CURRENT SCIENCE REVIEWS  By Joe Bruman  November 1998  P. 1 of 3

Calabrese V et al; Mov Disord 1998;13:768-774:
The novel soluble D2 agonist N-0923 given intravenous to 9
PD subjects was fast-acting, and fast-fading when stopped,
suggesting use where oral medication is impractical. It was
well tolerated in therapeutic amounts, although higher dosage
caused nausea and vomiting.

Skalabrin E et al; Mov Disord 1998;13:775-781:
They studied response to levodopa challenge in 9 advanced PD
cases, before and after unilateral posteroventral pallidotomy.
Some but not all symptoms were helped. The main benefit was
significant widening of the therapeutic levodopa window.

Dewey R et al; Mov Disord 1998;13:782-787:
In a double-blind controlled crossover study of 9 advanced PD
patients, they tested apomorphine by nasal spray as a rescue
from the "off" state. On average it worked within 11 minutes
and lasted 50 minutes, but nasal irritation was "disabling" in
3 subjects and mild in 2 others.

Ryoo H et al; Mov Disord 1998;13:788-797:
There are several types of dopamine receptors, in different
neural pathways and affected differently by agonists. Here,
authors analyzed postmortem tissue from 9 PD patients and 8
non-PD controls. In the striatum of long-term PD patients, D3
receptors are decreased and D2 receptors are increased.

Blanchet P et al; Mov Disord 1998;13:798-802:
They tested the glutamate NMDA receptor channel blocker
amantadine (Symmetrel) on four levodopa-primed parkinsonian
monkeys. Combined with a relatively low dose of levodopa, it
markedly suppressed dyskinesia but reduced the effect on other PD
symptoms. More levodopa controlled those, while dyskinesia still
was partly suppressed. This confirms that glutamate receptors
are a factor in levodopa-induced dyskinesia.

Louis E et al; Mov Disord 1998;13:803-808:
Study of essential tremor is difficult, because those affected
hardly ever seek treatment. Here they did a formal examination
of 73 suspected cases, finding the kinetic component more severe
than the postural component.

During M et al; Nat Med 1998;4:1131-1135:
The first successful gene therapy (in a non-PD animal model)
to be administered by mouth, avoiding the usual difficulties.

Limousin P et al; NEJM 1998;16:1105-1111:
They followed 24 advanced PD recipients of subthalamic nucleus
stimulator implants (STN DBS) for up to a year, finding general
improvement in symptoms, and reduction by half of dopaminergic
drug requirement.

Janava J, Aminoff M; J Neur N'surg Psych 1998;65:436-445:
Review of systemic dystonia (cramps) and chorea (dyskinesia),
discussing specific neural pathways and etiologies. One
hypothesis is selective circulation impairment (ischemia) in
parts of the basal ganglia, another is greater vulnerability
of the striatum due to its high oxygen metabolism.

CURRENT SCIENCE REVIEWS  By Joe Bruman  November 1998  P. 2 of 3

Bennett K et al; J Neur N'surg Psych 1998;65:479-487:
They tested kinematics of reach-to-grasp movement in 4 patients
before and after pallidotomy, finding some effects beneficial,
some not.

Blackwood S et al; J Neur N'surg Psych 1998;65:531-546:
They compared effects of vigorous exercise on cognitive and
motor function in 10 patients with chronic fatigue syndrome,
10 with clinical depression, and 10 healthy controls. The CFS
group had impaired attention and/or working memory capacity.

Racette B, Perlmutter J; J Neur N'surg Psych 1998;65:577-579:
The first case report, including MRI and DNA analysis, of a HD
patient who also presented levodopa-responsive parkinsonism.

Behrman A et al; J Neur N'surg Psych 1998;65:580-582:
Testing speed and spatial gait variables in 8 PD patients and
8 controls, they found that the former could reduce impairment
by means of attention to arm swing, stride length, tempo, etc.

Bhatia K et al; J Neur N'surg Psych 1998;65:604-605:
In a case report, long-standing attacks of paroxysmal dystonia
induced by exercise were helped by posteroventral pallidotomy.

Onofrj M et al; J Neur N'surg Psych 1998;65:605-606:
Case reports of two elderly rural patients who had reached
PD stage IV before diagnosis or treatment. After levodopa was
begun their PD symptoms improved, but they quickly developed
severe dyskinesia-dystonia and fluctuations.

Lieberman A et al; Neur 1998;51:1057-1062:
A 6-month controlled trial of ropinerole (Requip) as adjunct to
L-dopa in advanced PD with fluctuations showed benefit due to
reduced need for L-dopa.

Ondo W et al; Neur 1998;51:1063-1069:
They report results of motor function rating in 14 ET and 19 PD
patients before and 3 months after thalamic DBS implantation,
concluding that it is safe and effective against tremor from
either source, but should be limited to patients whose tremor
is disabling.

Contin C et al; Neur 1998;51:1076-1089:
Long-term followup, noting duration of response to standard
levodopa challenge in 34 patients, showed it be useful in
estimating progression rate of PD and cheaper than PET
imaging. Observing the decay of plasma concentration, they
found the half-life of a levodopa dose averaged 37 minutes
in PD patients at H-Y stage 1, and 6.5 minutes at stage 3.
The half-life declines faster in the initial stages of PD.

Dewey R et al; Arch Neur 1998;55:1320-2323:
Levodopa may be effective in generalized dystonia as well as in
PD. Those patients perceived motor fluctuations as in PD, but
objective tests failed to confirm it.




CURRENT SCIENCE REVIEWS  By Joe Bruman  November 1998 P. 3 of 3

Hutchison W et al; Ann Neur 1998;44:622-628:
In determining position of the subthalamic nucleus (STN) for
implantation of DBS electrodes, they find microelectrode
recording preferable to electrical stimulation. Findings in
monkeys and 8 human subjects suggest that STN neuronal activity
is elevated in PD.

Friedberg G et al; Clin Neuropharm 1998;21:280-284:
They applied their Parkinson Psychosis Rating Scale (PPRS) for
assessing levodopa-induced psychosis in PD patients, to 29
psychotic subjects before and after a standardized treatment,
finding it reliable, relevant, valid, and easily administered.

Friedman J et al; Clin Neuropharm 1198;21:285-288:
About 5-8% of PD patients on dopaminergic medication eventually
develop psychosis. Clozapine (Clozaril) is effective and well-
tolerated remedy, but hard to use because it requires weekly
monitoring for agranulocytosis, a rare but dangerous side
effect. Risperidone was tried as a substitute but is poorly
tolerated. So they tested the new antipsychotic olanzapine on
12 patients, but 9 quit because it worsened their PD symptoms.

Diederich N et al; Clin Neuropharm 1998;21:289-295:
To study the relation between visual hallucinations and impaired
discrimination of color and contrast, they tested 14 PD patients
with visual hallucinations and 21 without, finding all subjects
impaired but hallucinators more so.

Colm H, Wilson J; Lancet, 27 June 1998:1995-1996:
Three elderly patients with long-standing PD became confused
when started on tolcapone (Tasmar) but returned to normal when
it was stopped.

Kuhn W et al; Lancet, 17 Oct 1998:1313-1314:
They speculate that since COMT has a useful role in eliminating
certain toxins, the COMT inhibitor tolcapone (Tasmar) might have
a neurotoxic effect, despite its benefit of conserving levodopa.

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