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Pharmacokinetics of levodopa and 3-omd in patients with Parkinson's disease and motor fluctuations infected with Helicobacter pylori
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Abstracts / Journal of the Neurological Sciences 333 (2013) e65–e108
Abstract — WCN 2013 No: 1632 Topic: 2 — Movement Disorders The role of postoperative levodopa test in combining deep brain stimulation programming and medication therapy in Parkinson's disease P. Radicsa, L. Erőssb, A. Takátsa, D. Heldmannc, J. Giuffridac, G. Tamása. a Semmelweis University, Budapest, Hungary; bNational Institute of Neuroscience, Budapest, Hungary; cGreat Lakes NeuroTechnologies Inc., Cleveland, OH, USA Background: In Parkinson's disease, the combination of subthalamic deep brain stimulation (STN-DBS) and medication therapy need to be adjusted to treat the clinical symptoms. This strategy is assisted by a drug challenge test, when motor symptoms are evaluated by clinical rating scales during continuous bilateral stimulation, in medication ON and medication OFF states. Objective: We investigated if quantitative motion analysis during a postoperative levodopa test can help the therapy setting. Patients and methods: Eleven patients (age:61.7 ± 9.54 years, disease duration:18 ± 6.11 years) performed 14 s of finger tapping, hand grasping and pronation–supination of the arm in three conditions (STIM ON–MED OFF,STIM OFF–MED OFF and STIM ON– MED ON) one year after bilateral STN-DBS implantation. A motion sensor consisting of a three-dimensional gyroscope and accelerometer was worn on the index finger to measure limb movement. Speed as root mean square angular velocity and amplitude as root mean square excursion angle were calculated from the signal of the gyroscopes and compared with ANOVA for repeated measures (p b 0.05). Results: In case of optimal DBS settings, speed and amplitude of the three tasks did not differ significantly in the STIM ON–MED OFF and STIM ON–MED ON states and they were significantly higher than in the STIM OFF–MED OFF condition. In the single subject level, further DBS programming was needed when levodopa administration improved the speed and amplitude of the movement during bilateral STN-DBS. Conclusion: The postoperative levodopa test assisted by quantitative motion analysis facilitates the optimal setting of DBS, so medication dose can be reduced to avoid its side effects. doi:10.1016/j.jns.2013.07.635
Abstract — WCN 2013 No: 1627 Topic: 2 — Movement Disorders Pharmacokinetics of levodopa and 3-omd in patients with Parkinson's disease and motor fluctuations infected with Helicobacter pylori E. Narożańskaa,b, M. Białeckac, U. Adamiak-Gierad, B. GawrońskaSzklarzd, W. Sołtana, M. Schinwelskia,b, P. Robowskia,b, M. Madalińskie, J. Sławeka,b. aSt Adalbert Hospital, Szczecin, Poland; bMedical University of Gdansk, Gdansk, Szczecin, Poland; cDepartment of Experimental and Clinical Pharmacology, Szczecin, Poland; dPomeranian Medical University, Szczecin, Poland; eThe Pennine Acute Hospitals NHS Trust, Manchester, UK Background: Recent investigations suggest that eradication of Helicobacter pylori (H. pylori) may influence levodopa (LD) pharmacokinetics and improve the motor function of infected patients with Parkinson's disease (PD). Our study was aimed at comparison of pharmacokinetics of LD and its metabolite 3-O-methyldopa (3-OMD), between H. pylori-positive and -negative patients with Parkinson's disease and motor fluctuations.
Materials and methods: Seventy-three patients with the clinical diagnosis of PD, under stable LD therapy, reporting daily motor fluctuations and who had no history of previous eradication treatment, were screened for the infection with an antigen stool test. Thirty seven patients: 18 with H. pylori infection and 19 noninfected, matched both demographically and clinically, were selected for the examination of LD and 3-OMD pharmacokinetic parameters. Blood samples were collected immediately before and after morning LD dose 13 times: at 15 min intervals up to 2 h and then at 30 min intervals up to 4 h. LD and 3OMD concentrations were determined using a high-performance liquid chromatography method (HPLC) coupled with electrochemical detection. Results: The analysis of the pharmacokinetic parameters of LD and 3OMD showed no significant differences between H. pylori-infected and noninfected groups. Conclusions: There is no evidence for malabsorption of LD in H. pyloriinfected patients. doi:10.1016/j.jns.2013.07.636
Abstract — WCN 2013 No: 1682 Topic: 2 — Movement Disorders Incidence, prevalence and clinical pathway of Parkinson's disease among Pakistani population T. Hussaina, I.A. Khanb. aHoly Family Hospital, Rawalpindi, Pakistan; b Peshawar Medical College, Peshawar, Pakistan Introduction: Parkinson's disease is an idiopathic disorder of the extrapyramidal system characterized by rigidity, akinesia and tremors. The aim of this study was to describe the clinical spectrum of the disease from Pakistan, a developing country in south-east Asia. Methods: This study was conducted at the teaching hospitals of Peshawar Medical College, Pakistan over a period of 1 year from August 2011 to July 2012. Patients with Parkinson's disease were identified by an ICD-9 coding system of the hospital medical records. An informed consent was obtained from all the participants. Demographical characteristics, clinical features, laboratory investigations and radiological investigations were recorded and analyzed. Results: A total of 48 patients were identified. 30 were males and 18 were females. Mean age of onset of the disease was 51 years. 28 patients had onset of illness during the sixth or seventh decade of life. Mean duration of illness at the time of presentation was six years. Rigidity, bradykinesia, tremors, primitive reflexes, and difficulty in performing fine work and walking were the most common clinical features. 36 patients had predominantly unilateral symptoms. 12 patients had cognitive impairment. Cognitive decline was more common in the elderly and in patients with disease duration of longer than 8 years. Conclusion: Parkinson's disease is more common in males. Tremor, rigidity, walking difficulty, bradykinesia and difficulty in performing fine work are the commonest clinical features. Disease severity increases with duration of the disease. Cognitive impairment is not uncommon in these patients and is associated with disease duration and age of onset of the illness. doi:10.1016/j.jns.2013.07.637
Abstract — WCN 2013 No: 1685 Topic: 2 — Movement Disorders Transcranial sonography in movement disorders M. Budisic, A. Lovrencic-Huzjan, V. Supanc, Z. Trkanjec, V. Basic-Kes. University Hospital Sestre Milosrdnice, Zagreb, Croatia
Abstracts / Journal of the Neurological Sciences 333 (2013) e65–e108
Abstract — WCN 2013 No: 1632 Topic: 2 — Movement Disorders The role of postoperative levodopa test in combining deep brain stimulation programming and medication therapy in Parkinson's disease P. Radicsa, L. Erőssb, A. Takátsa, D. Heldmannc, J. Giuffridac, G. Tamása. a Semmelweis University, Budapest, Hungary; bNational Institute of Neuroscience, Budapest, Hungary; cGreat Lakes NeuroTechnologies Inc., Cleveland, OH, USA Background: In Parkinson's disease, the combination of subthalamic deep brain stimulation (STN-DBS) and medication therapy need to be adjusted to treat the clinical symptoms. This strategy is assisted by a drug challenge test, when motor symptoms are evaluated by clinical rating scales during continuous bilateral stimulation, in medication ON and medication OFF states. Objective: We investigated if quantitative motion analysis during a postoperative levodopa test can help the therapy setting. Patients and methods: Eleven patients (age:61.7 ± 9.54 years, disease duration:18 ± 6.11 years) performed 14 s of finger tapping, hand grasping and pronation–supination of the arm in three conditions (STIM ON–MED OFF,STIM OFF–MED OFF and STIM ON– MED ON) one year after bilateral STN-DBS implantation. A motion sensor consisting of a three-dimensional gyroscope and accelerometer was worn on the index finger to measure limb movement. Speed as root mean square angular velocity and amplitude as root mean square excursion angle were calculated from the signal of the gyroscopes and compared with ANOVA for repeated measures (p b 0.05). Results: In case of optimal DBS settings, speed and amplitude of the three tasks did not differ significantly in the STIM ON–MED OFF and STIM ON–MED ON states and they were significantly higher than in the STIM OFF–MED OFF condition. In the single subject level, further DBS programming was needed when levodopa administration improved the speed and amplitude of the movement during bilateral STN-DBS. Conclusion: The postoperative levodopa test assisted by quantitative motion analysis facilitates the optimal setting of DBS, so medication dose can be reduced to avoid its side effects. doi:10.1016/j.jns.2013.07.635
Abstract — WCN 2013 No: 1627 Topic: 2 — Movement Disorders Pharmacokinetics of levodopa and 3-omd in patients with Parkinson's disease and motor fluctuations infected with Helicobacter pylori E. Narożańskaa,b, M. Białeckac, U. Adamiak-Gierad, B. GawrońskaSzklarzd, W. Sołtana, M. Schinwelskia,b, P. Robowskia,b, M. Madalińskie, J. Sławeka,b. aSt Adalbert Hospital, Szczecin, Poland; bMedical University of Gdansk, Gdansk, Szczecin, Poland; cDepartment of Experimental and Clinical Pharmacology, Szczecin, Poland; dPomeranian Medical University, Szczecin, Poland; eThe Pennine Acute Hospitals NHS Trust, Manchester, UK Background: Recent investigations suggest that eradication of Helicobacter pylori (H. pylori) may influence levodopa (LD) pharmacokinetics and improve the motor function of infected patients with Parkinson's disease (PD). Our study was aimed at comparison of pharmacokinetics of LD and its metabolite 3-O-methyldopa (3-OMD), between H. pylori-positive and -negative patients with Parkinson's disease and motor fluctuations.
Materials and methods: Seventy-three patients with the clinical diagnosis of PD, under stable LD therapy, reporting daily motor fluctuations and who had no history of previous eradication treatment, were screened for the infection with an antigen stool test. Thirty seven patients: 18 with H. pylori infection and 19 noninfected, matched both demographically and clinically, were selected for the examination of LD and 3-OMD pharmacokinetic parameters. Blood samples were collected immediately before and after morning LD dose 13 times: at 15 min intervals up to 2 h and then at 30 min intervals up to 4 h. LD and 3OMD concentrations were determined using a high-performance liquid chromatography method (HPLC) coupled with electrochemical detection. Results: The analysis of the pharmacokinetic parameters of LD and 3OMD showed no significant differences between H. pylori-infected and noninfected groups. Conclusions: There is no evidence for malabsorption of LD in H. pyloriinfected patients. doi:10.1016/j.jns.2013.07.636
Abstract — WCN 2013 No: 1682 Topic: 2 — Movement Disorders Incidence, prevalence and clinical pathway of Parkinson's disease among Pakistani population T. Hussaina, I.A. Khanb. aHoly Family Hospital, Rawalpindi, Pakistan; b Peshawar Medical College, Peshawar, Pakistan Introduction: Parkinson's disease is an idiopathic disorder of the extrapyramidal system characterized by rigidity, akinesia and tremors. The aim of this study was to describe the clinical spectrum of the disease from Pakistan, a developing country in south-east Asia. Methods: This study was conducted at the teaching hospitals of Peshawar Medical College, Pakistan over a period of 1 year from August 2011 to July 2012. Patients with Parkinson's disease were identified by an ICD-9 coding system of the hospital medical records. An informed consent was obtained from all the participants. Demographical characteristics, clinical features, laboratory investigations and radiological investigations were recorded and analyzed. Results: A total of 48 patients were identified. 30 were males and 18 were females. Mean age of onset of the disease was 51 years. 28 patients had onset of illness during the sixth or seventh decade of life. Mean duration of illness at the time of presentation was six years. Rigidity, bradykinesia, tremors, primitive reflexes, and difficulty in performing fine work and walking were the most common clinical features. 36 patients had predominantly unilateral symptoms. 12 patients had cognitive impairment. Cognitive decline was more common in the elderly and in patients with disease duration of longer than 8 years. Conclusion: Parkinson's disease is more common in males. Tremor, rigidity, walking difficulty, bradykinesia and difficulty in performing fine work are the commonest clinical features. Disease severity increases with duration of the disease. Cognitive impairment is not uncommon in these patients and is associated with disease duration and age of onset of the illness. doi:10.1016/j.jns.2013.07.637
Abstract — WCN 2013 No: 1685 Topic: 2 — Movement Disorders Transcranial sonography in movement disorders M. Budisic, A. Lovrencic-Huzjan, V. Supanc, Z. Trkanjec, V. Basic-Kes. University Hospital Sestre Milosrdnice, Zagreb, Croatia