Neurology International (Dec 2020)

Istradefylline to Treat Patients with Parkinson’s Disease Experiencing “Off” Episodes: A Comprehensive Review

  • Amnon A. Berger,
  • Ariel Winnick,
  • Alexandra Welschmeyer,
  • Alicia Kaneb,
  • Kevin Berardino,
  • Elyse M. Cornett,
  • Alan D. Kaye,
  • Omar Viswanath,
  • Ivan Urits

DOI
https://doi.org/10.3390/neurolint12030017
Journal volume & issue
Vol. 12, no. 3
pp. 109 – 129

Abstract

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Parkinson’s disease (PD) is a common neurodegenerative disorder that leads to significant morbidity and disability. PD is caused by a loss of dopaminergic, cholinergic, serotonergic, and noradrenergic neurons in the central nervous system (CNS), and peripherally; the syndromic parkinsonism symptoms of movement disorder, gait disorder, rigidity and tremor are mostly driven by the loss of these neurons in the basal ganglia. Unfortunately, a significant proportion of patients taking levodopa, the standard of care treatment for PD, will begin to experience a decrease in effectiveness at varying times. These periods, referred to as “off episodes”, are characterized by increased symptoms and have a detrimental effect on quality of life and disability. Istradefylline, a novel adenosine A2A receptor antagonist, is indicated as a treatment addition to levodopa/carbidopa in patients experiencing “off episodes”. It promotes dopaminergic activity by antagonizing adenosine in the basal ganglia. This review will discuss istradefylline as a treatment for PD patients with off episodes.

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