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Stopping Trimetazidine May Ease Parkinson’s Symptoms, Improve Quality of Life, Study Says

trimetazidine and Parkinson's symptoms

Discontinuing trimetazidine treatment in people with Parkinson’s disease may lessen their motor and non-motor symptoms and improve their quality of life, a study has found.

The study, “The Impact of Trimetazidine on Disease Severity and Quality of Life in Parkinson’s Disease,” was published in the journal Scientific Reports.

Trimetazidine, which is sold under the brand name Vastarel and also available as a generic, is an antianginal medication used as add-on therapy for treating stable coronary heart disease — conditions that cause a reduction of blood flow to the heart. It is approved for this indication in Europe and other countries but not in the U.S. 

Previous studies have shown trimetazidine to have adverse effects on motor function, including causing reversible parkinsonism, tremor, and orofacial dyskinesia (involuntary repetitive movements of the mouth and face). It can also worsen symptoms of existing movement disorders like Parkinson’s disease.

These effects may be caused by the medication’s piperazine core, a chemical compound also found in antipsychotic medications that have been reported to induce parkinsonism and worsen Parkinson’s symptoms. 

Piperazine is thought to block the action of dopamine receptors, which play an important role in movement regulation. 

Based on previous studies, in 2012, the European Medicines Agency recommended against the administration of trimetazidine to patients with Parkinson’s disease.

However, recent data show that this recommendation is not followed strictly enough, and trimetazidine is still being prescribed to people with movement disorders.

Researchers at University of Pécs in Hungary have now evaluated the impact of trimetazidine treatment on the severity of clinical symptoms and its effects on health-related quality of life in people with Parkinson’s disease. 

The study included 42 patients with Parkinson’s disease, at a mean age of 71.1 years, who had been prescribed trimetazidine. All patients were also taking oral anti-parkinsonian medications.

At the start of the study, patients had been taking trimetazidine for a mean of 6.5 years, at a mean dose of 72.1 mg. Participants underwent detailed neurological and neuropsychological assessments.

Trimetazidine was stopped and patients were again reevaluated three months later. Their oral antiparkinsonian treatment was kept stable until the follow-up.

Results showed significant lessening of Parkinson’s clinical symptoms at follow-up, measured by the Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), a four-part assessment of motor and non-motor Parkinson’s symptoms.

Clinically relevant improvements were observed upon discontinuation of trimetazidine according to changes in scores of different parts of the MDS-UPDRS, compared with the beginning of the study: a 25.7% change in part 1, which relates to non-motor experiences of daily living; a 23.8% change in part 2, which assesses motor experiences of daily living; a 28.5% change in part 3, a motor examination that included notable lessening in disturbances of posture, gait (walking) problems, and postural instability; and a 30.1% change in part 4, which also measured motor complications.

Trimetazidine discontinuation also lessened Parkinson’s disease severity in 16 patients (38.1%), including two whose motor symptoms completely disappeared. However, in these two cases, “discontinuation of antiparkinsonian medications resulted in the reemergence of Parkinsonian symptoms,” the researchers wrote.

They also noted an overall lessening of non-motor symptoms, especially sleep problems and depression. 

“The use of [trimetazidine] in patients with [Parkinson’s disease] and the negative impact of the drug on the severity of Parkinsonian symptoms seem to be clinically meaningful problems,” the researchers wrote.

Additionally, patients experienced better health-related quality of life, as measured using the 39-item Parkinson’s Disease Questionnaire, which assesses patient-reported health status and quality of life.

Stopping trimetazidine and using alternative antianginal treatment did not cause any cardiovascular events in these patients up to 12 months of follow-up.

“Our results provide clinical rationale for avoiding the use of [trimetazidine] in [Parkinson’s]. [Trimetazidine] seems to worsen the severity of Parkinsonian symptoms in a clinically meaningful manner and have a negative impact on the [health-related quality of life],” the team wrote. 

“Therefore, discontinuation of the drug in patients with [Parkinson’s] seems to be a clinically adequate therapeutic intervention,” they concluded.

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Study Finds Yoga and Occupational Therapy Program Well-received by Parkinson’s Patients

yoga

A fall prevention program that combines yoga and occupational therapy was well-received by people living with Parkinson’s disease, a new study reports.

Although the study didn’t find significant effects of the program on quality of life, participants perceived improvements in several domains, including social aspects and mobility, pointing to a need for more research to examine effects over a longer period of time.

The study, “Health-related quality of life changes after the merging yoga and occupational therapy for Parkinson’s disease program: A mixed-methods study,” was published in Complementary Therapy in Clinical Practice.

Parkinson’s disease can take a toll on a person’s health-related quality of life (HRQoL), a broad term that encompasses physical, mental, emotional, and social well-being, with a particular emphasis on how an individual’s health affects these aspects of their life.

Falls can contribute to poor HRQoL among people with Parkinson’s; as such, fall prevention programs might be expected to increase HRQoL.

One such program is Merging Yoga and Occupational Therapy (MY-OT). It involves the combination of yoga (to strengthen core muscles and improve balance) and occupational therapy (to provide education about reducing fall risk). Originally developed for stroke, a modified version of MY-OT has been adapted for people with Parkinson’s.

In the new study, 17 people with Parkinson’s completed an eight-week MY-OT program, including biweekly yoga and occupational therapy sessions. The participants were predominantly male (55.6%), married (72.2%), white (100%), college graduates (44.4%), and retired (88.9%); the average age was 71.7 years. The small and relatively homogenous sample size was an acknowledged limitation of this study.

Researchers measured the participants’ HRQoL eight weeks before starting the MY-OT program, immediately before the program, and immediately after the program. HRQoL was evaluated with the Parkinson’s Disease Questionnaire-8 (PDQ-8), a validated instrument for measuring HRQoL in people with Parkinson’s.

There were no statistically significant differences in HRQoL scores before or after MY-OT, or among subgroup comparisons.

The researchers noted that, since HRQoL tends to decline over time in people with Parkinson’s, a finding showing no significant difference could still be meaningful, as it could indicate that HRQoL isn’t getting worse. But, because this study was done in a fairly short period of time and did not include a control group, there isn’t much evidence to support that conclusion based only on this study.

“Thus, seeing no decline in HRQoL scores may be important, but a follow-up assessment would be necessary to track these changes and establish a clear relationship between HRQoL changes over time,” the researchers wrote.

After MY-OT, 16 of the study participants participated in one of two focus groups, during which they were asked about their impressions of the program.

Overall, the program was well-received. Most notably, participants reported that social aspects of the program were valuable.

“I think what I liked the best was the group and seeing myself in everybody else and having that reflected back to me and seeing the kindness of the humanity of the group and what they’re going through and … that’s what was the best for me,” one participant was quoted as saying.

“You know we could have done the same kind of thing as a home study. … But having the group here makes it a lot better,” said another.

Some participants also reported that the intervention helped them feel more mobile, allowed them to participate in day-to-day activities with greater ease, and lessened pain and bodily discomfort.

“In my walking … it took me about an hour to do 6 blocks. I now go over 22 blocks in an hour,” one participant said.

“Instead of it taking you 45 [minutes] to make the bed you can make it in 15,” said another.

A few participants also reported that the intervention made communication easier, helped reduce disease-related stigma, and helped facilitate better emotional well-being. Broadly, participants reported that the intervention helped them feel less stressed and more in tune with their bodies.

“I feel like I’m in such peace … before I used to be very anxious about things and worrying. I don’t do that too much now …. I just have kind of a peace over me that, you know, I’m going to be ok,” one participant was quoted.

Overall, the researchers concluded that, “Although quantitative results showed no significant improvement during the study time, participants in the MY-OT for PD program spoke to improvements in HRQoL over the course of the intervention.” They emphasized the need for more long-term research.

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STN-DBS Leads to Similar Benefits in Men and Women with Parkinson’s, Study Finds

STN-DBS men women

Apart from physical health-related quality of life — which seemed to improve to a greater extent in males — the benefits of subthalamic nucleus deep brain stimulation (STN-DBS) on motor, cognitive, and mental function are similar in men and women with Parkinson’s disease, a study has found.

The study, “Sex differences in the short-term and long-term effects of subthalamic nucleus stimulation in Parkinson’s disease,” was published in Parkinsonism and Related Disorders.

STN-DBS is a non-destructive surgical treatment for Parkinson’s disease that involves implanting a device to stimulate targeted regions of the brain with electrical impulses generated by a battery-operated neurostimulator.

Since its implementation, STN-DBS has become an accepted and effective therapeutic option to treat motor symptoms associated with Parkinson’s. It also is used to treat other complications caused by prolonged dopaminergic treatment in advanced forms of the disease.

“There have been discussions on the influence of sex on the effect of STN-DBS in PD. Several short-term studies have suggested that overall improvements in motor and non-motor symptoms following STN-DBS are similar between male and female PD patients, whereas the short-term results on sex differences in postoperative health-related quality of life (HRQoL) are inconsistent,” the researchers said.

In this study, a team of Korean scientists set out to investigate the influence of sex on short- and long-term effects of STN-DBS in Parkinson’s.

The prospective study analyzed the medical records of 48 men and 52 women with the disease who received STN-DBS between 2005 and 2013 at the Movement Disorder Center of Seoul National University Hospital (SNUH) and were followed for at least five years.

The patients’ motor, cognitive and mental function, as well as health-related quality of life, or HRQoL, were assessed in all participants at the start of the treatment (baseline), and at one and five years of follow-up. HRQoL was assessed using the 36-Item Short Form Health Survey (SF-36), which contains physical and mental component subscores.

With the exception of the physical component of the SF-36, no differences were found between men and women in the effects of STN-DBS on any of the clinical parameters from baseline to follow-up.

STN-DBS led to significant improvements in the physical component of the SF-36 in individuals from both sexes from baseline to one year of follow-up. However, this positive effect was more pronounced among men than among women.

In addition, the researchers found that improvements in the physical component of the SF-36 from baseline to five years of follow-up were only statistically significant in men.

“In conclusion, we found that STN-DBS led to a similar degree of short-term and long-term effects on motor function, depressive and cognitive symptoms, and functional status between male and female PD patients,” the researchers said.

“Nevertheless, the physical HRQoL appears to improve to a greater extent in men over a long-term observation,” they concluded.

The researchers said further studies are warranted “to reveal the precise mechanism underlying the sex-associated differences in postoperative HRQoL, and to design an effective strategy to improve HRQoL in women undergoing STN-DBS.”

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