SHORT REPORT

Low dose quetiapine for drug induced dyskinesias in Parkinson’s disease: a double blind cross over study

R Katzenschlager^1,2, A J Manson³, A Evans¹, H Watt⁴ and A J Lees¹

¹ Reta Lila Weston Institute of Neurological Studies, University College London and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
² Department of Neurology, Donauspital/SMZ-Ost, Vienna, Austria
³ Wessex Neurological Centre, Southampton, UK
⁴ Medical Statistics Unit, London School of Hygiene and Tropical Medicine and Institute of Neurology, Queen Square, London, UK

Correspondence to:
Correspondence to:
Professor Andrew J Lees
Reta Lila Weston Institute of Neurological Studies, Windeyer Building, 46 Cleveland Street, London W1 T 4JF, UK; alees{at}ion.ucl.ac.uk

Objective: Drug induced dyskinesias remain a challenging problem in the long term management of Parkinson’s disease (PD). We have assessed the effect of quetiapine on dyskinesias in a double blind placebo controlled cross over study.

Methods: Nine patients with PD were enrolled and received 25 mg of quetiapine or placebo at night for two weeks in prerandomised order, with one week of wash out between treatment periods. Assessments were made using on–off diaries, self assessment of dyskinesias, and L-dopa challenges at baseline and after each treatment period. Videotapes were rated blindly by two raters using modified Abnormal Involuntary Movement Scale and Goetz scores. Patients subsequently went on open label quetiapine at 50 mg/day, for a mean duration of 30 days, and completed the same self assessment forms.

Results: During the double blind phase, no significant change in dyskinesias was found on either 25 mg of quetiapine or placebo. Duration of off states and Unified PD Rating Scale motor scores also remained unchanged. Moderate tiredness and daytime sleepiness occurred in two patients on quetiapine. One patient dropped out early for unrelated reasons. Eight patients completed the open label phase. On 50 mg/day of quetiapine, a slight reduction in dyskinesias occurred on some scales. Reduction in dyskinesia severity on visual analogue scales was by 50.1%. Off time was not significantly increased. This improvement was not strongly reflected in patients’ overall impression of treatment effect. Drowsiness and daytime sleep episodes led to discontinuation in four patients, after completion of the study, and two additional patients stopped treatment after the study because of lack of effect.

Conclusion: Our study failed to demonstrate an antidyskinetic effect of low dose (25 mg) quetiapine. The absence of an increase in parkinsonism combined with a possible antidyskinetic effect on higher doses warrants further investigation.

Keywords: dyskinesias; Parkinson’s disease; quetiapine; randomised controlled trial

Abbreviations: AIMS, Abnormal Involuntary Movements Scale; PD, Parkinson’s disease; UPDRS, Unified PD Rating Scale; VAS, visual analogue scale

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