BACKGROUND: The development of dyskinesia in patients with Parkinson's Disease (PD) has been associated with several risk factors, including the use of Levodopa.
OBJECTIVES: To determine the prevalence of dyskinesia among Filipino patients with Parkinson's Disease given Levodopa versus Dopamine Agonist. To determine the time to development of dyskinesia among Filipino PD patients given Levodopa versus Dopamine Agonists, and to determine the risk factors for the development of dyskinesia among patients on Levodopa.
METHODS: In this retrospective case-control study, the occurrence of dyskinesia was evaluated in 367 PD patiems given Levodopa or Dopamine Agonists.
RESULTS: The prevalence of dyskinesia was significand higher in patients on Levodopa compared to those on DopamineAgonist (36.11% vs 0.86%, p 0.005). Kaplan Meier survival curve showed that at 9 years of treatment, a greater proportion of patients in the dopamine agonist group remained free of dyskinesia compared to the levodopa group (87 vs 3-5%) Patients in the Dopamine agonist group had a longer time to dyskinesia at 7 years compared to those in the Levodopa group at 6.25 years (CI 2 - 20 years). Among patients on Levodopa younger at onset of PD (53.29 vs. 62.37, p < 0.05), female sex (60.44 vs. 39.56%, p 0.006), and longer duration of treatment (6.25 vs. 3.73, p < 0.05) were significant risk factors for the occurrence of dyskinesia.
CONCLUSION: Among Filipino PD patients, the prevalence of dyskinesia is significantly higher in patients on Levodopa compared to those on Dopamine Agonists (36.11% vs 0.8%). At 9 years of treatment, a greater proportion of patients in the DA group remained free of dyskinesia compared to the L-dopa group (87% vs 37.5%). Patients on DAs also had a longer time to the onset dyskinesia at 7 years of treatment compared to those in the L-dopa group at 6.25 years (range at 2 - 20 years of treatment). Among patients on L-dopa, the significant risk factors that predispose patients to the development of dyskinesia are: younger age, female sex, and longer duration of treatment.

Human ; Female ; Antiparkinson Agents ; Disease Susceptibility ; Dopamine Agonists ; Dyskinesias ; Kaplan-meier Estimate ; Levodopa ; Parkinson Disease ; Prevalence

Parkinson's disease (PD) is a neurodegenerative disorder with a complex, multifactorial aetiology. The brains of patients affected with PD are characterized by a loss of neurons in dopamine neurons in the substantia nigra, decreasing of dopamine secretion, and the deposition of Lewy bodies (LBs) in the cytoplasm of remaining neurons. In China the data show that the incidence of Parkinson's disease increases at least 20 times in recent 20 years, and it makes things worse for the aging society. Developing good anti-PD drugs to improve the patient's quality of life is particularly important. The treatment of PD using traditional Chinese medicine (TCM) has made remarkable effect, while the the molecular mechanisms of it is still not known, while elucidating the molecular mechanism of TCM is the base of better understanding its function. Using genetically modified PD model of Caenorhabditis elegans, which is suitable for molecular mechanism study, to explore the interference mechanism of TCM to PD might be an effective way. This review briefly introduces the research progress on molecular mechanism of PD, and then discusses the idea of using C. elegans to study molecular mechanism of TCM intervention to PD.
Animals ; Antiparkinson Agents ; pharmacology ; Caenorhabditis elegans ; drug effects ; Disease Models, Animal ; Humans ; Medicine, Chinese Traditional ; Parkinson Disease ; etiology

OBJECTIVE: To explore the association of VEGFR2 gene polymorphisms (rs2305948 and rs1870377) with the effect of levodopa (L-dopa) and dyskinesia in Chinese population and to provide theoretical basis for clinical treatment.
 METHODS: By using Taqman MGB analysis and gene sequencing, the rs2305948 and rs1870377 polymorphisms of 69 enrolled Parkinson's disease (PD) patients were detected. Among them, 32 cases developed dyskinesia during 5 years and 37 cases did not develop dyskinesia during 8 years (as the control).
 RESULTS: There was no significant association between the occurrence of dyskinesia and VEGFR2 polymorphisms at rs2305948 and rs1870377. However, rs1870377 polymorphism of AA showed greater maximum L-dopa dose [(565.00±163.55) mg/d vs (396.88±200.39) mg/d, (300.00±80.18) mg/d, P=0.038] and higher value of Modified Abnormal Involuntary Movement Scale (mAIMS) compared with that with polymorphisms of AT and TT [17.00±5.24 vs 8.94±6.53, 7.86±4.45, P=0.026]. 
 CONCLUSION VEGFR2 genes polymorphism (rs1870377) is associated with maximum L-dopa dose and mAIMS value in PD patients.
Antiparkinson Agents ; pharmacology ; Humans ; Levodopa ; pharmacology ; Parkinson Disease ; drug therapy ; genetics ; Polymorphism, Genetic ; Vascular Endothelial Growth Factor Receptor-2 ; genetics

In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.
Antiparkinson Agents ; Anxiety* ; Bipolar Disorder* ; Brain ; Dementia ; Diagnosis, Differential ; Dihydroergotamine ; Drainage ; Female ; Gait* ; Humans ; Hydrocephalus, Normal Pressure* ; Hypokinesia* ; Mood Disorders ; Negotiating ; Neuroimaging ; Psychomotor Agitation ; Urinary Incontinence

Antiparkinson Agents ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Integrative Medicine ; methods ; Levodopa ; therapeutic use ; Parkinson Disease ; drug therapy ; Phytotherapy

Aged, 80 and over ; Antiparkinson Agents ; pharmacology ; therapeutic use ; Female ; Humans ; Lewy Body Disease ; drug therapy ; psychology ; Memantine ; adverse effects ; pharmacology ; therapeutic use ; United States

The dysfunction of subthalamic nucleus is the main cause of Parkinson's disease. Local field potentials in human subthalamic nucleus contain rich physiological information. The present study aimed to quantify the oscillatory and dynamic characteristics of local field potentials of subthalamic nucleus, and their modulation by the medication therapy for Parkinson's disease. The subthalamic nucleus local field potentials were recorded from patients with Parkinson's disease at the states of on and off medication. The oscillatory features were characterised with the power spectral analysis. Furthermore, the dynamic features were characterised with time-frequency analysis and the coefficient of variation measure of the time-variant power at each frequency. There was a dominant peak at low beta-band with medication off. The medication significantly suppressed the low beta component and increased the theta component. The amplitude fluctuation of neural oscillations was measured by the coefficient of variation. The coefficient of variation in 4-7 Hz and 60-66 Hz was increased by medication. These effects proved that medication had significant modulation to subthalamic nucleus neural oscillatory synchronization and dynamic features. The subthalamic nucleus neural activities tend towards stable state under medication. The findings would provide quantitative biomarkers for studying the mechanisms of Parkinson's disease and clinical treatments of medication or deep brain stimulation.
Antiparkinson Agents ; therapeutic use ; Beta Rhythm ; Electrodes ; Evoked Potentials ; Humans ; Oscillometry ; Parkinson Disease ; drug therapy ; physiopathology ; Subthalamic Nucleus ; physiopathology ; Theta Rhythm

L-dopa (l-3,4-dihydroxyphenylalanine)-induced dyskinesia (LID) is a debilitating complication of dopamine replacement therapy for Parkinson's disease. The potential contribution of striatal D₂ receptor (D₂R)-positive neurons and downstream circuits in the pathophysiology of LID remains unclear. In this study, we investigated the role of striatal D₂R⁺ neurons and downstream globus pallidus externa (GPe) neurons in a rat model of LID. Intrastriatal administration of raclopride, a D₂R antagonist, significantly inhibited dyskinetic behavior, while intrastriatal administration of pramipexole, a D₂-like receptor agonist, yielded aggravation of dyskinesia in LID rats. Fiber photometry revealed the overinhibition of striatal D₂R⁺ neurons and hyperactivity of downstream GPe neurons during the dyskinetic phase of LID rats. In contrast, the striatal D₂R⁺ neurons showed intermittent synchronized overactivity in the decay phase of dyskinesia. Consistent with the above findings, optogenetic activation of striatal D₂R⁺ neurons or their projections in the GPe was adequate to suppress most of the dyskinetic behaviors of LID rats. Our data demonstrate that the aberrant activity of striatal D₂R⁺ neurons and downstream GPe neurons is a decisive mechanism mediating dyskinetic symptoms in LID rats.
Rats ; Animals ; Levodopa/toxicity* ; Dopamine ; Parkinsonian Disorders/drug therapy* ; Oxidopamine ; Dyskinesia, Drug-Induced ; Corpus Striatum/metabolism* ; Neurons/metabolism* ; Receptors, Dopamine D2/metabolism* ; Antiparkinson Agents/toxicity*

OBJECTIVETo observe and assess the efficacy enhancing and toxicity attenuating effect of Nuzhen Yangyin Granule (NYG) to the anti-parkinsonism (paralysis agitans) therapy with Medopa and Artane.

METHODSAdopting the randomized double-blinded method, the effect of adding NYG to 30 patients with Parkinsonism in the treated group, who already received anti-Parkinsonism treatment but showing decreased response to Medopa and Artane and with obvious adverse reaction, was observed and controlled by 30 patients treated by adding placebo.

RESULTSThe total effective rate in the treated group and the control group was 86.7% and 56.7% respectively, the total syndrome improving rate was 90% and 56.7% respectively and the toxicity attenuating rate 90% and 43.3% respectively, comparison between the two groups showed significant difference (P < 0.05 or P < 0.01). NYG also showed markedly effective in reducing the adverse reactions of Medopa and Artane on digestive, neuro-psychiatric and cardiovascular system.

CONCLUSIONNYG has obvious efficacy enhancing and toxicity attenuating effects caused by the anti-Parkinsonism treatment with Medopa and Artane.

Aged ; Antiparkinson Agents ; therapeutic use ; Double-Blind Method ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Levodopa ; therapeutic use ; Male ; Middle Aged ; Parkinson Disease ; drug therapy ; Phytotherapy

Acute Disease ; Adult ; Antidotes ; therapeutic use ; Antiparkinson Agents ; therapeutic use ; Benserazide ; Cholinesterase Inhibitors ; poisoning ; Humans ; Insecticides ; poisoning ; Levodopa ; therapeutic use ; Male ; Organophosphate Poisoning ; Parkinson Disease ; drug therapy ; pathology ; Pralidoxime Compounds ; therapeutic use ; Trihexyphenidyl ; therapeutic use