Pallidotomy improves motor responses and widens the levodopa therapeutic window in Parkinson's disease
Identifieur interne : 001537 ( Istex/Corpus ); précédent : 001536; suivant : 001538Pallidotomy improves motor responses and widens the levodopa therapeutic window in Parkinson's disease
Auteurs : Elaine J. Skalabrin ; Edward R. Laws Jr. ; James P. Bennett Jr.Source :
- Movement Disorders [ 0885-3185 ] ; 1998-09.
English descriptors
Abstract
Stereotactic posteroventral pallidotomy (PVP) as a treatment for Parkinson's disease (PD) symptoms has been increasingly used in moderate‐advanced disease. We examined the pharmacodynamic responses of PD patients to single oral levodopa doses and intravenous levodopa infusions before and after PVP surgery. Nine subjects with advanced PD received a single oral dose and ramped intravenous levodopa infusions before and 3–5 weeks after unilateral PVP. Timed motor tasks, Unified Parkinson's Disease Rating Scale (UPDRS) evaluations, and ordinal dyskinesia rating were performed after oral levodopa and during IV levodopa infusions. Serum prolactin and dopa levels were measured during the levodopa infusions. Overall timed motor but not motor UPDRS scores were improved after PVP in both the worst (“off”) and best (“on”) states. Contralateral but not ipsilateral limb dyskinesias were substantially reduced at all serum (dopa) levels after PVP. Ipsilateral and contralateral timed motor performance at low serum (dopa) levels was improved by PVP. Walking speeds at all serum (dopa) levels were not changed by PVP. Serum prolactin was reduced equally by increasing (dopa) preoperatively and postoperatively. PVP significantly and favorably altered oral and intravenous levodopa pharmacodynamics by improving bilateral limb motor function and contralateral dyskinesia but did not alter walking speed. PVP appears to widen significantly the therapeutic window for levodopa in PD.
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DOI: 10.1002/mds.870130504
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We examined the pharmacodynamic responses of PD patients to single oral levodopa doses and intravenous levodopa infusions before and after PVP surgery. Nine subjects with advanced PD received a single oral dose and ramped intravenous levodopa infusions before and 3–5 weeks after unilateral PVP. Timed motor tasks, Unified Parkinson's Disease Rating Scale (UPDRS) evaluations, and ordinal dyskinesia rating were performed after oral levodopa and during IV levodopa infusions. Serum prolactin and dopa levels were measured during the levodopa infusions. Overall timed motor but not motor UPDRS scores were improved after PVP in both the worst (“off”) and best (“on”) states. Contralateral but not ipsilateral limb dyskinesias were substantially reduced at all serum (dopa) levels after PVP. Ipsilateral and contralateral timed motor performance at low serum (dopa) levels was improved by PVP. Walking speeds at all serum (dopa) levels were not changed by PVP. Serum prolactin was reduced equally by increasing (dopa) preoperatively and postoperatively. PVP significantly and favorably altered oral and intravenous levodopa pharmacodynamics by improving bilateral limb motor function and contralateral dyskinesia but did not alter walking speed. PVP appears to widen significantly the therapeutic window for levodopa in PD.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Elaine J. Skalabrin MD</name><affiliations><json:string>Departments of Neurology, University of Virginia Health Sciences Center, Charlottesville, Virginia, U.S.A.</json:string></affiliations></json:item><json:item><name>Edward R. Laws Jr. MD</name><affiliations><json:string>Departments of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, U.S.A.</json:string></affiliations></json:item><json:item><name>James P. 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Serum prolactin was reduced equally by increasing (dopa) preoperatively and postoperatively. PVP significantly and favorably altered oral and intravenous levodopa pharmacodynamics by improving bilateral limb motor function and contralateral dyskinesia but did not alter walking speed. 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Serum prolactin was reduced equally by increasing (dopa) preoperatively and postoperatively. PVP significantly and favorably altered oral and intravenous levodopa pharmacodynamics by improving bilateral limb motor function and contralateral dyskinesia but did not alter walking speed. 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Serum prolactin was reduced equally by increasing (dopa) preoperatively and postoperatively. PVP significantly and favorably altered oral and intravenous levodopa pharmacodynamics by improving bilateral limb motor function and contralateral dyskinesia but did not alter walking speed. PVP appears to widen significantly the therapeutic window for levodopa in PD.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><!--Version 0.6 générée le 3-12-2015--><mods version="3.6"><titleInfo lang="en"><title>Pallidotomy improves motor responses and widens the levodopa therapeutic window in Parkinson's disease</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>PALLIDOTOMY IMPROVES LEVODOPA MOTOR RESPONSES</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Pallidotomy improves motor responses and widens the levodopa therapeutic window in Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Elaine J.</namePart><namePart type="family">Skalabrin</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurology, University of Virginia Health Sciences Center, Charlottesville, Virginia, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Edward R.</namePart><namePart type="family">Laws Jr.</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Departments of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">James P.</namePart><namePart type="family">Bennett Jr.</namePart><namePart type="termsOfAddress">MD, Phd</namePart><affiliation>Departments of Neurology, University of Virginia Health Sciences Center, Charlottesville, Virginia, U.S.A.</affiliation><affiliation>Departments of Psychiatric Medicine, University of Virginia Health Sciences Center, Charlottesville, Virginia, U.S.A.</affiliation><description>Correspondence: The Department of Neurology, Box 394, University of Virginia Health Sciences Center, Charlottesville, VA 22908, U.S.A.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre authority="originalCategForm">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">1998-09</dateIssued><dateCaptured encoding="w3cdtf">1997-10-17</dateCaptured><dateValid encoding="w3cdtf">1998-03-13</dateValid><copyrightDate encoding="w3cdtf">1998</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">5</extent><extent unit="references">21</extent></physicalDescription><abstract lang="en">Stereotactic posteroventral pallidotomy (PVP) as a treatment for Parkinson's disease (PD) symptoms has been increasingly used in moderate‐advanced disease. We examined the pharmacodynamic responses of PD patients to single oral levodopa doses and intravenous levodopa infusions before and after PVP surgery. Nine subjects with advanced PD received a single oral dose and ramped intravenous levodopa infusions before and 3–5 weeks after unilateral PVP. Timed motor tasks, Unified Parkinson's Disease Rating Scale (UPDRS) evaluations, and ordinal dyskinesia rating were performed after oral levodopa and during IV levodopa infusions. Serum prolactin and dopa levels were measured during the levodopa infusions. Overall timed motor but not motor UPDRS scores were improved after PVP in both the worst (“off”) and best (“on”) states. Contralateral but not ipsilateral limb dyskinesias were substantially reduced at all serum (dopa) levels after PVP. Ipsilateral and contralateral timed motor performance at low serum (dopa) levels was improved by PVP. Walking speeds at all serum (dopa) levels were not changed by PVP. Serum prolactin was reduced equally by increasing (dopa) preoperatively and postoperatively. PVP significantly and favorably altered oral and intravenous levodopa pharmacodynamics by improving bilateral limb motor function and contralateral dyskinesia but did not alter walking speed. PVP appears to widen significantly the therapeutic window for levodopa in PD.</abstract><subject lang="en"><genre>Keywords</genre><topic>Stereotactic pallidotomy</topic><topic>Parkinson's disease</topic><topic>L‐dopa, Pharmacodynamics</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title><subTitle>Official Journal of the Movement Disorder Society</subTitle></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><subject><genre>article category</genre><topic>Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>1998</date><detail type="volume"><caption>vol.</caption><number>13</number></detail><detail type="issue"><caption>no.</caption><number>5</number></detail><extent unit="pages"><start>775</start><end>781</end><total>7</total></extent></part></relatedItem><identifier type="istex">85893F050C56CEB88EB8A88A3103BBAFB5712D1C</identifier><identifier type="DOI">10.1002/mds.870130504</identifier><identifier type="ArticleID">MDS870130504</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 1998 Movement Disorder Society</accessCondition><recordInfo><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin><recordContentSource>WILEY</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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