Evaluation of the Efficacy of Pramipexole for Treating Levodopa-induced Dyskinesia in Patients with Parkinson's Disease

Abstract

Objective The long-term use of levodopa to treat Parkinson's disease (PD) is often limited by the development of motor complications (e.g. levodopa-induced dyskinesia, LID). We hypothesized that a non-ergot dopamine agonist with strong affinity for D3 dopamine receptors (pramipexole) may improve LID in patients taking an ergot D1/D2 dopamine agonist. Methods Patients with PD and LID being treated with levodopa in addition to an ergot dopamine agonist were randomized to either a group in which pramipexole was added to current medications or a group in which the ergot dopamine agonist was switched to pramipexole. Dyskinesia was evaluated using Core Assessment Program for Surgical Interventional Therapies scores. The Unified Parkinson's Disease Rating Scale scores, Modified Hoehn and Yahr stages (at 'on' time), Parkinson's Disease Questionnaire-39 scores and Clinical Global Impression-Improvement scores were also used for evaluation. Results At 24 weeks, pramipexole alleviated LID with more efficiency in the switch group. Conclusion Pramipexole may be a therapeutic option for treating LID because its effects on D3 dopamine receptors may balance the D1 dopamine receptor supersensitivity associated with LID.

Promising cannabinoid-based therapies for Parkinson’s disease: motor symptoms to neuroprotection

“…Although levodopa remains the primary mode of symptomatic treatment for PD, its chronic use is coupled with the development of motor complications such as response oscillations and levodopa-induced dyskinesia (LID), which affects 30–35% of patients after just 24 months of levodopa exposure. Thus, to avoid the motor complications arising with use of levodopa, on-going research pursues to develop new non-dopaminergic symptomatic agents capable to attenuate motor deficits and to restore dopamine transmission without producing dyskinesia [ 7 ]. Cannabinoids are one such interesting class of agents that not only have demonstrated neuroprotective ability but have also been evaluated for their potential to alleviate motor symptoms observed in PD.…”

Levodopa alone compared with levodopa-sparing therapy as initial treatment for Parkinson’s disease: a meta-analysis

“…Following this, attention focused on the possibility of using L-dopa-sparing therapy (dopamine agonists or MAOBI) as initial treatment for PD. These treatment strategies would allow either a delayed start or lower dose of L-dopa, thus potentially preventing or delaying the onset of the late complications of L-dopa therapy [7]. In recent years, a major shift in this treatment approach is occurring, on the basis of results of longer follow-up of earlier trials and recognition of important differences in side effects condition [8].…”

Original article Cabergoline protects dopaminergic neurons against rotenone-induced cell death in primary mesencephalic cell culture

“…Its specific symptomatology results primarily from progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNpc) and subsequent depletion in striatal dopamine levels [3]. Thus dopamine denervation leads to the classic motor symptoms of PD, most notably tremor, rigidity, bradykinesia and postural instability [30].…”