Late Fluctuations in Idiopathic Parkinson's Disease: Treatment with GM1

Abstract

The diagnosis and severity of Parkinson´s disease areestablished by clinical criteria. The motor manifestationspredominate while few are sensory. Initially, treatmentincludes dopaminergic drugs and/or agonists with goodresults in the first years. Later symptoms appear requiringdifferent therapeutic strategies. Here, we present the resultsof a series of patients with late fluctuations treated withmonosialo-ganglioside. Seven patients older than 70 years,treated for idiopathic Parkinson´s, presented combinedmotor and sensory fluctuations: four painful foot dystonias,one painful freezing, and two camptocormia with low backpain. After the increase in levodopa and the addition ofagonists without favorable results, gangliosides were appliedintramuscularly on alternate days, maintaining a fixed doseof levodopa and agonists, for 3 months. The Initial and finalvalues of pain, determined with the Visual Analogic Scaleand motor fluctuations with the unified Parkinson diseaserating scale and compared with the one-tailed Wilcoxonassuming the null hypothesis that the treatment was notsuccessful. In the second week of evaluation, improvementswere observed in the seven patients. The probability ofseven sucesses in seven trials under the null hypothesisis 0.0078l thus it was rejected. Dopaminergic drugs, usefulin the first years of treatment have uncertain effects on themotor and sensory fluctuations appearing later. The use ofgangliosides at this stage was useful, improving these latemanifestations, including camptocormia.