Therapeutic response to pramipexole in a patient with multiple system atrophy with predominant parkinsonism: positron emission tomography and pharmacokinetic assessments.

Abstract

Multiple system atrophy with predominant parkinsonism (MSA-P) usually shows poor responsiveness to dopaminergic medications. We herein describe a patient with MSA-P who exhibited a good response to pramipexole but not to an ordinary dose of L-dopa. Positron emission tomography (PET) displayed severely impaired presynaptic dopaminergic availability and relatively preserved postsynaptic D2 receptor binding capacity. The pharmacokinetic analyses demonstrated relatively low bioavailability for L-dopa and adequate plasma levels of pramipexole, even at baseline, on a stable daily dose. The PET features and pharmacokinetic differences between L-dopa and pramipexole indicate the presence of unique therapeutic responses to dopaminergic medications in the patient.

• Authors: Masayuki Ueda, Nobuhito Nakajima, Hiroshi Nagayama, Yasuhiro Nishiyama, Kenji Ishii, Yasuo Katayama
• Journal: Internal medicine (Tokyo, Japan) (Intern Med) Vol. 52 Issue 15 Pg. 1731-5 ( 2013) ISSN: 1349-7235 [Electronic] Japan
• PMID: 23903508 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antiparkinson Agents
• Benzothiazoles
• Levodopa
• Pramipexole

Topics

• Antiparkinson Agents (pharmacokinetics, therapeutic use)
• Benzothiazoles (pharmacokinetics, therapeutic use)
• Brain (pathology)
• Comorbidity
• Dose-Response Relationship, Drug
• Humans
• Levodopa (pharmacokinetics, therapeutic use)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Multiple System Atrophy (diagnostic imaging, drug therapy, epidemiology)
• Parkinsonian Disorders (diagnostic imaging, drug therapy, epidemiology)
• Positron-Emission Tomography
• Pramipexole
• Treatment Outcome