To Parkinsn list: The article referred to in that news release which Mario offered for discussion does NOT debunk the connection between medications and sudden sleep attacks (SSA). The full article is available on-line, free of charge, at: http://jama.ama-assn.org/issues/v287n4/rfull/joc10367.html If I may quote from the article itself: Falling asleep at the wheel is typically preceded by a warning of sleepiness rather than occurring suddenly and unpredictably. Patients should be warned about the nature of excessive daytime sleepiness. They should be educated to recognize the warning symptoms and the associated risks of these episodes occurring while driving, and about the importance of never driving when sleepy. Finally, patients should be asked regularly during follow-up visits about symptoms that suggest daytime sleepiness39 or sudden onset of sleep. EPISODES SUGGESTING SUDDEN "SLEEP ATTACKS" WERE VERY UNCOMMON IN OUR STUDY. AT PRESENT IT SEEMS THAT THE BEST PREDICTOR OF FUTURE SLEEP ATTACKS AT THE WHEEL IS AN INITIAL SLEEP ATTACK AT THE WHEEL Conclusions ***Excessive daytime sleepiness is common*** even in patients with PD who are independent and do not have dementia. ***SUDDEN-ONSET SLEEP WITHOUT WARNING IS INFREQUENT.*** The Epworth score has adequate sensitivity for predicting prior episodes of falling asleep while driving and its specificity can be increased by use of the Inappropriate Sleep Composite Score. ***It is unknown if routinely performing these assessments could be more effective in predicting future risk for these rare sleep attacks.*** PATIENTS SHOULD BE WARNED NOT TO DRIVE IF THEY DOZE IN UNUSUAL CIRCUMSTANCES." The article DOES NOT say that there is no connection between the sudden sleep attacks and the drugs. The article does say that PWP seem to have excessive daytime sleepiness to a greater extent than non-PWP people, and suggests that excessive daytime sleepiness could be a risk while driving, even more so than the sudden sleep attacks. This is not because the sudden sleep attacks do not happen, but because they are infrequent, and are much less frequent than excessive daytime sleepiness and drowsiness. Even in non-PWP people, excessive daytime sleepiness causes many accidents, and if excessive daytime sleepiness occurs, extra caution is necessary. Indeed, the following figures from the study are sobering: 1) 420 of the 638 patients studied were driving 2) Of those 420, 78 (19%) had experienced dozing while driving or being stopped in traffic. 49 (12%) experienced dozing while actually in movement. Another important issue emphasized in the article: """The fact that most individuals were taking multiple drugs reduced our power to separate clearly the effects of individual medications.""" If you look carefully, however, one can see the following 1) There were 152 patients treated with levodopa ALONE amongst the drivers, and only 5 of those (3.3%) dozed off while driving. 2) Of those 420, 268 were either on no drug or combination (which may have included levodopa). According to Table 3, 235 were on dopamine agonists (alone, or in combination) Of these, 42 (17.8%) dozed of while driving and were on agonist alone or a combination of levodopa with agonist. It seems that the data overwhelmingly support the notion that the risk of falling asleep at the wheel is much greater if you are taking agonist, alone or in combination, than with levodopa alone, whether you have sudden sleep attack or just doze off. It is sad to see that in this case, it is the media who distorted this report. Jorge A Romero, MD ----- Original Message ----- From: "supermario" <[log in to unmask]> To: <[log in to unmask]> Sent: Saturday, February 02, 2002 9:32 AM Subject: Please read - important Parkinson's Drugs Don't Cause Sudden Sleep by: Ed Edelson, HealthScoutNews Reporter 01/22/2002 (HealthScoutNews) -- Debunking previous research, a new study finds no connection between medications people with Parkinson's disease take and their sudden bouts of sleepiness while driving. The finding is especially important in Canada, because that government has required warning letters about pramipexole (Mirapex) and ropinirole (Requip), based on studies suggesting they promote sleepiness, says Dr. Douglas E. Hobson, lead author and an assistant professor of neurology at the University of Manitoba. "When the Canadian government requested the warning letters on these two drugs, it said the warning was pending further information," Hobson says. "This is further information." The U.S. Food and Drug Administration has not issued a similar warning, but many doctors here have been cautious about prescribing the drugs. Excessive daytime sleepiness is known to be common among patients with Parkinson's disease, in which a deficit of the brain chemical dopamine can cause trembling, stiffness, difficulty walking, and reduced mental function. The two drugs, which promote dopamine activity, have been reported to cause sudden sleepiness while driving. But a study of 638 patients at 18 Canadian clinics found no such connection, says a report in tomorrow's issue of the Journal of the American Medical Association. The researchers used the Epworth Sleepiness Scale and an Inappropriate Sleep Composite Score, specifically developed for the study, to determine not only the risk of falling asleep, but also how often it occurs. They found 51 percent of the patients reported daytime sleepiness, and the number of times that happened was not affected by any medication the patients were taking. They also found the risk of the much-feared sudden onset of sleep while driving is rare. Only 16 patients reported a sudden onset of sleep while driving, and only 3 said it occurred without warning. The score on the two tests, taken together, "is a useful tool to identify patients who are abnormally sleepy, and may play a role in increasing patient and physician awareness of this significant clinical problem," the journal report says. "We were looking for predictors, because everyone was told they shouldn't drive," Hobson says. "This will be helpful in selecting out the patients who shouldn't be driving." The study is also useful because it gives solid information about unwanted sleepiness, he says. "No one knew how often it happens," Hobson says. "Knowing the frequency will help a lot in relation to regulations about driving." The study will help doctors treating Parkinson patients because it gives them a way of identifying patients at high risk of unwanted sleepiness, says Dr. Cynthia L. Comella, of Rush-Presbyterian-St Luke's Medical Center in Chicago. "The most important point of the study is the ability to measure sleepiness in Parkinson's disease," says Comella, who wrote an accompanying editorial. "The method is quite simple and clinically applicable. Until now, nothing has been shown to assess sleepiness in correlation with driving." ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn