scholarly journals The Added Benefit of Opicapone When Used Early in Parkinson's Disease Patients With Levodopa-Induced Motor Fluctuations: A Post-hoc Analysis of BIPARK-I and -II

2021 ◽  
Vol 12 ◽  
Author(s):  
José-Francisco Rocha ◽  
Georg Ebersbach ◽  
Andrew Lees ◽  
Eduardo Tolosa ◽  
Joaquim J. Ferreira ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Wide Spectrum ◽  
Motor Fluctuation ◽  
Motor Fluctuations ◽  
Disease Course ◽  
Treatment Pathway ◽  
Levodopa Treatment ◽  
Post Hoc ◽  
Off Time

Introduction: Opicapone (OPC) was efficacious in reducing OFF-time in two pivotal trials in patients with Parkinson's disease (PD) and end-of-dose motor fluctuations (BIPARK-I and -II). Post-hoc analyses of these trials evaluated the efficacy of OPC following pre-defined segmentation of the wide spectrum of motor fluctuations in PD.Methods: Data from matching treatment arms in BIPARK-I and -II were combined for the placebo (PLC) and OPC 50-mg groups, and exploratory post-hoc analyses were performed to investigate the efficacy of OPC 50 mg vs. PLC in subgroups of patients who were in “earlier” vs. “later” stages of both their disease course (e.g., duration of PD <6 years vs. ≥6 years) and levodopa treatment pathway (e.g., number of daily levodopa intakes <4 vs. ≥4). Efficacy variables included changes from baseline in absolute OFF-time and total ON-time.Results: The Full Analysis Set included 517 patients (PLC, n = 255; OPC 50 mg, n = 262). OPC 50 mg was significantly more effective than PLC in reducing OFF-time and increasing ON-time in the majority of subgroup analyses (p < 0.05). Moreover, patients in “earlier” stages of both their disease course and levodopa treatment pathway experienced numerically greater efficacy when using OPC 50 mg, in comparison with those in “later” stages.Conclusion: OPC 50 mg was efficacious over the whole trajectory of motor fluctuation evolution in PD patients. There was also a signal for enhanced efficacy in patients who were earlier vs. later in their disease course and levodopa treatment pathway.

scholarly journals A Spanish Consensus on the Use of Safinamide for Parkinson’s Disease in Clinical Practice

2020 ◽  
Vol 10 (3) ◽  
pp. 176 ◽  
Author(s):  
Javier Pagonabarraga ◽  
José Matías Arbelo ◽  
Francisco Grandas ◽  
Maria-Rosario Luquin ◽  
Pablo Martínez Martín ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Practice ◽  
Motor Fluctuations ◽  
Adjunctive Treatment ◽  
Good Tolerability ◽  
Time Control ◽  
Clinical Scenarios ◽  
Off Time

Safinamide is an approved drug for the treatment of motor fluctuations in Parkinson’s disease (PD). Scarce data are available on its use in clinical practice. A group of Spanish movement disorders specialists was convened to review the use of safinamide across different clinical scenarios that may guide neurologists in clinical practice. Eight specialists with recognized expertise in PD management elaborated the statements based on available evidence in the literature and on their clinical experience. The RAND/UCLA method was carried, with final conclusions accepted after a 2-round modified Delphi process. Higher level of agreement between panellists was reached for the following statements. Safinamide significantly improves mean daily OFF time without troublesome dyskinesias. Adjunctive treatment with safinamide is associated with motor improvements in patients with mid-to-late PD. The efficacy of safinamide on motor fluctuations is maintained at long-term, with no increase over time in dyskinesias severity. The clinical benefits of safinamide on pain and depression remain unclear. Safinamide presents a similar incidence of adverse events compared with placebo. The efficacy and safety of safinamide shown in the pivotal clinical trials are reproduced in clinical practice, with improvement of parkinsonian symptoms, decrease of daily OFF time, control of dyskinesias at the long term, and good tolerability and safety.

Mood swings associated with the ‘on—off’ phenomenon in Parkinson's disease

1987 ◽  
Vol 17 (4) ◽  
pp. 899-904 ◽  
Author(s):  
H. Nissenbaum ◽  
N. P. Quinn ◽  
R. G. Brown ◽  
B. Toone ◽  
A.-M. Gotham ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Questionnaire Survey ◽  
Motor Fluctuations ◽  
Functional Impact ◽  
Motor Disability ◽  
Therapeutic Implications ◽  
Levodopa Treatment

SynopsisMood swings accompanying the motor fluctuations of patients with Parkinson's disease on chronic levodopa treatment frequently occur, but are poorly recognized. Occasionally, their functional impact may be greater than that caused by the motor disability itself.In this study we have assessed the nature of, and relationship between, mood and motor fluctuations in nine Parkinsonian patients with ‘on—off’ motor swings. The results of an additional questionnaire survey confirm that ‘on–off’ mood swings occur in approximately two thirds of patients with Parkinson's disease experiencing motor fluctuations on dopaminergic treatment. Aetiological and therapeutic implications are discussed.

scholarly journals How Far Do the Complaints of Patients with Parkinson’s Disease Reflect Motor Fluctuation? Quantitative Analysis Using a Portable Gait Rhythmogram

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Hiroya Utsumi ◽  
Hiroo Terashi ◽  
Yohei Ishimura ◽  
Tomoko Takazawa ◽  
Yasuyuki Okuma ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Quantitative Analysis ◽  
Motor Fluctuation ◽  
Gait Disorders ◽  
Gait Disorder ◽  
New Device ◽  
The Times ◽  
Off Time ◽  
Normal Controls

In advanced-stage Parkinson’s disease (PD), motor fluctuation is a frequent and disabling problem. Assessment of motor fluctuation depends on patient’s subjective self-statement. We examined whether the subjective fluctuation matched the objective motor fluctuation defined by gait disorders. Using a new device, the portable gait rhythmogram, we recorded gait cadence and acceleration continuously over the 24-hour period in 54 patients with PD and 17 normal controls, for the quantitative evaluation of motor fluctuation. The patients were asked to estimate motor fluctuation every hour. In 44 of 54 patients, changes in the cadence were associated with simultaneous changes in acceleration. We examined the subjective fluctuation in these 44 patients who were confirmed to have motor fluctuation. Nineteen (82.7%) of 23 patients who felt no fluctuation showed distinct gait disorders. During off time, they walked with marked short or bradykinetic stepping. No matching changes were observed in either the cadence or acceleration in 11 (52.4%) of 21 patients who perceived motor fluctuation. No synchronization was noted in 30 (68.2%) of the 44 patients, between the times of subjectively assessed motor fluctuation and those of quantitative analysis of gait disorder. This discrepancy suggests that the objective continuous recording of the cadence and acceleration is necessary to understand motor fluctuation.

scholarly journals Neuropsychiatric Behaviors in the MPTP Marmoset Model of Parkinson’s Disease

2010 ◽  
Vol 37 (1) ◽  
pp. 86-95 ◽  
Author(s):  
Susan H. Fox ◽  
Naomi Visanji ◽  
Gaby Reyes ◽  
Philippe Huot ◽  
Jordi Gomez-Ramirez ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Time Course ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Motor Fluctuations ◽  
Disease State ◽  
Duration Of Treatment ◽  
Behavior Rating Scale ◽  
Levodopa Treatment

Objectives:Neuropsychiatric symptoms are increasingly recognised as a significant problem in patients with Parkinson's disease (PD). These symptoms may be due to ‘sensitisation’ following repeated levodopa treatment or a direct effect of dopamine on the disease state. The levodopa-treated MPTP-lesioned marmoset was used as a model of neuropsychiatric symptoms in PD patients. Here we compare the time course of levodopa-induced motor fluctuations and neuropsychiatric-like behaviors to determine the relationship between duration of treatment and onset of symptoms.Methods:Marmosets were administered 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (2.0 mg/kg s.c.) for five days, resulting in stable parkinsonism. Levodopa (15 mg/kg and benserazide, 3.75 mg/kg) p.o. b.i.d. was administered for 30 days. Animals were evaluated for parkinsonian disability, dyskinesia and on-time (motor fluctuations) and neuropsychiatric-like behaviors on Day 0 (prior to levodopa) and on Days 1, 7, 13, 27 and 30 of treatment using post hoc DVD analysis by a trained rater, blind to the treatment day.Results:The neuropsychiatric-like behavior rating scale demonstrated high interrater reliability between three trained raters of differing professional backgrounds. As anticipated, animals exhibited a progressive increase in levodopa-induced motor fluctuations, dyskinesia and wearing-off, that correlated with the duration of levodopa therapy. In contrast, levodopa-induced neuropsychiatric-like behaviors were present on Day 1 of levodopa treatment and their severity did not correlate with duration of treatment.Conclusions:The data suggest that neuropsychiatric disorders in PD are more likely an interaction between levodopa and the disease state than a consequence of sensitisation to repeated dopaminergic therapy.

Non‐Motor Fluctuations in Parkinson's Disease: Validation of the Non‐Motor Fluctuation Assessment Questionnaire

2021 ◽  
Author(s):  
Galit Kleiner ◽  
Hubert H. Fernandez ◽  
Kelvin L. Chou ◽  
Alfonso Fasano ◽  
Kevin R. Duque ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Fluctuation ◽  
Motor Fluctuations ◽  
Assessment Questionnaire
Sign in / Sign up

Export Citation Format

Share Document