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Jill Beech - One of the best experts on this subject based on the ideXlab platform.

  • treatment with Pergolide or cyproheptadine of pituitary pars intermedia dysfunction equine cushing s disease
    Journal of Veterinary Internal Medicine, 2002
    Co-Authors: Mark T Donaldson, Bernadette H Lamonte, Peter R Morresey, Gary Smith, Jill Beech
    Abstract:

    Medical records of 27 horses (including 13 ponies) treated with Pergolide or cyproheptadine for pituitary pars intermedia dysfunction were reviewed to determine the effect of treatment on plasma ACTH, insulin, and glucose concentrations and clinical signs. Prior to treatment, the most common clinical signs were laminitis, hirsutism, and abnormal body fat distribution. The median Pergolide dose was 3.0 microg/kg p.o. q24h (range, 1.7-5.5 microg/kg). All horses treated with cyproheptadine were given 0.25 mg/kg p.o. q24h. After Pergolide treatment, ACTH concentrations (n = 20; median = 30.4 pg/ml; range, 4.2-173) were significantly lower (P < .01) than those in horses treated with cyproheptadine (n = 7; median = 141.0 pg/ml: range, 10-1,230). Among horses treated with Pergolide, there was a correlation between ACTH concentration after treatment and the duration of treatment (P < .001) and Pergolide dose (P = .04). Significantly (P = .02) more owners of horses treated with Pergolide (85%, 17/20) reported an improvement in clinical signs compared to owners of horses treated with cyproheptadine (28%, 2/7).

  • treatment with Pergolide or cyproheptadine of pituitary pars intermedia dysfunction equine cushing s disease
    Journal of Veterinary Internal Medicine, 2002
    Co-Authors: Mark T Donaldson, Bernadette H Lamonte, Peter R Morresey, Gary Smith, Jill Beech
    Abstract:

    Medical records of 27 horses (including 13 ponies) treated with Pergolide or cyproheptadine for pituitary pars intermedia dysfunction were reviewed to determine the effect of treatment on plasma ACTH, insulin, and glucoseconcentrations and clinical signs. Prior to treatment, the most common clinical signs were laminitis, hirsutism, and abnormal body fat distribution. The median Pergolide dose was 3.0 μg/kg PO q24h (range, 1.7-5.5 μg/kg). All horses treated with cyproheptadine were given 0.25 mg/kg PO q24h. After Pergolide treatment, ACTH concentrations (n = 20; median = 30.4 pg/ml; range, 4.2-173) were significantly lower (P <.01) than those in horses treated with cyproheptadine (n = 7; median = 141.0 pg/ml; range, 10-1,230). Among horses treated with Pergolide, there was a correlation between ACTH concentration after treatment and the duration of treatment (P < .001) and Pergolide dose (P =.04). Significantly (P =.02) more owners of horses treated with Pergolide (85%, 17/20) reported an improvement in clinical signs compared to owners of horses treated with cyproheptadine (28%, 2/7). Kev words: ACTH; Hyperadrenocorticism; Pituitary adenoma; Pituitary dysfunction; Pituitary hyperplasia; Pituitary tumor.

Claudia Trenkwalder - One of the best experts on this subject based on the ideXlab platform.

  • high dose treatment with Pergolide in parkinson s disease patients with motor fluctuations and dyskinesias
    Parkinsonism & Related Disorders, 2005
    Co-Authors: Alexander Storch, Hanspeter Hundemer, Claudia Trenkwalder, Juliane Winkelmann, Christian Oehlwein, Ulrich Polzer, Johannes Schwarz
    Abstract:

    Motor complications arising after long-term treatment with levodopa remain one of the main challenges in the treatment of patients with Parkinson's disease (PD). Monotherapy with dopamine agonists may delay the onset of motor complications or reduce their severity when added to levodopa treatment. Here, we retrospectively analyzed data from 62 patients with advanced PD who presented with moderate to severe response fluctuations in whom we increased the dose of oral treatment with Pergolide beyond 4.5mg daily. Patients had been treated with levodopa for 10.7+/-4.8 years. Pergolide was increased to 8.2+/-4.3 mg per day over a median titration period of 13.5 weeks. Mean daily dose of levodopa prior to Pergolide high-dose treatment was 733+/-468 mg and decreased to 348+/-186 mg after Pergolide titration. The duration of OFF times decreased from 7.3+/-3.8 to 1.7+/-0.9 h per day (p < 0.001) measured by patients' diaries. Dyskinesias, present for 5.0+/-3.3 h per day at baseline, were reduced to 1.4+/-0.8 h per day (p < 0.001) and the total daily duration of motor fluctuations (off-time duration plus dyskinesia duration) decreased from 10.5+/-7.0 to 2.8+/-2.2 h (p < 0.001). There was a significant improvement in parkinsonian symptoms (baseline to endpoint reduction of UPDRS III from a median of 36 to 8; p < 0.001). To reduce gastrointestinal side effects 23 patients required concomitant treatment with domperidone. Seven patients developed hallucinations during the titration period, six patients required treatment with clozapine. Our data indicate that increasing the dose of Pergolide above 5mg per day can dramatically reduce the need for levodopa, motor fluctuations and severity of clinical symptoms. Controlled trials are needed to further substantiate the efficacy and safety of this treatment strategy.

  • efficacy of Pergolide in treatment of restless legs syndrome the pearls study
    Neurology, 2004
    Co-Authors: Claudia Trenkwalder, Hanspeter Hundemer, Alberto Lledo, John Swieca, Olli Polo, Thomas C Wetter, Luigi Ferinistrambi, H De Groen, Deborah Quail, U Brandenburg
    Abstract:

    Objective: To evaluate the short- and long-term safety and efficacy of Pergolide therapy for restless legs syndrome (RLS) in a double-blind, placebo-controlled, randomized trial (Pergolide European Australian RLS [PEARLS] study). Methods: We randomized 100 patients with idiopathic RLS were randomized to Pergolide, 0.25 to 0.75 mg, in the evening or placebo for 6 weeks (phase 1); thereafter, patients with response on the Patient Global Impression (PGI) scale continued on double-blind Pergolide or placebo, and nonresponders received open-label Pergolide up to 1.5 mg/d for 12 months of treatment (phase 2). Sleep efficiency (SE) and periodic limb movements during sleep (PLMS) arousal index were monitored by centrally evaluated polysomnography (PSG). The severity of RLS was assessed using the validated International RLS Scale (IRLS). Results: In phase 1 (change from baseline to week 6), Pergolide reduced PLMS arousal index vs placebo (mean ± SD, −12.6 ± 10.0 vs −3.6 ± 15.9; p = 0.004), and SE did not improve (mean ± SD, +11.3 ± 11.9% vs +6.1 ± 18.6%; p = 0.196). Pergolide improved RLS severity score (−12.2 ± 9.9 vs −1.8 ± 7.5 placebo; p p p p = 0.019), and quality of sleep ( p p = 0.028) and PLM index ( p Conclusions: Pergolide substantially improves periodic limb movement measures and subjective sleep disturbance associated with restless legs syndrome. Low-dose Pergolide was well tolerated and maintained its efficacy in the long term.

  • Pergolide restores sleep maintenance but impairs sleep eeg synchronization in patients with restless legs syndrome
    Sleep Medicine, 2002
    Co-Authors: Hirokuni Tagaya, Hanspeter Hundemer, Claudia Trenkwalder, Thomas C Wetter, Juliane Winkelmann, M Rubin, Elisabeth Friess
    Abstract:

    Background: The treatment with the long-acting dopamine D1/D2 receptor agonist Pergolide has been proven as very effective in lowering the frequency of periodic leg movements (PLM) in patients with restless legs syndrome (RLS). To further investigate the influence of this potent dopaminergic drug on the microstructure of rapid eye movement (REM) and non-REM sleep EEG we established a quantitative analysis of the EEG data. Methods: The study group consisted of 15 patients with primary RLS (mean age 57.1±10.1 years) who were a subgroup of patients within a double-blind randomized crossover treatment study with Pergolide versus placebo. The polysomnographic recordings were analyzed visually and submitted to a quantitative EEG analysis (fast Fourier transformation). Results: The Pergolide treatment induced a significant reduction of the spectral power in the delta range (0.78–3.9 Hz; P<0.05; t-test) during SWS, as well as a significant reduction of PLMs. In addition, we observed a decrease in the sigma EEG activity (12.1–14.8 Hz; P<0.03) during non-REM sleep and stage 2 sleep. The visual sleep scoring revealed a significant increase in stage 2 sleep (P<0.005), whereas wakefulness was markedly diminished (P<0.001). The REM sleep parameters including the EEG power spectrum remained unchanged. Conclusions: The treatment with Pergolide markedly improved the sleep quality in RLS patients but did not restore SWS including the spectral power in the lower frequencies. Our results suggest that the dopamine agonist Pergolide interferes with the subcortical mechanisms regulating the process of EEG synchronization during non-REM sleep.

  • long term effects of Pergolide in the treatment of restless legs syndrome
    Neurology, 2001
    Co-Authors: K Stiasny, Hanspeter Hundemer, Thomas C Wetter, U Brandenburg, Juliane Winkelmann, Thomas Penzel, M Rubin, W H Oertel, Claudia Trenkwalder
    Abstract:

    An open follow-up of a controlled study in patients with restless legs syndrome (RLS) shows that the beneficial effect of Pergolide on RLS symptoms persists throughout at least 1 year. Twenty-two patients of 28 (78.6%) continued to take Pergolide. Polysomnographic measurements showed a persistent improvement of PLM index, PLMS arousal index, total sleep time, and sleep efficiency (p = 0.0001). Side effects, in particular nausea, were common but were well controlled by domperidone in most patients.

  • a randomized controlled study of Pergolide in patients with restless legs syndrome
    Neurology, 1999
    Co-Authors: Thomas C Wetter, Wolfgang H Oertel, U Brandenburg, K Stiasny, Juliane Winkelmann, A Buhlinger, Thomas Penzel, R Medori, M Rubin, Claudia Trenkwalder
    Abstract:

    Background: Open clinical trials indicate that low doses of Pergolide, a long-acting D1 and D2 dopamine agonist, lead to a reduction in the symptoms of restless legs syndrome (RLS) with subjective improvement in sleep quality. Objective: To assess the therapeutic efficacy of Pergolide in improving sleep and subjective measures of well-being in patients with idiopathic RLS using polysomnography and clinical ratings. Methods: In a randomized, double-blind, placebo-controlled crossover design we enrolled 30 patients with idiopathic RLS according to the criteria of the International RLS Study Group. All patients were free of psychoactive drugs for at least 2 weeks before the study. Patients were monitored using polysomnography, clinical ratings, and sleep diaries at baseline and at the end of a 4-week Pergolide or placebo treatment period. The initial dosage of 0.05 mg Pergolide was increased to the best subjective improvement paralleled by 20 mg domperidone tid. Results: At a mean dosage of 0.51 mg Pergolide as a single daily dose 2 hours before bedtime, there were fewer periodic leg movements per hour of time in bed (5.7 versus 54.9, p p Conclusion: Pergolide given as a single low-to-medium bedtime dose in combination with domperidone provides a well-tolerated and effective treatment of sensorimotor symptoms and sleep disturbances in patients with primary RLS.

Mark T Donaldson - One of the best experts on this subject based on the ideXlab platform.

  • treatment with Pergolide or cyproheptadine of pituitary pars intermedia dysfunction equine cushing s disease
    Journal of Veterinary Internal Medicine, 2002
    Co-Authors: Mark T Donaldson, Bernadette H Lamonte, Peter R Morresey, Gary Smith, Jill Beech
    Abstract:

    Medical records of 27 horses (including 13 ponies) treated with Pergolide or cyproheptadine for pituitary pars intermedia dysfunction were reviewed to determine the effect of treatment on plasma ACTH, insulin, and glucose concentrations and clinical signs. Prior to treatment, the most common clinical signs were laminitis, hirsutism, and abnormal body fat distribution. The median Pergolide dose was 3.0 microg/kg p.o. q24h (range, 1.7-5.5 microg/kg). All horses treated with cyproheptadine were given 0.25 mg/kg p.o. q24h. After Pergolide treatment, ACTH concentrations (n = 20; median = 30.4 pg/ml; range, 4.2-173) were significantly lower (P < .01) than those in horses treated with cyproheptadine (n = 7; median = 141.0 pg/ml: range, 10-1,230). Among horses treated with Pergolide, there was a correlation between ACTH concentration after treatment and the duration of treatment (P < .001) and Pergolide dose (P = .04). Significantly (P = .02) more owners of horses treated with Pergolide (85%, 17/20) reported an improvement in clinical signs compared to owners of horses treated with cyproheptadine (28%, 2/7).

  • treatment with Pergolide or cyproheptadine of pituitary pars intermedia dysfunction equine cushing s disease
    Journal of Veterinary Internal Medicine, 2002
    Co-Authors: Mark T Donaldson, Bernadette H Lamonte, Peter R Morresey, Gary Smith, Jill Beech
    Abstract:

    Medical records of 27 horses (including 13 ponies) treated with Pergolide or cyproheptadine for pituitary pars intermedia dysfunction were reviewed to determine the effect of treatment on plasma ACTH, insulin, and glucoseconcentrations and clinical signs. Prior to treatment, the most common clinical signs were laminitis, hirsutism, and abnormal body fat distribution. The median Pergolide dose was 3.0 μg/kg PO q24h (range, 1.7-5.5 μg/kg). All horses treated with cyproheptadine were given 0.25 mg/kg PO q24h. After Pergolide treatment, ACTH concentrations (n = 20; median = 30.4 pg/ml; range, 4.2-173) were significantly lower (P <.01) than those in horses treated with cyproheptadine (n = 7; median = 141.0 pg/ml; range, 10-1,230). Among horses treated with Pergolide, there was a correlation between ACTH concentration after treatment and the duration of treatment (P < .001) and Pergolide dose (P =.04). Significantly (P =.02) more owners of horses treated with Pergolide (85%, 17/20) reported an improvement in clinical signs compared to owners of horses treated with cyproheptadine (28%, 2/7). Kev words: ACTH; Hyperadrenocorticism; Pituitary adenoma; Pituitary dysfunction; Pituitary hyperplasia; Pituitary tumor.

Richard B Dewey - One of the best experts on this subject based on the ideXlab platform.

  • cardiac valve regurgitation with Pergolide compared with nonergot agonists in parkinson disease
    JAMA Neurology, 2007
    Co-Authors: Richard B Dewey, Sharon C Reimold, Padraig Osuilleabhain
    Abstract:

    Main Outcome Measure: Valve scores (1 indicates trace; 2, mild; 3, moderate; and 4, severe) for the Pergolide group were compared with those for the nonergot agonist control group. Results:The mean±SD valve regurgitation scores in the matched Pergolide group compared with the nonergot group were as follows: aortic, 0.83±1.23 vs 0.19±0.53 (P=.01); mitral, 1.42±1.0 vs 0.39±0.65 (P.001); and tricuspid,1.43±1.0vs0.19±0.53(P.001).Lifetimeexposure to a dopamine agonist was not statistically differentbetweenthePergolideandnonergotagonistgroups (P=.18). Conclusions: These data strengthen the conclusion that Pergolide contributes to cardiac valve regurgitation when used in the long term as a treatment for PD. There appears to be low risk of cardiac valve regurgitation when using non–ergot-derived dopamine agonists.

  • Pergolide use in parkinson disease is associated with cardiac valve regurgitation
    Neurology, 2004
    Co-Authors: D G Baseman, Padraig Osuilleabhain, Sharon C Reimold, S R Laskar, J G Baseman, Richard B Dewey
    Abstract:

    Objective: To determine if Pergolide injures heart valves, by comparing echocardiographic findings in Pergolide-treated patients with those of a historical control group. Methods: Letters were sent to all patients in the authors’ practice believed to be taking Pergolide, and those responders who wished to continue it were urged to undergo echocardiography. Echocardiograms were obtained on 46 patients, and scores for valvular regurgitation were compared with those from an age-matched control group derived from the Framingham Study. The composite valve regurgitation score was modeled as a linear function of total milligrams lifetime use of Pergolide, controlling for age. Results: Eighty-nine percent of Pergolide-treated patients had some degree of valvular insufficiency. For each of the three valves for which there are control data, we found an approximately 2- to 3-fold increased risk of abnormal valves in the Pergolide patients (odds ratio [OR] ≈ 3) and an estimated 14-fold increased risk of concerning tricuspid regurgitation (OR = 18.4). The composite valve score (the sum of valve scores for each of the four valves) was a function of lifetime Pergolide use. Conclusion: Pergolide may injure cardiac valves, resulting most commonly in tricuspid regurgitation.

Bernadette H Lamonte - One of the best experts on this subject based on the ideXlab platform.

  • treatment with Pergolide or cyproheptadine of pituitary pars intermedia dysfunction equine cushing s disease
    Journal of Veterinary Internal Medicine, 2002
    Co-Authors: Mark T Donaldson, Bernadette H Lamonte, Peter R Morresey, Gary Smith, Jill Beech
    Abstract:

    Medical records of 27 horses (including 13 ponies) treated with Pergolide or cyproheptadine for pituitary pars intermedia dysfunction were reviewed to determine the effect of treatment on plasma ACTH, insulin, and glucose concentrations and clinical signs. Prior to treatment, the most common clinical signs were laminitis, hirsutism, and abnormal body fat distribution. The median Pergolide dose was 3.0 microg/kg p.o. q24h (range, 1.7-5.5 microg/kg). All horses treated with cyproheptadine were given 0.25 mg/kg p.o. q24h. After Pergolide treatment, ACTH concentrations (n = 20; median = 30.4 pg/ml; range, 4.2-173) were significantly lower (P < .01) than those in horses treated with cyproheptadine (n = 7; median = 141.0 pg/ml: range, 10-1,230). Among horses treated with Pergolide, there was a correlation between ACTH concentration after treatment and the duration of treatment (P < .001) and Pergolide dose (P = .04). Significantly (P = .02) more owners of horses treated with Pergolide (85%, 17/20) reported an improvement in clinical signs compared to owners of horses treated with cyproheptadine (28%, 2/7).

  • treatment with Pergolide or cyproheptadine of pituitary pars intermedia dysfunction equine cushing s disease
    Journal of Veterinary Internal Medicine, 2002
    Co-Authors: Mark T Donaldson, Bernadette H Lamonte, Peter R Morresey, Gary Smith, Jill Beech
    Abstract:

    Medical records of 27 horses (including 13 ponies) treated with Pergolide or cyproheptadine for pituitary pars intermedia dysfunction were reviewed to determine the effect of treatment on plasma ACTH, insulin, and glucoseconcentrations and clinical signs. Prior to treatment, the most common clinical signs were laminitis, hirsutism, and abnormal body fat distribution. The median Pergolide dose was 3.0 μg/kg PO q24h (range, 1.7-5.5 μg/kg). All horses treated with cyproheptadine were given 0.25 mg/kg PO q24h. After Pergolide treatment, ACTH concentrations (n = 20; median = 30.4 pg/ml; range, 4.2-173) were significantly lower (P <.01) than those in horses treated with cyproheptadine (n = 7; median = 141.0 pg/ml; range, 10-1,230). Among horses treated with Pergolide, there was a correlation between ACTH concentration after treatment and the duration of treatment (P < .001) and Pergolide dose (P =.04). Significantly (P =.02) more owners of horses treated with Pergolide (85%, 17/20) reported an improvement in clinical signs compared to owners of horses treated with cyproheptadine (28%, 2/7). Kev words: ACTH; Hyperadrenocorticism; Pituitary adenoma; Pituitary dysfunction; Pituitary hyperplasia; Pituitary tumor.