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April 19, 2002


Long-Term Benefits Found in Two Drugs Used to Treat Hallucinations in Parkinson's Disease Patients

Two drugs used to treat hallucinations in patients with Parkinson's disease (PD) can not only reduce hallucinations, but may also lead to long-term benefits in these patients, according to a group of Emory University researchers. The long-term benefits may include reduced mortality and a reduced risk of nursing home placement. The drugs studied were the atypical antipsychotics quetiapine (trade name Seroquel®) and clozapine (trade name Clozaril®).

Jorge Juncos, M.D., associate professor of neurology, Emory University School of Medicine, and colleagues will present their findings at the American Academy of Neurology 54th Annual Meeting in Denver, Colo., on April 18. The research will also appear as an abstract in the April issue of the journal, Neurology.

"Drug-induced psychotic symptoms, such as visual hallucinations, are seen in a significant number of patients with advanced PD," says Dr. Juncos. "Approximately 15 to 20 percent of PD patients may experience these hallucinations over time. They are due to a interaction between the progression of the illness and the drugs used to treat its symptoms," Dr. Juncos explains.

The Emory researchers conducted a retrospective chart review between 1996 and 2001 in 27 patients with advanced PD (mean duration of illness of 13 years, plus or minus six years). Hallucinations had been treated for approximately 36 months using quetiapine in 23 patients and clozapine in four patients. "We compared the antipsychotic efficacy, mortality and risk of nursing home placement to published historical data (Goetz & Stebbins, Neurology 1996) in similarly affected patients treated with low doses of typical anti-psychotics before 1996," Dr. Juncos says.

Based on clinical exams or caregiver reports, Emory researchers found hallucinations in these patients were reduced by almost half (from 100 to 59 percent) while patients were on one of the study medications. Symptoms of agitation were also reduced (from 37 to 19 percent). During the 36 months of observation, the mortality rate for the group was 52 percent for outpatients and 62 percent for nursing home residents. This mortality rate is somewhat higher than the estimated general mortality rate of 36 percent for all PD patients after 13 years of illness. However, this mortality rate is lower than the mortality rate of 80 percent reported prior to 1996 for patients with PD and hallucinations residing in nursing homes and treated with typical antipsychotics. By the end of the 36-month follow-up, 50 percent of hallucinating PD patients had been placed in nursing homes. That number was a significant improvement from the 80 percent reported by others before 1996.

"These preliminary results support the view that quetiapine and clozapine may have long-term benefits in PD patients with hallucinations," Dr. Juncos says. "This benefit may translate into reduced mortality and a reduced risk of nursing home placement."

The Emory University American Parkinson Disease Association Center of Excellence in PD Research and the Fauver Family Foundation supported this study.

Parkinson's disease is a progressive disorder of the central nervous system, affecting over one million people in the United States.

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