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From: "WE MOVE" < [log in to unmask]> Dte: Sat, 15 May 2004 08:04:56 -0400 Saturday, May 15, 2004 Issue 3 VOLUME 1 ISSUE 3 The Use of Pergolide May Be Linked to Changes in Heart Valves Previously published reports have identified a limited number of cases of abnormalities in the heart valves of patients who have taken pergolide. In a study that was published in the journal Lancet in April 2004, researchers examined all patients with Parkinson's disease in their clinic and found that the connection between the use of pergolide and damage to heart valves was more common than previously thought to be. [FULL STORY] The Use of Pergolide May Be Linked to Changes in Heart Valves Researchers in Belgium recently published their findings on a possible association between the use of pergolide (Permax®) and problems with the valves of the heart. (To see a review of the structure and function of the heart, please click here). Pergolide (a dopamine-receptor agonist) is a drug that mimics the effects of a chemical in the body that helps to regulate movement—dopamine—and is approved by the US Food and Drug Administration for the treatment of Parkinson’s disease. It may also be used to treat restless legs syndrome. This drug is an ergot derivative, meaning that it has a chemical structure based on ergot, a substance that is produced from a fungus called Claviceps purpurea. Several scientific papers have been published that have identified a possible increased risk of problems with heart valves with the use of pergolide; however, this is the first time that researchers have examined a large group of patients who are taking pergolide and determined the rate at which these problems occurred. Dr. Van Camp and his associates used sound waves to create a moving picture of the heart (echocardiography) and examined the structures and pressures in the hearts of 96 people—78 of whom had taken pergolide for the treatment of Parkinson’s disease and 18 people who had Parkinson’s disease but who had never taken an ergot-derived dopamine-receptor agonist (these people served as the control group). Those who had taken pergolide were divided into two groups—a high-dose group (defined as those people taking 5 mg or more per day of pergolide) and a low-dose group (those taking less than 5 mg per day). The researchers identified stiffening of the valves of the heart and regurgitation, or backward flow of blood through these valves, (restrictive valvular heart disease) in 42% of the patients in the high-dose group, 29% in the low-dose group, and 0% in the control group. Twenty patients had stiffening of the mitral valves, seven of the aortic valve, and six of the tricuspid valve. Those patients who had taken pergolide, as compared to those in the control group, had higher pressures in the blood vessels that carry the blood from the heart to the lungs (pulmonary hypertension). Six patients stopped taking pergolide after they were found to have restrictive valvular heart disease; two of these six had less stiffening of their valves when they were reexamined six months later. However, the researchers noted that the size of the group that stopped taking pergolide was too small to be able to draw conclusions about the reversibility of the valvular disease. The authors concluded, “Although pergolide remains a good treatment for the symptoms of Parkinson’s disease, our findings underline the necessity to inform patients of the possible risk of inducing restrictive valvular heart disease and pulmonary hypertension. Clinicians must be aware of this possible side-effect, and close clinical and echocardiographic follow-up is mandatory.” Van Camp G, Flamez A, Cosyns B, et al. Treatment of Parkinson's disease with pergolide and relation to restrictive valvular heart disease. Lancet. 2004;363(9416):1179-1183. http://www.imakenews.com/wemovenews/e_article000257909.cfm?x=a2R6THW,a1NT jR5g ---------------------------------------------------------- Results from a Preliminary Study of the Use of Glial Cell-Line Derived Neurotrophic Factor in Parkinson's Disease Hold Promise In a report presented at the American Academy of Neurology meeting in San Francisco, researchers provided the results of a preliminary study of the treatment of Parkinson's disease with glial cell-line derived neurotrophic factor (GNDF). In this two-year study, the five patients showed improved scores on a subjective rating scale and increased density in dopamine transporters on imaging studies. GDNF is a protein that the body requires in order to create, maintain, and grow nerve cells. [FULL STORY] Results from a Preliminary Study of the Use of Glial Cell-Line Derived Neurotrophic Factor in Parkinson's Disease Hold Promise At the American Academy of Neurology meeting held in April 2004, physicians and scientists shared the results of their latest research on a wide variety of neurologic disorders. In one of these seminars, researchers from London presented the findings from their two-year study of five patients with Parkinson’s disease who received an experimental treatment called glial cell-line derived neurotrophic factor, or GDNF. (Click here to learn more about GDNF.) The patients, on average, were 54 years old and had had Parkinson’s disease for 19 years. Medication was no longer effective in controlling their symptoms, and, rather than undergoing one of the commonly performed operations for the treatment of PD (pallidotomy or deep brain stimulation), they opted instead to receive GDNF for two years. Both a rating scale (the Unified Parkinson Disease Rating Scale) and an imaging study (fluorodopa PET scanning) showed that the five patients had positive results. The UPDRS scores improved by 40%, whereas scores normally would have gotten worse over this two-year period, and the density of dopamine transporters seen with the PET scanning increased by 60%, which the investigators think means that the dopamine cells had sprouted new nerve endings, a sign of restored health; however, both of these findings could have alternative explanations. The announcement of these results produced cautious optimism among neurologists who specialize in Parkinson's disease. The results must be confirmed by randomized, double-blind, placebo-controlled studies. There is, in fact, such a study currently underway in which more than 350 patients are enrolled. All of these patients have had an operation to implant the drug-delivery pump, but only half are receiving GDNF. Therefore, both patients and their physicians are “blinded” to their treatment status. The results of this study are expected to be announced in the fall of 2004. Even if these forthcoming results are positive, GDNF will not be available for at least several years because of the lengthy approval process. Both the drug and the delivery device need to be separately approved by the Food and Drug Administration; the use of GDNF has not been approved for any condition, and the device has not been approved for delivery directly into the brain. Before it can be approved, GDNF will need to be shown to be not only effective, but also safe for long-term use; to date, the treatment appears to be safe and well tolerated, but more data in more patients will be needed before all of the remaining questions can be answered. http://www.imakenews.com/wemovenews/e_article000258982.cfm?x=a2R6THW,a1NT jR5g ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn