Treatment of Mild Camptocormia with Selegiline in Patients with Parkinson's Disease

Abstract

Background: Camptocormia in Parkinson's disease (PD) is unresponsive to various therapies and induced difficulties in their day-to-day life. Objective: This study, an open trial, was aimed at assessing the efficacy of selegiline in the treatment of mild camptocormia in PD patients. Methods: Participants were administered 5 mg of selegiline for the first 8 weeks and 7.5 mg for the second 8 weeks. Results: As primary endpoints, the degree of thoracolumbar anteflexion decreased from 23.2° (mean) (11.8° (SD)) at baseline to 18.3° (7.1°) at 16 weeks, and the area of postural sway measured using a Gravicorder increased. However, the differences were not significant. Thoracolumbar anteflexion improved in 60% of the participants. Conclusions: In this study, 60% of the participants showed an improvement in anteflexion of the thoracolumbar spine with selegiline, but the change in the degree of anteflexion was 5°, which was not statistically significant. Participants with significant improvement in thoracolumbar anteflexion had an increased postural sway. This change was induced by a decrease in truncal muscle tonus or change in the center of gravity. This study combined the study of anteflexion and stability, and provides information on the treatment of short-term or mild camptocormia.

The significance of uric acid in the diagnosis and treatment of Parkinson disease

“…[ 7 , 8 ] What is more, oxidative stress intertwines with almost all other mechanisms that have been implicated in PD, including protein misfolding and aggregation, mitochondrial dysfunction, cell cycle reactivation, apoptosis, and excito-toxicity. [ 9 , 10 ] Although several biological candidates of oxidative damage, including selegiline, [ 11 ] vitamin E, [ 12 ] coenzyme 10 (CoQ10), [ 13 , 14 ] and mostly recently creatine, [ 15 , 16 ] are elevated for early diagnosis to identify at-risk groups and disease modification, the results have disappointingly failed to show clear benefits. [ 17 ] As an important physiological antioxidant, uric acid (UA), mainly as the urate in human body, can scavenge free oxygen radicals [ 18 ] and interact other antioxidant systems.…”

Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions

“… 13 patients with ATF (CC) ≥45° −2.6 ± 2.2 4 patients with AC ≥20° −1.5 ± 1.8.7 patients with LTF (PS)-1.8 ± 0.8 Posture angles measured with the use of “Image J” software Pain and cognitive status: NR The angle of the overall abnormal posture significantly decreased (p < 0.001). The angle of the abnormal posture significantly decreased for AF and AC in both natural position (AF p < 0.001, AC p = 0.002) and in a position with the back averted (AF p = 0.003, AC p = 0.029), but did not change significantly in patients with LTF (p = 0.099) Natural position posture pre-post:AF from 62.6 ± 11.3° to 51.8 ± 13.3° AC from 38.1 ± 12.9° to 13.0 ± 6.3° PS from 19.3 ± 17.2° to 13.7 ± 10.1° Only evaluation 5–10 min after LD infusion Fair −4 Yoritaka et al 2016 [25] Prospective Interventional Before After 20 (8F) 6.3 ± 4.8––2.5 ± 0.4 Cognitive exclusion criteria: NR Response of CC to selegiline -Participants were administered 5 mg/day of selegiline in the first 8 weeks, and subsequently, 7.5 mg/day for 8 weeks, and for the next 8 weeks, selegiline was discontinued CC (clinical) – NR Changes in the degree of AF and the envelope of postural sway (ENV AREA) from baseline to 16 weeks post-treatment studied using Gravicorder (GS-3000 ANIMA).Changes in the ROM AREA (the ratio of the ENV Area with the eye closed to the ENV Area with the eye opened). Changes in total UPDRS part II, part III, and part III-28 (posture scale), lateral flexion, and Visual Analog Scale (VAS) scores.Cognitive status: NR Twelve of 20 participants showed an improved degree of anteflexion with selegiline, but the changes in the degree of anteflexion and ENV AREA from baseline to the 16th week were not significant.The total UPDRS, UPDRS part II, part III, III-28, and VAS scores improved significantly.VAS reduced from 49.8 ± 25.8: 39.6 ± 36.4 16 weeks of treatment, and 8 weeks after conclusion Poor Mensikova et al 2015 [26] Prospective Interventional Before After 5 (2F) 6.2 ± 3.3 –NR Cognitive exclusion criteria: NR To assess the effects of apomorphine on CC -Subcutaneous infusion of apomorphine CC (clinical) -–12 years UPDRS-III; Unified Parkinson’s Dyskinesia Scale (UPDyskS); Clinical Global Impression (CGI) scale of CC Pain and cognitive status: NR CC had improved in all patients by the fourth week of continuous apomorphine treatment.…”

“…We found 20 pertinent studies on the effect of oral pharmacological treatment on PA in PD, including 205 patients: 50 % (n = 10) were case reports [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , 25 % (n = 5) were prospective interventional before after [23] , [24] , [25] , [26] , [27] , 20 % (n = 4) were case series [28] , [29] , [30] , [31] , and 1 case-control study [32] . The studies included 80 CC, 59 PS, and 19 AC; no studies divided CC according to a higher (i.e., thoracic fulcrum) or lower (i.e., lumbar fulcrum) spine flexion.…”

“…The median duration of PD and of the PA at time of evaluation were 6.7 years (range 3–11.6 years) and 1 year (range 0.1–6 years), respectively. Outcome measures differed across studies: 12 employed a clinical evaluation (visual estimation) [14] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [26] , [29] , [30] , [31] , 3 used the UPDRS/MDS-UPDRS or UDRS [23] , [26] , [32] , 3 used the angle of spine flexion [24] , [25] , [28] , 2 using the angle of the dropped head [15] , [24] , and three other types of postural angle measurements [13] , [25] , [27] . Only one case-control study evaluated the differences following the exposure to dopamine agonists between patients with and without PA [32] .…”

Correlation of Serum Uric Acid with Cognition, Severity, and Stage of Disease in Patients with Idiopathic Parkinson’s Disease and Vascular Parkinsonism: A Cross-Sectional Study

“…Oxidative stress intertwines with all other mechanisms that have been implicated in PD, including protein misfolding and aggregation, mitochondrial dysfunction, cell cycle reactivation, apoptosis, and excitotoxicity [3]. Several biological markers of oxidative damage, such as selegiline [4], vitamin E [5], coenzyme 10 (CoQ10) [6], and creatine [7], are elevated that may assist in the early diagnosis and identification of at-risk groups. However, the results have disappointingly failed to show clear benefits.…”