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PARKINSN  August 2010, Week 1

PARKINSN August 2010, Week 1

Subject:

Re: Neuropathy in Parkinson’s Disease May Be Related to L-DopaExposure

From:

kbachn <[log in to unmask]>

Reply-To:

Parkinson's Information Exchange Network <[log in to unmask]>

Date:

Wed, 4 Aug 2010 08:26:01 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (107 lines)

English translation please :-)

defn of IPD and PN would help......

Ken

----- Original Message ----- 
From: "mschild" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, August 04, 2010 1:19 AM
Subject: Neuropathy in Parkinson’s Disease May Be Related to L-DopaExposure


> Posted: 07/26/2010; AccessMedicine from McGraw-Hill © 2010 The McGraw-Hill
> Companies
>
>
>
>
>
> Idiopathic Parkinson’s disease (IPD) is a central nervous system disorder
> affecting the basal ganglia that is caused by death of dopamine-producing 
> cells
> in the substantia nigra. Although IPD is thought classically to spare the
> peripheral nervous system, an association between peripheral neuropathy 
> (PN)
> and IPD has been demonstrated in some of the rare genetic forms of 
> Parkinson’s
> disease. A recent study (Toth et al, 2010) aimed to examine the 
> relationship
> between the more common form of IPD and PN.
>
> The authors conducted a prospective cohort study by randomly selecting
> patients from a database of IPD patients at a tertiary center in Canada.
> Patients as well as age- and gender-matched controls underwent detailed
> clinical assessment, neurophysiologic testing using nerve conduction 
> studies,
> and a thorough laboratory assessment for causes of neuropathy. Patients 
> who
> could not tolerate these tests or who had known risk factors for PN such 
> as
> diabetes were excluded.
>
> A total of 58 IPD patients were included in the study. Symptoms of PN were
> present in 43% of the IPD patients but in only 5% of the control subjects.
> There were no significant differences in risk factors for PN between the 
> IPD and
> control patients. Three IPD patients were excluded because two 
> neurologists,
> one blinded to the diagnosis of IPD, disagreed as to the diagnosis of PN. 
> Of
> the remaining 55 IPD patients, 32 (58%) were diagnosed with PN using a
> standard electrophysiologic and clinical assessment; 24 of these had
> symptomatic PN. Only 5 of the 58 controls (9%) were diagnosed with PN.
> Duration of IPD before assessment was similar in the IPD with and without 
> PN
> groups, although severity of IPD was greater in the IPD with PN patients.
>
> To discern the etiology of PN in IPD patients, the authors examined a 
> number
> of known causes of neuropathy, most of which were unrevealing. Although
> similar cobalamin levels were found in the IPD groups with and without PN,
> fasting homocysteine and methylmalonic acid (MMA) levels were 
> significantly
> higher in the IPD group with PN.
>
> The odds ratio for exposure to L-dopa in the IPD patients with PN was 12.4
> (95% confidence interval, 1.4–109.1). There were no differences between 
> the
> groups in the use of other PD drugs, including dopamine agonists, COMT
> inhibitors, anticholinergic agents, and amantadine. Cumulative L-dopa 
> exposure
> was associated not only with PN, but also with elevated fasting MMA levels
> across all IPD patients in the study. L-dopa exposure was also associated 
> with
> PN severity in the IPD patients with PN.
>
> This intriguing study demonstrates a somewhat unexpectedly high prevalence 
> of
> PN in IPD patients and cites an association with elevated MMA levels, 
> perhaps
> mediated by exposure to L-dopa. L-dopa may indeed interact with 
> methylation
> pathways involved in folate metabolism, providing a mechanism for MMA
> elevation. Although causation is not proven here, if verified, this study 
> may
> change the way we care for patients with IPD. PN in IPD could 
> substantially
> contribute to gait disturbance and disability in some patients with IPD, 
> and
> prevention of PN would be an important advance. Exposure to L-dopa is
> inevitable in most IPD patients at some point during their course, but 
> perhaps
> we should be measuring MMA levels in these patients and treating with
> cobalamin supplementation to reduce MMA levels and prevent neuropathy. 
> Further
> studies, including treatment trials, seem warranted.
>
> ----------------------------------------------------------------------
> To sign-off Parkinsn send a message to: 
> mailto:[log in to unmask]
> In the body of the message put: signoff parkinsn
> 

----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:[log in to unmask]
In the body of the message put: signoff parkinsn

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June 2002, Week 5
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April 2002, Week 3
April 2002, Week 2
April 2002, Week 1
March 2002, Week 5
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March 2002, Week 3
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March 2002, Week 1
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February 2002, Week 1
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December 2001, Week 4
December 2001, Week 3
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December 2001, Week 1
November 2001, Week 5
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November 2001, Week 1
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October 2001, Week 3
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April 2001, Week 1
March 2001, Week 5
March 2001, Week 4
March 2001, Week 3
March 2001, Week 2
March 2001, Week 1
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February 2001, Week 3
February 2001, Week 2
February 2001, Week 1
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January 2001, Week 3
January 2001, Week 2
January 2001, Week 1
December 2000, Week 5
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December 2000, Week 3
December 2000, Week 2
December 2000, Week 1
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February 2000, Week 1
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December 1999, Week 5
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December 1999, Week 3
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March 1999, Week 1
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July 1998, Week 3
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April 1998, Week 1
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March 1998, Week 1
February 1998, Week 5
February 1998, Week 4
February 1998, Week 3
February 1998, Week 2
February 1998, Week 1
January 1998, Week 5
January 1998, Week 4
January 1998, Week 3
January 1998, Week 2
January 1998, Week 1
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December 1997, Week 4
December 1997, Week 3
December 1997, Week 2
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November 1997, Week 5
November 1997, Week 4
November 1997, Week 3
November 1997, Week 2
November 1997, Week 1
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October 1997, Week 4
October 1997, Week 3
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October 1997, Week 1
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April 1997, Week 3
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March 1996, Week 3
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February 1996, Week 1
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January 1996, Week 3
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January 1996, Week 1
December 1995, Week 5
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