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Am Fam Physician. 1999;60(4):1213-1214

Laser Pointers May Help Persons with Parkinson's Disease

(51st Annual Meeting of the American Academy of Neurology) A hand-held laser pointer may help persons with Parkinson's disease alleviate a sudden and frustrating condition that causes muscles to become stiff and unmovable in some patients, according to a study of six patients with Parkinson's disease conducted at the University of Rochester (N.Y.). The condition is a common complication of Parkinson's disease and is known as sudden transient freezing. The patients in the study were asked to “step” on the laser's light, which the patients pointed 2 ft in front of themselves during a freezing episode. Each participant was tested on the ability and speed in which he or she was able to move onto the light beam. The speed and ability of movements of the patients were also measured when they were not using a laser pointer. Three of the patients improved an average of 20 percent using the laser pointer. One patient did not improve while she held her own laser pointer, but she did improve when assisted by a researcher. Two patients did not have a freezing episode while walking during the study. The researchers believe that using a laser pointer is an inexpensive and practical way to help patients who have this condition.—lin zhang, m.d., ph.d., et al., University of Rochester, Rochester, N.Y.

Pramipexole Is Effective in the Treatment of Early Parkinson's Disease

(American Academy of Neurology) Two open-label studies have shown that pramipexole is well tolerated and effective as initial treatment in patients with Parkinson's disease without the use of levodopa for up to three years. The open-label studies were begun after the conclusion of two double-blind placebo-controlled studies. There were 282 patients in one of the open-label studies and 222 patients in the second open-label study. Following a lowering of the dosage at the end of the double-blind studies, the dosage of pramipexole was titrated to a maximum tolerable dosage or up to a maximum of 4.5 mg per day. The mean dosage in both studies was 4.0 mg per day. The patients were evaluated on the basis of the United Parkinson's Disease Rating Scale. Over 50 percent of the patients have been treated successfully without the use of levodopa. Side effects in patients with early Parkinson's disease included nausea, dizziness, drowsiness and insomnia. Frequent side effects reported in patients with advanced stages of Parkinson's disease were postural hypotension, dyskinesias, extrapyramidal syndrome, insomnia, dizziness and hallucinations. The investigators recommend that patients be warned about the potential for postural hypotension and hallucinations during the course of treatment.—susan bressman, m.d., et al., Albert Einstein College of Medicine, New York, N.Y.

Botulinum Toxin May Help Patients with Tension-Type Headaches

(American Academy of Neurology) Results of an eight-week, double-blind, placebo-controlled study show that an injection of botulinum toxin may help relieve the pain associated with tension-type headaches. Sixteen patients, aged 23 to 64 years, who had tension-type headaches were in the study. The patients were randomized to receive injections of botulinum toxin or placebo in the muscles around the head. Tenderness of the muscles was evaluated before the injection and at one, two, four and eight weeks. The patients also kept a diary in which they recorded the severity of each headache. The patients who received placebo reported no changes in the number and severity of headaches, while the patients who received the injection of botulinum toxin reported less frequent and less severe headaches. No adverse effects were reported.—maja relja, m.d., ph.d., et al., University of Zagreb, Zagreb, Croatia.

Investigational Drug Appears Effective in Children with Epilepsy

(American Academy of Neurology) The investigational drug zonisamide appears to be effective for seizure control in children with epilepsy, according to data from studies in Japan that were reviewed by U.S. researchers. The investigators reviewed data on 815 children from 10 clinical studies conducted in Japan. The subjects ranged in age from three months to 26 years, which was the oldest age for some subjects who had started taking zonisamide while they were teenagers. The subjects were receiving zonisamide either alone or in combination with up to six other antiepileptic medications. The usual starting dosages were from 1 to 6 mg per kg of zonisamide per day (2 mg per kg was most common). Depending on the response, dosage was titrated upward to a maximum of 10 to 12 mg per kg. The investigators observed that a dosage of two 100-mg capsules per day was appropriate in this age group for optimal control of seizures. Adverse effects associated with therapy included drowsiness, ataxia, appetite loss and decreased mental activity.—john pellock, m.d., et al.,Medical College of Virginia.

Medication and Psychotherapy Together Help Relieve Depression

(152nd Annual Meeting of the American Psychiatric Association) Interim results of a large multi-center study indicate that a new combination of pharmacotherapy and psychotherapy is more effective than either medication or psychotherapy alone in the treatment of patients with chronic depression. A total of 681 patients who had been depressed for at least two years participated in the 80-week study. The medication in the study was nefazodone. The psychotherapy involved education to help the patient understand emotional triggers affecting his or her life. After 12 weeks, 85 percent of the patients who received a combination of the study drug nefazodone and psychotherapy showed significant improvement, compared with 55 percent of the patients who received the drug alone and 52 percent of the patients who underwent psychotherapy alone. The investigators believe that further studies are needed to determine if other common antidepressants and other forms of psychotherapy would produce similar results.—alan schatzberg, m.d., et al., Stanford University School of Medicine, Stanford, California.

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