We have used single photon emission computed tomography to study cerebral blood flow (CBF), CBF reactivity to acetazolamide, and cerebral blood volume (CBV) in 15 subjects presenting widespread leukoaraiosis, with the aim of answering the question if chronic ischaemia or hypo metabolism is associated with leukoaraiosis. We compared these subjects to 9 controls presenting no leukoaraiosis but with similarly distributed factors for leukoaraiosis. The subjects with leukoaraiosis showed a low regional (r)CBF in their white matter, while CBV and CBF reactivity to acetazolamide were not significantly affected. rCBF, rCBV and rCBF reactivity to acetazolamide did not differ between the cortex of patients and controls. Our results suggest that the low white matter CBF of the patients with leukoaraiosis was related mainly to hypometabolism and not to oligaemia. The capacity of the cerebral vessels to vasodilate does not appear to be affected by leukoaraiosis.
Background-Domperidone is used to treat gastrointestinal symptoms in patients withParkinson's disease (PD). Due to increased risk of cardiac adverse events, the European Medicines Agency (EMA) has issued recommendations restricting its use mainly in terms of age and dose and treatment duration.
Objective-The aim of this study was to investigate nowadays prescription practices of domperidone in PD among French neurologists.
Methods-A cross sectional study based on a questionnaire was conducted among French neurologists from Parkinson Expert Centers from the French NS-Park/FCRIN network, general hospitals and private practice.Results-Among the 253 neurologists who completed the questionnaire, 86 (34%) were physicians from Expert Centers and 167 (66%) from other healthcare settings; 209 (83%) were aware of recommendations restricting domperidone use. The majority of neurologists (92%) declared prescribing domperidone regardless of the age of the patients. Neurologists were 61% to prescribed domperidone beyond 7 days in newly diagnosed patients, 33% in patients with orthostatic hypotension and 79% in patients under continuous apomorphine.They did not follow the recommendation on posology in newly diagnosed patients (7% of neurologists), patients with orthostatic hypotension (10%) and patients under continuous apomorphine therapy (25%). Finally, 58% of neurologists declared taking specific precautions before prescribing domperidone.Conclusions-These findings underline most French neurologists who responded do not fully follow the restrictions on domperidone use, particularly in terms of treatment duration, and in patients with continuous apomorphine. This may reflects unmet needs to prevent nausea in PD patients treated with dopaminergic drugs, particularly continuous apomorphine.
key points The European Medicines Agency has issued recommendations restricting domperidone use to patients younger than 60 years-old, at doses below 30 mg/day and for a short period only; making it challenging for neurologists to prescribe domperidone for patients with Parkinson's disease. Our results underline most French neurologists who responded do not fully follow the restrictions on domperidone use and specific precautions are not always taken before prescribing this medicine to Parkinson disease patients. This study highlights the unmet needs to prevent nausea in Parkinson disease patients treated with dopaminergic drugs.
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