ABSTRACT
Objective: To evaluate the effectiveness of oral pharmacologic therapy in improving postural control and functionality in patients with DCP, with less than 20 years old, compared with any therapy or placebo. Methods: Randomized clinical trials and quasi-experimental with no restriction in publication date or language were included. The search was conducted in PubMed, EMBASE, The Cochrane Library (CENTRAL), Virtual Health Library (LILACS, SCIELO), ClinicalTrials.gov and Opengrey. The risk of bias was assessed according to the Cochrane Handbook for Interventions Systematic Reviews. Results: 3 cross over studies were included, according to the established criteria. The three drugs that were analyzed were: levodopa, and trihexyphenidyl and tetrabenazine, compared to placebo. No study had significant favorable results for the use of the drug over placebo. Conclusion: At the moment there is no evidence to support the use of oral medication in patients with DCP, based on the small number of high quality studies found, it is necessary to increase research on oral pharmacologic therapy in this group of patients.
Objetivo: Evaluar la efectividad del tratamiento farmacológico oral destinado a mejorar el control postural y la funcionalidad en pacientes con parálisis cerebral disquinética (PCD) menores de 20 años comparado con cualquier terapia o placebo. Métodos: Se incluyeron ensayos clínicos aleatorizados y cuasi experimentales sin restricción de fecha de publicación o lenguaje. La búsqueda se realizó en Pubmed, EMBASE, The Cochrane Library (CENTRAL), Biblioteca Virtual de la Salud (LILACS, SCIELO), ClinicalTrials.gov y Opengrey. El riesgo de sesgo fue evaluado de acuerdo al Manual Cochrane de Revisiones Sistemáticas de Intervenciones. Resultados: Se incluyeron 3 estudios cross-over de acuerdo a los criterios establecidos. Los tres fármacos analizados fueron: levodopa, tetrabenazina y trihexifenidilo, comparados con placebo. Ningún estudio tuvo resultados favorables de manera significativa para el uso del medicamento sobre placebo. Conclusión: Por el momento no existe evidencia que sustente el uso de la medicación oral en los pacientes con PCD en base al escaso número de estudios de alta calidad encontrados, siendo necesario que se aumente la investigación sobre el tratamiento farmacológico oral en este grupo de pacientes.
Subject(s)
Humans , Child , Dopamine Agents/administration & dosage , Levodopa/administration & dosage , Cerebral Palsy/drug therapy , Tetrabenazine/administration & dosage , Trihexyphenidyl/administration & dosage , Administration, Oral , Dystonia/drug therapy , Postural BalanceABSTRACT
PURPOSE: Levodopa is the most effective anti-Parkinsonian agent. It has also been known to exhibit analgesic properties in laboratory and clinical settings. However, studies evaluating its effects on neuropathic pain are limited. The aim of the present study was to examine the anti-allodynic effects of levodopa in neuropathic rats. MATERIALS AND METHODS: Sprague-Dawley male rats underwent the surgical procedure for L5 and L6 spinal nerves ligation. Sixty neuropathic rats were randomly divided into 6 groups for the oral administration of distilled water and levodopa at 10, 30, 50, 70, and 100 mg/kg, respectively. We co-administered carbidopa with levodopa to prevent peripheral synthesis of dopamine from levodopa, and observed tactile, cold, and heat allodynia pre-administration, and at 15, 30, 60, 90, 120, 150, 180, and 240 min after drug administration. We also measured locomotor function of neuropathic rats using rotarod test to examine whether levodopa caused side effects or not. RESULTS: Distilled water group didn't show any difference in all allodynia. For the levodopa groups (10-100 mg/kg), tactile and heat withdrawal thresholds were increased, and cold withdrawal frequency was decreased dose-dependently (p0.05). CONCLUSION: Levodopa reversed tactile, cold and heat allodynia in neuropathic rat without any side effects.
Subject(s)
Animals , Male , Rats , Carbidopa/administration & dosage , Dopamine Agents/administration & dosage , Hyperalgesia/drug therapy , Levodopa/administration & dosage , Neuralgia/drug therapy , Rats, Sprague-Dawley , Rotarod Performance TestABSTRACT
Underweight and malnutrition are well documented in Parkinson's disease (PD), while overweight has been less reported. We carried out a cross-sectional study including 177 healthy controls and 177 PD patients attending a tertiary care center. We recorded weight and height for all participants. A statistically significant difference was found in body mass index (BMI) between controls and PD patients (29.1±5.4 versus 27.2±4.7, p<0.001). In the PD Group, two patients were underweight, 32.7% were within normal range, 46.9% had overweight, and 19.2% were obese. Overweight and normal weight were more prevalent in the PD Group (p=<0.01 and <0.001, respectively) when compared to controls. In conclusion, overweight/obesity are common among patients with PD, while underweight is almost negligible.
Baixo peso e desnutrição são muito documentadas na doença de Parkinson (DP), enquanto que o excesso de peso tem sido menos relatado. Foi realizado um estudo transversal com 177 controles saudáveis e 177 pacientes com DP que frequentavam um centro terciário. O peso e a altura de todos os participantes foram arquivados. Uma diferença estatisticamente significativa no índice de massa corporal (IMC) foi encontrada entre controles e pacientes com DP (29,1±5,4 versus 27,2±4,7, p<0,001). No Grupo DP, dois pacientes estavam abaixo do peso, 32,7% estavam dentro do intervalo normal, 46,9% apresentavam sobrepeso e 19,2% eram obesos. Peso normal e excesso de peso foram mais prevalentes no Grupo DP (p=<0,01 e <0,001, respectivamente) em relação aos controles. Em conclusão, o sobrepeso/obesidade são comuns entre os pacientes com DP, enquanto baixo peso nessa população é quase insignificante.
Subject(s)
Aged , Female , Humans , Middle Aged , Body Mass Index , Overweight/epidemiology , Parkinson Disease/epidemiology , Antiparkinson Agents/administration & dosage , Case-Control Studies , Dyskinesia, Drug-Induced , Dopamine Agents/administration & dosage , Levodopa/administration & dosage , Mexico/epidemiology , Obesity/epidemiology , Prevalence , Parkinson Disease/drug therapy , Severity of Illness Index , Thinness/epidemiologyABSTRACT
Background: Non-motor symptoms are common among patients with Parkinson disease and include cognitive, psychiatric, sleep and autonomic dysfunctions. Aim: To determine if the detection of non-motor symptoms along with the appropriate referral to an specialist has an impact on their prevalence after one year follow-up. Material and Methods: We included 60 patients diagnosed with Parkinson´ s disease attending to the Movement Disorder Clinic. The presence of non-motor symptoms was determined by the non-motor symptom questionnaire (NMSQuest). Results: The mean NMSQuest scores at baseline and at one year follow up were 12.6 ± 6.2 and 9.9 ± 5.6, respectively (p < 0.01). The non-motor symptoms that showed a statistically significant differences in frequency between baseline and the final assessment, were constipation (p = 0.04), urinary urgency (p = 0.02), hallucinations (p = 0.04), dizziness (p = 0.02) and vivid dreams (p = 0.04). Conclusions: Intentional search for non-motor symptoms in patients with Parkinson´ s disease along with a multidisciplinary approach has an impact on their prevalence. The change in specific symptoms is probably related to adjustments in dopaminergic management.
Subject(s)
Aged , Female , Humans , Male , Dopamine Agents/administration & dosage , Dopamine/administration & dosage , Motor Activity , Movement Disorders/epidemiology , Parkinson Disease/complications , Follow-Up Studies , Motor Activity/drug effects , Movement Disorders/diagnosis , Parkinson Disease/drug therapy , Surveys and Questionnaires/standardsABSTRACT
Realizamos un estudio de casos y controles con 483 pacientes consecutivos con enfermedad de Parkinson idiopática (EP) y 533 controles apareados por edad y sexo con el fin de investigar la relación entre la EP y los factores de riesgo de enfermedades cardiovasculares. Mediante análisis multivariado, la diabetes, la hipertensión, los antecedentes de tabaquismo, colesterol elevado y altos niveles de triglicéridos fueron significativamente menos frecuentes en la EP que en los controles. Además, estas asociaciones resultaban más evidentes para los pacientes tratados con levodopa. Interpretamos esta asociación entre EP y reducción de los factores de riesgo vascular como debidos a insuficiencia en el eje hipotálamo-hipófisosuprarrenal, desnervación simpática generalizada en la EP y estimulación central o periférica de los receptores dopamínicos D1 y D2 por la levodopa. Estos efectos cardiovasculares y metabólicos favorables sugieren que la medicación dopaminérgica puede resultar útil en el tratamiento de los trastornos cardiovasculares.
Subject(s)
Dopamine Agents/administration & dosage , Dopamine Agents/therapeutic use , Physiological Effects of Drugs , Parkinson Disease/complications , Parkinson Disease/therapy , Metabolic Diseases/therapyABSTRACT
El Síndrome de Piernas Inquietas (SPI) se caracteriza por una sensación desagradable en las piernas que lleva a la imperiosa necesidad de moverlas. Ocurre en reposo y es de preferencia nocturna. Su frecuencia varía entre 2-15 por ciento de la población general adulta y 20-30 por ciento en pacientes urémicos en diálisis. A nivel nacional se da una frecuencia estimativa de 13 por ciento en la población general adulta y 27 por ciento en los pacientes urémicos en diálisis.
Subject(s)
Adult , Humans , Child , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/etiology , Restless Legs Syndrome/therapy , Dopamine Agents/administration & dosage , Dopamine Agents/adverse effects , Dopamine Antagonists/adverse effects , Diagnosis, Differential , Dopamine/biosynthesis , Iron/deficiency , Iron/cerebrospinal fluid , Iron/therapeutic use , Polysomnography , Restless Legs Syndrome/epidemiology , Uremia/complicationsSubject(s)
Adolescent , Anti-Dyskinesia Agents/administration & dosage , Carbidopa/administration & dosage , Circadian Rhythm/physiology , Dopamine Agents/administration & dosage , Drug Combinations , Dystonia/complications , Female , Follow-Up Studies , Humans , Levodopa/administration & dosage , Vitiligo/complicationsABSTRACT
Doença de Parkinson (DP) é a causa mais freqüente de parkinsonismo em nosso meio, responsável por 58 por cento dos casos. Devem-se excluir outras causas, como uso de drogas antidopaminérgicas (20 por cento dos casos). Levodopa é o agente mais importante para o tratamento de DP. Há controvérsia sobre quando se introduzir esta droga mas deve-se reservá-la para quando surgir substancial comprometimento funcional. Drogas acessárias säo anticolinérgicos, úteis para o tremor, amantadina, para bradicinesia e rigidez; e agonistas dopaminérgicos que ajudam no manuseio de complicaçöes da levodopa. A selegelina tem discreta açäo sintomática e possível açäo neuroprotetora. O tratamento de DP pode ser complicado por falha primária, falha secundária e problemas do uso da levodopa. A falha primária pode ser causada por uso de agentes antidopaminérgicos, presença de tremor de repouso severo ou erro diagnóstico. A causa mais comum de falha secundária é progressäo da DP. As principais complicaçöes do uso da levodopa säo flutuaçöes e discinesias. Outros problemas comuns säo disautonomia, depressäo, psicose e demência. Fenomenologia e manuseio destas complicaçöes säo discutidos. Perspectivias futuras incluem cirurgias para reversäo de patologia
Subject(s)
Humans , Parkinson Disease/drug therapy , Levodopa/therapeutic use , Parkinson Disease, Secondary/diagnosis , Parkinson Disease, Secondary/etiology , Parkinson Disease/diagnosis , Parkinson Disease/physiopathology , Dopamine Agents/administration & dosage , Dopamine Agents/adverse effects , Dopamine Agents/therapeutic use , Dopamine Agonists/administration & dosage , Dopamine Agonists/therapeutic use , Levodopa/administration & dosage , Levodopa/adverse effectsABSTRACT
El síndrome a largo plazo por levodopa (L-Dopa) corresponde a las manifestaciones adversas provocadas por el fármaco, que aparecen generalmente después de un año o más de su empleo y que afectan aproximadamente al 50 por ciento de los casos. Los síntomas son muy variados y polimorfos, los más habituales son de tipo motor (diskinesias, distonías posturales y disminución de la respuesta motora), se agregan otros, como trastornos mentales, neurovegetativos y sensitivos. Para la profilaxis de este síndrome debe considerarse el retraso en la iniciación de la terapia, usándose como alternativa: selegilina, bromocriptina, anticolinérgicos (thihexifenidilo) o antidepresivos. En casos severos de enfermedad de Prkinson y que no pueda obviarse el uso de L-Dopa, ésta debe emplearse inicialmente en la dosis mínima efectiva, la que se aumenta en forma lenta y progresiva en varias semanas. Otra variables es el uso de formulaciones de liberación controlada (Prolopa HBS o Sinemet CR). También es recomendable la asociación de agonistas dopaminérgicos que tendrían un efecto protector en el síndrome a largo plazo de L-Dopa