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From the American Neurological Association Annual Meeting (October 10-13, 1999)

Ethnic Considerations
Representing the Parkinson Study Group, Dr. Caroline M. Tanner (Parkinson's Institute, California) reported on their study of 144 patients (from 18 centers) representing three groups of minorities (African-, Hispanic- and Asian-Americans). The purpose of this study was to detail the effects of pramipexol (Mirapex) on non-Caucasian PD patients to determine if ethnicity has any effect on the benefits derived, or side effects seen. The single difference seen was that the participants in this group did not experience the sudden-onset sleepiness from pramipexol as did Caucasian patients. These are important findings for the clinician when selecting a pharmacologic option for a non-Caucasian patient.

An Alternative to Clozapine
A novel antidepressant, mirtazapine (Remeron) was studied in a small number of PD patients to determine its benefits. In addition to its antidepressant properties, preliminary results showed that this alpha-2 antagonist is useful for mild tremor (both resting and action) control, is an aid to sleep and helps reduce levodopa-induced dyskinesias. The added benefit versus Clozapine is that Remeron does not cause white blood cell problems so patients utilizing this drug need not undergo bi-monthly blood tests.

Cuban Doctors Lesioning the Deep Subthalamic Nucleus
Deep brain stimulation (DBS) involves surgical placement of a wire deep into the brain and an expensive electrical appliance to stimulate the brain area. Cost is a deterrent for many Cuban PWPs who could otherwise benefit from DBS as a corrective measure for their Parkinson symptoms. From a collaborative study (neurosurgeons from Cuba, Spain and with Emory University in Atlanta), Dr. Lazaro Alvarez reported on a two-year study in which they lesioned the deep subthalamic nucleus (similar to the studies using the stimulator) of eleven patients. The benefits to the patients' symptoms were similar to those seen in DBS, e.g. dramatically reduced dyskinesias and freezing episodes. Thus, for patients who can't afford DBS, an alternative might be lesioning the nucleus.

Source Date: Nov 02 1999