Low dosage clozapine effects on L-dopa induced dyskinesias in parkinsonian patients

Pierelli, Francesco; Adipietro, A.; Soldati, G.; Fattapposta, Francesco; Pozzessere, G.; Scoppetta, C

doi:10.1111/j.1600-0404.1998.tb05955.x

Cited by 42 publications

(22 citation statements)

References 27 publications

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“…Thus, 5-HT 2 antagonists reduce symptoms in PD patients (Henderson et al, 1992) and improve neuroleptic-induced parkinsonism (Bersani et al, 1990;Ikeguchi and Kuroda, 1995). Moreover, low-dose clozapine treatment of PD patients with iatrogenic psychosis reduces motor symptoms (Bonuccelli et al, 1997;Durif et al, 1997;Friedman et al, 1999;Pirelli et al, 1998). Since DA antagonists exacerbate parkinsonian symptoms, it is likely that the high 5-HT 2A affinity of clozapine contributes to the motoric improvement.…”

Section: Functional Implicationsmentioning

confidence: 99%

Distribution of serotonin 5-HT2A receptors in afferents of the rat striatum

Bubser

Backstrom

Sanders‐Bush

et al. 2001

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Section: Functional Implicationsmentioning

confidence: 99%

Distribution of serotonin 5-HT2A receptors in afferents of the rat striatum

Bubser

Backstrom

Sanders‐Bush

et al. 2001

Synapse

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“…It may also be effective in decreasing dyskinesias [72], and a few studies have focused on its antidyskinetic effect [93, 94]. However, the hematologic monitoring necessary with clozapine can be burdensome for both the patient and the physician and can limit its usefulness.…”

Section: Symptomatic Treatment Of Dyskinesiasmentioning

confidence: 99%

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

Encarnacion¹,

Hauser

2008

Eur Neurol

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Levodopa is the most effective agent to alleviate motor dysfunction in Parkinson’s disease but its long-term use is associated with the development of dyskinesias. Although the pathogenic processes behind the development of levodopa-induced dyskinesias are still being elucidated, it appears that chronic administration of this short-lived agent results in nonphysiologic pulsatile stimulation of striatal neurons and abnormal firing patterns in the basal ganglia. Dyskinesias have been associated with decreased quality of life, and a number of methodologies to evaluate severity of dyskinesias are now available. Strategies to avoid, reduce, or eliminate dyskinesias include providing more continuous dopaminergic stimulation, administering an antidyskinetic agent, and surgery. Several new compounds that may provide an antidyskinetic effect are also under investigation.

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“…Another 4-month, open-label study in 10 patients with PD taking clozapine (mean dose of 30 mg/d) found that dyskinesia was significantly reduced from baseline after 1 week of treatment (P < 0.05) [50]. There was a greater reduction in dyskinesia after 2 weeks of treatment and the effect persisted through the remainder of the study.…”

Section: Clozapinementioning

confidence: 95%

Levodopa-induced Dyskinesia in Parkinson’s disease: Epidemiology, etiology, and treatment

Zesiewicz

Sullivan²,

Hauser³

2007

Curr Neurol Neurosci Rep

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Although levodopa is the gold standard for treating motor symptoms of Parkinson's disease (PD), long-term therapy leads to levodopa-induced dyskinesia (LID). Dyskinesia refers to involuntary movements other than tremor and most commonly consists of chorea that occurs when levodopa-derived dopamine is peaking in the brain ("peak-dose dyskinesia"). However, dyskinesia can also consist of dystonia or myoclonus and occur during other parts of the levodopa dosing cycle. New validated rating scales and home diaries can better help the health care provider assess the timing and severity of dyskinesia. The exact etiology of LID is unknown, but there is evidence that abnormal pulsatile stimulation of dopamine receptors may be contributory. Treatment of LID includes adjustment of PD medications to maximize "on" time without troublesome dyskinesia. Amantadine is the only medication available with demonstrated ability to reduce the expression of established LID without reducing antiparkinsonian benefit. Other medications that are currently being studied to treat established LID include antiepileptics and serotonergic medications. Deep brain stimulation of the subthalamic nucleus is now the most commonly used surgical procedure for PD patients, and it is very effective in treating LID.

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Low dosage clozapine effects on L-dopa induced dyskinesias in parkinsonian patients

Abstract: A low dose of clozapine appears to be beneficial for patients with L-dopa induced dyskinesias that do not respond to other drugs and therapeutic measures.

Cited by 42 publications

References 27 publications

Distribution of serotonin 5-HT2A receptors in afferents of the rat striatum

Distribution of serotonin 5-HT2A receptors in afferents of the rat striatum

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

Levodopa-induced Dyskinesia in Parkinson’s disease: Epidemiology, etiology, and treatment

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