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Current Science Reviews By Joe Bruman June 1996 (part 1 of 4) Morens D et al; Neur 1996;46:1044-1050: Pursuing the hypothesis that PD incidence is lower in Asians than Caucasians, authors tracked a cohort of 8006 American men of Japanese or Okinawan ancestry, born between 1900 and 1919, living in Hawaii, for 29 years. Although PD was associated with markedly shorter lifespan, there was no firm evidence for different incidence of PD. Djaldetti R et al; Neur 1996;46:1051-1054: Authors tested 15 PD patients having symptom fluctuations and 15 without, and found delayed gastric emptying, probably affecting levodopa absorption, to be more marked in those with response fluctuations. Contin M et al; Neur 1996;46:1055-1058: Length of the short-time (hours) response to levodopa appears to diminish with progression of PD. Authors confirmed that by finger-tapping tests on 66 PD patients. Pahwa R et al; Neur 1996;46:1059-1062: Early morning end-of-dose akinesia is prolonged by slow absorption of Sinemet CR. One remedy is to break the morning CR tablet in half, thus increasing its surface area. Another is to start with a regular Sinemet tablet whose effect "kicks in" as soon as 15 to 30 minutes, and follow with the CR tablet 2 hours later. Authors confirmed that by double-blind, placebo-controlled, crossover study of plasma concentration and motor performance in 15 PD patients with early-morning akinesia. Hutton J et al; Neur 1996;46:1062-1065: Randomized, placebo-controlled, double-blind test of the long-lasting dopamine agonist cabergoline in 188 patients on levodopa-carbidopa showed it to be effective in reducing motor fluctuations and levodopa requirement, and to be well tolerated. Its effect lasts much longer than that of bromocryptine, pergolide, or lisuride. Hubble J et al; Neur 1996;46:1150-1153: Authors report significant reduction of essential tremor (ET) by chronic stimulation of the left Vim thalamic nucleus, using the Medtronic implanted device. Benefits in 10 ET patients were still present 6 months later, while the common complications of thalamotomy were avoided. Goyal R, Hirano I; NEJM, 25 Apr 1996:1106-1115: Review of the enteric nervous system, which functions independent of the central nervous system and may be affected in PD. Authors list many neurotransmitters of the enteric ns but, curiously, omit dopamine. Jankovic J et al; Neur 1995;45:645-648: Essential tremor is common in families of PD patients, and the two seem to be associated. PD patients with ET live significantly longer than those without. J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks CA 91403