Restatement and Prospectives of Ergot Alkaloids in Clinical Neurology and Psychiatry

Abstract

The pharmacological action of the ergot alkaloids on the brain, except for the well-known hallucinogenic effects, has never been well understood. If we exclude the documented α-adrenolytic action and the central nervous system depression, nothing has been described with certainty. However, therapeutically, a pharmacologic action could be documented both in the elderly and in chronic cerebrovascular disorders, such as reduction in subjective symptomatology and overall improvement in the autonomy. This was generally associated with a psychotonic action. Considering these results for many years, researchers have been attempting to demonstrate the pharmacological action of ergot alkaloids on the cerebral circulation and metabolism. It has, therefore, been wished to demonstrate the effect on the cerebral blood flow, the metabolism and the EEC The possibility of a psychopharmacological effect, whose mode of action could not be evidenced evaluating parameters using such coarse techniques, has been demonstrated. In our view, the new dimension shown by bromocriptine is in accordance with these considerations. Therefore, our presentation should be restricted to the results and the prospectives opened by bromocriptine in neuropsychiatry. We shall report our personal results obtained in parkinsonism, degenerative chorea and the depressive syndromes. Studies in progress in the elderly and in epilepsy will also be reported.

Relevance of Dopamine Autoreceptors for Psychiatry: Preclinical and Clinical Studies

“…Corsini et al (1978b) reported that the ability of apomorphine to reduce the AIMs in their subjects was blocked by sulpiride and haloperidol, but that sulpiride was more potent than haloperidol. Agnoli, Ruggieri, and Casacchia (1978) reported that acute treatment with apomorphine, 0.002 mg/kg subcutaneously, produced moderate improvement in eight patients with choreiform disorders, three of whom were diagnosed as Huntington's disease. Chronic treatment with bromocriptine (7.5-15 mg per day) produced marked improvement in three of four patients studied.…”

“…Chronic treatment with bromocriptine (7.5-15 mg per day) produced marked improvement in three of four patients studied. There is also some evidence that L-DOPA and amantadine, which may enhance the release of dopamine, may not exacerbate or may even improve the AIMs of some Huntington's disease patients (Agnoli et al 1978;Cotzias, Papavasilou, and Gellane 1969;Scotti and Spinnler 1972;Tan, Leijnse-Ybema, and van den Brand 1972). In light of the evidence that the AIMs in Huntington's disease are related to increased dopaminergic activity in the striatum (Chase 1973), both Tolosa and Sparber (1974) and Corsini et al (1978) interpreted their findings with apomorphine as supportive of the concept of dopamine autoreceptors Effect of Apomorphine in Tourette's Syndrome.…”

Adjunctive Dopamine Agonists in Treatment-Resistant Bipolar II Depression: an Open Case Series

“…Regarding dopamine agonists (DAAs), bromocriptine, piribedil and amantadine have been widely used to treat Parkinsons disease. Four open trials on the antidepressant efficacy of bromocriptine showed a positive response in 57 % of a mixed group (n = 56) of mostly treatment-resistant depressed patients [1,7,17,30]. Three double-blind trials (total n = 125) found bromocriptine to be as effective as either imipramine or amitriptyline [4,32,34].…”

Bromocriptine and Its Use in Parkinsonism

“…Compared to antiparkinson drugs other than levodopa, bromocriptine is more potent than amantadine (50, 51) or trihexphenidyl (50). Considering either improvement in individual patients or average improvement in groups of patients, bromocriptine has variously been reported to be less (35, 41, 42, 49, 52), equally (37, 38, 53–55), or more (39, 50, 56–59) potent than levodopa.…”