The Clinical And ～(99m)Tc-TRODAT-DAT-SPECT Study Of Three Kinds Of Therapy Project To The Parkinson's Disease

PART IThe clinical effects of three kinds of therapy project to the Parkinson' s diseaseObjective: To observe the efficacy and safety of three different kinds of therapy project to the movement ability, living quality, mood, sleep and dyskinesia, motor fluctuation in Parkinson' s disease.Methods: 63 PD patients were divided into three groups. 22 patients with levodopa, 25 patients with levodopa and piribedil, 16 patients with pribedil. At beginning, the informations were collected by a trained investigator from all cases with a standardized questionnaire in face-to-face interviews, after one month, three month and six minth, the same evaluations were done. All patients took no dopaminergic drug for at least 12h before each assessment. The data was analyzed with SPSS11.0 statistic software.Result: (l)In the patients with levodopa and piribedil , the all parts of UPDRS, Hoehn-Yahr stages, improved Weber, Hamilton rating scales (24 items) , Parkinson' s Disease Sleep Scale (PDSS) and PDQ distinctly changed compared with pre-treatment stage. After one-month treatment, in the patients with piribedil UPDRS total scores, UPDRSII-III, improved Weber and PDQ, Hamilton rating scales prominently improved. But after six month, only the changes of UPDRS total scores, UPDRSIII and Hamilton rating scales significantly excelled to pre-treatment. In the patients with levodopa, after one month, UPDRS total scores and UPDRSIII significantly decreased, but after six month, there was no change. (2) In the patients with levodopa and piribedil, after one month of treatment the grooved pegboard test showed that the mean times of right and left hand were significantly decreased, timed motor test showed that the mean motor numbers of right and left hand of patients in one minute were significantly increased, 10m turned back test showed the mean times of patients were significantly decreased. After six month, there was statistical difference in them. In the patients with piribedil, after one month, the three examinations significantly changed, but after six month, there were no changes. In the patients with levodopa,there were no difference in the grooved pegboard test, timed motor test and 10m turned back test. (3) After six month, in the patients with levodopa and piribedil, the dose of levodopa significantly decreased, acting time distinctly extended and there were no patient appeared dyskinesia and motor fluctuation. (4) The side effects of piribedil significantly exceed levodopa, but can be released by dopanliton.Conclusion: Not only using piribedil but with levodopa can significantly improved the movement ability, living quality, mood, sleep and dyskinesia, motor fluctuation in Parkinson' s disease. The combination of piribedil with LD may be more useful therapy for PD than LD alone. To early PD patients can choose only using piribedil or with a little levodopa, to late PD patients, choosing piribedil with levodopa can relax the sates of illness and extend the course of disease.Key Keywords: Parkinson's disease, Dopamine receptor agonist, Piribedil, LevodopaPART II99mTc-TRODAT-DAT-SPECT Study of three kinds of therapy project to the Parkinson's diseaseObjective: To investigate the effects of three different kinds of therapy project to the dopamine transporters in PD patients by the Single Photon Emission Computed Topography (SPECT) and analyzing with UPDRS.Methods: 63 PD patients were divided into three groups. 22 patients with levodopa, 25 patients with levodopa and piribedil, 16 patients with pribedil. At beginning, the information were collected by a trained investigator from all cases with a standardized questionnaire in face-to-face interviews, then all patients were carried through "Tc-TRODAT-DAT-SPECT examination. After six minth, the same evaluations were done. All patients took no dopaminergic drug for at least 24h before each assessment. The data was analyzed with SPSS11.0 statistic software.Result: (1) In the patients with levodopa and piribedil, the UPDRS total scores, UPDRSIII, Hoehn-Yahr stages, improved Weber distinctly changed compared with pre-treatment. After treament one month, in the patients with piribedil UPDRS total scores, UPDRSIII and improved Weber prominently improved. After six month, the changes of UPDRS total scores and UPDRSIII significantly excel to pre-treatment. In the patients with levodopa, after one month, UPDRS total scores and UPDRSIII significantly decreased, but after six month, there were no change. (2) In low-grade (H-YI-II1/2) patients, there were significantly activating of DAT in hypokinesia patients thantremor and rigidity. (3) After six month, the activating of DAT decreased 2. 78% in the patients with levodopa and piribedil, which is lowest. (4) There was a negative correlation of the percentage loss of striatal^c-TRODAT uptake from baseline with the change in total UPDRS score from baseline in patients with levodopa and increasing negative correlation with the change in UPDRSIII. But there was no correlation in the patients with levodopa and piribedil or with piribedil alone.Conclusions: Not only using piribedil alone but piribedil with a little levodopa can demonstrated a significantly reduction in loss of striatal "Tc-TRODAT uptake, a marker of dopamine neuron degeneration, compared with those treated with levodopa, during six month period. These imaging datas imply the need to further compare imaging and clinical end points of PD progression in long-term studies.