Highlights, AAN 51st Annual Meeting, From:       Page 1 of 3
Neurology 1999;51:Supplement 2:April 1999

S13.007 Ichise et al: Combined D2 and DAT SPECT scans, with two
different radioactive iodine markers, may help in differential
diagnosis of MSA or PD. (Medical Research Council of Canada)

S13.008 Raff U: A new scanning technique enables MRI to show
presymptomatic structural change of the substantia nigra in PD.
(Arthur Stanton Fund)

S14.003 Wendell C et al: In an ongoing survey of 176 PD patients
the chief complaints during the first decade after diagnosis were
tremor and fatigue. Fluctuations, dyskinesia, dystonia, freezing,
and hallucinations became important later on.

S14.004 Goetz C et al: Motor impairment can be held in check by
treatment during H-Y Stage II, but in Stage III, progressive
deterioration is unavoidable. (UPF)

S14.005 Nurmi E et al: Fluoridopa PET scans showed that FDOPA
uptake declined faster in the posterior putamen than in the
caudate nucleus of PD patients, while it remained constant in
healthy controls.

S14.006 Marek K et al: Sequential beta-CIT SPECT imaging may be
used to monitor progressive reduction of dopamine transporter
density in PD. (NPF)

S14.007 Wenning G et al: Postmortem studies showed that motor
disability progressed significantly within the first year of
diagnosis only where the parkinsonian syndrome was atypical.

S14.008 Bower J et al: Autopsy study of 39 PD brains showed that
vascular parkinsonism is more common than previously thought.
In levodopa-responsive PD, Lewy bodies aren't always present.
(NIH grants)

P03.110 Wilde M et al: Study of 15 PVP recipients revealed little
if any cognitive decliine. (Houston Area Parkinson's Society)

P03.112 Press D et al: Working memory in PD may be either
improved or impaired by levodopa treatment. (Harvard-MIT; Pfizer)

S34.001 Bressman S et al: Two controlled trials of 282 and 221
PD patients respectively showed pramipexole (Mirapex) well
tolerated and effective up to 3 years without other medication.
(Pharmacia & Upjohn)

S34.002 Weiner W. et al: Four-year open-label extension of a
controlled trial in 306 PD patients showed pramipexole (Mirapex)
to be safe and effective. (Boehringer Ingelheim Pharmaceuticals)

S34.003 Parkinson Study Group: Three placebo-controlled trials
as monotherapy in 200 patients, adjunct to levodopa in 279, and
in 39 more with disabling dyskinesia showed that the glutamate
antagonist remacemide improves motor performance in PD, besides
having some neuroprotective potential. (Astra Pharmaceuticals)


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S34.004 Juncos J et al: They tested the antipsychotic quetiapine
(Seroquel) in 40 elderly PD patients, finding it effective, well
tolerated and, curiously, of transient benefit to motor symptoms.
(Zeneca Pharmaceuticals)

S34.005 Chaudhuri K et al: They compared a single nocturnal dose
of the long-acting dopamine agonist cabergoline (Cabaser) in 25
PD patients with severe sleep-disturbing nocturnal disabilities
against a single dose of levodopa (Sinemet CR) in 15 similar
patients. With a 65-hour plasma half-life, cabergoline was the
winner, significantly improving levodopa-resistant nocturnal
off-state disabilities and sleep quality.

S34.006 Nutt J et al: In fluctuating PD patients, oral D2
dopamine agonists cannot duplicate the long-term response of
levodopa. To study long-term response they substituted continuous
apomorphine infusion for normal levodopa treatment for a few days
in 6 patients with fluctuating-stage PD. Apomorphine produced
long-term improvement only in those subjects who also experienced
short-term improvement, suggesting that long-duration response is
a post-synaptic effect. (NIH/NINDS)

S38.001 Hammerstad et al: A blind-controlled comparison of
pallidal versus subthalamic nucleus stimulation in 10 patients
showed that deep-brain stimulation (DBS) implants at either site
are safe and effective against dyskinesia, but only the STN DBS
reduced the requirement for levodopa.

S38.002 Van Blercom N et al: Bilateral STN DBS in trials on 43
patients with fluctuating PD and levodopa-induced motor symptoms
remained effective for up to 4 years. (Medtronic, INSERM, Region
Rhone Alpes)

S38.003 Charles D et al: Bilateral STN implants in 56 consecutive
recipients who had advanced PD with severe levodopa-induced
complications produced improvement related to levodopa response.
Younger and levodopa-responsive patients are more likely to
have the best response to STN DBS. (Medtronic, INSERM, Region
Rhone Alpes)

S38.004 Damier P et al: By varying stimulation in 10 bilateral
STN DBS recipients, they established that the main benefits are
contralateral, therefore bilateral implants are much preferable.
(INSERM, Association France Parkinson, Nat'l Parkinson Found.)

S38.005 Freed C et al: The first double-blind controlled trial of
human embryonic mesencephalon dopamine cell transplants in 40
patients showed that cells cultured as strands survive without
immunosuppression, project to the putamen, and make synaptic
connections. (NIH, NPF, PDF, Program to End Parkinson's Disease)

S62.001 Louis E et al: Family history reporting relatives of ET
patients is of limited value.

S62.002 Koller W et al: Previous studies showed promise of
injected botulinum toxin (Botox) against spasms of essential
tremor (ET) and other disorders. The present trial in 133
patients was to formally demonstrate safety and efficacy.
(Allergan Pharmaceuticals)
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S62.003 Jankovic J et al: The customary drugs Inderal and
Primidone for essential tremor (ET) lose efficacy with chronic
use, so a substitute is needed. In open trials, gabapentin
(Neurontin) was beneficial against essential tremor (ET), but a
controlled trial at low dosage failed to show that. So in another
trial on 25 ET patients, they bumped the dosage to as much as
3600mg/day, and found some improvement. (Parke-Davis)

S62.004 Pahwa R et al: A group of 17 essential tremor (ET)
patients who received thalamotomy were compared with 17 matched
counterparts who underwent DBS implant. Interestingly, the first
group started with 35 but 18 weren't counted for various reasons,
including 3 deaths from hemorrhage, pneumonia, or suicide, and
one thalamotomy that was unsuccessful. The efficacy of
thalamotomy and DBS implant was similar, but complications were
more common in the former.

S62.005 Troster A et al: They studied cognitive effects of DBS
implants in 27 ET patients, finding few if any changes.

S62.006 Kumar R et al: To study long-term effects, they followed
8 PD recipients and 5 ET recipients of unilateral thalamic DBS
implants, for up to 4.5 years. For the first year, all showed
reduction of tremor, and 3 PD and 1 ET subject continued to do
so up to the last followup. But 4 of the 8 PD subjects rarely
used the stimulator because tremor was no longer the primary
complaint, and one found adequate relief from medication only.
Two ET subjects quit because their tremor was gone even without
the stimulation, in two more stimulation became ineffective,
and the implant of the remaining ET subject was removed because
of infection. They recommend implantation in the subthalamic
nucleus (STN) or globus pallidus (GPi), or pallidotomy, for the
wider range of benefits. (National Parkinson Foundation,
Parkinson Foundation of Canada, Medtronic Neurological Inc)

S70.001 Nelson L et al: A large population-based controlled
study in Northern California of the association of PD with
alcohol and smoking. Alcohol reduced the risk by 60%, smoking
reduced it by 80%. The mechanism remains speculative. (NINDS)

S70.002 White L et al: In an ongoing survey of 8006 Japanese-
American men, mid-life coffee consumption is inversely and
independently associated with later diagnosis of PD. (Dept of
Defense, Nat'l Inst. on Aging, Nat'l Heart and Blood Inst.)

S70.004 Tanner C et al: In 500 newly diagnosed PD patients and
541 matched healthy controls, darker skin color and tendency to
tan on exposure were associated with lower risk of PD, for
Caucasians as well as Afro-Americans. This suggests that
dermal melanin protects against PD. (NINDS)

S70.005 Schrag A et al: Examination of 121,608 patient records
in the UK showed that atypical parkinsonism such as MSA or PSP
is more prevalent than formerly thought. (SmithKline Beecham)

S71.003 Goldstein D et al: Positron-Emission Tomography (PET)
scans can distinguish sympathetic neurocirculatory failure and
peripheral autonomic failure in PD from that of Shy-Drager
Syndrome (SDS). PD affects areas beyond the central system.
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