Amantadine for dyskinesia in Parkinson's disease

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Abstract
Abnormal involuntary movements known as dyskinesias are amongst the most disabling side‐effects of levodopa therapy. It is thought that amantadine, an NMDA‐receptor antagonist, may reduce dyskinesias in patients with Parkinson's disease without worsening Parkinsonian symptoms. To compare the efficacy and safety of adjuvant amantadine therapy versus placebo in treating dyskinesia in patients with Parkinson's disease, already established on levodopa, and suffering from motor complications. Electronic searches of The Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2001), MEDLINE (1966‐2001), EMBASE (1974‐2001), SCISEARCH (1974‐2001), BIOSIS (1993‐2001), GEROLIT (1979‐2001), OLDMEDLINE (1957‐1965), LILACS (1982‐2001), MedCarib (17th Century ‐ 2001), PASCAL (1973‐2001), JICST‐EPLUS (1985‐2001), RUSSMED (1973‐2001), DISSERTATION ABSTRACTS (2000‐2001), SIGLE (1980‐2001), ISI‐ISTP (1990‐2001), Aslib Index to Theses (2001), Clinicaltrials.gov (2001), metaRegister of Controlled Trials (2001), NIDRR (2001) and NRR (2001) were conducted. Grey literature was hand searched and the reference lists of identified studies and reviews examined. The manufacturers of amantadine were contacted. Randomised controlled trials comparing amantadine with placebo in the treatment of dyskinesia in patients with a clinical diagnosis of idiopathic Parkinson's disease. Data was abstracted independently by NC and KD onto standardised forms and disagreements were resolved by discussion. Three randomised controlled trials were found comparing amantadine with placebo in the treatment of dyskinesia in patients with idiopathic Parkinson's disease. Three trials were excluded on the basis that they had no control group and a further three did not state whether they randomised the treatment that participants received. The included trials were double‐blind cross‐over studies involving a total of 53 patients. All three studies failed to present data from the first arm, instead presenting results as combined data from both treatment arms and both placebo arms. Two trials had no wash‐out interval between the treatment periods. In view of the risk of a carry‐over effect into the second arm, the results of these trials were not analysed. The final trial had a one week wash‐out interval but only examined 11 participants. One study reported side‐effects of amantadine in 8 of the 18 participants, including confusion and worsening of hallucinations. Another reported reversible edema of both feet in one of eleven participants. Due to lack of evidence it is impossible to determine whether amantadine is a safe and effective form of treatment for levodopa‐induced dyskinesias in patients with Parkinson's disease. 以Amantadine治療帕金森氏症的運動障礙 異常非自主性的動作稱為運動障礙，是levodopa治療的副作用中最容易使人殘障的。一般認為Amantadine這個NMDA受體拮抗劑，可能可以減少帕金森氏症的運動障礙，且不會惡化帕金森氏症的症狀。 比較安慰劑和輔助性amantadine治療，用於治療已經在使用levodopa且有運動併發症的帕金森氏病患的運動障礙的療效和安全性。 我們搜尋了The Cochrane Controlled Trials Register﹝The Cochrane Library 2001年，第3期﹞、MEDLINE﹝1966 – 2001﹞、EMBASE﹝1974 – 2001﹞、SCISEARCH﹝1974 – 2001﹞、BIOSIS﹝1993 – 2001﹞、GEROLIT﹝1979 – 2001﹞、OLDMEDLINE﹝1957 – 1965﹞、LILACS﹝1982 – 2001﹞、MedCarib﹝17世紀−2001﹞、PASCAL﹝1973 – 2001﹞、JICSTEPLUS﹝1985 – 2001﹞、DISSERTATIONABSTRACTS﹝2000 – 2001﹞、SIGLE﹝1980 – 2001﹞、ISIISTP﹝1990 – 2001﹞、Aslib Index to Theses﹝2001﹞、Clinicaltrials.gov﹝2001﹞、Controlled Trials的metaRegister﹝2001﹞、NIDRR﹝2001﹞和NRR﹝2001﹞等電子資源。手動搜尋了Grey literature以及檢視找到的研究中的參考資料。和amantadine的製造商連絡。 比較以amantadine和安慰劑治療臨床診斷罹患原發性帕金森氏症病患的運動障礙的隨機對照試驗。 分別由NC和KD將數據摘錄成標準格式，並經過討論解決意見分歧的部分。 我們找到了3個比較以amantadine和安慰劑治療原發性帕金森氏病患的運動障礙的隨機對照試驗。由於沒有對照組，我們排除了3個試驗，而其他3個沒有表示參與者的治療組別是否為隨機分配。收錄的試驗是雙盲的交叉研究，總共包含53位病患。3個研究都沒有列出第一組的數據，只有列出兩種療法和兩個安慰劑的合併數據。有2個試驗在不同治療方式間沒有清除間隔。由於第二組的殘餘效應風險，這些試驗的結果沒有經過分析。最後一個試驗有一個星期的清除間隔，但只有檢視11位參與者。有一個試驗回報18位參與者中有8位發現有amantadine的副作用，包括困惑、幻覺情行的惡化。另一個試驗則回報在11位參與者中，有1位發生不可逆的雙腳水腫。 由於證據的缺乏，我們無法確定以amandtadine治療帕金森氏症病患的levodopa誘導的運動障礙，是否確實安全且有效。 本摘要由朱奕蓁翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。...

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