Cannabis in Parkinson’s Disease — the patient’s perspective versus clinical trials: a systematic literature review

Abstract Introduction Early non-motor symptoms of Parkinson’s Disease (PD) include sleep and digestive disturbances that share a common pathology via alpha-synuclein (AS) deposition in the central nervous system (CNS) and formation in the enteric (ENS). The concept of prodromal PD as expressed by the brain-gut-microbiota axis continues to gain credibility across multiple literatures; yet, no unified treatment plan has been suggested. Disconnected, symptomatic treatment of prodromal PD may unintentionally hasten its development via compromise of REM sleep quality and reciprocal gut health. A more connected, comprehensive approach is needed. We conducted a systematic literature review to hypothesize next steps in treatment research for prodromal PD. Methods A systematic literature review using the Boolean combinations of “ALPHA-SYNUCLEIN” & - “SLEEP”, “GUT MICROBIOME”, and “EXERCISE” in all fields, restricted to the last 5 years, focusing on specification of prodromal PD, was conducted. Results were combined with an examination of current treatment practices in PD. Results 38 articles met inclusion criteria. Results were categorized through a presupposed primacy of sleep. Conclusion Due to the emerging nature of the prodromal PD idea, current treatment practice is myopic and may contribute to the progression of PD. Specifically, 1) sedative-hypnotic sleep interventions suppress REM, where clearing of CNS alpha-synuclein occurs, and 2) proton-pump inhibitors (PPI) cause significant gut dysbiosis, which may contribute to initial AS misfolding in the gut. Early identification of prodromal PD symptoms via cross-referenced clinical interview may allow for early behavioral interventions that underlie healthy brain-gut-microbiota axis functioning. Results outline specific measures that may slow PD-related synucleinopothies. The highest impact practices in this regard are REM-focused sleep hygiene and cardiovascular conditioning in a reciprocal relationship, highlighting the necessity of an early-intervention, preventative health model for conquering PD. Support This work was made possible in part by a donation from Drs. Shane Pitts and Michelle Hilgeman in support of Birmingham-Southern College’s Southern Sleep Laboratory.

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Patterns and Determinants of Prescribing for Parkinson’s Disease: A Systematic Literature Review

Parkinson s Disease ◽

10.1155/2019/9237181 ◽

2019 ◽

Vol 2019 ◽

pp. 1-40 ◽

Cited By ~ 2

Author(s):

Khalid Orayj ◽

Emma Lane

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Literature Review ◽

Systematic Literature Review ◽

Common Factor ◽

Safety Data ◽

Prescribing Patterns ◽

Efficacy And Safety ◽

Ovid Medline ◽

Number Of Patients

Since the discovery of levodopa (L-dopa) in 1967, the range of medications available to treat Parkinson’s disease has increased significantly and guidance on the use, efficacy, and safety of these medications has evolved. To assess levels of adherence to national prescribing guidelines and awareness of changes in the efficacy and safety data published in the profiles of medications for the treatment of PD, we have reviewed studies on patterns and determinants of prescribing PD medications conducted in the last 50 years (since the discovery of L-dopa). A systematic literature review was conducted using EMBASE (1967 to March, 2018), Ovid MEDLINE(R) ALL (1967 to March 16, 2018), PsycINFO (1967 to the 2nd week of March, 2018), and PubMed to identify all studies measuring prescribing patterns of PD medication between 1967 and 2017. Study design, source of data, country, year of study, number of patients and/or prescriptions, unit of analysis, prescribing determinants, and percentage utilisation of PD medications were extracted where possible. 44 studies examining prescribing patterns and/or prescribing determinants across 17 countries were identified. Unsurprisingly, L-dopa was the most commonly prescribed medication in all studies, accounting for 46.50% to 100% of all prescriptions for PD. In several studies, the prescribing rate of ergot-derived dopamine agonists (DAs) decreased over time in concordance with guidance. In contrast, the prescribing rates of non-ergot DAs increased over the last ten years in most of the included studies. In examining prescribing factors, two major categories were exemplified, patients’ factors and prescribers’ factors, with patients’ age being the most common factor that affected the prescription in most studies. In conclusion, L-dopa is now the most commonly prescribed medication for cases of PD but there is large variation in the prescribing rates of catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, amantadine, and anticholinergics between countries. New studies examining the effects of recent clinical trials and measuring the prescribing rates of newly approved medications are warranted.

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