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There were recents comments concerning the use of Cisapride as a treatment of constipation in Parkinson's Disease. These are the latest abstracts on its effectiveness. <1> Authors Neira WD. Sanchez V. Mena MA. de Yebenes JG. Institution Department of Neurology, Fundacion Jimenez Diaz, Madrid, Spain. Title The effects of cisapride on plasma L-dopa levels and clinical response in Parkinson's disease. Source Movement Disorders. 10(1):66-70, 1995 Jan. Abstract Cisapride (CIS) is a prokinetic agent that increases gastrointestinal motility in normal individuals and improves constipation in Parkinson's disease (PD). We studied the effects of CIS on the clinical response and the peripheral pharmacokinetics of orally administered L-dopa given to patients with PD. Twenty patients with idiopathic PD and chronic constipation, whose response to L-dopa was suboptimal or characterized by fluctuations, agreed to participate in an open study that lasted for 2 weeks. Fourteen patients completed the study (mean age 65 +/- 9.3 years, mean duration of treatment 5.7 +/- 4.2 years, mean L-dopa daily doses 658.9 +/- 269.9 mg); six patients were excluded due to lack of compliance or changes in medication during the study. The end points of the study included the mean levels of L-dopa, the height of the peak of L-dopa in plasma, mean plasma levels of 3-OM-dopa, and the speed and quality of gait and visuomanual coordination before and during treatment with CIS. CIS increased peak plasma levels of L-dopa by 37% and the mean plasma levels of L-dopa by 13% with respect to those obtained with the same dose of L-dopa before the addition of CIS. Therefore, CIS appears to increase early absorption of L-dopa through acceleration of gastric emptying. CIS also increased plasma 3-OM-dopa levels, improved visuomanual coordination, and reduced gait disability. CIS improves gastrointestinal function and response to L-dopa in patients with PD and could be a helpful add-on medication in these patients. <2> Authors Djaldetti R. Koren M. Ziv I. Achiron A. Melamed E. Institution Department of Neurology, Beilinson Medical Center, Petah-Tiqvo, Israel. Title Effect of cisapride on response fluctuations in Parkinson's disease. Source Movement Disorders. 10(1):81-4, 1995 Jan. Abstract Impaired gastric emptying may be the cause for some response fluctuations in Parkinson's disease (PD), especially the "delayed-on" and "no-on" phenomena. Cisapride is a prokinetic drug that enhances gastric emptying by releasing acetylcholine from the myenteric plexus. Tolerability and safety as well as efficacy of cisapride was studied in an open-label trial on 15 fluctuating PD patients. Twelve patients had "delayed-on" and six had "no-no" phenomena. They filled out daily diaries on times of levodopa intake and of turning "on" and "off" for 1 week on levodopa alone and for an additional week of pretreatment with cisapride, 30 min before early morning, early afternoon, and late evening doses of levodopa. Cisapride significantly shortened latency to "on" from 60 +/- 20 to 45 +/- 19 min after the morning dose and from 63 +/- 17 to 47 +/- 22 min after the evening doses. Patients with "no-no" phenomenon had a decreased number of dose failures from 23 before to nine during cisapride treatment. The drug was well tolerated, with no important side effects. Our study supports the role of impaired gastric emptying in some subtypes of motor fluctuations and indicates that they may be improved by prokinetic drugs. <3> Authors Jost WH. Schimrigk K. Institution Neurologische Klinik, Universitat des Saarlandes, Homburg/Saar, Federal Republic of Germany. Title The effect of cisapride on delayed colonic transit time in patients with idiopathic Parkinson's disease. Source Wiener Klinische Wochenschrift. 106(21):673-6, 1994. Abstract Disorders of autonomic regulation are common in patients with Parkinson's disease (PD). Patients most frequently complain of dysphagia and therapy resistant constipation, as far as the gastrointestinal tract is concerned. These symptoms have to be attributed to a neuronal degeneration. In a pilot study we therefore investigated the effect of stimulation of the myenteric plexus by cisapride. 11 women and 13 men were examined, the average age was 67.3 years, the Webster rating 17 points. In 2 out of 24 patients, colonic transit was prolonged up to the limit, both with and without therapy. The other 22 patients showed an acceleration in transit on response to cisapride. On average the colonic transit of 130 hours was reduced to 79 hours. This objective improvement was associated with a subjective improvement. Central side effects or a worsening of Parkinsonian symptoms were not found. We conclude that cisapride is effective in the treatment of constipation in idiopathic PD. <4> Authors Jost WH. Schimrigk K. Institution Department of Neurology, University of Saarland, Homburg/Saar, F.R.G. Title Cisapride treatment of constipation in Parkinson's disease. Source Movement Disorders. 8(3):339-43, 1993 Jul. Abstract Constipation, a frequent symptom in Parkinson's disease (PD), is probably caused by degeneration of the autonomic nervous system, particularly the myenteric plexus. Cisapride is a drug that causes increased release of acetylcholine in the myenteric plexus. In a pilot study, cisapride therapy was investigated in 20 PD patients, 10 women and 10 men, who suffered from delayed intestinal transit. In all cases, cisapride therapy was associated with a significant acceleration of colonic transit, as measured by radioopaque pellets viewed on radiographs. Pellet count fell from a mean of 53.8 pretreatment to 30.4 after cisapride treatment. No adverse reaction and no "overshoot affects," such as diarrhea, were seen. Our findings suggest that cisapride may alleviate the constipation associated with Parkinson's disease. John Cottingham [log in to unmask] OR [log in to unmask]