EFNS CONGRESS: Cabergline Improves Nocturnal Parkinson’s Symptoms

LISBON, PORTUGAL -- Sept. 10, 1999 -- The nightmare of sleep problems,
suffered by up to 70 percent of Parkinson’s disease patients and their
negative impact on quality of life and daytime performance, could be
significantly improved by the use of the long-acting dopamine agonist
cabergoline, according to evidence presented today at the fourth
congress of the European Federation of Neurological Societies.

Neurologists attending a satellite symposium of the congress were told
that PD patients needed better control of their nocturnal symptoms to
produce improvements in sleep and daily living.

"Patients’ complaints of sleep problems should be taken seriously," said
neurologist Dr. Bertram Holinka from the University of Bochum in
Germany, who stressed that good quality sleep was essential for a good
quality of life.

Holinka said he recommended the use of dopamine agonists that gave
effective PD symptom control when used in the lowest possible doses,
ensuring little or no adverse effects on sleep structure and patterns.

Dr. Ray Chaudhuri, co-director of the Regional Movement Disorders and
Autonomic Unit at London’s King’s College and Lewisham Hospitals,
reported on the results of his work that demonstrated the superiority of
dopamine agonist cabergoline over controlled-release levodopa and
pergolide in overcoming nocturnal disabilities of Parkinson’s disease.

"Traditional treatment for PD is often aimed at improving daytime
symptoms of the condition," Chaudhuri explained. "However, most
medications for PD have a relatively short duration of action. Their
effect wears-off during the night, allowing the return of distressing
symptoms such as akinesia [inability to move], muscle tremor, painful
spasms and cramps, making it difficult for patients to fall asleep and
causing them to wake up frequently.

"Cabergoline is the longest-acting dopamine agonist available [half-life
over 65 hours]. Its beneficial effects appear to be due to the sustained
stimulation of dopamine receptors that it can achieve, successfully
controlling PD symptoms throughout the night and helping patients to
sleep longer."

In their most recent study comparing cabergoline to pergolide in 61
patients, whose nocturnal disabilities were resistant to levodopa
therapy, preliminary results at six month follow-up suggest that
cabergoline, but not pergolide produced a highly significant reduction
in pain, muscle spasm and night-time awakenings, Dr. Chaudhuri
explained. "Cabergoline was also much better tolerated by patients than
pergolide."

All patients on pergolide required anti-nausea therapy throughout the
duration of the trial, yet 40 percent of the patients discontinued
therapy, mainly due to nausea. These patients were transferred to
cabergoline. Of this group five continue to take cabergoline, with good
tolerance. In comparison, 24 percent of the patients on cabergoline
required anti-nausea therapy beyond the first three days of treatment.
The main side effects reported for cabergoline in this study were
fatigue and occasional ankle swelling.

Further support for cabergoline’s superiority for Parkinson’s disease
patients with disturbed sleep patterns was unveiled by research by Dr.
Holinka. After comparing cabergoline, pergolide and ropinirole, in
patients already taking levodopa Dr. Holinka concluded that the long
half-life of cabergoline, offered distinct advantages to PD patients
with sleep problems, in terms of both effectiveness and tolerability.

"All the dopamine agonists tested led to a prolongation of sleep time,
with patients reporting an improvement in their quality of sleep, yet we
found cabergoline particularly useful because of its longer duration of
action, which allowed for a good eight hour sleep cycle," Dr. Holinka
said. "As it is a once-daily treatment, there is no need to interrupt
patients’ sleep to give a second dose and the drug has a levodopa
sparing effect, which could reduce the side-effects of that drug on
sleep structure."

Cabergoline is currently the only dopamine agonist that can be
administered as a once-a-day dose. It has a longer duration of action
than any other treatment for Parkinson’s disease, giving proven symptom
and fluctuation control over 24 hours.
    All contents Copyright (c) 1999 P\S\L Consulting Group Inc.
--
Judith Richards, London, Ontario, Canada
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