There were recents comments concerning the use of Cisapride as a treatment of
constipation in Parkinson's Disease. These are the latest abstracts on its
effectiveness.
 
 
 
<1>
Authors
  Neira WD.  Sanchez V.  Mena MA.  de Yebenes JG.
Institution
  Department of Neurology, Fundacion Jimenez Diaz, Madrid, Spain.
Title
  The effects of cisapride on plasma L-dopa levels and clinical response in
  Parkinson's disease.
Source
  Movement Disorders.  10(1):66-70, 1995 Jan.
Abstract
  Cisapride (CIS) is a prokinetic agent that increases gastrointestinal
  motility in normal individuals and improves constipation in Parkinson's
  disease (PD). We studied the effects of CIS on the clinical response and
  the peripheral pharmacokinetics of orally administered L-dopa given to
  patients with PD. Twenty patients with idiopathic PD and chronic
  constipation, whose response to L-dopa was suboptimal or characterized by
  fluctuations, agreed to participate in an open study that lasted for 2
  weeks. Fourteen patients completed the study (mean age 65 +/- 9.3 years,
  mean duration of treatment 5.7 +/- 4.2 years, mean L-dopa daily doses
  658.9 +/- 269.9 mg); six patients were excluded due to lack of compliance
  or changes in medication during the study. The end points of the study
  included the mean levels of L-dopa, the height of the peak of L-dopa in
  plasma, mean plasma levels of 3-OM-dopa, and the speed and quality of gait
  and visuomanual coordination before and during treatment with CIS. CIS
  increased peak plasma levels of L-dopa by 37% and the mean plasma levels
  of L-dopa by 13% with respect to those obtained with the same dose of
  L-dopa before the addition of CIS. Therefore, CIS appears to increase
  early absorption of L-dopa through acceleration of gastric emptying. CIS
  also increased plasma 3-OM-dopa levels, improved visuomanual coordination,
  and reduced gait disability. CIS improves gastrointestinal function and
  response to L-dopa in patients with PD and could be a helpful add-on
  medication in these patients.
 
<2>
Authors
  Djaldetti R.  Koren M.  Ziv I.  Achiron A.  Melamed E.
Institution
  Department of Neurology, Beilinson Medical Center, Petah-Tiqvo, Israel.
Title
  Effect of cisapride on response fluctuations in Parkinson's disease.
Source
  Movement Disorders.  10(1):81-4, 1995 Jan.
Abstract
  Impaired gastric emptying may be the cause for some response fluctuations
  in Parkinson's disease (PD), especially the "delayed-on" and "no-on"
  phenomena. Cisapride is a prokinetic drug that enhances gastric emptying
  by releasing acetylcholine from the myenteric plexus. Tolerability and
  safety as well as efficacy of cisapride was studied in an open-label trial
  on 15 fluctuating PD patients. Twelve patients had "delayed-on" and six
  had "no-no" phenomena. They filled out daily diaries on times of levodopa
  intake and of turning "on" and "off" for 1 week on levodopa alone and for
  an additional week of pretreatment with cisapride, 30 min before early
  morning, early afternoon, and late evening doses of levodopa. Cisapride
  significantly shortened latency to "on" from 60 +/- 20 to 45 +/- 19 min
  after the morning dose and from 63 +/- 17 to 47 +/- 22 min after the
  evening doses. Patients with "no-no" phenomenon had a decreased number of
  dose failures from 23 before to nine during cisapride treatment. The drug
  was well tolerated, with no important side effects. Our study supports the
  role of impaired gastric emptying in some subtypes of motor fluctuations
  and indicates that they may be improved by prokinetic drugs.
 
<3>
Authors
  Jost WH.  Schimrigk K.
Institution
  Neurologische Klinik, Universitat des Saarlandes, Homburg/Saar, Federal
  Republic of Germany.
Title
  The effect of cisapride on delayed colonic transit time in patients with
  idiopathic Parkinson's disease.
Source
  Wiener Klinische Wochenschrift.  106(21):673-6, 1994.
Abstract
  Disorders of autonomic regulation are common in patients with Parkinson's
  disease (PD). Patients most frequently complain of dysphagia and therapy
  resistant constipation, as far as the gastrointestinal tract is concerned.
  These symptoms have to be attributed to a neuronal degeneration. In a
  pilot study we therefore investigated the effect of stimulation of the
  myenteric plexus by cisapride. 11 women and 13 men were examined, the
  average age was 67.3 years, the Webster rating 17 points. In 2 out of 24
  patients, colonic transit was prolonged up to the limit, both with and
  without therapy. The other 22 patients showed an acceleration in transit
  on response to cisapride. On average the colonic transit of 130 hours was
  reduced to 79 hours. This objective improvement was associated with a
  subjective improvement. Central side effects or a worsening of
  Parkinsonian symptoms were not found. We conclude that cisapride is
  effective in the treatment of constipation in idiopathic PD.
 
<4>
Authors
  Jost WH.  Schimrigk K.
Institution
  Department of Neurology, University of Saarland, Homburg/Saar, F.R.G.
Title
  Cisapride treatment of constipation in Parkinson's disease.
Source
  Movement Disorders.  8(3):339-43, 1993 Jul.
Abstract
  Constipation, a frequent symptom in Parkinson's disease (PD), is probably
  caused by degeneration of the autonomic nervous system, particularly the
  myenteric plexus. Cisapride is a drug that causes increased release of
  acetylcholine in the myenteric plexus. In a pilot study, cisapride therapy
  was investigated in 20 PD patients, 10 women and 10 men, who suffered from
  delayed intestinal transit. In all cases, cisapride therapy was associated
  with a significant acceleration of colonic transit, as measured by
  radioopaque pellets viewed on radiographs. Pellet count fell from a mean
  of 53.8 pretreatment to 30.4 after cisapride treatment. No adverse
  reaction and no "overshoot affects," such as diarrhea, were seen. Our
  findings suggest that cisapride may alleviate the constipation associated
  with Parkinson's disease.
 
 
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