Administration Of Dopamine Agonists Research Articles

Methylphenidate reduces spatial attentional bias by modulating fronto-striatal connectivity.

Spatial attention bias reflects tendency to direct attention to specific side in space. This bias reflects asymmetric dopamine (DA) signaling in the striatum. Administration of DA agonists reduces spatial bias, yet the underlying mechanism is not yet clear. To address this, the current study tested whether methylphenidate (MPH; an indirect DA agonist) reduces orienting bias by modulating fronto-striatal connectivity. 54 adults with consistent bias completed the greyscales task which detects subtle biases during fMRI scanning under MPH (20mg) or placebo, in a double-blind design. As hypothesized, MPH reduced bias by increasing orienting towards non-preferred hemispace, regardless of whether the initial bias was left or right. MPH-induced increases were found in activation of the medial superior frontal gyrus (mSFG: F[1;53] = 4.632, cluster-defining threshold of P< 0.05, minimal cluster size = 0, p_FWE = 0.036, η2= 0.08) and its functional connectivity with the caudate (left caudate: F[1;53] = 12.664, p_FWE = 0.001, η2= 0.192; right caudate: F[1;53] = 11.069, p_FWE = 0.002, η2= 0.172), when orienting towards the non-preferred hemispace. MPH also reduced mSFG activation and fronto-striatal connectivity for the preferred hemispace. Results suggest modulation of frontal excitability due to increased caudate-mSFG functional connectivity. This mechanism may underlie the positive effect of dopaminergic agonists on abnormal patterns of directing attention in space.

Trait Impulsivity as a Feature of Parkinson's Disease Treatment and Progression.

Heightened trait impulsivity in both subclinical and pathological senses is becoming increasingly recognised in Parkinson's disease (PD). Impulsive behaviours and impulse control disorders (ICDs) are a consequence of perturbation to the rewards pathway leading individuals to conduct activities in a repetitive, excessive, and maladaptive fashion. Commonly linked to PD, heightened trait impulsivity has been found to primarily manifest in the forms of hypersexuality, pathological gambling, compulsive shopping, and binge eating, all of which may significantly impact social and financial standing. Subsequent burden to quality of life for both individuals with PD and caregivers are common. Although risk factors and indicators for ICDs in PD are currently lacking, it is recognised that the condition is often precipitated by dopamine replacement therapies, primarily dopamine agonist administration. While this nonmotor symptom is being increasingly diagnosed in PD populations, it remains relatively elusive in comparison to its motor counterparts. Through discussion of impulsivity characteristics, neuroanatomy, and neurochemistry, in addition to reviewing existing research on the potential contributing factors to impulsivity in PD, this review highlights impulsivity as a significant and detrimental PD symptom. Thus, emphasising the imperative need to establish efficacious diagnostic tools and treatments.

The Outcome of Prolactinoma in the Postpartum Period: a Study from a Tertiary Care Hospital in Pakistan

Objective: Prolactin is an essential hormone secreted by the pituitary gland of pregnant women. The pituitary gland undergoes growth, due to lactotroph hyperplasia in response to placental estrogen during pregnancy. Research on the postpartum outcomes of prolactinomas is less. This study evaluates the prevalence of Prolactinoma and the occurrence of spontaneous resolution of Prolactinomas after pregnancy. Materials and Methods: A cross-section study was conducted at the Punjab Institute of Neurosciences, Lahore. 200 pregnant women were recruited; their blood samples were collected to evaluate serum prolactin levels. Women diagnosed with prolactinomas exhibiting positive symptoms were given dopamine agonists. The administration of dopamine agonist was discontinued at the 24th week of gestation. All participants were monitored till birth, at 40 days after delivery, and throughout breastfeeding. Their prolactin levels were evaluated, and magnetic resonance imaging (MRI) was conducted to verify the resolution of prolactinoma. Results: The mean age of females in the study was 29.03 ± 7.20 years. Out of 200, 40 (20%) females had prolactinoma. Out of 40, 13 (32.5%) were given Bromocriptine while 27 (67.5%) were given Cabergoline. At presentation, the mean serum prolactin level was 138.91 ± 149.02 ng/ml, which reduced to 21.38 ± 9.80 ng/ml. The mean tumor size at presentation was 7.23 ± 2.07 mm, which reduced to 0.79 ± 0.66 mm after delivery. Out of 40, 30 (75.0%) had spontaneous resolution. Conclusion: The occurrence of prolactinoma is low in symptomatic patients and can resolve spontaneously after delivery in the majority of cases.

Prolactin Relationship with Fertility and In Vitro Fertilization Outcomes-A Review of the Literature.

Hyperprolactinemia is a known cause of amenorrhea and infertility. However, there is an increasing body of evidence suggesting that prolactin is involved in multiple physiological aspects of normal reproduction. Thus, the present paper aims to review the current literature regarding the relationship between serum prolactin level and in vitro fertilization (IVF)/intracytoplasmic sperm injection outcome and the role of dopamine agonists treatment in IVF success. Moreover, the mechanisms by which prolactin may exert its role in fertility and infertility were summarized. Although not all studies agree, the available evidence suggests that higher prolactin levels in follicular fluid are associated with increased oocytes competence, but also with positive effects on corpus luteum formation and survival, endometrial receptivity, blastocyst implantation potential and survival of low-motile sperm. Transient hyperprolactinemia found in IVF cycles was reported in most of the studies not to be related to IVF outcome, although a few reports suggested that it may be associated with higher implantation and pregnancy rates, and better-cumulated pregnancy outcomes. Administration of dopamine agonists for hyperprolactinemia preceding IVF treatment does not seem to negatively impact the IVF results, while treatment of transient hyperprolactinemia during IVF might be beneficial in terms of fertilization rates and conception rates. Due to limited available evidence, future studies are necessary to clarify the optimal level of circulating prolactin in patients performing IVF and the role of dopamine agonist treatment.

Case Report: Secondary Amenorrhea with Hyperprolactinemia due to Pituitary Macroadenoma

Introduction: Secondary amenorrhea has a broad etiology, so each case must be studied in depth. One of the causes of secondary amenorrhea is a state of hyperprolactinemia caused by a mass in the anterior pituitary. Pituitary macroadenoma patients may be asymptomatic or have a hormone imbalance or mass impact symptoms. Tumors in asymptomatic patients might be identified during a routine head imaging examination for unrelated medical issues. Case Presentation: A 24-year-old unmarried woman with complaints of headache, blurred vision, and worsening for one year ago. The patient complained of not having menstruation in the past five years ago, with a history of previous normal menstruation. On physical examination, found breast and pubic Tanner stage 5. On laboratory examination, it was found FSH (2.21), Oestradiol (20.23), and Prolactin (1365.47). On an MRI of the head examination on April 14, 2021, a solid intrasellar mass of suspected pituitary macroadenoma was found with a size of ± 1.3 cm x 1.4 cm x 1.6 cm. Conclusion: Secondary amenorrhea caused by hyperprolactinemia due to pituitary macroadenoma is a rare case (40%). First-line therapy for prolactinomas is dopamine agonist administration because most pituitary macroadenomas respond to dopamine agonists.

Case Report: Hyperprolactinemia In Suprasellar Meningioma

Introduction: Hyperprolactinemia is a condition in which abnormally elevated prolactin levels (normal prolactin levels are 10-28 g/L) is a common endocrine disorder. Establishing the diagnosis and etiology of hyperprolactinemia should include a thorough medical history and the use of drugs, physical examination, laboratory tests, analysis of the pituitary, and sella turcica features. Pituitary tumor imaging analysis using MRI remains the method of choice. The main goals of managing hyperprolactinemia are restoring and maintaining fertility function and preventing osteoporosis. The choice of treatment depends on the underlying etiology. Case Presentation: A 33-year-old woman complained that her right side of vision could not function properly, and her left side of vision began to blur, which started four years ago with irregular menstrual disorders, and milk came out of her breasts. On breast examination, Tanner 5 was found with galactorrhea and pubic hair Tanner stage 3. On Laboratory examination found FSH (5.50 mIU/mL), LH (1.7 mIU/mL) and prolactin (1125 IU/mL). The MRI examination showed an extra-axial solid mass, broad-based on the planum sphenoidal to the dorsum sellae, suggesting a meningioma; with compression of the optic chiasm, middle cerebral artery, and bilateral anterior cerebral arteries, size 3.1 x 2.8 x 2.3 cm. Conclusion: Hyperprolactinemia with meningiomas is a unique case. First-line therapy for prolactinomas is dopamine agonist administration and, in this case, is followed by surgery, which showed significant results.

Dopamine-induced changes to thalamic GABA concentration in impulsive Parkinson disease patients

Impulsivity is inherent to behavioral disorders such as substance abuse and binge eating. While the role of dopamine in impulse behavior is well established, γ-aminobutyric acid (GABA) therapies have promise for the treatment of maladaptive behaviors. In Parkinson disease (PD), dopaminergic therapies can result in the development of impulsive and compulsive behaviors, and this clinical syndrome shares similar pathophysiology to that seen in addiction, substance abuse, and binge-eating disorders. We hypothesized that impulsive PD patients have a reduced thalamic GABAergic response to dopamine therapy. To test this hypothesis, we employed GABA magnetic resonance spectroscopy, D2-like receptor PET imaging, and clinical and quantitative measures of impulsivity in PD patients (n = 33), before and after dopamine agonist administration. We find a blunted thalamic GABA response to dopamine agonists in patients with elevated impulsivity (p = 0.027). These results emphasize how dopamine treatment differentially augments thalamic GABA concentrations, which may modify behavioral impulsivity.

Does Intravitreal Dopamine Agonist and Antagonist Administration Have Effects on the Brain? An Experimental Study in Rats.

There might be dopaminergic connections between the retina and the brain. In this context, the study was aimed to investigate the possible interaction between the retina and basal ganglia through the dopaminergic system. In total, 32 healthy rats were randomized into 4 groups: healthy, Sham, dopamine antagonist injected group (risperidone, 0.04 mg/kg intravitreally), and dopamine agonist injected group (apomorphine, 0.4 mg/kg intravitreally). The locomotor activity and Morris water maze tests were applied to all rats twice, before the injection and 28 days after, to detect changes in movement, memory, and attention. Histopathologically, the basal ganglia and hippocampus regions were removed and examined. In the locomotor activity test, a statistical significance was found between the first and last measurement values of the apomorphine group and a decrease in activities and an increase in resting times (P < .05). In the Morris water maze test, a statistical significance was detected between the first and last tests of the control group and the apomorphine groups and showed significantly shorter learning times (P < .05). Histological analyses of the substantia nigra and hippocampus were noteworthy in that the number of damaged neurons in the risperidone group was considerably higher than the other groups. The number of damaged neurons in the apomorphine group was significantly lower than in the healthy group. Intravitreal administration of dopamine agonists and antagonists has given rise to alterations in the cerebral dopaminergic system, leading to changes in locomotor activity and memory and histopathological changes.

Altered Pain Processing Associated with Administration of Dopamine Agonist and Antagonist in Healthy Volunteers.

Striatal dopamine dysfunction is associated with the altered top-down modulation of pain processing. The dopamine D2-like receptor family is a potential substrate for such effects due to its primary expression in the striatum, but evidence for this is currently lacking. Here, we investigated the effect of pharmacologically manipulating striatal dopamine D2 receptor activity on the anticipation and perception of acute pain stimuli in humans. Participants received visual cues that induced either certain or uncertain anticipation of two pain intensity levels delivered via a CO2 laser. Rating of the pain intensity and unpleasantness was recorded. Brain activity was recorded with EEG and analysed via source localisation to investigate neural activity during the anticipation and receipt of pain. Participants completed the experiment under three conditions, control (Sodium Chloride), D2 receptor agonist (Cabergoline), and D2 receptor antagonist (Amisulpride), in a repeated-measures, triple-crossover, double-blind study. The antagonist reduced an individuals’ ability to distinguish between low and high pain following uncertain anticipation. The EEG source localisation showed that the agonist and antagonist reduced neural activations in specific brain regions associated with the sensory integration of salient stimuli during the anticipation and receipt of pain. During anticipation, the agonist reduced activity in the right mid-temporal region and the right angular gyrus, whilst the antagonist reduced activity within the right postcentral, right mid-temporal, and right inferior parietal regions. In comparison to control, the antagonist reduced activity within the insula during the receipt of pain, a key structure involved in the integration of the sensory and affective aspects of pain. Pain sensitivity and unpleasantness were not changed by D2R modulation. Our results support the notion that D2 receptor neurotransmission has a role in the top-down modulation of pain.

Early decreases in cortical mid-gamma peaks coincide with the onset of motor deficits and precede exaggerated beta build-up in rat models for Parkinson's disease

Evidence suggests that exaggerated beta range local field potentials (LFP) in basal ganglia-thalamocortical circuits constitute an important biomarker for feedback for deep brain stimulation in Parkinson's disease patients, although the role of this phenomenon in triggering parkinsonian motor symptoms remains unclear. A useful model for probing the causal role of motor circuit LFP synchronization in motor dysfunction is the unilateral dopamine cell-lesioned rat, which shows dramatic motor deficits walking contralaterally to the lesion but can walk steadily ipsilaterally on a circular treadmill. Within hours after 6-OHDA injection, rats show marked deficits in ipsilateral walking with early loss of significant motor cortex (MCx) LFP peaks in the mid-gamma 41–45 Hz range in the lesioned hemisphere; both effects were reversed by dopamine agonist administration. Increases in MCx and substantia nigra pars reticulata (SNpr) coherence and LFP power in the 29–40 Hz range emerged more gradually over 7 days, although without further progression of walking deficits. Twice-daily chronic dopamine antagonist treatment induced rapid onset of catalepsy and also reduced MCx 41–45 Hz LFP activity at 1 h, with increases in MCx and SNpr 29–40 Hz power/coherence emerging over 7 days, as assessed during periods of walking before the morning treatments. Thus, increases in high beta power in these parkinsonian models emerge gradually and are not linearly correlated with motor deficits. Earlier changes in cortical circuits, reflected in the rapid decreases in MCx LFP mid-gamma LFP activity, may contribute to evolving plasticity supporting increased beta range synchronized activity in basal ganglia-thalamocortical circuits after loss of dopamine receptor stimulation.

DRD1 downregulation contributes to mechanical stretch-induced lung endothelial barrier dysfunction

Rationale: The lung-protective effects of dopamine and its role in the pathology of ventilator-induced lung injury (VILI) are emerging. However, the underlying mechanisms are still largely unknown.Objective: To investigate the contribution of dopamine receptor dysregulation in the pathogenesis of VILI and therapeutic potential of dopamine D1 receptor (DRD1) agonist in VILI.Methods: The role of dopamine receptors in mechanical stretch-induced endothelial barrier dysfunction and lung injury was studied in DRD1 knockout mice, in isolated mouse lung vascular endothelial cells (MLVECs), and in lung samples from patients who underwent pulmonary lobectomy with mechanical ventilation for different time periods.Measurements and Main Results: DRD1 was downregulated in both surgical patients and mice exposed to mechanical ventilation. Prophylactic administration of dopamine or DRD1 agonist attenuated mechanical stretch-induced lung endothelial barrier dysfunction and lung injury. By contrast, pulmonary knockdown or global knockout of DRD1 exacerbated these effects. Prophylactic administration of dopamine attenuated mechanical stretch-induced α-tubulin deacetylation and subsequent endothelial hyperpermeability through DRD1 signaling. We identified that cyclic stretch-induced glycogen-synthase-kinase-3β activation led to phosphorylation and activation of histone deacetylase 6 (HDAC6), which resulted in deacetylation of α-tubulin. Upon activation, DRD1 signaling attenuated mechanical stretch-induced α-tubulin deacetylation and subsequent lung endothelial barrier dysfunction through cAMP/exchange protein activated by cAMP (EPAC)-mediated inactivation of HDAC6.Conclusions: This work identifies a novel protective role for DRD1 against mechanical stretch-induced lung endothelial barrier dysfunction and lung injury. Further study of the mechanisms involving DRD1 in the regulation of microtubule stability and interference with DRD1/cAMP/EPAC/HDAC6 signaling may provide insight into therapeutic approaches for VILI.

Understanding the Role of Incentive Salience in Sexual Decision-Making.

In the search for understanding female sexual decision-making, progress has been made in uncovering a variety of perceptual biases and most of these concern the animal's sensory biology and cognitive processes. We are now poised to dig deeper into the female's decision-making and ask if incentive salience, which plays a role in all types of appetitive behaviors, also influences a female's "taste for the beautiful." The incentive salience hypothesis suggests that dopamine assigns value or salience to objects or actions. After value is assigned to all potential actions, an action selection system then chooses among potential options to select the most valuable action. In this view, dopamine stimulates reward-seeking behavior by assigning incentive salience to specific behavioral actions, which in turn, increases pursuit and focus on objects or stimuli that represent the valuable action. Here, we apply this framework to understand why females are compelled to respond maximally to some male courtship signals over others and how this process may reveal a female's hidden mate preferences. We examine studies of dopamine and the mesolimbic reward system because these may play a role in expanding the female's perceptual landscape for novelty in male courtship signals and establishing novel hidden preferences. We review three avenues of research that may identify signatures of incentive salience in females during sexual decision-making. This review includes studies of dopamine agonist or antagonist administration in females during mate choice or partner preference tests, measures of neural activity in dopaminergic neural circuits during mate choice or partner preference tests, and social regulation of dopamine in females when entering reproductive contexts and/or exposure to mate signals. By applying the incentive salience hypothesis to female reproductive decision-making, it redefines how we see the female's role in sexual encounters. Females cannot be considered passive during reproductive encounters; rather they are seeking sexual encounters, particularly with males that tap into their perceptual biases and initiate a reward-seeking response. Incentive salience applied to reproductive behavior requires considering females as viewing sexual stimuli as rewarding and initiating action to seek out this reward, all of which indicates females are driving sexual encounters.

Circadian-timed dopamine agonist treatment reverses high-fat diet-induced diabetogenic shift in ventromedial hypothalamic glucose sensing.

IntroductionWithin the ventromedial hypothalamus (VMH), glucose inhibitory (GI) neurons sense hypoglycaemia while glucose excitatory (GE) neurons sense hyperglycaemia to initiate counter control mechanisms under normal conditions. However, potential electrophysiological alterations of these two neuronal types in vivo in insulin‐resistant states have never been simultaneously fully documented. Further, the anti‐diabetic effect of dopamine agonism on this VMH system under insulin resistance has not been studied.MethodsThis study examined the impact of a high‐fat diet (HFD) on in vivo electrophysiological recordings from VMH GE and GI neurons and the ability of circadian‐timed dopamine agonist therapy to reverse any adverse effect of the HFD on such VMH activities and peripheral glucose metabolism.ResultsHFD significantly inhibited VMH GE neuronal electrophysiological response to local hyperglycaemia (36.3%) and augmented GI neuronal excitation response to local hypoglycaemia (47.0%). Bromocriptine (dopamine agonist) administration at onset of daily activity (but not during the daily sleep phase) completely reversed both VMH GE and GI neuronal aberrations induced by HFD. Such timed treatment also normalized glucose intolerance and insulin resistance. These VMH and peripheral glucose metabolism effects of circadian‐timed bromocriptine may involve its known effect to reduce elevated VMH noradrenergic activity in insulin‐resistant states as local VMH administration of norepinephrine was observed to significantly inhibit VMH GE neuronal sensing of local hyperglycaemia in insulin‐sensitive animals on regular chow diet (52.4%).ConclusionsHFD alters VMH glucose sensing in a manner that potentiates hyperglycaemia and this effect on the VMH can be reversed by appropriately circadian‐timed dopamine agonist administration.

Movement Disorders: What Are You Doing? What Can We Do?

Movement Disorders: What Are You Doing? What Can We Do? Abstract. Disturbances of movement are common and varied. Frequent causes are systemic diseases such as Parkinson's syndromes and the essential tremor. Treatment options in practice and hospital include conservative, predominantly drug strategies such as oral administration of dopamine precursors or agonists, and pharmacological or non-pharmacological escalation strategies such as intramuscular botulinum toxin A injections, the subcutaneous or enteral drug pumps for apomorphine or levodopa and carbidopa, the effective deep brain stimulation and the novel focused ultrasound therapy, which are bound to highly specialized centers and should be considered as treatment option quite earlier and more frequently.

Combination of dopamine agonist and prostaglandin administration for pregnancy termination in bitches – a novel approach

ABSTRACT Pregnancy termination is a required procedure in companion animal practice. In healthy bitches with confirmed pregnancy, good results are obtained with the combination of prostaglandin F2 and dopamine agonist, followed by regular sonographic examination until confirmed abortion. The aim of this study was to establish a simple and easily applicable procedure, with different dynamics of application of dinoprost and cabergoline. Dinoprost was administered intramucousally in the vestibule of vagina. Twenty bitches were divided into four equal groups. Group A received dinoprost and cabergoline daily; group B received dinoprost every 48 h and cabergoline daily; group C received dinoprost daily and cabergoline every 48 h, and group D received both cabergoline and dinoprost every 48 h. The treatment lasted until abortion was sonographically confirmed. The pregnancy was successfully terminated in all bitches, and side effects appeared in 90% animals, though they were of strong intensity in only 15% of bitches. Dinoprost administered intramucousally was effective with fewer undesirable, strong, systemic side effects. Drug administration every 48 h also induced abortion, with negligible side effects, but with slightly longer duration of treatment. This combination could be interesting in cases with time-limited owners and in countries where other drugs are unavailable.

Enhancement in dopamine reduces generous behaviour in women.

Generosity is a human behavior common in social contexts. However, humans are not equally generous to everyone alike. Instead, generosity decreases as a function of social distance, an effect called social discounting. Studies show that such social discounting effect depends on diverse factors including personality traits, cultures, stress or hormonal levels. Recently, the importance of the neurotransmitter dopamine in regulating social interactions has been highlighted. However, it remains unclear how exactly dopamine agonist administration modulates generous behavior as a function of social discounting. Here, we investigate the causal effect of dopamine agonist administration on social discounting in a pharmacological intervention study. We employ a randomized, double-blind, within-subject design to investigate the impact of the D2/D3 receptor agonist pramipexole on social discounting by keeping gender constant. We apply hyperbolic social discount model to the data and provide evidence that women under pramipexole become less generous in general, especially towards close others. Our results highlight the crucial role of dopamine in social decision making.

Pituitary Disease in Pregnancy: Special Aspects of Diagnosis and Treatment?

The diagnosis and treatment of pituitary disease in pregnancy represents a special clinical challenge. Not least because there is very little data on the treatment of pregnant patients with pituitary disorders. A selective search of the literature was carried out with the aim of compiling evidence about the diagnosis and treatment of pituitary disease in pregnancy. The search covered the databases PubMed/MEDLINE including PubMed Central and also used the Livivo (ZB MED) search engine. Recent studies were evaluated for recommendations about the care of pregnant patients with hormone-inactive and hormone-active pituitary adenomas (prolactinoma, acromegaly and Cushingʼs disease), pituitary insufficiency, pituitary apoplexy and hypophysitis. The most well-established forms of treatment are for prolactinoma, due to the incidence of this disease and its impact on fertility. When pregnancy has been confirmed, prolactinoma treatment with dopamine agonists should be paused. Although microprolactinomas rarely increase significantly in size after the administration of dopamine agonists is discontinued, symptomatic tumor growth of macroprolactinomas can occur. In such cases, treatment with dopamine agonists can be resumed. If the primary tumor is large and the risk that it will continue to grow is high, it may be necessary to continue medical treatment from the start of pregnancy. If one of the partners has a pituitary disorder, it is often still possible for many couples to achieve their wish of having children if they receive medical support to plan and the pregnancy is carefully monitored. Given the complexity of pituitary disease, pregnant patients with pituitary disorders should be cared for and treated by a multidisciplinary team in centers specializing in the diagnosis and treatment of pituitary disease.

Dopamine effects on frontal cortical blood flow and motor inhibition in Parkinson's disease

Parkinson's disease (PD) is characterized by dysfunction in frontal cortical and striatal networks that regulate action control. We investigated the pharmacological effect of dopamine agonist replacement therapy on frontal cortical activity and motor inhibition. Using Arterial Spin Labeling MRI, we examined 26 PD patients in the off- and on-dopamine agonist medication states to assess the effect of dopamine agonists on frontal cortical regional cerebral blood flow. Motor inhibition was measured by the Simon task in both medication states. We applied the dual process activation suppression model to dissociate fast response impulses from motor inhibition of incorrect responses. General linear regression model analyses determined the medication effect on regional cerebral blood flow and motor inhibition, and the relationship between regional cerebral blood flow and motor inhibitory proficiency. We show that dopamine agonist administration increases frontal cerebral blood flow, particularly in the pre-supplementary motor area (pre-SMA) and the dorsolateral prefrontal cortex (DLPFC). Higher regional blood flow in the pre-SMA, DLPFC and motor cortex was associated with better inhibitory control, suggesting that treatments which improve frontal cortical activity could ameliorate motor inhibition deficiency in PD patients.

Problems Associated with Non-Ergot Dopamine Agonist Maintenance Therapy in Patients with Advanced Parkinson’s Disease

Non-ergot dopamine agonists have become popular for treating motor complications associated with long-term use of levodopa-containing drugs. We conducted a retrospective study in which we identified clinical problems related to use of non-ergot dopamine agonists. The study included 38 patients with Parkinson’s disease (PD) who suffered the wearing-off phenomenon and had thus been under non-ergot dopamine receptor agonist therapy for 1 - 2 years. Some presented with problems such as major symptoms of PD (30.3%), psychiatric symptoms (24.2%), and postural dysfunction (21.2%). Comparison between two different non-ergot drugs showed the levodopa dosage to be greater among patients taking ropinirole than among those taking pramipexole. In patients with advanced PD, various problematic symptoms can develop early after administration of a non-ergot dopamine agonist to treat the wearing-off phenomenon, necessitating identification and treatment of such symptoms on a patient-to-patient basis.

The Chance of Permanent Cure for Micro- and Macroprolactinomas, Medication or Surgery? A Systematic Review and Meta-Analysis.

Background: This meta-analysis aims to evaluate the long-term efficacy of medication treatment vs. surgery treatment in patients with prolactinomas.Methods: An electronic literature search was performed using MEDLINE, EMBASE and Web of Science databases for studies dated before July in 2018. Patients with prolactinomas received primary dopamine agonists (DAs) treatment or primary surgical interventions were included in this study. A systematic review and meta-analysis were performed in pertinent studies meeting eligible criteria. The clinical outcome was measured by the long-term remission rate of prolactin (PRL) in each cohort. The pooled data was analyzed according to a random effect model.Results: Thirteen publications with total 809 patients were included in the final meta-analysis. In the overall patients with prolactinomas, long-term remission rate was achieved in 88% patients treated with surgeries and in 52% patients treated with DAs (P = 0.001). The long-term remission rates in surgery cohort were also significantly higher than medication cohort in both microprolactinomas and macroprolactinomas (91 vs. 60%, P = 0.002; 77 vs. 43%, P = 0.003).Conclusions: Patients with prolactinomas, especially microprolactinomas, can consider transsphenoidal surgery as an alternative first-line treatment strategy. After receiving primary surgical intervention, administration of DAs should be considered based on the postoperative PRL level to achieve the best long-term remission rate.