普拉克索治疗帕金森病的临床疗效观察

目的 观察普拉克索治疗帕金森病的临床疗效.方法 对40例帕金森病病人进行统一评分量表(UPDRS)评分,其中6例病人未服用任何抗帕金森药物即予普拉克索治疗,其余病人在原药基础上加服普拉克索.用药12周后再次应用UDPRS量表进行评分.比较普拉克索治疗前后UDPRS量表分值的差异.部分帕金森病人采用2周,4周,8周,12周随访,对病情进行评分,来观察疗效.结果 40例病人经普拉克索治疗后,有效35例,有效率87.5%.治疗前后,大部分帕金森患者在UDPRS总评分、日常活动、运动功能、震颤、肌僵直、精神症状、开关现象等方面的评分改善均有统计学意义.而且对部分门诊病人的随访评分中发现,病人的各方面病情也有很大的好转.结论 普拉克索可有效改善帕金森病人的临床症状,是一种使用安全、疗效理想的抗帕金森病药物.     

Medications used to treat Parkinson's disease and the risk of gambling

Recent case–series studies indicated that a medication used to treat Parkinson's disease (PD), in particular Pramipexole, is associated with gambling. A case–series study cannot test this hypothesis; therefore, we need to design a case–control or cohort study to test the aforementioned hypothesis. Typical of a case–control design, we sampled on the dependent variable, which we defined as incident gambling in PD. A research neurologist, who was kept uninformed of the case–control status, retrospectively measured the exposure of interest (i.e. medications used to treat PD) by using the medical database system of Mayo Clinic Jacksonville. Eleven patients with PD without history of gambling, but had newly developed gambling, were matched by age and sex to the control group of 37 PD patients without gambling at a ratio of one case to at least three controls. Disease duration, age, and sex did not differ between cases and controls. Combined therapy with Pramipexole and levodopa did not increase the risk of gambling as compared to monotherapy with Pramipexole (OR, 0.15; 95% CI, 0.01–1.26). Treatment with Pramipexole was associated with increased risk of gambling and this association approached significance (OR, 3.6; 95% CI, 0.9–14.9). Patients with PD who newly developed gambling behavior were more likely to have been taking Pramipexole than other anti-PD medication. However, the association between Pramipexole and gambling behavior is not necessarily etiologic.     

Antidepressant effects of pramipexole, a novel dopamine receptor agonist

Summary Pramipexole (2-amino-4,5,6,7-tetrahydro-6-propyl-amino-benzthiazole-dihydrochloride), a new dopamine receptor agonist with preference for D₃ compared to D₂ and D₄ receptors, was tested in rats in respect of its potential antidepressant activity. In the forced swimming test the drug under study, given three times in rats, reduced the immobility time. In the forced swimming test, joint treatment with antidepressants (imipramine, amitriptyline) and pramipexole evoked a more potent effect than any of the drugs given alone; however, the locomotor hyperactivity was weaker after joint administration. Citalopram and fluoxetine, inactive per se in the forced swimming tests, visibly enhanced the antidepressant-like effect of pramipexole but, on the other hand, they attenuated the locomotor hyper-activity evoked by the drug. Repeated treatment with pramipexole (0.3 or 1 mg/kg, twice daily for 14 days) increased the locomotor activity measured at 1h after the last dose. Repeated administration of pramipexole (as above) potentiated the D-amphetamine- or quinpirole-induced locomotor hyperactivity.The obtained results indicate that, in the tests used, pramipexole evokes effects similar to those of typical antidepressants and, at the same time, enhances their activity (the forced swimming test in rats); therefore it may be regarded as a potential antidepressant drug.     

普拉克索在减轻小鼠肝缺血再灌注损伤中应用

目的探讨普拉克索(PPX)对小鼠缺血再灌注(I/R)后肝损伤的影响及机制。方法选择健康、雄性C57BL/6小鼠40只,随机分为4组:Sham+DMSO组、Sham+PPX组、I/R+DMSO组、I/R+PPX组,每组各10只。Sham组小鼠仅接受中线开腹、游离肝十二指肠韧带及关腹操作;I/R通过Pringle法诱导肝缺血再灌注模型。DMSO和PPX(1 mg/kg)均在术前30 min腹腔注射。再灌注3、6、24 h后检测血清谷丙转氨酶/谷草转氨酶(ALT/AST)水平,观察肝形态学变化;TUNEL染色了解肝细胞凋亡情况;通过试剂盒检测肝氧化应激指标MDA、HNE、SOD水平;使用Clark氧电极法检测肝线粒体功能指标RCR、ADP/O;检测肝ATP水平。结果与I/R+DMSO组比较,I/R+PPX组小鼠肝功能损伤指标ALT/AST水平显著降低(P<0.01),HE染色显示,I/R+PPX组小鼠肝细胞肿胀、排列紊乱、内皮细胞结构完整性破坏情况有明显改善(P<0.01);而从肝细胞凋亡统计情况可以看出,I/R+PPX组细胞凋亡数量减少(P<0.01);同时,I/R后的氧化应激指标水平较I/R+DMSO组显著减轻(P<0.05);I/R+PPX组肝线粒体功能水平及ATP生成水平较I/R+DMSO组显著提高(P<0.05)。结论 PPX能够保护肝线粒体功能,并进一步减轻肝的I/R损伤。     

盐酸普拉克索联合美多芭治疗100例帕金森病的临床研究

目的：探讨盐酸普拉克索联合美多芭治疗帕金森病的价值。方法200例帕金森病患者,根据治疗方案的不同分为研究组（治疗方案为美多芭+盐酸普拉克索）和对照组（治疗方案为美多芭）。结果两组治疗6周、治疗12周 UPDRS 帕金森评定量表评分比较有差异（ P <0.05）;研究组与对照组治疗的有效率分别是74.0%与61.0%,差异比较具有统计学意义（P<0.05）;两组治疗期间不良反应发生率比较无差异（ P>0.05）。结论盐酸普拉克索联合美多芭治疗帕金森病疗效肯定,安全性好。     

普拉克索治疗原发性不宁腿综合征的疗效和安全陛观察

目的 观察普拉克索对我国原发性不宁腿综合征(RLS)患者的治疗效果以及可能发生的不良反应. 方法 选择自2009年5月至11月在哈尔滨医科大学第二附属医院神经内科就诊的10例中到重度原发性RLS患者,给予普拉克索0.125～0.75mg/d,每日睡前2～3h顿服,持续治疗6周.利用国际RLS研究小组的RLS严重程度量表(mLS)、临床总体印象改善量表(CGI-I)、患者总体印象量表(PGI)和Epworth嗜睡量表(ESS)对患者治疗前后的RLS症状严重程度和嗜睡程度进行评估.并对结果进行统计学分析,同时记录不良反应.结果 (1)治疗后患者的IRLS评分较治疗前平均降低73.7%,比较差异有统计学意义(P<0.05),9例患者IRLS评分降低在50%以上;(2)治疗结束时,8例患者PGI评估选择"很好"或"非常好",9例患者CGI-I评估为"明显改善"或"非常明显改善";(3)患者ESS评分在治疗后较治疗前平均降低3.80±1.75,比较差异有统计学意义(P<0.05);(4)1例患者在治疗末期加量至0.5mg/d时出现轻度恶心,胃区不适,治疗结束停药2 d后症状自行消失;(5)1例患者首次用药后双下肢感觉异常和睡眠障碍即有明显改善.结论 为期6周的临床实验表明,在每日口服剂量为0.125～0.75 mg时,普拉克索对于我国原发性RLS的治疗是安全有效的.     

多巴胺受体激动剂对帕金森综合征的疗效分析

目的：探讨多巴胺受体激动剂普拉克索对于不同时期帕金森综合征的临床疗效及安全性。方法：将本院收治的108例帕金森综合征患者随机分为普拉克索组及美多巴组,分别给予普拉克索及美多巴治疗,分别于治疗前及治疗4周、8周后采用帕金森评定量表第Ⅲ部分（UPDRSⅢ）对两组患者的临床疗效进行评价,并观察两组患者不良反应的发生情况。结果：两组患者治疗4周UPDRSm评分比较,差异无统计学意义（P〉0．05）,而普拉克索组中晚期患者治疗8周后UPDRSⅢ评分显著低于美多巴组（P〈0．05）;普拉克索不良反应发生率显著低于美多巴组（P〈0．05）。结论：对于美多巴疗效较差的中晚期帕金森综合征患者,多巴胺受体激动剂能够达到良好的疗效,且安全性较高,值得临床推广应用。     

普拉克索与多巴丝肼治疗帕金森病的成本效果分析

目的 比较单用多巴丝肼与合用普拉克索治疗帕金森病两种方法效果.方法 采用对照研究方法,比较多巴丝肼治疗组(A组)及合用普拉克索治疗组(B组)的治疗效果及治疗成本.结果 B组虽然在药物费用及治疗费用方面较A组明显增加(P＜0.01),但其帕金森病综合量表评分显著下降(P＜0.05),而且在帕金森病各期均可应用.结论 联合应用普拉克索虽会加重药物成本及治疗成本,但在改善帕金森病各期临床症状方面效果更好,且可应用于不同分期的帕金森病患者,应个体化推荐.     

Effect of pramipexole on RLS symptoms and sleep: a randomized, double-blind, placebo-controlled trial

BackgroundPatients with Restless Legs Syndrome (RLS) often seek treatment because of sleep problems related to nocturnal symptoms. Our goal was to test the ability of pramipexole to improve sleep in RLS patients and to reconfirm its efficacy for primary RLS symptoms.MethodsAdults with moderate or severe RLS were randomized to receive placebo or pramipexole (flexibly titrated from 0.25 to 0.75 mg), 2–3 h before bedtime for 12 weeks. The co-primary outcome measures were change in Medical Outcomes Study (MOS) sleep disturbance score and International RLS Study Group Rating Scale (IRLS) score at 12 weeks.ResultsThe intent-to-treat population included 357 patients: 178 received pramipexole and 179 received placebo. At 12 weeks, the adjusted mean change from baseline was greater for pramipexole (vs. placebo) for IRLS score (−13.4 ± 0.7 vs. −9.6 ± 0.7) and MOS sleep disturbance score (−25.3 ± 1.5 vs. −16.8 ± 1.5) (p ⩽ 0.0001; ANCOVA). Responder rates (clinical and patient global impression and IRLS) were also significantly higher in the pramipexole group. RLS-QOL score was improved over placebo at Week 12 (p < 0.01) as were MOS sleep adequacy (p = 0.0008) and quantity (p = 0.08) scores. Nine percent of patients in each group withdrew because of adverse events.ConclusionsPramipexole is effective and well-tolerated for RLS and related sleep disturbance.     

KNS-760704 [(6R)-4,5,6,7-tetrahydro-N6-propyl-2, 6-benzothiazole-diamine dihydrochloride monohydrate] for the treatment of amyotrophic lateral sclerosis

Developing effective treatments for chronic neurodegenerative disorders such as amyotrophic lateral sclerosis (ALS) has proven extremely difficult. ALS is universally fatal, characterized by progressive weakness due to the degeneration of upper and lower motor neurons, and leads eventually to respiratory failure which is the usual cause of death. Only a single treatment has been approved, the modestly effective nonspecific neuroprotectant Rilutek (riluzole; 2-amino-6-(trifluoromethoxy)benzothiazole). KNS-760704 [(6R)-4,5,6,7-tetrahydro-N6-propyl-2,6-benzothiazole-diamine dihydrochloride, RPPX], a synthetic amino-benzothiazole with demonstrated activity in maintaining mitochondrial function, is being developed as a treatment for ALS. It has proven to be effective in multiple in vitro and in vivo assays of neuroprotection, including the G93A-SOD1 mutant mouse model; however, its specific mechanism of action remains unknown. The potential of KNS-760604 as a treatment for ALS was first suggested by studies showing that its optical enantiomer, Mirapex[(6S)-4,5,6,7-tetrahydro-N6-propyl-2,6-benzothiazole-diamine; pramipexole dihydrochloride; PPX], a high-affinity agonist at dopamine D2, D3, and D4 receptors, exhibits important neuroprotective properties independent of its dopamine receptor agonism. In cell-based assays, both RPPX and PPX reduce the production of reactive oxygen species (ROS), attenuate the activation of apoptotic pathways, and increase cell survival in response to a variety of neurotoxins. However, PPX has limited utility as a clinical neuroprotective agent because the drug concentrations required for neuroprotection would likely produce unacceptable dopaminergic side effects. RPPX, on the other hand, while possessing the same neuroprotective potential as PPX, is a much lower-affinity dopamine receptor agonist and may therefore be more useful in the treatment of ALS. This review will examine the data supporting the hypothesis that the RPPX may have therapeutic potential for the treatment of neurodegenerative disorders including ALS. In addition, we will briefly review recent preclinical data in support of RPPX, and discuss the current status of its clinical development.