
Dopaminérgicos/uso terapêutico
Levodopa/uso terapêutico
[Mh] Termos MeSH secundário: Terapia Combinada
Combinação de Medicamentos
Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Dopamine Agents); 0 (Drug Combinations); 0 (benserazide, levodopa drug combination); 46627O600J (Levodopa); 762OS3ZEJU (Benserazide)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1136/acupmed-2016-011342


  10 / 15124 MEDLINE  
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[PMID]:29311446
[Au] Autor:Sato Y; Yasumiishi C; Chiba T; Umegaki K
[Ad] Endereço:Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition.
[Ti] Título:[A Systematic Review to Identify Unacceptable Intake Levels of Vitamin B6 among Patients Taking Levodopa].
[So] Source:Shokuhin Eiseigaku Zasshi;58(6):268-274, 2017.
[Is] ISSN:1882-1006
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:The interaction of levodopa and vitamin B6 is a well-known issue. This study investigated the incidence of unacceptable intake levels of vitamin B6 among levodopa users by means of a systematic review. We searched two databases (PubMed and "Igaku Chuo Zasshi") for articles about adverse events due to the interaction of levodopa and vitamin B6 published up to August 2017. Of 98 citations retrieved, 11 studies met the selection criteria. The results indicated that a vitamin B6 intake level of more than 50 mg/day could reduce the efficacy of levodopa. The recommended intake of vitamin B6 for Japanese adults is 1.4 mg/day for men and 1.2 mg/day for women. Therefore, the acceptable intake of vitamin B6 for levodopa patients would be within the range of the recommended intake level, which is also within the usual range in foods in Japan, except for dietary supplements or health foods. Levodopa users should be cautious about taking dietary supplements and over-the-counter drugs.
[Mh] Termos MeSH primário: Levodopa/administração & dosagem
Nível de Efeito Adverso não Observado
Vitamina B 6/administração & dosagem
[Mh] Termos MeSH secundário: Bases de Dados Bibliográficas
Suplementos Nutricionais
Interações Medicamentosas
Feminino
Seres Humanos
Masculino
Medicamentos sem Prescrição
Doença de Parkinson/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Nonprescription Drugs); 46627O600J (Levodopa); 8059-24-3 (Vitamin B 6)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.3358/shokueishi.58.268



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