"Clinicians and patients often struggle with what is the right initial approach to treating Parkinson's disease," said University of Rochester Medical Center neurologist Kevin Biglan, M.D., M.P.H., the lead author of the paper and a member of the Parkinson's Study Group, an international network of researchers that oversaw the clinical trial.
"This study tells us that, over the long haul, patients on the different drugs end up at roughly the same place in terms of their level of disability and quality of life."
Parkinson's disease is a progressive neurological disorder that erodes a person's control over their movements and speech. Over time, Parkinson's patients may experience stiffness or rigidity of the arms and legs, slowness or lack of movement, and walking difficulties, in addition to tremors in their hands, arms, legs, jaw or face.
The study compared two drugs – levodopa and pramipexole – that are generally employed as the first line of treatment for Parkinson's disease. The two drugs use different mechanisms to counteract the decline in the production of dopamine in the brain that is a result of a progressive loss of cells that secrete the neurochemical. Levodopa is an amino acid that the body metabolizes into dopamine. Pramipexole is a dopamine agonist that binds with dopamine receptors on cells in the brain and mimics the chemical's molecular function.
While levodopa is considered to be better at addressing the motor control symptoms of the disease such as mobility issues and tremors, it is also associated with side effects such as dyskinesia (involuntary movements) and the effectiveness of the drug can diminish, or wear off, over time. Pramipexole is less effective with respect to motor control symptoms and more often causes sleepiness, but is less commonly associated with dyskinesias and wearing off. Pramipexole is often prescribed because clinicians believe it essentially extends the window in which the patient can benefit from levodopa by delaying the initial use of the drug – and its eventually wearing off. Most Parkinson's patients end up taking levodopa at some point regardless of their initial treatment because it is more effective at improving the symptoms of the disease.
The initial study followed 301 Parkinson's patients in 22 sites in the U.S. and Canada over a 2 year period. A sub-set (222) of the group was followed for an additional 4 years. Half the patients were randomly assigned to be initially treated with levodopa and the other half with pramipexole. After 6 years of follow-up, essentially all of the participants (90%) were taking levodopa. The researchers evaluated study participants using tools that measure disability (ability to perform daily activities), side effects, disease severity, and the patient's sleepiness.
The study confirmed that patients who are initially treated with levodopa are more likely to develop motor complications such as dyskinesias and wearing off even 6 years after treatment. However, it also shows that these complications did not have a significant impact on the quality of life or disability of the patients.
"Clinicians and patients still need to establish their treatment priorities to understand unique circumstances that argue in favor of one drug vs. the other," said Biglan. "However, this study should assuage any concerns that the treatment decisions that are made early in the disease will have long-term implications, which does not appear to be the case."
Mark Michaud | EurekAlert!
Further reports about: > Parkinson's treatments > Tremors > body metabolizes > chemical's molecular function > dopamine > dyskinesia > involuntary movements > lack of movement > levodopa > pramipexole > progressive neurological disorder > quality of life > rigidity of the arms and legs > walking difficulties
New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)
Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
26.04.2017 | Materials Sciences
26.04.2017 | Agricultural and Forestry Science
26.04.2017 | Physics and Astronomy