Opicapone Treats Motor Fluctuations, Directional DBS Favored in PD, MRgFUS is Effective as Hand Tremor Treatment

September 19, 2020

Neurology News Network for the week ending September 19, 2020.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus. This week, we take a look at a few presentations from the MDS Virtual Congress.

Data from an exploratory post-hoc analysis of the BIPARK I and II trials suggest that 50-mg opicapone is a viable option as a first-line adjunctive treatment for patients with Parkinson disease treated with levodopa who experience motor fluctuations. The assessment included 68 patients given the once-daily, oral, selective COMT inhibitor and 59 administered placebo, all of whom were only treated with levodopa. In total, the changes from baseline in absolute OFF and ON time were significantly greater for the opicapone group. “Levodopa still remains the most effective symptomatic treatment for Parkinson’s disease,” poster presenter Joaquim Ferreira and colleagues wrote, noting that post oral administration of levodopa, the drug is extensively metabolized in the periphery by dopa decarboxylase and COMT, opening a window for opicapone to fill that need.

Data presented at the 2020 MDS Virtual Congress, from the PROGRESS study revealed that 90.6% of patients with Parkinson disease had a wider therapeutic window when undergoing treatment with directional deep brain stimulation compared with omnidirectional DBS. The study included 234 patients who received subthalamic nucleus DBS programed with omnidirectional stimulation for 3 months followed by directional stimulation for 3 months. A blinded, off-medication evaluation of TW for directional vs conventional stimulation at 3 months, the primary end point of the study, was met with superiority for directional DBS. Additionally, patients showed a mean increase in TW of 41% compared with 2.11 for omnidirectional DBS. Scores on the Unified Parkinson Disease Rating Scale part III motor score (on medication) were improved in both groups at both timepoints.

Preliminary results presented at the 2020 MDS Virtual Congress, demonstrated that bilateral magnetic resonance-guided focused ultrasound thalamotomy is safe and effective for the treatment of essential tremor. In efforts to prove whether MRgFUS bilateral thalamic ablation can be tolerated, investigators assessed 5 patients who underwent a second thalamotomy on the contralateral hemisphere for non-treated tremor after receiving unilateral MRgFUS thalamotomy at least 1 year prior. Led by Raul Martinez-Fernandez, MD, PhD, all patients had achieved tremor control in the treated hand and did not show any permanent adverse effects from the first thalamotomy. Investigators then observed the safety of the second lesion based on an evaluation of observed and/or reported treatment-related adverse effects.

For more direct access to expert insight and coverage of the 2020 MDS Virtual Congress, head to NeurologyLive.com. This has been Neurology News Network. Thanks for watching.