PD: Glutamate antagonists (AAN report)

Subject: PD: Glutamate antagonists (AAN report)

Date: 4/26/1999

1. The glutamate antagonist remacemide improves motor performance in levodopa-treated Parkinson's disease
Parkinson's Study Group
Neurology 1999;52(Suppl 2):A262

Remacemide as an adjunct to levodopa can reduce motor fluctuations, according to this placebo-controlled double-blind study. Placebo or remacemide at four different doses (75, 150, 300, or 600 mg/day) was administered to three patient groups–as monotherapy in early PD, as a levodopa adjunct in patients with motor fluctuations, and as a levodopa adjunct in patients with severe dyskinesias. UPDRS scores and percent "on" times improved most at intermediate doses when used with levodopa, while monotherapy was ineffective. Dyskinesias were not worsened. Dizziness was the major adverse effect, especially at higher doses, and the drug was better tolerated with q.i.d. vs. b.i.d. dosing. The authors note, "Benefits were comparable to those obtained by the addition of dopamine agonists or COMT inhibitors in patients with levodopa- related
motor fluctuations."

Supported by Astra Pharmaceuticals

2. Amantadine-sulfate infusion in treatment of motor fluctuations and dyskinesia in Parkinson's disease
E Ruzicka, H Streitova, R Jech, P Kanovsky, J Roth, I Rektorova, P Mecir, H Hortova, M Bares, B Hejdukova, I Rektor
Neurology 1999;52(Suppl 2):A213

Infusion of amantadine followed by oral administration can reduce motor fluctuations and dyskinesia, according to this open study in 20 patients. Patients received 200-400 mg/day of amantadine sulfate by infusion for 7 days, followed by 300-600 mg/day oral administration for 14 days. Mean UPDRS motor scores fell from 25.2 at baseline to 15.1 after 7 days, and remained improved throughout the study in almost all patients. "Off" time was reduced by more than half, and duration of
dyskinesias by almost half.

Supported by Merck Ltd.

3. Double-blind, placebo-controlled study to assess safety and efficacy of riluzole as a neuroprotective drug in patients with early, untreated Parkinson's disease
C Hunter, J Jankovic
Neurology 1999;52(Suppl 2):A214-215

Riluzole dosed at 50 mg b.i.d. is well-tolerated by patients with untreated early PD, according to this placebo-controlled double-blind study. No symptomatic effects were reported in the 19 patients completing the six-month study, as measured by UPDRS scores at baseline, 1,2,3, and 6 months, and after a six-week washout. The authors note that while it was not possible to determine if riluzole exerted any neuroprotective effect, the tolerability of the drug has prompted the initiation of a multicenter trial designed to look for such an effect.

E-MOVE Editor: Richard Robinson, NASW, WE MOVE

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