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Post of the Week: Amantadine long term and dyskinesia


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#1 Dr. Okun

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Posted 07 March 2010 - 12:04 PM

Dear forum members,

As many of you know practitioners like to use amantadine for dyskinesia later in the course of PD. The question has always been how long do the effects last, or in other words are there lasting effects worth pursuing amantadine for a longer treatment period. Here these authors below tested the hypothesis by removing a group of patients and comparing them to a group not removed. The amantadine group seemed to have better anti-dyskinetic efficacy.

Here is the article abstract for those interested:

Long-term antidyskinetic efficacy of amantadine in Parkinson's disease
Elisabeth Wolf, MD 1, Klaus Seppi, MD 1, Regina Katzenschlager, MD 2, Guenter Hochschorner, MD 3, Gerhard Ransmayr, MD 4, Petra Schwingenschuh, MD 5, Erwin Ott, MD 5, Iris Kloiber, MD 6, Dietrich Haubenberger, MD 7, Eduard Auff, MD 7, Werner Poewe, MD 1 *
1Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
2Department of Neurology, Sozialmedizinisches Zentrum Ost, Vienna, Austria
3Department of Neurology, Neurological Center Rosenhügel, Vienna, Austria
4Department of Neurology, General Hospital Linz, Linz, Austria
5Department of Neurology, Medical University Graz, Graz, Austria
6Department of Neurology, Barmherzige Brüder Graz, Graz, Austria
7Department of Neurology, Medical University of Vienna, Vienna, Austria
email: Werner Poewe (werner.poewe@i-med.ac.at)
*Correspondence to Werner Poewe, Department of Neurology, Medical University Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria

Potential conflict of interest: Nothing to report.
Funded by:
Austrian Parkinson's Disease Study Group
Merz Pharma GmbH, Frankfurt, Germany
Sabine Embacher of the Clinical Trial Center (CTC)
Medical University Innsbruck

KEYWORDS
Parkinson's disease • amantadine • dyskinesia
ABSTRACT
Several randomized placebo-controlled trials have consistently shown antidyskinetic effects of amantadine in levodopa treated patients with advanced Parkinson's disease (PD). However, all of these were of short duration and there have been claims that the effect of amantadine on levodopa induced dyskinesias (LID's) wear off after about 9 months of treatment. This randomized placebo-controlled parallel-group study was performed to assess the long-term antidyskinetic effect of amantadine in 32 PD patients, who after having been on stable amantadine therapy for LID over at least one year- were switched in a double blind manner to amantadine or placebo and followed for 3 weeks. Dyskinesia duration and intensity were assessed by UPDRS IV items 32 and 33 as well as by patient's diaries. The primary outcome was the score change of UPDRS IV items 32 + 33 between baseline and 3 weeks after treatment as well as the between treatment group comparison of the score change of UPDRS IV items 32 + 33. There was a significant increase of UPDRS IV items 32 + 33 in patients treated with placebo from 3.06 (95% CI, 2.1-4.03) at baseline to 4.28 (95% CI, 3.1-5.4) at three-week follow-up (P = 0.02) compared with no significant change between baseline 3.2 (95% CI, 2.1-4.4) to follow-up 3.6 (95% CI, 2.3-4.8) in patients staying on amantadine. These findings argue for long-term antidyskinetic efficacy of amantadine in PD patients with LID's. © 2010 Movement Disorder Society
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#2 Guest__*

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Posted 14 March 2010 - 06:50 AM

Your post of the week was very timely for me. Most of my dyskinesias were gone after DBS surgery in 9/06. Several months later my neurologist put me on 100mg Amantadine 3 times a day which completely eliminated any remaining dyskinesias but he cautioned me that the effect might not last. Soon after I started noticing the web-like veins showing on my leg so we reduced the dose to twice per day and this side effect went away but after three years on this I am still dyskinesia free.

#3 Dr. Okun

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Posted 14 March 2010 - 12:50 PM

So glad this worked for you and thanks for sharing your story.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#4 Woody

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Posted 30 March 2010 - 11:08 PM

Hi Doctor
My husband went onto Amantadine a week ago for relief of dyskinesias, he is 48, diagnosed 12 years now....
So far no relief at all and his total meds regime at this stage, 'seems' compromised - he hasnt been 'on' fully for a week now.

Any ideas?

Woody

#5 Dr. Fernandez

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Posted 25 May 2010 - 03:56 PM

Could be that Amantadine is not for him, and he needs a change. Or, it can be that he needs a higher dose. The top dose is typically 400 mg per day.

Yours
Hubert H. Fernandez




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