An Alternative Medication for Dementia With Lewy Bodies

March 2, 2018

Information sourced from NEJM Journal Watch:

 

An Alternative Medication for Dementia with Lewy Bodies

 

An antiepileptic drug improves motor symptoms without exacerbating psychiatric symptom

 

In patients with Parkinson disease (PD) and related disorders such as dementia with Lewy bodies (DLB), psychotic symptoms can develop, especially as a reaction to the dopaminergic medications necessary to improve motor symptoms. Thus, finding alternative medications to treat motor manifestations without producing psychosis is important. This manufacturer-funded, placebo-controlled, randomized, double-blind, phase-2 study explored the efficacy and safety of zonisamide, an FDA-approved anticonvulsant that has been used in Japan adjunctively for PD, in 158 patients diagnosed with probable DLB (mean age, 75; 59% male).

 

Fluctuating cognition and visual hallucinations were present in 70% of patients. Patients were on levodopa or a decarboxylase inhibitor for more than 12 weeks before a 4-week placebo run-in period; zonisamide was provided at 25 or 50 mg. Discontinuation rates were greater in the 25-mg and 50-mg zonisamide groups (18% and 14%) than in the placebo group (9%), with 137 patients completing treatment.

 

At 12 weeks, Parkinson-symptom scale ratings improved more with 50-mg zonisamide than with placebo. There was no deterioration in cognition in any group. Adverse effects were more frequent with zonisamide (weight loss, decreased appetite, rash), but the groups did not differ in delusions and visual hallucinations.

 

COMMENT

It is important that alternative medications for the motor symptoms of DLB not exacerbate the psychiatric symptoms of the illness. Although the mechanism for zonisamide’s effects on parkinsonism is unclear, clinicians might wish also to consider this drug for patients with PD. These options can be discussed with patients and their families, along with the neurologist who may be the primary physician for treating the DLB or PD patient.

 

Jonathan Silver, MD reviewing Murata M et al. Neurology 2018 Jan 24.

 

CITATION(S):

Murata M et al. Adjunct zonisamide to levodopa for DLB parkinsonism: A randomized, double-blind phase 2 study. Neurology 2018 Jan 24; [e-pub].

 

NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright ©2018 Massachusetts Medical Society. All rights reserved.

 

The above message comes from NEJM Journal Watch, who is solely responsible for its content.

Please reload

Featured Monthly Article
Recent News
Please reload

Please reload

Curt Wood, R.Ph., FASCP

Board Certified Geriatric Pharmacist

Elder Care Pharmacy Consultants take pride in being truly independent. Elder Care Pharmacy Consultants, LLC. has a comprehensive approach to antipsychotic use in order to help ensure nursing homes reach their goals, enhance star quality measures, and maintain federal and state compliance. Our success depends on your satisfaction with the services we provide..

The Consultant Pharmacist's Creed
 
I hold my patients' interest above all others.
 
I take responsibility for my patients' medication-related needs.
 
I ensure my patients' medications are the most appropriate, the most effective available, the safest possible, and are used correctly.
 
I identify, resolve and prevent medication-related problems that may interfere with the goals of therapy.

Address: 17566 Doe Run Rd.

               New London, MO 63459

 

Telephone : (573) 795 - 6351

Fax: (573) 985 - 3076
Email : curt@eldercarepharmacyconsultants.com

Copyright © Elder Care Pharmacy Consultants 2015

  • LinkedIn App Icon
  • Wix Twitter page
"Elder Care Pharmacy Consultants LLC., provides experienced clinical and regulatory pharmacy and consulting services relating to safe and effective medication use to skilled, assisted living, residential care nursing facilities." "Our mission is to provide pharmacy consulting services intended to optimize safe and effective medication use with the goal of helping skilled, assisted living and residential care nursing facilities provide the highest quality of care to achieve the best outcomes and maintain regulatory compliance."