A multicentre longitudinal observational study of changes in self reported health status in people with Parkinson's disease left untreated at diagnosis.

Institute of Neurological Sciences, Glasgow, UK.
Journal of neurology, neurosurgery, and psychiatry (Impact Factor: 4.87). 06/2007; 78(5):465-9. DOI: 10.1136/jnnp.2006.098327
Source: PubMed

ABSTRACT The issue of when to start treatment in Parkinson's disease (PD) remains controversial. Some favour treatment at diagnosis while others opt for a "wait and watch" policy. The effect of the latter policy on the self reported health status of people with PD is unknown.
To record self reported health status through longitudinal use of a validated PD specific questionnaire (PDQ-39) in untreated PD patients in multiple centres in the UK. To compare patients who were left untreated with those who were offered treatment during follow-up.
A multicentre, prospective, "real life" observational audit based study addressing patient reported outcomes in relation to self reported health status and other sociodemographic details.
198 untreated PD were assessed over a mean period of 18 months. During two follow-up assessments, the self reported health status scores in all eight domains of the PDQ-39 and the overall PDQ-39 summary index worsened significantly (p<0.01) in patients left untreated. In a comparative group in whom treatment was initiated at or soon after diagnosis, there was a trend towards improvement in self reported health status scores after treatment was started.
This study addresses for the first time self reported health status, an indicator of health related quality of life, in untreated PD. The findings may strengthen the call for re-evaluation of the policy to delay treatment in newly diagnosed patients with PD.

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    ABSTRACT: BACKGROUND: Non-ergot dopamine agonists (DA) are effective treatments for Parkinson's disease (PD). A review is presented of the pharmacology, evidence of efficacy and safety profile of pramipexole, ropinirole and rotigotine, and practical recommendations are given regarding their use in clinical practice. RESULTS: Extended release formulations of pramipexole and ropinirole and transdermal continuous delivery rotigotine patches are currently available; these may contribute to the stability of plasma levels and continuous dopaminergic stimulation. In early PD, the three of them significantly improved disability scales, delay time to dyskinesia and allow a later introduction of levodopa. In late PD they reduced total off-time, improved Unified Parkinson's Disease Rating Scale (UPDRS) in both on and off state and allowed a reduction in total levodopa dosage. Also, a significant improvement in quality of life scales has been demonstrated. Extended release formulations have proved to be non-inferior to the immediate release formulations, and even better tolerated (ropinirole). Despite a generally good safety profile, serious adverse events, such as impulse control disorder and sleep attacks need to be routinely monitored. Although combination therapy has not been addressed in scientific literature, certain combinations, such as apomorphine and another DA, may be helpful. Switching from a DA to another is feasible and safe, although in the first days an overlap of dopaminergic side effects may occur. When treatment with DA is stopped, dopamine withdrawal syndrome needs to be prevented. On suspension of a DA, especially pramipexole, the risk of producing apathy has to be considered. CONCLUSIONS: New non-ergot DA are a valuable option for the treatment of both early and late PD. Despite a good safety profile, serious adverse effects may appear and need to be monitored. A pathoplastic effect on the course of the disease cannot be ruled out.
    Neurologia 07/2011;
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    ABSTRACT: Abreviaturas AD Agonista dopaminérgico EP Enfermedad de Parkinson GDNF Factor neurotrófico derivado de línea celular glial (por sus siglas en inglés, glial cell line-derived neurotrophic factor) NGF Factor de crecimiento de los nervios (por sus siglas en inglés, nerve growth factor) REM Movimiento ocular rápido (por sus siglas en inglés, Rapid Eye Movement) UPDRS Escala unificada de valoración de la enfermedad de Parkinson (por sus siglas en inglés, Unified Parkinson's Disease Rating Scale)-II: síntomas motores y III: actividades de la vida diaria Farmacología básica Un agonista dopaminérgico (AD) se define como una estructura molecular similar a la dopamina. La similitud entre la molécula y la dopamina explica su acción ago-nista sobre los receptores dopaminérgicos. La ventaja respecto a la L-dopa reside en su acción directa sobre los receptores sin necesidad de metabolismo previo. Los AD actúan no sólo sobre el sistema dopaminérgico sino también sobre otros sistemas, incluyendo el seroto-ninérgico y noradrenérgico [1 • • ]. Este hecho es impor-tante, ya que los agonistas no ergolínicos son relativa-mente específicos sobre los receptores D2 y D3, mientras que el resto actúa sobre todos los receptores de dopamina y también sobre los de serotonina. La actuación sobre los receptores serotoninérgicos es gene-ralmente de tipo agonista, aunque existe alguna excep-ción como la lisurida [2]; este AD, actualmente en des-uso, actúa como un antagonista serotoninérgico.
    Curr Opin Neurol. 01/2007; 20:s33-s39.
  • The Lancet Neurology 05/2013; · 23.92 Impact Factor

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