Parkinson Disease: Miyasaki JM

Miyasaki JM, Shannon K, Voon V, Ravina B, Kleiner-Fisman G, Anderson K, Shulman LM, Gronseth G, Weiner WJ, Anonymous00046. · University of Toronto, Canada. · Neurology. · Pubmed #16606910 No free full text.

Abstract: OBJECTIVE: To make evidence-based treatment recommendations for patients with Parkinson disease (PD) with dementia, depression, and psychosis based on these questions: 1) What tools are effective to screen for depression, psychosis, and dementia in PD? 2) What are effective treatments for depression and psychosis in PD? 3) What are effective treatments for PD dementia or dementia with Lewy bodies (DLB)? METHODS: A nine-member multispecialty committee evaluated available evidence from a structured literature review using MEDLINE, and the Cochrane Database of Health and Psychosocial Instruments from 1966 to 2004. Additional articles were identified by panel members. RESULTS: The Beck Depression Inventory-I, Hamilton Depression Rating Scale, and Montgomery Asberg Depression Rating Scale should be considered to screen for depression in PD (Level B). The Mini-Mental State Examination and the Cambridge Cognitive Examination should be considered to screen for dementia in PD (Level B). Amitriptyline may be considered to treat depression in PD without dementia (Level C). For psychosis in PD, clozapine should be considered (Level B), quetiapine may be considered (Level C), but olanzapine should not be considered (Level B). Donepezil or rivastigmine should be considered for dementia in PD (Level B) and rivastigmine should be considered for DLB (Level B). CONCLUSIONS: Screening tools are available for depression and dementia in patients with PD, but more specific validated tools are needed. There are no widely used, validated tools for psychosis screening in Parkinson disease (PD). Clozapine successfully treats psychosis in PD. Cholinesterase inhibitors are effective treatments for dementia in PD, but improvement is modest and motor side effects may occur.

Miyasaki JM, Martin W, Suchowersky O, Weiner WJ, Lang AE. · No affiliation provided · Neurology. · Pubmed #11781398 No free full text.

Abstract: In 1993, the last AAN Practice Parameter on medical treatment of Parkinson's disease (PD) concluded that levodopa was the most effective drug for management of this disorder. Since then, a number of new compounds including non-ergot dopamine agonists (DA) and sustained-release levodopa have been released and studied. Thus, the issue of treatment in de novo PD patients warrants reexamination. Specific questions include: 1) does selegiline offer neuroprotection; 2) what is the best agent with which to initiate symptomatic treatment in de novo PD; and 3) is there a benefit of sustained release levodopa over immediate-release levodopa? Using evidence-based principles, a literature review using MEDLINE, EMBASE, and the Cochrane Library was performed to identify all human trials in de novo PD between 1966 and 1999. Only articles that fulfilled class I or class II evidence were included. Based on this review, the authors conclude: 1) Selegiline has very mild symptomatic benefit (level A, class II evidence) with no evidence for neuroprotective benefit (level U, class II evidence). 2) For PD patients requiring initiation of symptomatic therapy, either levodopa or a DA can be used (level A, class I and class II evidence). Levodopa provides superior motor benefit but is associated with a higher risk of dyskinesia. 3) No evidence was found that initiating treatment with sustained-release levodopa provides an advantage over immediate-release levodopa (level B, class II evidence).

Lim SY, Evans AH, Miyasaki JM. · Movement Disorders Centre, Toronto Western Hospital, Toronto, Ontario, Canada. · Ann N Y Acad Sci. · Pubmed #18990123 No free full text.

Abstract: In the past decade, impulse control disorders, punding, and dopamine dysregulation syndrome (which we refer to collectively as disinhibitory psychopathologies) have been increasingly recognized in treated patients with Parkinson's disease. Practicing neurologists must understand these problems to limit potential harm. In this article, we summarize current knowledge regarding these behavioral disorders, including phenomenology, epidemiology, pathophysiology, and treatment.

Piboolnurak P, Lang AE, Lozano AM, Miyasaki JM, Saint-Cyr JA, Poon YY, Hutchison WD, Dostrovsky JO, Moro E. · Movement Disorders Center, Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada. · Mov Disord. · Pubmed #17443692 No free full text.

Abstract: Subthalamic nucleus deep brain stimulation (STN-DBS) is effective in advanced Parkinson's disease (PD), but its effects on the levodopa response are unclear. We studied the levodopa response after long-term STN-DBS, STN-DBS efficacy and predictive value of preoperative levodopa response to long-term DBS benefit in 33 PD patients with bilateral STN-DBS. Patients were assessed using the Unified Parkinson's Disease Rating Scale preoperatively (with and without medications) and postoperatively (without medications or stimulation, with only medications or stimulation, and with both medications and stimulation). Levodopa response significantly decreased postoperatively by 31.1% at 3 years and 32.3% at 5 years, possibly related to the reduction in medication requirement, direct STN stimulation effect or PD progression. STN-DBS alone significantly improved motor scores (37.2% at 3 years and 35.1% at 5 years) and activities of daily living scores (27.1% at 3 years and 19.2% at 5 years). Anti-PD drugs were significantly reduced by 47.9% at 3 years and 39.8% at 5 years. However, the magnitude of the preoperative response to levodopa did not predict DBS benefit at 3 and 5 years.

Voon V, Thomsen T, Miyasaki JM, de Souza M, Shafro A, Fox SH, Duff-Canning S, Lang AE, Zurowski M. · National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA. · Arch Neurol. · Pubmed #17296836 links to  free full text

Abstract: OBJECTIVE: To evaluate factors associated with pathological gambling (PG) in Parkinson disease (PD). DESIGN: Case-control study. SETTING: Outpatient tertiary clinic. Patients Twenty-one patients with idiopathic PD with PG after the patients began receiving medications compared with a consecutive sample of 42 patients with idiopathic PD without compulsive behaviors. MAIN OUTCOME MEASURES: Clinical features, comorbid psychiatric and substance use disorders, personality traits, and impulsivity scores. RESULTS: Patients with PG had a younger age at PD onset (P = .006), higher novelty seeking (P<.001), medication-induced hypomania or mania (P = .001), impaired planning (P = .002), or a personal or immediate family history of alcohol use disorders (P = .002). Novelty seeking, a personal or immediate family history of alcohol use disorders, and younger age at PD onset accurately predicted PG at 83.7% in a logistic regression model, with the model accounting for 62% of the variance. CONCLUSIONS: Patients with PD having a younger age at PD onset, higher novelty seeking traits, and a personal or family history of alcohol use disorders may have a greater risk for PG with dopamine agonists.

Miyasaki JM, Al Hassan K, Lang AE, Voon V. · Movement Disorders Centre, Toronto Western Hospital, University Health Network, Krembil Neuroscience Centre, University of Toronto, Toronto, Canada. · Mov Disord. · Pubmed #17230464 No free full text.

Abstract: The purpose of this study was to determine punding prevalence in an ambulatory Parkinson's disease (PD) population. We conducted a patient-and-caregiver-completed punding survey in 373 consecutive patients in an academic ambulatory center. Completion rate was 78%. Only four patients were identified as punding. Patients did not retain insight to their behavior. Forty patients with high-dose levodopa monotherapy or levodopa and dopamine agonist treatment had physician-administered interview. None had punding. Punding incidence was low in this patient group (1.4%) in contrast with previous reports of 14%. Despite the low incidence, this behavior is disruptive and should be carefully elicited by physicians caring for Parkinson's disease patients.

Miyasaki JM. · Movement Disorders Centre, Toronto, ON, Canada. · Nat Clin Pract Neurol. · Pubmed #17117162 No free full text.

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Nieves AV, Miyasaki JM, Lang AE. · Division of Neurology, Toronto Western Hospital, Ontario, Canada. · Mov Disord. · Pubmed #11215587 No free full text.

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Miyasaki JM, Grimes D, Lang AE. · No affiliation provided · Neurology. · Pubmed #10331717 No free full text.

This publication has no abstract.