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A progressive disorder of the nervous system marked by muscle tremors, muscle rigidity, decreased mobility, stooped posture, slow voluntary movements, and a mask-like facial expression.

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Haloperidol versus placebo for schizophrenia

Haloperidol was first developed in the late 1950s. Research subsequently showed its therapeutic effects on the symptoms of schizophrenia, such as hearing voices and seeing things (hallucinations), having strange beliefs (delusions), aggressiveness, impulsiveness and states of excitement. This led to the introduction of haloperidol as one of the first antipsychotic drugs. Antipsychotic drugs are the main treatment for the symptoms of schizophrenia. Despite the introduction of newer antipsychotic drugs (second generation or ‘atypical’ drugs), haloperidol remains in widespread use and is the benchmark for judging the effectiveness of newer antipsychotic drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Lisuride versus bromocriptine for levodopa‐induced complications in Parkinson's disease

Background: Long‐term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Speech and language therapy for speech problems in Parkinson’s disease

Many people with Parkinson's disease suffer from disorders of speech. The most frequently reported speech problems are weak, hoarse, nasal or monotonous voice, imprecise articulation, slow or fast speech, difficulty starting speech, impaired stress or rhythm, stuttering and tremor. People with the condition also tend to give fewer non‐verbal cues such as using facial expression to convey information. These disabilities tend to increase as the disease progresses and can lead to serious problems with communication.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa in its treatment.

One trial compared pramipexole with bromocriptine but this was not designed to examine differences between the two treatments as there were too few patients included. However, there was a larger reduction in the time patients spent in the immobile off state with pramipexole therapy compared with bromocriptine by an average of 1.4 hours. No differences occurred in dyskinesia rating scale, dyskinesia as a side effect or Unified Parkinson's Disease Rating Scale (UPDRS) complication score. The UPDRS activities of daily living and motor scores showed similar improvements compared to placebo with both agonists. Levodopa dose reduction was similar with both agonists. Subscales of a quality of life measure, the Functional Status Questionnaire, showed significant improvements compared to placebo with both agonists. The finding that another quality of life scale, the EuroQol, improved significantly compared with placebo with pramipexole but not bromocriptine should be treated with caution. Side effects such as nausea, vomiting, and faintness were similar with each agonist, as was the withdrawal from treatment rate.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

[Does eradication of the organism Helicobacter pylori from the gut of patients with Parkinson's disease improve the absorption of the main drug used to treat patients symptoms?]

Helicobacter pylori (H pylori) is a common infection of the gut and is often associated with duodenal and gastric ulcers. The exact mechanism is unknown but there is some evidence that infection with H pylori can interfere with the absorption of some drugs in the gut. One such drug is levodopa, the main drug used to treat the motor symptoms of Parkinson's disease. Whilst levodopa is very effective for treating Parkinson's symptoms, after time it can become less effective in some patients which may be due to variable absorption. If H pylori is eradicated with the use of antibiotics then absorption of levodopa may be improved and in turn the patient's motor symptoms may be improved.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Opicapone (Ongentys) for Parkinson's disease: Overview

Opicapone (trade name: Ongentys) has been approved in Germany since June 2016 for adults with advanced Parkinson's disease.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 26, 2017

Pergolide versus bromocriptine for levodopa‐induced complications in Parkinson's disease

Background: Long‐term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Bromocriptine/levodopa combined versus levodopa alone for early Parkinson's disease

Parkinson's disease is a disabling condition characterised by slowness of movement, trembling (tremors) and stiffness. Currently, the best treatment is levodopa. However, according to the number of levodopa treatment years, new disabling fluctuations of movement occur. To overcome this problem, bromocriptine has been tried in combination with levodopa. This review of relevant published trials found no evidence that early use of combined bromocriptine/levodopa prevents or delays such fluctuations of movement in patients with Parkinson's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

The COMT inhibitors entacapone and tolcapone show similar benefits in relieving levodopa‐induced complications in Parkinson's disease but more data on the safety of tolcapone is required.

As Parkinson's disease progresses the control of the symptoms often requires the addition of other drugs to levodopa. The principle aim of COMT inhibitor therapy is to increase the duration of effect of each levodopa dose and thus reduce the time patients spend in the relatively immobile 'off' phase. Tolcapone and entacapone can be used to reduce off time, reduce levodopa dose, and modestly improve motor impairment and disability. This is based on, at best, medium term evidence. However some participants on tolcapone had raised liver enzymes. Post‐marketing surveillance identified three cases of fatal hepatic toxicity in patients treated with tolcapone. As a result, tolcapone has been withdrawn from some countries and severe restrictions on its use have been imposed in others.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Creatine for Parkinson's disease

Parkinson's disease is one of the most common neurodegenerative disorders and mitochondrial dysfunction plays an important role in its pathogenesis. Creatine has been shown to help improve mitochondrial function and may, therefore, useful for treating people with Parkinson's disease. Researchers from the Cochrane Collaboration examined the evidence on whether creatine is effective and safe to treat people with Parkinson's disease, used alone or as an adjuvant treatment, up to 10 November 2013.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Parkinson's: Can exercise help?

People with Parkinson's can improve their flexibility and coordination by doing exercise. Regular exercise can help to cope better with everyday activities.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 27, 2015

There is not enough evidence about the safety and effectiveness of amantadine for people with Parkinson's disease.

Parkinson's disease causes progressive muscle rigidity, tremors and other symptoms. The most common drug used to try and relieve these symptoms is levodopa, but serious physical and psychiatric adverse effects are common. Amantadine is another option, used alone or with levodopa. Amantadine can have serious adverse effects (including psychiatric problems), and people can become resistant to the drug. The review found that there is not enough evidence from trials about the effects of amantadine for people with Parkinson's disease. Adverse effects in trials so far have not been severe, and included skin rash, dry mouth and blurred vision.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Physiotherapy for the treatment of Parkinson's disease

In spite of various medical and surgical treatments for Parkinson's disease (PD) patients gradually develop significant physical problems. Physiotherapists aim to enable people with PD to maintain their maximum level of mobility, activity and independence through the provision of the appropriate treatment. A range of approaches to movement rehabilitation are used, which aim to enhance quality of life by maximising physical ability and minimising secondary complications over the whole course of the disease. Evidence has shown that physiotherapy has short‐term benefits in PD, however which approach of physiotherapy is most effective remains unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD

Dementia is frequently associated with Parkinson's Disease. While a number of neurotransmitters appear to be involved, loss of cholinergic functioning is particularly associated with Parkinson's Disease Dementia (PDD) suggesting a potential utility for cholinesterase inhibitors. Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD. There was a clinically meaningful benefit in 15% of patients. Efficacy in other domains requires confirmation. Tolerability in particular nausea, vomiting and tremor appear problematic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Anticholinergic drugs can improve movement symptoms of Parkinson's disease, but with adverse mental effects, and there is not enough evidence to compare the different drugs.

Anticholinergics were the first drugs available for Parkinson´s disease and they are still widely used. They are believed to work by counteracting an imbalance which exists in Parkinson´s disease between two chemicals in the brain which transmit messages between nerve cells. However, anticholinergic drugs have been associated with unfavourable side effects. They are used alone, or with other anti‐Parkinson's drugs. The review of trials found that anticholinergics can improve movement problems in people with Parkinson's disease, but also cause adverse mental effects (such as confusion, memory problems, restlessness and hallucinations). There is not enough evidence to compare the different anticholinergic drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Monoamine oxidase B inhibitors compared with other treatments in early Parkinson's

Many of the symptoms of Parkinson's disease are due to the loss of certain groups of nerves in the brain, which results in the lack of a chemical called dopamine. Currently, there are several different treatments available for people with newly diagnosed Parkinson's including levodopa (Sinemet or Madopar) which is converted into dopamine in the brain, dopamine agonists (for example, ropinirole and pramipexole) which mimic the action of dopamine, and monoamine oxidase B (MAO‐B) inhibitors (selegiline or rasagiline) which reduce the breakdown of dopamine in the brain. Each of these types of drugs has theoretical advantages and disadvantages. For example, although a very good treatment, levodopa can cause involuntary movements (dyskinesia), painful cramps (dystonia) and a shortened response to each dose (motor fluctuations) after a while, whilst MAO‐B inhibitors and dopamine agonists may reduce the risk of these complications but are not so good at improving the symptoms of Parkinson's. At present, therefore, it is not clear which of these three groups of drugs should be prescribed when people with early Parkinson's first need treatment. We reviewed the trials that compared giving MAO‐B inhibitors with other types of medication in people with early Parkinson's to see if there was good evidence that MAO‐B inhibitors were the best treatment to offer. However, unfortunately we only identified two trials (593 patients) so there was only limited evidence. The results showed that MAO‐B inhibitors were less good at improving the symptoms of Parkinson's than either levodopa or dopamine agonists but that they may reduce motor fluctuations compared with levodopa, though not compared with dopamine agonists. MAO‐B inhibitors did, however, have fewer major side effects than some dopamine agonists.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

The effect of anti‐inflammatory drugs in protecting the nerve cells involved in Parkinson's Disease

Different agents have been examined for their effects in protecting the nerve cells that die in Parkinson's disease (PD). These are often called neuroprotective or disease‐modifying agents. They can act by preventing the onset of the disease itself (called primary prevention) or by halting the progression of PD once it has been established (called secondary prevention). Inflammation in the nervous system is thought to be one of the possible mechanisms of nerve cell death in PD, which has led investigators to look at the potential of anti‐inflammatory drugs in PD. The current review aimed to look at the effects of anti‐inflammatory drugs on both preventing the onset of PD and also on symptoms and the progression of disease in people who already have PD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Treadmill training for people with Parkinson's disease

Question: We assessed whether treadmill training and body weight support, individually or in combination, could improve walking in people with Parkinson's disease when compared with other gait training methods or no treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Speech and language therapy for speech problems in Parkinson's disease

Many people with Parkinson's disease suffer from disorders of speech. The most frequently reported speech problems are weak, hoarse, nasal or monotonous voice, imprecise articulation, slow or fast speech, difficulty starting speech, impaired stress or rhythm, stuttering and tremor. People with the condition also tend to give fewer non‐verbal cues, such as facial expressions and hand gestures. These disabilities tend to increase as the disease progresses and can lead to serious problems with communication.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Cabergoline for levodopa‐induced complications in Parkinson's disease

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (choreoathetosis), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end‐of‐dose deterioration' or the 'wearing‐off effect'. Dopamine agonist drugs act by mimicking levodopa in the brain, but they do not cause these long‐term treatment complications when used as initial therapy. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Cabergoline is a new dopamine agonist recently licensed in the UK for the treatment of later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how effective it is and what side effects it causes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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