Evaluation of Dyskinesias in a Pilot, Randomized, Placebo-Controlled Trial of Remacemide in Advanced Parkinson Disease

Abstract

Diaries may provide a valid means of evaluating dyskinesias in clinical trials for Parkinson disease, but there remain other aspects of dyskinesias, as assessed by the MGDRS and LFADLDS, that are not reflected in diary ratings.

Levodopa-Induced Dyskinesias in Parkinson’s Disease: Etiology, Impact on Quality of Life, and Treatments

“…It includes a patient- or caregiver-provided estimate of dyskinesia duration during the waking day (0, 1–25, 26–50, 51–75 or 76–100%) for the past week and a rating of its severity (not disabling, mildly disabling, moderately disabling, severely disabling or completely disabling) [36]. In clinical trials, dyskinesia has been considered present if the duration item response is at least 1–25% of the waking day [23].…”

“…It is familiar to clinicians, can be completed quickly, and can be used in routine clinical settings and clinical trials. Its major limitation is that it captures dyskinesia at one moment in time and does not assess functional impairment [36]. A modified version for use in patients with PD is commonly used in clinical trials [38, 39].…”

“…Its main advantage is the documentation of the functional impairment caused by dyskinesias at the time of assessment [36], and it has good interrater and intrarater reliability [40]. On the other hand, its disadvantages include only evaluating function over a short time period (minutes), and the office examination may not reflect the patient’s condition at home.…”

“…On the other hand, its disadvantages include only evaluating function over a short time period (minutes), and the office examination may not reflect the patient’s condition at home. In addition, completion of the scale is somewhat labor intensive and time consuming [36]. …”

“…Other noncompetitive NMDA antagonists, such as dextromethorphan [96, 97] and remacemide, have been studied. The latter was studied in a larger trial and was found to be safe and well tolerated but did not show any demonstrable anti-dyskinetic benefit [36]. Topiramate, an AMPA glutamate antagonist, significantly reduced levodopa-induced dyskinesias in the MPTP-lesioned marmoset model of PD [98].…”