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Motor fluctuations associated with levodopa therapy are common problems encountered in the long-term treatment of Parkinson's disease(PD). Entacapone,a peripherally acting,reversible inhibitor of catechol-O- methyltransferase,slows the elimination of levodopa in humans by reducing the formation of 3-O-methyldopa.We conducted a placebo-controlled,double- blind,parallel-group,multicenter trial of entacapone in PD patients with motor fluctuations.Two hundred five patients were randomized to receive either entacapone 200 mg or matching placebo with each dose of levodopa and were followed for 24 weeks.The primary measure of efficacy was the change in percentage of"on"time(relief of parkinsonism)while awake,as recorded by subjects at home in diaries completed at 30-minute intervals. At baseline,patients averaged approximately 10 hours of"on"time per day while awake(60.5%"on"time),and entacapone treatment increased the percentage"on"time by 5.0 percentage points.The effect of entacapone was more prominent in patients with a smaller percentage"on"time(<55%)at baseline,and increased as the day wore on.Entacapone is effective at increasing the duration of response to levodopa and at relieving parkinsonism in patients experiencing motor fluctuations and was well tolerated during the 24 weeks of treatment.newabs PC5BN Restoration of a long-lasting euglycemic state by a functioning pancreatic transplantation (PTx)is the most logical treatment for insulin-dependent diabetes mellitus and for amelioration of secondary complications,including neuropathy.We evaluated neurological function by clinical examination,nerve conduction studies,and autonomic function tests in 115 patients with a functioning PTx and in 92 control patients treated with insulin,at baseline and 1,2,3, 5.5.7,and 10 years later.In control patients,neuropathy progressively worsened during followup.The clinical examination score and composite indices also decreased but significantly only after one year.In patients who received a successful PTx,the neuropathy improved.The motor and sensory nerve conduction indices increased significantly at all intervals after transplantation,whereas the clinical examination and autonomic tests improved only slightly.Patients who received either a PTx alone,a PTx after a kidney graft,or simultaneous pancreatic and kidney transplantations improved similarly over the followup.These results indicate that a functioning PTx halts the progression and improves the signs of diabetic polyneuropathy by restoration of a normoglycemic state. |
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catechol-o-methyltransferase inhibitor
entacapone
enzyme inhibition
Parkinson disease
Parkinson disease,fluctuations in
Parkinson disease,treatment of
Parkinson disease,wearing off
treatment of neurologic disorder
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