A Multidisciplinary Approach to Manage Gait Difficulty in Parkinson Patients
Status:
Withdrawn
Trial end date:
2017-11-01
Target enrollment:
Participant gender:
Summary
The study team proposes to treat Parkinson's patients with gait difficulty with
multidisciplinary approach of medications. Single medication treatment, such as the use of
cholinergic-boosting anti-dementia medication targeting cholinergic deficiency to improve
executive dysfunction and attention deficit, or the use of medication boosting the
norepinephrine system, have not proven effective so far in treating the gait difficulty.
Anti-anxiety medications, particularly the SNRI (serotonin and norepinephrine reuptake
inhibitor) medications, which also ameliorate the norepinephrinergic deficiency, have not
been studied except for one successful case report using duloxetine to treat primary
progressive freezing of gait.
Targeting multiple mechanisms at same time, such as the combination of a SNRI antianxiety
medication (also boosting the norepinephrine system, such as duloxetine) with an
anti-dementia medication correcting the cholinergic deficiency (such as donepezil), or
targeting a new mechanism, such as the use of anti-GABAergic medication targeting the area
responsible for gait and sleep cycle (pedunculopontine nucleus area, PPNa) should be tried.
Therefore, a collaboration of multidisciplinary teams among the neurology movement disorder
team and cognition and sleep team, and psychiatry team is essential, which has not been tried
before in studying and treating the challenging gait difficulty in Parkinson patients.