CURRENT SCIENCE REVIEWS   By Joe Bruman   May 1998   Part 1 of 3

Heikkila V-M et al; J Neur N'surg Psych 1998;64:325-330:
Evidently, control of driver licenses in Finland is much stricter
than in the U.S. Authors gave psychological and psychomotor lab
tests and a standard driving test to 20 PD patients, 3 of whom had
recently caused accidents, and 20 matched controls. Results were
compared and driving ability evaluated by a neurologist, a
psychologist, a vocational rehabilitation counsellor, a driving
instructor, and patients themselves. PD patients' driving ability
was greatly impaired, but their self-assessment was much too
optimistic. The PD group equaled controls in highway driving, but
did poorly in an unfamiliar city with heavy traffic. Authors
mention, but don't allow for, compensation by less-skilled or
handicapped drivers who avoid such situations. [Articles like this
no doubt will lure license officials to pre-judge any applicant
with PD, threatening the independence of driving one's own car.]

Deuschl G, Goddemeier C; J Neur N'surg Psych 1998;64:320-324:
They found blink rate to be a weak diagnostic tool for several CNS
disorders. Incidentally, in PD the reflex blink is hyper-reactive.

Kimpara T et al; J Neur N'surg Psych 1998;64:416:
They describe recent inconclusive search for a gene mutant that
is common to both idiopathic and familial PD.

Morrish P et al; J Neur N'surg Psych 1998;64:314-319:
By successive PET scans with fluorodopa marker on 32 PD patients,
they looked for correlation with clinical progression. Results
by backward extrapolation indicate a mean preclinical period of
only 3 years, compared with previous estimates of up to 50 years,
and raising doubt about validity of PET studies for that purpose.

Monza D et al; Arch Neur 1998;55:372-378:
A battery of general neuropsychological tests on patients with
PSP, MSA, or PD showed congnitive and motility impairment.

Kopyov O et al; Exp Neurology 1997;146:536-545:
Among 13 successful fetal tissue grafts in PD patients, 6 got
20 cubic mm of tissue, 7 got 24, and the latter group had
significantly better symptomatic improvement.

Kopyov O et al; Exp Neurology 1998;149:97-108:
As a preliminary safety test, they did fetal tissue transplants
in three Huntington's Disease patients, with no serious effects.
Clinical improvement was variable but encouraging, for use of the
transplant technique against other diseases besides Parkinson's.

Davie C; Mov Disord 1998;13:1-2:
The new techique of Magnetic Resonance Spectroscopy (MRS) is to
Magnetic Resonance Imaging (MRI) as color photography is to black-
and-white. Mapping concentration of specific metabolic compounds
as well as tissue density in the living brain can distinguish PD from
other neurodegenerative diseases such as MSA or PSP, and help in study
of the disease process.

Holmgren B et al; Mov Disord 1998;13;70-77:
In a survey including 19 PD patients, 12 with progressive
supranudclear palsy (PSP) and 10 with multiple system atrophy (MSA),
concentration in the cerebrospinal fluid (CSF) of a principal protein
component of neural axons was higher in the latter groups, reflecting
the axonal degeneration of those
diseases and suggesting CSF analysis as a diagnostic tool.

CURRENT SCIENCE REVIEWS   By Joe Bruman   May 1998   Part 2 of 3

Nguyen JP et al; Mov Disord 1998;13:84-88:
Facial pain and severe left arm action tremor following surgery
were relieved by chronic stimulation of the motor cortex. The
stimulation parameters most effective for pain and tremor were
different, suggesting that pain and tremor mechanisms also differ.

Riedl A et al; Mov Disord 1998;13:212-220:
Mutations of the gene CYP2D6 have been suspected as predisposing
to PD, but a survey of literature and recent studies indicates
otherwise.

Banati R et al; Mov Disord 1998;13:221-227:
Elaborate postmortem search for signs of apoptosis in dead neurons
of the substantia nigra of 10 PD patients failed to find any.

Pearce R et al; Mov Disord 1998;13:234-241:
Either bromocriptine or ropinirole alone in MPTP monkeys improves
motor symptoms with less dyskinesia than the equivalent dosage of
levodopa. However, if use of either agonist follows treatment with
levodopa, it elicits dyskinesia comparable with that of levodopa.
So they conclude that PD treatment should  begin with an agonist.

Dodel R et al; Mov Disord 1998;13:249-254:
The cost of PD care in Great Britain is estimated at 383 million
pound sterling/year. Among 409 PD patients of a German clinic,
mean daily cost per patient of drugs alone ranged from DM6.60 to
DM74.30, depending on stage and severity of the disease.

Dietz V, Colombo G; Mov Disord 1998;13:255-261:
By electromyographic (EMG) sensors they tested the effect of body
load on the gait of PD patients. The lower leg flexor muscle
activity is independent of load, while that of the extensor muscle
is load-sensitive, suggesting that decreased extensor load reflex
mechanism contributes to gait impairment in PD.

Lagopoulos J et al; Mov Disord 1998;13:262-267:
Comparing event-related potentials [via electrodes on scalp] of
15 PD patients and 50 normal controls, they found the PD group
deficient in N200 amplitude at several sites in the central and
temporal regions, possibly reflecting impaired response selection.

Antonini A et al; Mov Disord 1998;13:268-274:
Idiopathic PD (IPD)is hard to distinguish from other, atypical
parkinsonian disorders (APD) by clinical signs alone, but Positron
Emission Tomography (PET) mapping of glucose metabolism effectively
sorted out 56 IPD and 48 APD patients.

Dethy S et al; Mov Disord 1998;13:275-280:
With levodopa responsiveness as tentative discriminant, PET mapping
of glucose metabolism (using 18F fluorodeoxyglucose marker) was able to
distinguish 9 cases of presumed PD from 10 of striatonigral
degeneration.

Louis E et al; Mov Disord 1998;13:287-293:
Although essential tremor is common, diagnosis is difficult. To
find a reliable protocol, they had two movement disorder specialists
examine 35 previously diagnosed ET patients and 40
matched controls, using a standardized Tremor Interview and a
videotaped Tremor Examination, in a blind trial. From the excellent
agreement they conclude that the protocol is a reliable one.


CURRENT SCIENCE REVIEWS   by Joe Bruman   May 1998   Part 3 of 3

Syed N et al; Mov Disord 1998;13:336-338:
Late-stage PD patients with severe motor fluctuations may resort to an
enteral infusion pump, to maintain steady availability. But the
inconvenience and discomfort of the apparatus are discouraging, and
authors would like development of a less cumbersome system.

Marsden C; Clin Neuropharm 1994;17:Supp 2:S32-S44:
[This and next 4 items belatedly appeared in Medline]
Reviews problems of long-term levodopa therapy for PD: fluctuations,
dyskinesias, toxicity, loss of efficacy.

Tolosa E, Valldeoriola F; Clin Neuropharm 1994;17:Supp 2:S19-S31:
Fluctuations in mid-stage levodopa therapy for PD are usually due
to "wearing-off" or "end-of-dose" effects. Corrective strategies
include controlled-release levodopa, MAO-B inhibitors [Deprenyl],
COMT inhibitors, and various "direct" dopamine agonists.

Calne D; Clin Neuropharm 1994;17:Supp 2:S14-S18:
Best options for intial treatment of early-stage PD aren't agreed
on but include five categories of drugs, for symptomatic relief:
anticholinergics, amantadine, selegiline, dopamine agonists, and
levodopa. He prefers levodopa, with a decarboxylase inhibitor
to prevent nausea [e.g., Sinemet].

Stocchi F et al; Clin Neuropharm 1994;17:Supp 2:S7-S13:
Most fluctuations after chronic dopaminergic treatment reflect
decline of levodopa availability, usually countered by bigger or
more frequent dosage. In a 5-year trial they compared continuous
subcutaneous lisuride infusion in 18 PD patients, against 20 given
conventional oral levodopa. All complications worsened in the Ldopa
group, while in the lisuride group only dyskinesia got worse. Sinemet CR
reduced fluctuation but was slow to act, so they recommend a combination
of CR and standard Sinemet.

Sage J, Mark M; Clin Neuropharm 1994;17:Supp 2:S1-S6:
Pharmacokinetics of Sinemet CR are affected by absorption (gastric
emptying, solubility, uptake in gut); distribution (gut-blood,
blood-brain transport); and biotransformation (by various enzymes).
Sinemet CR has the advantage of lower and longer peak effect.

Laine K et al; Clin Neuropharm 1997;20:419-433:
In a short double-blind trial on 24 healthy volunteers, they
studied interaction of the MAO-B inhibitor selegiline and the
widely used selective serotonin reuptake inhibiting antidepressant
citalopram [brand name unknown], finding none of importance.

Ben-Shlomo Y et al; BMJ,18 April 1998:1191-1196:
Continuing the long Eldepryl debate, the UK group presents
new data implying that the excess mortality risk may be less
but still there, and that the benefits for PD, if any, are minor.
An editorial summary and comment appears in the same issue.

Golbe L; Lancet, 4 April 1988:998-999:
Microelectrode recording and stimulation, magnetic resonance
imaging, rapidly growing skill and experience have made pallidotomy
much safer and more effective than when it was first tried about
50 years ago, but it still should be a last resort, for PWP who are not
demented and who do respond to levodopa. It doesn't reduce the
need for drug treatment, but may permit an increase in levodopa
dosage by alleviating levodopa-induced dyskinesia. The risk (1%-3%) of
serious or fatal complications is considered acceptable.

J. R. Bruman   (818) 789-3694
3527 Cody Road
Sherman Oaks, CA 91403-5013