EFNS CONGRESS: Cabergline Improves Nocturnal Parkinson’s Symptoms LISBON, PORTUGAL -- Sept. 10, 1999 -- The nightmare of sleep problems, suffered by up to 70 percent of Parkinson’s disease patients and their negative impact on quality of life and daytime performance, could be significantly improved by the use of the long-acting dopamine agonist cabergoline, according to evidence presented today at the fourth congress of the European Federation of Neurological Societies. Neurologists attending a satellite symposium of the congress were told that PD patients needed better control of their nocturnal symptoms to produce improvements in sleep and daily living. "Patients’ complaints of sleep problems should be taken seriously," said neurologist Dr. Bertram Holinka from the University of Bochum in Germany, who stressed that good quality sleep was essential for a good quality of life. Holinka said he recommended the use of dopamine agonists that gave effective PD symptom control when used in the lowest possible doses, ensuring little or no adverse effects on sleep structure and patterns. Dr. Ray Chaudhuri, co-director of the Regional Movement Disorders and Autonomic Unit at London’s King’s College and Lewisham Hospitals, reported on the results of his work that demonstrated the superiority of dopamine agonist cabergoline over controlled-release levodopa and pergolide in overcoming nocturnal disabilities of Parkinson’s disease. "Traditional treatment for PD is often aimed at improving daytime symptoms of the condition," Chaudhuri explained. "However, most medications for PD have a relatively short duration of action. Their effect wears-off during the night, allowing the return of distressing symptoms such as akinesia [inability to move], muscle tremor, painful spasms and cramps, making it difficult for patients to fall asleep and causing them to wake up frequently. "Cabergoline is the longest-acting dopamine agonist available [half-life over 65 hours]. Its beneficial effects appear to be due to the sustained stimulation of dopamine receptors that it can achieve, successfully controlling PD symptoms throughout the night and helping patients to sleep longer." In their most recent study comparing cabergoline to pergolide in 61 patients, whose nocturnal disabilities were resistant to levodopa therapy, preliminary results at six month follow-up suggest that cabergoline, but not pergolide produced a highly significant reduction in pain, muscle spasm and night-time awakenings, Dr. Chaudhuri explained. "Cabergoline was also much better tolerated by patients than pergolide." All patients on pergolide required anti-nausea therapy throughout the duration of the trial, yet 40 percent of the patients discontinued therapy, mainly due to nausea. These patients were transferred to cabergoline. Of this group five continue to take cabergoline, with good tolerance. In comparison, 24 percent of the patients on cabergoline required anti-nausea therapy beyond the first three days of treatment. The main side effects reported for cabergoline in this study were fatigue and occasional ankle swelling. Further support for cabergoline’s superiority for Parkinson’s disease patients with disturbed sleep patterns was unveiled by research by Dr. Holinka. After comparing cabergoline, pergolide and ropinirole, in patients already taking levodopa Dr. Holinka concluded that the long half-life of cabergoline, offered distinct advantages to PD patients with sleep problems, in terms of both effectiveness and tolerability. "All the dopamine agonists tested led to a prolongation of sleep time, with patients reporting an improvement in their quality of sleep, yet we found cabergoline particularly useful because of its longer duration of action, which allowed for a good eight hour sleep cycle," Dr. Holinka said. "As it is a once-daily treatment, there is no need to interrupt patients’ sleep to give a second dose and the drug has a levodopa sparing effect, which could reduce the side-effects of that drug on sleep structure." Cabergoline is currently the only dopamine agonist that can be administered as a once-a-day dose. It has a longer duration of action than any other treatment for Parkinson’s disease, giving proven symptom and fluctuation control over 24 hours. All contents Copyright (c) 1999 P\S\L Consulting Group Inc. -- Judith Richards, London, Ontario, Canada [log in to unmask] ^^^^ \ / \ | / Today’s Research \\ | // ...Tomorrow’s Cure \ | / \|/ `````