Unbound MEDLINE

N-Methyl-D-Aspartate antagonists in levodopa induced dyskinesia: a meta-analysis.

Abstract

BACKGROUND
Levodopa-induced dyskinesias (LID) are amongst the most disabling side-effects of levodopa therapy for Parkinson's disease (PD). It has been suggested that that N-Methyl-D-Aspartate (NMDA)-receptor antagonist may reduce peak-dose dyskinesia in PD patients and may lead to motor improvement. In this study, we compared the efficacy of NMDA receptor antagonists versus placebo in the treatment of LID in PD through a meta-analysis of controlled trials.
METHODS
Electronic search of Pubmed (1990 - 2010), Medline (1966-2010), EMBASE (1974-2010) and other databases for relevant studies were performed. Controlled clinical trials of the effects of NMDA antagonists on LID that fulfill the study protocol were selected. Pooled data from included studies was then used to perform random and fixed effect models meta-analysis.
RESULTS
The search resulted in 11 randomized, placebo controlled clinical trials that involved a total of 253 PD patients with peak-dose LID. The outcome measures were various dyskinesia rating scales and the Unified Parkinson Disease Rating Scale (UPDRS) subscales III and IV. The analysis showed significant reduction in Standard Mean Difference (SMD) for UPDRS IV (SMD -1.45; 95%CI -2.28 to -0.63) and UPDRS III (SMD -0.41; 95%CI -0.69 to -0.12) after treatment with amantadine. Other included drugs did not show significant change in the outcomes measured.
CONCLUSION
This meta-analysis provides an update on the clinical trials and confirms the short-term benefits of amantadine therapy in the treatment of dyskinesia. The effects of other NMDA receptor antagonists need to be evaluated further in clinical trials.

Links

  • Aggregator Full Text

    • Authors

    Elahi B, Phielipp N, Chen R

    Institution

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

    Source

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 39:4 2012 Jul pg 465-72

    MeSH

    Amantadine
    Databases, Factual
    Disability Evaluation
    Double-Blind Method
    Dyskinesia, Drug-Induced
    Excitatory Amino Acid Antagonists
    Humans
    Levodopa
    Parkinson Disease
    Randomized Controlled Trials as Topic
    Receptors, N-Methyl-D-Aspartate
    Severity of Illness Index

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22728853