New approaches to treatments for sleep, pain and autonomic failure in Parkinson's disease - Pharmacological therapies

Rukavina, Katarina; Batzu, Lucia; Leta, Valentina

doi:10.1016/j.neuropharm.2022.108959

Cited by 7 publications

(8 citation statements)

References 142 publications

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“…A high proportion (87.05%) of PD patients developed more than one NMS in the past month and the autonomic disorders were the most common NMSs. Besides, in accordance with others, pain and depression were relatively common in this study [34] . PD patients often complain pain symptoms, especially musculoskeletal and dystonia pain [35] .…”

Section: Overview Of Nmsssupporting

confidence: 92%

Risk Factors of Non-motor Symptoms in Different Stages of Parkinson’s Disease

Jiang,

Jin,

et al. 2023

Preprint

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Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder and non-motor symptoms can affect the treatment nature of PD. Aims: To investigate the clinical features and NMSs at different Hoehn and Yahr (H&Y) stages among patients with PD, and the risk factors of common NMSs. Methods: We collected the clinical characteristics of 193 PD patients and used binary logistic regression analysis to evaluate the risk factors of NMSs among three groups based on H&Y stage. Results: The results showed that 87.05% of PD patients had more than one NMS. Clinical features varied across three groups including disease duration, right upper limb onset, motor subtypes, antiparkinson drugs administration and Levodopa equivalent daily dose (LEDD). Autonomic disorders were the most common NMSs in which the prevalence of constipation was the highest. For risk factors of NMSs, antiparkinson drugs were dominant. Longer disease duration was a risk factor for pain and urinary dysfunction at early stage, respectively. Gender and LEDD by disease duration might be associated with depression and orthostatic hypotension at intermediate stage, respectively. Conclusions: Pain and constipation were the most common NMSs in PD patients. Chinese PD patients often turn to Chinese Medicine, especially acupuncture, to treat NMSs such as pain. Our study will help clinicians to accurately judge the possibility of PD patients developing certain NMSs and their risk factors at different H&Y stage, and to guide medication regimen to a certain extent, so as to better manage patients.

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Section: Overview Of Nmsssupporting

confidence: 92%

Risk Factors of Non-motor Symptoms in Different Stages of Parkinson’s Disease

Jiang,

Jin,

et al. 2023

Preprint

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“…Treatments for pain in PwP have been very recently reviewed by Rukavina et al , who summarised that, to date, only three drugs (rotigotine, oxycodone/naloxone, and duloxetine) had been investigated specifically for their analgesic effects in PwP in double-blind RCT setting [ 125 ]. None of the studies met their primary endpoint [ 122 , 126 , 127 ].…”

Section: Painmentioning

confidence: 99%

Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson’s Disease: An Update Since 2017

Wamelen

Rukavina

Podlewska

et al. 2023

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Background: Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson’s disease (PD). However, a robust evidence base for their treatment is still a major unmet need. Objective: To provide an updated review on advances in pharmacological, non-pharmacological, and exercise- based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations. Methods: We performed a literature search to identify pharmacological, non-pharmacological, and exercise- based interventions for NMS in PD. As there are recent reviews on the subject we have only included studies from the 1 st of January 2017 to 1 st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials. Results: We discuss new strategies to manage NMS based on data that have become available since 2017, for instance on treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness. Conclusion: Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options may have a significant beneficial effect on quality of life and need to be considered in the pathways of treatment of PD.

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“…To date, the exploitation of the central pharmacology of the A 2A receptor has centered on the use of antagonist molecules for the treatment of PD, and for that reason, it will form the backbone of this review. However, since PD is characterized by both motor and non-motor symptoms, including a range of neuropsychiatric symptoms (depression, cognitive decline, sleep disturbance), this may hint at the potential of adenosinergic modulation as a target for central nervous system disorders in general [ 28 , 29 , 30 ]. A limitation with the current symptomatic therapies for PD is that they are almost entirely based on dopamine-replacement therapy (levodopa, dopamine agonists, enzymatic inhibitors) that shows a loss of efficacy (response fluctuations such as ‘wearing off’) with disease duration and severity, and where significant side effects occur (dyskinesia, hallucinations, impulse control disorders, sleep disturbance) [ 31 ].…”

Section: Adenosine a 2a Receptors And Parkinson’s ...mentioning

confidence: 99%

“…In addition, most non-motor symptoms are only partially responsive to dopaminergic drugs, leaving a high degree of unmet need [ 8 ]. However, the widespread adaptive changes that occur within the basal ganglia as a result of the loss of dopaminergic neurons affect multiple neuronal systems that are non-dopaminergic in nature, offering potential new targets for treating both motor and non-motor symptoms [ 30 , 32 ].…”

Section: Adenosine a 2a Receptors And Parkinson’s ...mentioning

confidence: 99%

The Pharmacological Potential of Adenosine A2A Receptor Antagonists for Treating Parkinson’s Disease

et al. 2022

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The adenosine A2A receptor subtype is recognized as a non-dopaminergic pharmacological target for the treatment of neurodegenerative disorders, notably Parkinson’s disease (PD). The selective A2A receptor antagonist istradefylline is approved in the US and Japan as an adjunctive treatment to levodopa/decarboxylase inhibitors in adults with PD experiencing OFF episodes or a wearing-off phenomenon; however, the full potential of this drug class remains to be explored. In this article, we review the pharmacology of adenosine A2A receptor antagonists from the perspective of the treatment of both motor and non-motor symptoms of PD and their potential for disease modification.

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New approaches to treatments for sleep, pain and autonomic failure in Parkinson's disease - Pharmacological therapies

Cited by 7 publications

References 142 publications

Risk Factors of Non-motor Symptoms in Different Stages of Parkinson’s Disease

Risk Factors of Non-motor Symptoms in Different Stages of Parkinson’s Disease

Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson’s Disease: An Update Since 2017

The Pharmacological Potential of Adenosine A2A Receptor Antagonists for Treating Parkinson’s Disease

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