The following article first appeared in Spring 1997 issue of "Parkinson News
& Views," the newsletter of the Arizona Chapter of APDA. It was written by
neurologist Erwin B. Montgomery, Jr,. MD. Dr. Montgomery is now on staff at
the Cleveland Clinic Foundation.
-- Cynthia Holmes, APDA Coordinator, University of
Arizona
Olanzepine for the treatment of hallucinations and paranoia in PD
Erwin B. Montgomery, Jr., MD
Dr. Montgomery is an Associate Professor of Neurology at the University of
Arizona College of Medicine. He is Medical Director of the APDA Information
& Referral Center at the University of Arizona, Advisor to the APDA's
Arizona Chapter, and a member of APDA's national Scientific Advisory Board.
=20
When James Parkinson first described this disease in 1817, he said that the
intellect was unimpaired. We now know that as many as 20% of patients with
Parkinson's disease will develop problems with their thinking. Patients in
Dr. Parkinson's time died an early death and did not live long enough to
develop these problems. Now with better treatments for Parkinson's disease
and with better medicines in general many Parkinson patients are living long
enough to get old enough to develop these problems. A particularly
troublesome problem is the development of hallucinations and paranoia.
For some patients the hallucinations and paranoia are brought on by their
Parkinson medications and there is the terrible dilemma of whether it is
better to be mobile and hallucinate, or to be immobile and not hallucinate.
Since the 1950s there have been medications that can help prevent
hallucinations and paranoia, but often they make the Parkinson's symptoms
worse.=20
Several years ago a new medication was introduced called Clozaril. This
medication was very good at controlling the hallucinations and paranoia and
was an improvement over earlier medications because it did not worsen
Parkinson's symptoms. However, this medication was associated with
significant risk of a very serious side effect =96 a reduction in the white
blood cell count.=20
White blood cells are very important in fighting off infection. Patients
who do not have enough white blood cells are more prone to infections, and
indeed there had been several deaths in patients taking Clozaril. The risk
of the drop in the white blood cell count made it necessary to do a weekly
blood test. This contributed to the difficulty and expense of using Clozaril
in Parkinson's patients. Still, many patients get tremendous relief from
Clozari. They are able to continue on their Parkinson's medications without
hallucinations and paranoia. =20
Within the last year a brand new medication has been introduced. It is
called Olanzepine. It is similar to the Clozaril in that it controls
hallucinations and paranoia and does not make Parkinson's symptoms worse.
Unlike Clozaril it does not reduce the white blood cell count making weekly
blood tests unnecessary. Olanzepine comes in a 5 mg tablet. It is our usual
practice to start with one tablet at bedtime. If, after several days, the
problems of hallucinations and paranoia continue, the dose can be increased
to 10 mg, as long as the patient is not too sleepy. Olanzepine is available
only by prescription from your physician. =20
At 06:58 PM 1/2/98 -0700, you wrote:
>My father, who is 72, was diagnosed with Parkinson's 14 years ago, and is
>having problems with hallucinations. I'm hoping that somebody on this list
>has had some success in dealing with this symptom. Dad is taking quite a=
lot
>of Sinemet: about 8 25/100 of the immediate release form (in hourly divided
>doses), and 2 50/200 of the CR type, each day. The hallucinations began (or
>at least became much worse) during a trial of Mirapex. Unfortunately, they
>did not remit much when the trial was ended. He is not taking any other
>dopamine agonists. His neurologist has had him try Seroquel (a new
>anti-psychotic drug) and Melleril (an old one), but neither drug helped,=
and
>they may have actually made the problems worse. He is barely functional on
>the current Sinemet dose, and does not want to reduce it unless it is
>absolutely necessary.
>
>Any suggestions?
>Robert S. Massey ***********************
>
