Benserazide and carbidopa as substrates of catechol-O-methyltransferase: new mechanism of action in Parkinson's disease.
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On account of the conflicting data concerning the action of 5-HTP on human sleep, repeated high doses were administered to three healthy subjects. The paradoxical sleep time and percentage tend to show a decrease during the 2nd week of treatment, followed by a rebound effect after the end of the treatment. In two subjects who initially had a small amount of slow wave sleep (SWS), the treatment induced an increase in SWS that persisted after the end of the treatment. Similar results were obtained after administration of 5-HTP together with RO.04.4602.
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In this open study patients with advanced Parkinson's disease, who experienced pronounced fluctuations in symptoms while on standard L-dopa, were switched from Madopar/Sinemet to Madopar HBS. The dosage was adjusted until optimal response was obtained. The effect was unsatisfactory in 4 cases and side effects intervened in another 2. The remaining 16 patients exhibited substantial and frequently significant improvements with regard to both akinetic and dyskinetic phenomena. L-Dopa dosage was increased in all cases, and addition of standard L-dopa was required in one third of the cases. These benefits continued in the majority of patients.
In a open study in 13 patients with Parkinson's disease with 'on-off' fluctuations, all (n = 3) or part (n = 10) of the usual intake of levodopa (with peripheral decarboxylase inhibitor) was replaced by Madopar HBS for 5-122 days (median 35). Time 'off' increased in 2 of the 3 monotherapy subjects. With combined therapy, time 'on' was increased in 6, unchanged in 2 and reduced in 2. However, 11 of the 13 patients complained of reduced predictability of clinical response with Madopar HBS. Only 4 of the 13 patients preferred to continue with combined standard plus HBS treatment; this continued treatment led to an increase in time 'on' in 3 and a decrease in involuntary movements in 3 patients. Two of these four patients benefited on both counts.
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Ten advanced Parkinson pts (mean 8 years since diagnosis), 6 male and 4 female, 57 to 69 years old, mean 5.9 years on L-Dopa therapy, were put on Madopar HBS to assess the efficacy of the drug. All the pts had levodopa end-of-dose wearing-off type secondary motor fluctuations, 9 of them with dyskinesia and dystonia. Clinical evaluation was performed in basal conditions (pts on standard L-Dopa therapy) 1.6 and 12 months on Madopar HBS therapy. Parkinson signology was quantified with the modified Columbia scale (0 to 44), and motor fluctuations and dyskinesia with a scale 0 to 4 according to intensity and frequency. Pts received mean 1.150 mg. HBS daily dose plus 100 to 200 mg standard L-Dopa added to the early morning dose for a faster effect. At 12 months, a 60% decrease in "off" periods, a 50% decrease in feet dystonia, with no change in orofacial dystonia were observed. Dyskinesia decreased in intensity but not in frequency. There was a 50% decrease of Parkinson signology in "on" periods. In conclusion, Madopar HBS reduces the signology of the long-term Levodopa therapy syndrome and therefore is commendable in pts with advanced Parkinsonism.
The efficacy of a novel oral sustained-release preparation of levodopa/benserazide (Madopar HBS) was compared to that of previous conventional levodopa/benserazide treatment in 15 patients with idiopathic Parkinson's disease and with severe fluctuations in motor response to long-term levodopa therapy. In ten patients who suffered from clear-cut "end-of-dose" deterioration, significant benefit was obtained on HBS form, while 5 patients did not respond well to the new levodopa preparation. Plasma levels of levodopa were more stable with HBS compared to conventional levodopa preparation in our patients, although doses of HBS form required for an optimal response averaged 1.48 times that of previous conventional levodopa.
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