Review/Advanced in Neurological Therapeutics (2018). Parkinson's disease and related disorders

Abstract

We review reports published in 2018 providing new information on the management of Parkinson's disease (PD) and its related disorder. Adjunct zonisamide to levodopa improved parkinsonism in dementia with Lewy body, without worsening cognitive function or psychiatric symptoms. Camicinal, a gastroprokinetic resulted in significant reduction of off–time and significant decrease in motor symptom in patients with PD, which occurred in parallel with more rapid absorption of levodopa. Subcutaneous apomorphine infusion during waking hours (16 hour a day) significantly reduced off–time. Sodium oxybate, a first–line treatment in narcolepsy, improved excessive daytime sleepiness (EDS) and Epworth Sleepiness Scale (ESS) score in patients with PD. Rasagiline also showed beneficial effects on sleep quality in patients with PD with sleep disturbances. Safinamide improved PD chronic pain in the long term (2–year). Subthalamic nucleus (STN) deep brain stimulation (DBS) slowed rest tremor progression in early PD. STN–DBS decreased restless legs syndrome symptoms in patients with PD and the improvement was sustained over a 2–year period. STN–DBS was effective in improving impulse control disorders and neuropsychiatric fluctuations in the long term. The first randomised blinded evaluation of DBS in the caudal zona incerta (cZi) showed its efficacy on PD symptoms, especially for tremor. The doses of dopaminergic medications did not decrease. PRX002 is a humanized monoclonal antibody designed to target aggregated forms of α–synuclein. Multicenter, randomized, double–blind, placebo–controlled, multiple ascending–dose trial (phase Ib) in 80 patients with PD showed that single and multiple doses of PRX002 were generally safe and well tolerated and resulted in robust binding of peripheral α–synuclein. ProSavin is a lentiviral vector–based gene therapy that delivers local and continuous dopamine. Long–term follow up of a Phase I/II Study of ProSavin showed a significant reduction of off–time in patients with PD. ProSavin continued to be safe and well tolerated.