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CURRENT SCIENCE REVIEWS By Joe Bruman May 1999 Page 1 of 3 Advt; J Neur N'surg Psych 1999;66:2nd cover: For those who don't like the stimulation of selegiline (Eldepryl) in its current form, a new formulation is available in which a single 1.25mg dose daily is equivalent to the usual 5mg twice a day, and whose amphetamine metabolite is reduced 90%. It's sold in the UK by Athena Neurosciences under the name Zelapar; I don't know yet about U.S. approval. Fetoni V et al; J Neur N'surg Psych 1999;66:541-544: Comparative psychiatric evaluation of a group of PD patients and a group of multiple system atrophy (MSA) patients revealed that levodopa elevated mood in the PD subjects but not the MSA ones. Figuerias-Mendez R et al; J Neur N'surg Psych 1999;66:549-550: Bilateral stimulation (DBS) markedly improved severe levodopa- induced dyskinesia (LID) in a patient diagnosed with PD for 30 yr and treated with levodopa for 25 yr. Young D et al; Nat Med 1999;5:448-453: An enriched social and physical environment, represented by higher educational attainment, is associated with reduced risk of dementia related to Parkinson's or Alzheimer's disease. In a controlled trial with rats, authors housed one group in a plain cage with only food and water, and provided the other group with a running wheel, tunnels, rubber balls, a maze, a bar-pressing feeder, and nesting material. The enrichment reduced spontaneous apoptosis (in the hippocampus) by 45%, prevented siezures due to administered cerebral insult, and was neuroprotective, as indicated by stimulated expression of neural growth factors, as well as improving cognitive performance of the privileged rats. Suhr S et al; Arch Neur 1999;56:287-292: Illustrated tutorial, in simple language, on use of recombinant retroviruses for gene therapy in the central nervous system. [Gene therapy someday may offer a cure for PD by replacing dopamine-producing neurons.] Louis E et al; Arch Neur 1999;56:334-337: By regularly applying the UPDRS exam to a group of 237 patients for as long as 8 yr, they established quantitative progression rates of extrapyramidal signs (rigidity, tremor, bradykinesia, postural instability) in PD. Brown R et al; Ann Neur 1999;45:473-488: Bilateral Deep-Brain Stimulation (DBS) of either the pallidum or the subthalamic nucleus improved arm akinesia in 6 PD recipients, with effectiveness about equal to that of unilateral pallidotomy. Nakagawa T et al; Lancet, 3 April 1999:1157: Like PD patients, stroke victims develop difficulty swallowing, which can lead to pneumonia, and in either disorder the symptom is relieved by dopamine supplementation. So the authors did a controlled trial of the dopamine agonist amantadine (Symmetrel) on 163 stroke patients, and found that it reduced the risk of aspiration pneumonia about 20%. CURRENT SCIENCE REVIEWS By Joe Bruman May 1999 Page 2 of 3 Linazasoro G et al; Clin Neuropharm 1999;22:74-79: In an open study comparing Sinemet CR with regular Sinemet in 450 patients, more than 60% had some improvement in condition on switching to the controlled release formulation. Strijks E et al; Clin Neuropharm 1999;22:93-97: Although in a previous open trial progesterone seemed to worsen PD symptoms in post-menopausal women, a longer and controlled trial of estradiol, another female sex steroid, produced no significant dopaminergic effect. Spieker S et al; Clin Neuropharm 1999;22:115-119: In a 14-patient controlled study, budipine was effective against the tremor of PD, offering an alternative to anticholinergics. Kingsbury A et al; Mov Disord 1999;14:206-218: A controlled (postmortem?) study of mRNA in neurons of the substantia nigra of PD patients showed that vulnerability of those neurons to PD is unrelated to their intrinsic capacity for dopamine synthesis. Additionally, long-term L-dopa treatment appears not to compromise normal function of those neurons. Mellick G et al; Mov Disord 1999;14:219-224: A controlled study of DNA from blood samples of 204 Australian PD patients revealed that mutation of the gene for monoamine oxidase B (MAO-B) is associated with Parkinson's disease. Wan D et al; Mov Disord 1999;14:225-229: A controlled study of DNA in 101 Chinese PD patients failed to confirm suspicion that mutations of the dopamine D4 receptor gene are associated with PD. Sabbagh N et al; Mov Disord 1999;14:230-236: Checking a suspicion that mutations of the gene CYP2D6 may be associated with PD, they studied DNA from 109 sporadic PD patients and 68 members of familial PD clusters, concluding that CYP2D6 polymorphism is not a factor. Karlsen K et al; Mov Disord 1999;14:237-241: In a controlled study of 233 Norwegian PD patients, they found fatigue to be a common symptom that may overlap with, but does not depend on, depression. Durif F et al; Mov Disord 1999;14:242-245: Simulating the dyskinetic effect of levodopa by means of a standard single dose of apomorphine in 10 PD patients, they found that concurrent motor and mental tasks worsen the effect. Churchyard A et al; Mov Disord 1999;14:246-251: The same British team that set off the argument over selegiline (Eldepryl) mortality statistics (CSR JAN 96) has done a new study confirming that selegiline causes postural hypotension, and it is not the result of underlying autonomic failure. Schrag A et al; Mov Disord 1999;14:252-255: They compared the anticholinergic biperiden (Akineton) against the dopamine agonist apomorphine in 17 PD patients. Both were effective against resting, postural, and action tremor, but only apomorphine helped to reduce akinesia and rigidity. CURRENT SCIENCE REVIEWS By Joe Bruman May 1999 Page 3 of 3 Dalvi A et al; Mov Disord 1999;14:256-261: A one-yr followup of 20 posteroventral pallidotomy recipients revealed general improvement of PD symptoms, but the daily levodopa dose requirement was not significantly reduced. Matsumoto J et al; Mov Disord 1999;14:288-294: They describe a mechanical linkage device that can record position, velocity, and acceleration of a fingertip to quantify essential tremor for diagnosis, and its trial on 30 ET patients. Montastruc J et al; Mov Disord 1999;14:336-341: A previous trial of the dopamine agonist piribedil given iv had shown it useful against tremor of PD, so they tried it as a skin patch in a controlled trial on 27 PD patients. It didn't work, they suspect because of insufficient absorption from the patch (even though one group used two patches at a time). Science News, 24 April 1999:260 (news item) Dopamine is produced in the body by organs other than the substantia nigra. Early attempts at cell transplantation for PD used tissue from the adrenal glands, but the cells failed to survive. Now, workers have transplanted tissue from tiny glands in the neck called carotid bodies, in monkeys having induced PD, with encouraging improvement in motor symptoms. Using the patient's own tissue in this way avoids the need for immune suppression, as well as ethical debates over fetal tissue. -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013