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Current Neuropharmacology 2022Despite increasing worldwide incidence of Parkinson's disease, the therapy is still suboptimal due to the diversified clinical manifestations, lack of sufficient...
BACKGROUND
Despite increasing worldwide incidence of Parkinson's disease, the therapy is still suboptimal due to the diversified clinical manifestations, lack of sufficient treatment, the poor adherence in advanced patients, and varied response. Proper intake of medications regarding food and managing drug-food interactions may optimize Parkinson's disease treatment.
OBJECTIVES
We investigated potential effects that food, beverages, and dietary supplements may have on the pharmacokinetics and pharmacodynamics of drugs used by parkinsonian patients; identified the most probable interactions; and shaped recommendations for the optimal intake of drugs regarding food.
METHODS
We performed a systematic review in adherence to PRISMA guidelines, and included a total of 81 studies in the qualitative synthesis.
RESULTS AND CONCLUSION
We found evidence for levodopa positive interaction with coffee, fiber and vitamin C, as well as for the potential beneficial impact of low-fat and protein redistribution diet. Contrastingly, high-protein diet and ferrous sulfate supplements can negatively affect levodopa pharmacokinetics and effectiveness. For other drugs, the data of food impact are scarce. Based on the available limited evidence, all dopamine agonists (bromocriptine, cabergoline, ropinirole), tolcapone, rasagiline, selegiline in tablets, safinamide, amantadine and pimavanserin can be taken with or without a meal. Opicapone and orally disintegrating selegiline tablets should be administered on an empty stomach. Of monoamine oxidase B inhibitors, safinamide is the least susceptible for interaction with the tyramine-rich food, whereas selegiline and rasagiline may lose selectivity to monoamine oxidase B when administered in supratherapeutic doses. The level of presented evidence is low due to the poor studies design, their insufficient actuality, and missing data.
Topics: Antiparkinson Agents; Dietary Supplements; Humans; Levodopa; Monoamine Oxidase; Monoamine Oxidase Inhibitors; Parkinson Disease; Selegiline
PubMed: 34784871
DOI: 10.2174/1570159X19666211116142806 -
American Journal of Speech-language... Jan 2022Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized...
PURPOSE
Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized evidence regarding the effectiveness of interventions for dysphagia in PD.
METHOD
Electronic searches were conducted in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and speechBITE. Of the 2,015 articles identified, 26 met eligibility criteria: interventional or observational studies with at least five or more participants evaluating dysphagia interventions in adults with PD-related dysphagia, with outcomes measured using videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), or electromyography (EMG). Risk of bias (RoB) was evaluated using the Evidence Project tool and predetermined criteria regarding the rigor of swallowing outcome measures.
RESULTS
Interventions were classified as follows: pharmacological ( = 11), neurostimulation ( = 8), and behavioral ( = 7). Primary outcome measures varied across studies, including swallowing timing, safety, and efficiency, and were measured using VFSS ( = 17), FEES ( = 6), and EMG ( = 4). Critical appraisal of study findings for RoB, methodological rigor, and transparency showed the majority of studies failed to adequately describe contrast media used, signal acquisition settings, and rater blinding to time point. Low certainty evidence generally suggested improved swallow timing with exercises with biofeedback and deep brain stimulation (DBS), improved safety with DBS and expiratory muscle strength training, and improved efficiency with the Lee Silverman Voice Treatment and levodopa.
CONCLUSIONS
Studies with lower RoB and greater experimental rigor showed potential benefit in improving swallowing efficiency but not safety. Further research investigating discrete changes in swallowing pathophysiology post-intervention is warranted to guide dysphagia management in PD.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.17132162.
Topics: Adult; Biofeedback, Psychology; Deep Brain Stimulation; Deglutition; Deglutition Disorders; Exercise Therapy; Humans; Parkinson Disease; Physical Therapy Modalities
PubMed: 34890260
DOI: 10.1044/2021_AJSLP-21-00145 -
Journal of Parkinson's Disease 2020Signs of respiratory dysfunction can be present already early in the course of Parkinson's disease (PD). Respiratory training could alleviate this, but its effectiveness...
BACKGROUND
Signs of respiratory dysfunction can be present already early in the course of Parkinson's disease (PD). Respiratory training could alleviate this, but its effectiveness is not well understood.
OBJECTIVE
The purpose of this systematic review is to review the efficacy of different respiratory training interventions in PD.
METHODS
A search strategy was performed in four databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Methodological quality of original full-text articles was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for the controlled trials (CTs). Levels of evidence were rated by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach.
RESULTS
Six papers reporting on four randomized controlled trials and another four controlled trials were included. Positive effects were reported for inspiratory muscle strength training (IMST), expiratory muscle strength training (EMST), air stacking, breath-stacking, incentive spirometry and postural training on respiratory muscle strength, swallowing safety, phonatory aspects and chest wall volumes. Best methodological quality was found for breath-stacking and incentive spirometry. Best levels of evidence were found for EMST, IMST and EMST plus air stacking.
CONCLUSION
Respiratory training shows positive effects and should be considered when people with PD experience respiratory dysfunction. Future studies should focus on standardizing both training devices, instruments to measure outcomes and intervention protocols to further increase the level of evidence.
Topics: Breathing Exercises; Humans; Muscle Strength; Outcome Assessment, Health Care; Parkinson Disease; Respiration Disorders; Respiratory Muscles
PubMed: 32986684
DOI: 10.3233/JPD-202223 -
Cureus Jul 2021There are many successful interventions in medicine, especially in neurology and rehabilitation. The neurosciences represent an area of medicine with tremendous recent... (Review)
Review
Virtual Reality Intervention to Help Improve Motor Function in Patients Undergoing Rehabilitation for Cerebral Palsy, Parkinson's Disease, or Stroke: A Systematic Review of Randomized Controlled Trials.
There are many successful interventions in medicine, especially in neurology and rehabilitation. The neurosciences represent an area of medicine with tremendous recent research innovations, one of which is virtual reality. This paper aims to discover the powerful relationship between virtual reality and rehabilitation. We assessed the effectiveness of virtual reality-based rehabilitation compared to conventional rehabilitation on motor function recovery of three patient groups: patients with a diagnosis of cerebral palsy, Parkinson's disease, or stroke. We conducted a systematic review using PubMed and included only articles that were randomized controlled trials that were published in the last five years. We used a general search in combination with a more focused Medical Subject Headings (MeSH) search. After thorough assessment and risk of bias evaluation using the Cochrane risk of bias tool, we included thirteen studies in this review. The majority of the clinical trials showed a statistically significant effect for improved motor function. More specifically, improvements in upper extremity motor function, gait, and balance in patients diagnosed with stroke were seen. Similarly, when evaluating patients with Parkinson's disease, improved gait and posture were also seen. When it came to cerebral palsy, however, there were no significant differences between the experimental group and the control. The level of improvement in motor function with a virtual reality intervention was striking, particularly since a few studies demonstrated sustained motor improvement a few months post-trial as well. Virtual reality-based rehabilitation has promising results for adult patients diagnosed with stroke or Parkinson's disease. For pediatric patients, on the other hand, a larger number of clinical trials would still need to be conducted to validate if virtual reality interventions have the capability of providing improved motor function recovery.
PubMed: 34367835
DOI: 10.7759/cureus.16763 -
PloS One 2020Dance may help individuals living with Parkinson's disease (PD) improve motor and non-motor symptoms that impact quality of life (QOL). The primary aim of this... (Meta-Analysis)
Meta-Analysis
Dance may help individuals living with Parkinson's disease (PD) improve motor and non-motor symptoms that impact quality of life (QOL). The primary aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy of dance in improving motor and non-motor symptoms of PD and QOL. The secondary aims of this review were to evaluate the methodological quality of included studies by assessing risk of bias across nine categories and to inform the direction of future research. Peer-reviewed RCTs that included people living with PD at all disease stages and ages and measured the effects of a dance intervention longer than one day were included. Sixteen RCTs involving 636 participants with mild to moderate PD were eligible for inclusion in the qualitative synthesis and nine in the meta-analysis. Overall, the reviewed evidence demonstrated that dance can improve motor impairments, specifically balance and motor symptom severity in individuals with mild to moderate PD, and that more research is needed to determine its effects on non-motor symptoms and QOL. RCTs that use a mixed-methods approach and include larger sample sizes will be beneficial in fully characterizing effects and in determining which program elements are most important in bringing about positive, clinically meaningful changes in people with PD.
Topics: Activities of Daily Living; Cognition; Dancing; Gait; Humans; Mental Health; Motor Disorders; Parkinson Disease; Postural Balance; Quality of Life
PubMed: 32756578
DOI: 10.1371/journal.pone.0236820 -
International Journal of Environmental... Jun 2020The incidence of oropharyngeal dysphagia in Parkinson's disease (PD) is very high. It is necessary to search for effective therapies that could prevent pneumonia....
The incidence of oropharyngeal dysphagia in Parkinson's disease (PD) is very high. It is necessary to search for effective therapies that could prevent pneumonia. Previous results should be interpreted cautiously as there is a lack of evidence to support the use of compensatory or rehabilitative approaches to dysphagia. We reviewed the scientific literature to describe the treatments of dysphagia in PD. A systematic review was performed in PubMed, Scopus, Elsevier, and Medline according to PRISMA standards in 2018. The articles that did not mention dysphagia secondary to PD or used surgical treatment were excluded. Eleven articles met the criteria with information from 402 patients. The review relates to different protocols, such as training in expiratory muscle strength, postural techniques, oral motor exercises, video-assisted swallowing therapy, surface electrical stimulation, thermal stimulation, touch, compensatory interventions, training regime for swallowing, neuromuscular electrical stimulation, Lee Silverman voice treatment, swallow maneuver, airway protection, and postural compensation maneuvers. This review identifies the rationing interventions in each trial, if they are efficient and equitable. Several rehabilitative therapies have been successful. An improvement was seen in the degenerative function (coordination, speed, and volume), quality of life, and social relationships of people with PD. Further investigations concerning the clinical applicability of these therapies based on well-designed randomized controlled studies are needed. Larger patient populations need to be recruited to evaluate the effectiveness, long-term effects, and new treatment techniques.
Topics: Cohort Studies; Deglutition Disorders; Humans; Parkinson Disease; Pilot Projects; Prospective Studies; Quality of Life
PubMed: 32526840
DOI: 10.3390/ijerph17114104 -
Advances in Nutrition (Bethesda, Md.) Dec 2021Although levodopa remains the most effective drug for symptomatic management of Parkinson's Disease (PD), treatment during advanced disease stages may raise...
Although levodopa remains the most effective drug for symptomatic management of Parkinson's Disease (PD), treatment during advanced disease stages may raise unpredictable motor fluctuations and other complications. Counteracting these complications with other pharmacological therapies may prompt a vicious circle of side effects, and here, nutritional therapy may have great potential. Knowledge about the role of diet in PD is emerging and multiple studies have investigated nutritional support specifically with respect to levodopa therapy. With this systematic review, we aim to give a comprehensive overview of dietary approaches to optimize levodopa treatment in PD. A systematic search was performed using the databases of PubMed and Scopus between January 1985 and September 2020. Nutritional interventions with the rationale to optimize levodopa therapy in human PD patients were eligible for this study and their quality was assessed with the Cochrane risk-of-bias tool. In total, we included 22 papers that addressed the effects of dietary proteins (n = 10), vitamins (n = 7), fiber (n = 2), soybeans (n = 1), caffeine (n = 1), and ketogenic diets (n = 1) on levodopa therapy. Interventions with protein redistribution diets (PRDs), dietary fiber, vitamin C, and caffeine improved levodopa absorption, thereby enhancing clinical response and reducing motor fluctuations. Furthermore, supplementation of vitamin B-12, vitamin B-6, and folic acid successfully reduced high homocysteine concentrations that emerged from levodopa metabolism and promoted many metabolic and clinical complications, such as neuropathology and osteoporosis. In conclusion, dietary interventions have the potential to optimize levodopa efficacy and control side effects. Nutrition that improves levodopa absorption, including PRDs, fiber, vitamin C, and caffeine, is specifically recommended when fluctuating clinical responses appear. Supplements of vitamin B-12, vitamin B-6, and folic acid are advised along with levodopa initiation to attenuate hyperhomocysteinemia, and importantly, their potential to treat consequent metabolic and clinical complications warrants future research.
Topics: Antiparkinson Agents; Diet; Humans; Levodopa; Parkinson Disease; Vitamin B 12
PubMed: 34113965
DOI: 10.1093/advances/nmab060 -
EClinicalMedicine Oct 2022Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive form of brain stimulation that positively regulates the motor and non-motor symptoms of Parkinson's...
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive form of brain stimulation that positively regulates the motor and non-motor symptoms of Parkinson's disease (PD). Although, most reviews and meta-analysis have shown that rTMS intervention is effective in treating motor symptoms and depression, very few have used randomised controlled trials (RCTs) to analyse the efficacy of this intervention in PD. We aimed to review RCTs of rTMS in patients with PD to assess the efficacy of rTMS on motor and non-motor function in patients with PD.
METHODS
In this systematic review and meta-analysis, we searched PubMed, MEDLINE and Web of Science databases for RCTs on rTMS in PD published between January 1, 1988 to January 1, 2022. Eligible studies included sham-controlled RCTs that used rTMS stimulation for motor or non-motor symptoms in PD. RCTs not focusing on the efficacy of rTMS in PD were excluded. Summary data were extracting from those RCTs by two investigators independently. We then calculated standardised mean difference with random-effect models. The main outcome included motor and non-motor examination of scales that were used in PD motor or non-motor assessment. This study was registered with PROSPERO, CRD42022329633.
FINDINGS
Fourteen studies with 469 patients met the criteria for our meta-analysis. Twelve eligible studies with 381 patients were pooled to analyse the efficacy of rTMS on motor function improvement. The effect size on motor scale scores was 0.51 ( < 0.0001) and were not distinctly heterogeneous (I = 29%). Five eligible studies with 202 patients were collected to evaluate antidepressant-like effects. The effect size on depression scale scores was 0.42 ( = 0.004), and were not distinctly heterogeneous (I = 25%), indicating a significant anti-depressive effect (P = 0.004). The results suggest that high-frequency of rTMS on primary motor cortex (M1) is effective in improving motor symptoms; while the dorsolateral prefrontal cortex (DLPFC) may be a potentially effective area in alleviating depressive symptom.
INTERPRETATION
The findings suggest that rTMS could be used as a possible adjuvant therapy for PD mainly to improve motor symptoms, but could have potential efficacy on depressive symptoms of PD. However, further investigation is needed.
FUNDING
The National Natural Science Foundation of China (NO: 81873777, 82071414), Initiated Foundation of Zhujiang Hospital (NO: 02020318005), Scientific Research Foundation of Guangzhou (NO: 202206010005), and Science and Technology Program of Guangdong of China (NO: 2020A0505100037).
PubMed: 35923424
DOI: 10.1016/j.eclinm.2022.101589 -
European Journal of Clinical... Dec 2020To investigate the comparative effectiveness of dopamine agonists and monoamine oxidase type-B (MAO-B) inhibitors available for treatment of Parkinson's disease. (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
To investigate the comparative effectiveness of dopamine agonists and monoamine oxidase type-B (MAO-B) inhibitors available for treatment of Parkinson's disease.
METHODS
We performed a systematic literature search identifying randomized controlled trials investigating 4 dopamine agonists (cabergoline, pramipexole, ropinirole, rotigotine) and 3 MAO-B inhibitors (selegiline, rasagiline, safinamide) for Parkinson's disease. We extracted and pooled data from included clinical trials in a joint model allowing both direct and indirect comparison of the seven drugs. We considered dopamine agonists and MAO-B inhibitors given as monotherapy or in combination with levodopa. Selected endpoints were change in the Unified Parkinson's Disease Rating Scale (UPDRS) score, serious adverse events and withdrawals. We estimated the relative effectiveness of each dopamine agonist and MAO-B inhibitor versus comparator drug.
RESULTS
Altogether, 79 publications were included in the analysis. We found all the investigated drugs to be effective compared with placebo when given as monotherapy except safinamide. When considering combination treatment, the estimated relative effects of selegiline, pramipexole, ropinirole, rotigotine, cabergoline, rasagiline and safinamide were 2.316 (1.819, 2.951), 2.091 (1.889, 2.317), 2.037 (1.804, 2.294), 1.912 (1.716, 2.129), 1.664 (1.113, 2.418), 1.584 (1.379, 1.820) and 1.179 (1.031, 1.352), respectively, compared with joint placebo and levodopa treatment.
CONCLUSIONS
Dopamine agonists were found to be effective as treatment for Parkinson's disease, both when given as monotherapy and in combination with levodopa. Selegiline and rasagiline were also found to be effective for treating Parkinson's disease, and selegiline was the best option in combination with levodopa among all the drugs investigated.
Topics: Dopamine Agonists; Drug Therapy, Combination; Humans; Indans; Levodopa; Monoamine Oxidase Inhibitors; Parkinson Disease; Randomized Controlled Trials as Topic; Selegiline; Treatment Outcome
PubMed: 32710141
DOI: 10.1007/s00228-020-02961-6 -
Neurologia I Neurochirurgia Polska 2022Cannabis and cannabinoids are often considered in the treatment of Parkinson's Disease (PD). The purpose of this paper was to perform a systematic review of the...
Cannabis and cannabinoids are often considered in the treatment of Parkinson's Disease (PD). The purpose of this paper was to perform a systematic review of the available data on cannabis treatment. We aimed to assess randomised trials as well as surveys among patients. We identified 569 papers on PD and cannabinoid treatment. Of these, there were only seven papers featuring randomised trials on the effects of different cannabinoids on PD. The results of these trials did not support the efficacy of cannabinoids in the treatment of motor signs of PD. Based on the available data, we conclude that there is currently insufficient data to support the administration of cannabinoids to PD patients. Larger, randomised studies of cannabis use in PD should be conducted.
Topics: Cannabinoids; Cannabis; Humans; Medical Marijuana; Parkinson Disease
PubMed: 34985112
DOI: 10.5603/PJNNS.a2022.0004