The Monthly Transmitter (May 2011)
Thank you to those who took part in the DBS referral
survey. Your feedback and comments have been reviewed and the PADRECCs
are considering ways to implement your suggestions.
Preliminary planning has begun for a 2012 Consortium
Conference. Consortium Center Directors will receive an electronic
survey for input on potential dates and location over the coming weeks. These
biannual meetings are designed with member convenience and preferences in
mind so please be sure to respond. Thank you in advance for your participation!
Prepared by: Alec Glass, MD and Susan Heath, RN, MSN
San Francisco PADRECC
Preladenant in patients with Parkinson's disease and
motor fluctuations: a phase 2, double-blind, randomised trial.
Hauser RA, Cantillon M, Pourcher E, Micheli F, Mok V, Onofrj M, Huyck S, Wolski K.
Effectively treating motor
symptoms in Parkinson’s patients becomes more difficult with disease
progression and physicians often struggle to balance multiple medications in
order to limit motor fluctuations without increasing dyskinesias. Adenosine
receptor antagonists (A2a) such as Preladenant have been proposed as a novel
class of adjunctive agents that may decrease daily "off" time without
increasing dyskinesias. This Phase 2, double-blind, dose finding, safety
and efficacy trail aimed to determine if Preladenant at doses of 1, 2, 5, or
10 mg taken twice daily would reduce mean daily "off" time as compared to
placebo at 12 weeks as assessed by patient diary. A total of 253 patients
were randomized into the 1, 2, 5, 10mg or placebo group based on an adaptive
randomization protocol. The study met the primary outcome measure by
reducing mean total daily "off" time in the 5mg and 10mg groups by 1.0 and
1.2 hours respectively. In addition, although not adequately powered to
analyze, there did not seem to be an increase in dyskinesia associated with
the reduction in "off" time. Preladenant was well tolerated at these doses
when compared to placebo .
Lancet Neurol. 2011 Mar;10(3):221-9.
a-syn) propagates from mouse
brain to grafted dopaminergic neurons and seeds aggregation in cultured human
, , , et al.
similar to a prion-like mechanism, can pass from a donor cell to seed a
healthy cell, consistent with the Braak hypothesis. This result may explain
the central role in the progression of PD neuropathology where an external
pathogen may cause the spread of Lewy body-like aggregates and contribute to
Parkinson's Disease pathology. They reported using several cell lines and
in vivo models in transgenic mice with wild-type a-synuclein to show
a-synuclein propagates once inside the recipient cells and
creates endogenous misfolding and aggregation. However, the molecular
nature of the α-syn "seed" remains unclear. The authors suggest it is
important to develop animal models of this grafting paradigm to further
resolve the effects of inflammation and environmental oxidative stress as
contributing mechanisms for neurodegenerative proteinopathies.
Invest 2011: 121;715–725
Impulsivity and compulsivity in drug-naive patients with
Antonini, A., C. Siri, et al.
Impulsivity and compulsive
symptoms are well described in Parkinson's patients receiving dopaminergic
therapies. However, in early drug naïve PD pts, baseline features of
impulsiveness, compulsiveness or depression in newly diagnosed patients have not
been well described. Antonini and colleagues screened 103 consecutively
newly diagnosed PD pts for impulsive and compulsive behaviors using validated
screening tools. (Minnesota Impulsive Disorders Interview, MIDI; South Oaks
Gambling Screen, SOGS; Barratt Impulsiveness Scale, BIS-11; Maudsley
Obsessional-Compulsive Questionnaire, MOCQ/R; and Depression, GDS-15.) Comparisons
were made with healthy controls. Similar to healthy controls, 17.5% of pts
screened positive for at least one ICD (no one ICD was more prevalent than
the other and onset of symptoms (tremor vs. rigidity) nor side of onset (left
vs right) showed any difference,) but there was a trend for higher
attentional impulsiveness (lack of planning) and a relationship between
depression and impulsivity in drug-naïve PD pts. It is suggested that early
PD pts may suffer with baseline subclinical behavioral abnormalities and
careful assessment for these behaviors should be explored before initiating
dopaminergic therapy as they may then become clinically significant with
initiation of therapy.
Mov Disord 201: 26(3): 464-8.
June 5-9, 2011
Movement Disorders Society
International Congress of Parkinson’s Disease and Movement Disorders
July 14, 2011
Advances in Gene Therapy
September 8, 2011
Neuroprotection and Parkinson’s Disease
Clinical Care Committee
Rotation of Committee Chair: Leadership for the
clinical care committee rotates amongst the PADRECCs. Philadelphia leads the
committee for May and June. Committee meets first Tuesday of the month at
Standardize Clinical Care: Continues to discuss a
variety of clinical issues, provide clinical support to the Consortium
network, and work on measures to standardize clinical care across the PADRECC
Azilect is now on the national formulary
LA new patient note template is being piloted. It will
capture the AAN guidelines for nonmotor symptoms
- Discussion are taking place about standardizing
pharmacy recommendations/allowances so that all PADRECCs have the same
- PD Handbook: A smaller subcommittee will
spearhead a project in 2011 to draft a handbook for the VHA (similar to
a MS Handbook developed by MSCoE) that addresses such things as
definition of PD, purpose, authority and scope, system of care,
population served, etc.
PADRECC Transmitter: PADRECC clinicians provide reviews of recent
movement disorder publications that are included in the PADRECC Transmitter
- PADRECC/EES Movement
Disorder Series: The FY 2011 series is currently underway. Future
dates in 2011 are: Jul 14 and Sep 8. These audio conference series will
be archived on the www.parkinsons.va.gov
website under the Movement Disorder Series tab.
Patient Education Video Project: Susan Heath (SF
PADRECC) is working with EES and the education committee to develop a series
of videos for patient education in FY2011. Tapings are currently underway
PADRECC Transmitter: The committee continues to assemble
and distribute this e-newsletter every other month.
National Website: The committee is assisting in
updating the National VA PADRECC/Consortium Website .
Spotlight on San
Francisco Consortium Centers:
San Francisco's New Palliative Care Clinic - "Supportive
Care Clinic" for late Stage III-IV PD.
Late-stage PD patients often gain little to no benefit
from medication adjustments. In fact, medications are more frequently
withdrawn due to their side effects. The work of Gow and Carter from OHSU
suggests that families often have feelings of abandonment for care and
support in the final stages of care for patient with Parkinson's disease.
With this in mind, the SFVA developed a new interdisciplinary clinic for
advanced disease patients with the goal of improving the family's sense of
support for this end-stage phase of disease. Specifically, quality of life
interventions are the focus instead of curative interventions. The goal is
to avoid unnecessary hospitalizations and caregiver desperation. The
staffing is based on a team approach and the two hour visits start with an
intake of key issues solicited by either the nurses, a social worker, or
chaplain. Patient and family goals are explored and a plan of care is made
together incorporating recommendations from all involved parties.
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