Nursing Home Residents at Highest Heatstroke Risk

Heatstroke may be most lethal for people who live in nursing homes or take medication to lower their blood pressure, a French study finds. Heatstroke, which results from exposure to high temperatures, is "defined by an elevated core body temperature above 40 degrees Celsius (104 degrees Fahrenheit), associated with central nervous system abnormalities," the study authors wrote.

They looked at the survival rates and outcomes of 83 heatstroke patients hospitalized in the city of Lyon during a severe heat wave that struck Europe in 2003. Estimates of the death toll ranged from 22,000 to more than 70,000 people.

Of the 83 patients in the study, 58 percent died within 28 days after being admitted to hospital. The patients who died:

• more often came from an institution for the elderly (24 of 48 who died vs. 7 of 35 survivors);
• were more likely to have used blood-pressure lowering drugs long-term (33 of 48 who died vs. 13 of 35 survivors);
• had a higher average body temperature when they were admitted to hospital (41.3 degrees C/106.3 degrees F compared with 40.7 degrees C/105.3 degrees F among survivors);
• had more respiratory, cardiovascular or kidney dysfunctions than survivors;
• were more likely to be in a coma when they arrived at the hospital (81 percent of those who died vs. 23 percent of survivors), or to have anuria, the inability to form urine (19 of those who died vs. zero of survivors).

The study was published online Aug. 13 in the journal Archives of Internal Medicine and was expected to be published in a later print issue.

A second study, also published by the journal, found that being confined to bed, not leaving home daily, or being unable to care for oneself were associated with death from heatstroke.

For this study, Saudi Arabian researchers analyzed six previous studies that examined a total of 1,065 heat-related deaths.

source : news.yahoo.com

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China targets toy and drug manufacturers

China has banned two factories from exporting toys after a high-profile recall of Mattel products including Big Bird and Elmo because of fears about lead in paint. It has also put on trial five drug company managers accused of killing patients with a tainted medicine, exposing corruption and lax safety that have alarmed consumers worldwide. China has been struggling to convince the world its products are safe after a series of scandals over tainted pet food, drugs, tires, toys and toothpaste.

China stripped export licenses from Hansheng Wooden Products Factory and Lida Toy Company, both based in the booming southern province of Guangdong, the General Administration of Quality Supervision, Inspection and Quarantine watchdog said on its Web site on Thursday.

Lead is toxic and can pose serious health risk to young children who often put objects in their mouths.

Hansheng, based in Dongguan, was the producer of 1.5 million wooden vehicles, buildings and other train-set toys sold in the United States from January 2005 through June 2007, and then voluntarily recalled by U.S. toymaker RC2 Corp., an Illinois-based company that imports the popular "Thomas & Friends" toys.

About 1.5 million preschool toys made by Lida Toy, a Foshan-based contract manufacturer for Mattel Inc.'s Fisher-Price unit, were recalled across the globe by the U.S. company last week.

Mattel said the toys, which include popular characters such as Elmo, Cookie Monster and Dora, could have contained excessive amounts of lead in their surface paint.

The Chinese watchdog said the problem was with Lida's paint supplier, which had provided "fake lead-free" paint for use in production.

It ordered the companies to "correct" their problems, and said police were investigating.

But it defended the made-in-China brand and said the overwhelming majority of toys met American standards. Of about 300,000 batches for export, the U.S. Consumer Product Safety Commission had only made about 29 recalls, it said.

It added that importers and "brand" companies also had a "very big responsibility" and that it hoped that "foreign toy brands further improve product design and supervision and control to prevent loopholes in toy quality and safety."

The general manager of the Qiqihar No. 2 Pharmaceutical Company, Yin Jiade, and four other employees are accused of killing patients by using a cheap, fatal substitute ingredient in a drug to treat gall bladder, liver and gastric disorders, the China News Service reported on Thursday.

The tainted medicine killed 13 patients in the southern city of Guangzhou, where the trial began on Wednesday. The same Chinese-made chemical has been linked to dozens of deaths in Panama, where it was used in a cough syrup.

Testimony from the defendants has highlighted abuses that have alarmed domestic and foreign consumers and prompted China to execute the former head of its food and drug watchdog, Zheng Xiaoyu, for taking bribes and dereliction of duty in July.

Most of the staff of the company laboratory had no knowledge of chemistry or any training, lab director Chen Guifen was quoted as saying.

The victims died last year after receiving injections of tainted Armillarisni A, made by the Qiqihar No. 2 which is based in the country's northeast.

More than 5 million doses of drugs made by the company had been recalled nationwide since the scam was exposed in May 2006, state newspapers said

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Calcium supplements ward of pregnancy complication

Pregnant women who take calcium supplements reduce their risk of developing preeclampsia, sometimes called toxemia of pregnancy, according to a new study. However, calcium supplementation has no effect on the risk of preterm birth or stillbirth. Dr. G. J. Hofmeyr, of the University of the Witwatersrand/University of Fort Hare, East London, South Africa, and colleagues conducted a systematic review of 12 clinical trials, involving over 15,500 women, that compared at least 1 gram of calcium daily during pregnancy with an inactive "placebo" supplement.

Most of the women were at low risk for pregnancy complications, but they had low levels of calcium in their diet. Compared with placebo, calcium supplementation was associated with less high blood pressure and less preeclampsia, the investigators report in the British Journal of Obstetrics and Gynecology.No overall effect was seen on the risk of preterm birth or stillbirth or infant death before hospital discharge.

"Calcium supplementation during pregnancy for women with deficient dietary calcium intake offers modest benefit for individual women," Hofmeyr's team concludes.

"However, a public health policy of calcium supplementation during pregnancy is unlikely to have a major impact on the incidence of pre-eclampsia," they continue, because in those communities where dietary calcium is inadequate, high-risk women "often attend antenatal clinics late in pregnancy or not at all and so would not benefit from strategies directed at those attending for antenatal care."

The researchers therefore suggest "that future research be directed towards evaluation of improving calcium intake at a population level, for example by food fortification, rather than at an individual level."

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Some children shut out from vaccines

For children whose health insurance doesn't cover newly recommended shots, it's better to have no insurance at all, a new study suggests. Free vaccines are available to children who are uninsured or qualify for public insurance. But many states can't afford to help children with inadequate private insurance that doesn't cover new, expensive shots and even some older shots, the study found. That puts more than a million children at risk, researchers said.

Illinois, for example, doesn't provide vaccines against chickenpox, pneumonia, hepatitis A, human papillomavirus and rotavirus to children with insufficient private insurance. Parents would have to pay $400 out of pocket for those vaccines. "Health insurance plans are not necessarily keeping up with the new vaccines, posing significant ethical dilemmas to public health clinics," said the study's lead author Dr. Grace Lee of Harvard Medical School.

The study of the nation's patchwork system of paying for immunizations appears in Wednesday's Journal of the American Medical Association.

Childhood shots have become a $1 billion-a-year endeavor for government since the discovery of polio vaccine 55 years ago. The per-child cost grew more than sevenfold from $155 in 1995 to $900 for boys and $1,200 for girls this year. Costs in the private sector are higher.

Lee and her colleagues surveyed states to find out which shots they provide and to whom. Program managers from 48 states responded. Lee wouldn't say which states participated because researchers promised anonymity.

Sixteen of the states require health insurers to cover all recommended vaccines.

About 55 million employees and their dependents get coverage through self-insured companies that are exempt from state mandates. Those people are the most likely to be underinsured for vaccines, said vaccine policy expert Dr. Matthew Davis of the University of Michigan.

According to the research, 17 states reported they were unable to give a vaccine for meningitis to children with inadequate private insurance, even if they were seen in public health clinics. And eight states don't give pneumococcal shots to underinsured infants and toddlers.

A handful of states don't provide shots for chickenpox and hepatitis A to the underinsured. Two states don't provide Tdap, the combined booster shot for tetanus, diphtheria and pertussis (whooping cough) for 11- to 12-year-olds.

More than 1 million insured children are unable to get the meningococcal vaccine leaving them vulnerable to potentially deadly infection, the researchers estimated.

The survey did not ask about two vaccines recommended last year: an oral vaccine for infants against rotavirus, a common cause of childhood diarrhea and vomiting, and a vaccine for girls against human papillomavirus, which can cause cervical cancer.

Workers covered by plans marketed by Aetna and other insurance companies generally are covered for childhood vaccines, although they may have to pay co-payments or satisfy deductibles, said Mohit Ghose, a spokesman for America's Health Insurance Plans.

As costs rise, it may be necessary to decide at a national level which vaccines are most important, Davis said. He was not involved in the new study, but wrote an accompanying editorial in the journal.

Officials at the U.S. Centers for Disease Control and Prevention oppose prioritizing vaccines and instead favor better coverage by insurers and more government funding as a safety net, said CDC immunizations director Dr. Lance Rodewald.

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Energy drinks' caffeine in line with coffee

Despite such speedy-sounding names as "Full Throttle," "Amp" and "Rush," energy drinks pack a punch that is generally no stronger than coffee, according to a report released on Monday. A comparison of 12 popular energy drinks, published in the September issue of Consumer Reports, found that the caffeine in 8 ounces of various brands ranged from 50-145 milligrams (mg), though most were in the 75- to 80-mg range.

Results were rounded to the nearest 5 mg. By comparison, the caffeine in an 8-oz cup of brewed coffee can range from 65-120 mg, with an average of 85 mg, according to the National Coffee Association. The least-caffeinated energy drink Consumer Reports tested was the fruit punch-flavored offering by Target Corp.'s private label Archer Farms, with 50 mg. At the high end was the lemon-lime flavored Celsius with 145 mg.

Market-leading Red Bull had 80 mg of caffeine. Sobe No Fear, owned by PepsiCo Inc., had 85 mg of caffeine. Amp had 75 mg of caffeine, while Rush and Coca-Cola Co.'s Full Throttle both had 80 mg.

Jamie Kopf Hirsh, associate editor at Consumer Reports and the report's author, said it was "good news" that energy drinks were not much more caffeinated than coffee, but said consumers should still be cautious.

Even though 8 ounces is the standard serving size for measuring, most containers have more than that, and most consumers drink more than that.

"You don't have to be alarmed by this, you just have to account for it in your daily caffeine intake," Hirsh said, adding that energy drinks, with their graphic video-game-like logos that appeal to young men, could be "coffee for the new generation."

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Stress response tied to kids' behavior problems

A combination of nature and nurture may make some children more likely to develop behavioral problems, new research suggests.

In a study of 138 children, researchers found that it wasn't only the children's exposure to stress, but their bodies' reactions to the stress, that affected their future behavior.

Young children who had both a stressful home life and an exaggerated nervous system response to stress were more likely than their peers to develop behavioral problems over the next six years.

The findings suggest that family life and biology combine to shape a child's personality development, the researchers report in the journal Psychological Sciences.

In the case of children who are surrounded by stressful conditions and have a stronger physiological response to stress, the combination may set them on a course toward an "under controlled" personality, according to the study.

Young people with this personality type have difficulty adapting their behavior to different circumstances, tend to be plagued by negative emotions, and often have behavioral problems such as fighting with their peers.

The findings suggest that children with greater nervous system reactivity have a particular need to be shielded from chronic stress, lead study author Daniel Hart told Reuters Health.

"What some kids can shrug off (may) be harmful to others," explained Hart, a psychologist at the Center for Children and Childhood Studies at Rutgers University in Camden, New Jersey.

He and his colleagues based their findings on a six-year follow-up of 138 children who were in kindergarten through third grade at the study's start. At that time, the researchers measured the children's autonomic nervous response to stress.

The autonomic nervous system regulates involuntary bodily functions like heart rate and digestion. Hart's team gauged the children's autonomic responses to stress using a test that measures sweat production on the palms. The children were tested after seeing a short, emotionally neutral film, and after seeing a more stressful scene where a lamp triggers a fire in a girl's room.

The researchers also estimated the children's risk of having a stressful home life based on family income and mothers' education; children from low-income, less educated families were considered to be at risk of living under stressful conditions.

In general, the study found, children who had both a high risk of family stress and exaggerated responses to the stressful film were more likely to develop behavioral problems over the next six years.

But while the findings suggest that nature is important in a child's personality development and likelihood of behavior problems, nurture may win in the end.

In their ongoing research, Hart said, he and his colleagues have found that when children who are prone to greater stress reactions do not have chronic stress in their lives, they "may really flourish."

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Patients With Early Parkinson's Exhibit Sleepiness, Hallucinations

Factors such as gender, age and overall health may help predict which people with early Parkinson's disease will experience hallucinations, sleepiness or swelling, a new study says.

These symptoms are reported more frequently by people with early Parkinson's disease than the general population, the study authors said.

"By identifying risk factors, it may help guide treatment decisions, allow for early intervention and possibly reduce disability," study author Dr. Kevin Biglan, a physician at the University of Rochester (N.Y.) School of Medicine, said in a prepared statement.

Biglan and his team analyzed data from a four-year clinical trial involving 301 people who had early Parkinson's disease. None of the participants reported hallucinations at the beginning of the study.

One out of five people in the study developed hallucinations. More than one out of three developed sleepiness, and almost one out of two developed swelling within four years of starting treatment with either levodopa or pramipexole.

"In contrast to other studies, we found being male, having multiple health problems and taking pramipexole were independently associated with developing sleepiness," Biglan said in the prepared statement. "This is the first time a patient's other health problems have been identified as a risk factor for drowsiness."

Writing in the July issue of Neurology, the researchers noted that being older, having multiple health problems and the presence of slight memory problems were associated with an increased risk of hallucinations. The medications did not affect the risk of hallucinations.

Being female, having heart disease and pramipexole treatment were associated with an increased risk of swelling, the researchers said.

The findings are published in the July issue of Neurology.

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Cigarette Smoking May Lower Parkinson's Risk

Long-term and current smokers have a lower risk of Parkinson's disease than the general population, researchers say in a report that confirms previous observations that people with Parkinson's disease were less likely to be smokers.

Dr. Beate Ritz of the University of California, Los Angeles, School of Public Health and colleagues analyzed data from 11,809 people involved in 11 studies conducted between 1960 and 2004. Of those, 2,816 individuals had Parkinson's disease.

The data showed that current smokers and those who had continued to smoke within five years of Parkinson's disease diagnosis had the lowest risk. People who quit smoking up to 25 years before diagnosis also had a reduced risk. Other tobacco products such as cigars, pipe tobacco and chewing tobacco showed reduced risk as well.

The association between tobacco use and Parkinson's disease disappeared for people older than 75, however. And while the association was strong for people of Caucasian or Asian ancestry, it did not hold for Hispanics or blacks.

The researchers wrote that the biochemical basis for the effect is not well understood, but that either nicotine or carbon monoxide may, in fact, protect brain cells that produce dopamine. Dopamine is a chemical produced in the brain that enables the body to coordinate movement. Once 80 percent of the neurons that produce dopamine begin to fail, the symptoms of Parkinson's disease appear. Symptoms include tremors in hands and feet and a lack of flexibility or balance.

Writing in the July issue of the Archives of Neurology, the researchers called or further research to understand what chemicals in cigarettes and tobacco might be protective against Parkinson's disease.

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New treatment promising for Parkinson's

An experimental treatment for Parkinson's disease seemed to improve symptoms — dramatically so, for one 59-year-old man — without causing side effects in an early study of a dozen patients.

The gene therapy treatment involved slipping billions of copies of a gene into the brain to calm overactive brain circuitry.

The small study focused on testing the safety of the procedure rather than its effectiveness, and experts cautioned it's too soon to draw conclusions about how well it works. But they called the results promising and said the approach merits further studies.

"We still have quite a bit more testing to do," said Dr. Michael Kaplitt of Weill Cornell Medical College in New York, an author of the study. Still, "the initial results are extremely encouraging."

Kaplitt and collaborators report their results in this week's issue of the British medical journal, The Lancet.

They're not alone in trying gene therapy for Parkinson's. In April, another team told a medical meeting that its experiments, which delivered a different kind of gene to a different part of the brain, also appeared safe and gave a preliminary hint of benefit.

More than half a million Americans have Parkinson's. They endure symptoms that include tremors, rigidity in their limbs, slowness of movement and impaired balance and coordination. Eventually they can become severely disabled.

Nathan Klein, a 59-year-old freelance television producer in Port Washington, N.Y., said the disease left him "pretty messed up." It weakened his voice, impaired his walking and made his hand tremble so badly he couldn't hold a glass of wine without spilling it all.

Klein was the first patient to be treated with Kaplitt's gene therapy procedure in 2003, and he said his symptoms gradually subsided afterward. Nowadays, he said, apart from freezing now and then when he wants to walk, the symptoms are basically gone.

"I'm elated," said Klein, who continues to take his regular pills for the disease. "It's unbelievable."

Kaplitt, who has a financial interest in Neurologix Inc., which paid for the research, noted that the 12 patients in the study still have Parkinson's symptoms. The amount of medication they were already taking for their symptoms didn't change significantly in the year after the surgery.

Current medicines can control symptoms, but can't stop the disease from getting worse over time, and they can produce troublesome side effects like uncontrollable movement.

Some patients gain relief from a surgical treatment called deep brain stimulation, in which electrodes are placed in the brain and connected to a programmable stimulator.

Kaplitt's procedure was aimed at achieving the same goal as that surgery, calming overactive circuitry in the brain. It gets overactive because it loses the normal supply of a chemical called GABA. The gene therapy was designed to make the brain produce more GABA.

For the gene therapy surgery, a tube about the width of a hair was threaded through a hole about the size of a quarter at the top of the skull. The tube delivered a dose of a virus engineered to ferry copies of a gene into cells of a brain region called the subthalamic nucleus. The gene copies enable the cells to pump out more GABA.

The Lancet paper reports that over a year, patients showed no side effects from the procedure. What's more, they showed improvements in an overall assessment of symptoms like tremors, stiffness and walking problems.

The improvements were evident at a checkup three months after the procedure and persisted to the end of the study, one year after the surgery, researchers reported. By that time, the overall amount of improvement from before surgery was about 24 percent when measured at times that patients were off their normal medication, and 27 percent at times when they were on medication.

Most of the effect appeared on just one side of the body. Because of concerns about safety with the untested procedure, the researchers treated only the brain circuitry controlling one side of the body.

Dr. Karl Kieburtz of the University of Rochester Medical Center, who didn't participate in Kaplitt's work, said the lack of any apparent side effects is itself significant.

But he urged caution in interpreting the evidence of benefits in symptoms. Other experimental therapies that looked good at such a preliminary stage have failed to pan out in more rigorous studies, he said, so more research is needed.

Future studies could include a head-to-head test against deep brain stimulation to see which relieves symptoms better, said neurosurgeon Dr. Guy M. McKhann of the Columbia University Medical Center in New York.

Dr. J. Timothy Greenamyre of the University of Pittsburgh, who was also familiar with the results, said the new study and prior research in animals leave him "very optimistic" about Kaplitt's approach.

source : news.yahoo.com

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1st Gene Therapy Trial Effective Against Parkinson's

In an early trial, gene therapy has proven both safe and effective in easing the symptoms of Parkinson's disease, researchers say.

A dozen patients experienced a 25 percent to 30 percent improvement in their total symptoms without any side effects, the U.S. team noted in the June 23 issue of The Lancet.

"Safety and tolerability were met with flying colors. On that level, we are extremely encouraged," said Dr. Matthew During, senior author of the study and professor of molecular biology, immunology and medical genetics at Ohio State University. "All in all, we're very excited, but we have to be a little bit cautious, and we need to do a definitive study with the proper controls."

During completed the study while on the faculty of Weill Medical College of Cornell University in New York City. The trial was conducted with researchers from the Feinstein Institute for Medical Research, part of the North Shore-LIJ Health System, in New York. The study was funded by Neurologix, which was co-founded by During and another study author, Dr. Michael Kaplitt. The two remain as consultants to the company, and Kaplitt's father is chairman of the board of Neurologix.

Parkinson's disease affects some 1.5 million Americans, most of them over the age of 65, although younger patients are also affected, including actor and Parkinson's research advocate Michael J. Fox.

The illness is characterized by a loss of dopamine-producing brain cells, resulting in problems with motor function such as tremors, limb rigidity, slow movement and balance and coordination problems.

There are some treatments but no cure, and, as During pointe out, current treatments are far from ideal.

Patients eventually become resistant to drugs. Deep brain stimulation, which involves placing an electrode deep into the brain, has helped some patients who no longer respond to drugs. But the therapy has side effects and is only partially effective.

"There are wires and a huge battery pack in the chest. It's a bit Frankensteinian, and patients hate it," During said. "There's about a 30 to 40 percent adverse event rate. Although it works, it comes at a significant cost."

"There's an unmet need for Parkinson's disease" treatment, he added.

Gene therapy has shown some promise in different areas of medicine, but there have been lingering concerns about its safety after one patient receiving gene therapy for a rare inherited disorder died in 1999. That case led to a temporary suspension of trials.

The current trial is the first-ever phase I clinical trial looking at gene therapy against Parkinson's disease. The study involved 11 men and one woman, averaging 58 years of age. Participants were divided into three groups of four and given low, medium or high dose injections of the glutamic acid decarboxylase (GAD) gene directly into brain cells. The gene, which is involved in dopamine production, was transferred to the cells using an adeno-associated virus.

There were no side effects associated with the gene therapy and, although the study was not undertaken to show effectiveness, the researchers have noted improvements in movement within three months of the procedure.

Brain scans showed changes in metabolism similar to those that occur after surgery for Parkinson's.

The benefits were equivalent to improvements seen with deep brain stimulation, although deep brain stimulation is given to both sides of the brain, and the gene therapy was only given to one side of the brain because of concerns about side effects.

"It's sort of a proof of concept that the adenovirus vector process is not going to be detrimental for patients or doesn't show signs that it will," said Dr. Gerald Frye, a professor of neuroscience and experimental therapeutics at the Texas A&M Health Science Center College of Medicine. "I am impressed that there weren't a lot of negative things that happened. That's really encouraging."

But Frye added that, right now, it's hard to gauge whether this will be superior or inferior to deep brain stimulation.

"The authors argue that not having to go in and modulate your stimulator is an advantage for gene therapy. But, I would say that the fact that you can modulate stimulation is an advantage," Frye said. "Once you put the gene in, you can't take it back out and turn it up or down."

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Parkinson's Linked to Pesticides, Head Trauma

Pesticides and head injury can both bump up risks for Parkinson's disease, European researchers report.

Moreover, odds for the illness increase as exposure to these brain insults rises, the report found.

For example, "Those who were heavily exposed to pesticides had a 41 percent increased risk of developing Parkinson's disease, and those with lower exposure had a 13 percent increased risk," said lead researcher Dr. Finlay Dick, from the Department of Environmental and Occupational Medicine at Aberdeen University Medical School, Aberdeen, U.K.
In addition, people who were knocked unconscious even once had a 35 percent increased risk of developing Parkinson's, Dick said.

That finding has real implications for sports such as boxing, the researchers said. In fact, professional boxing legend Muhammad Ali, 65, now suffers from advanced Parkinson's disease.

The findings are published in the May 30 online edition of Occupational and Environmental Medicine.

According to the National Parkinson Foundation, 1.5 million Americans currently have the degenerative illness, which strikes men and women in roughly equal numbers, usually after the age of 65.

In the study, Dick's team collected data on 959 people with Parkinson's or Parkinson's-like syndromes and almost 2,000 people without the condition. All the people were questioned about their exposure to pesticides as well as iron, copper and manganese. They were also asked if they had ever having been knocked unconscious or had a family history of Parkinson's disease.

The team found that people who had been exposed to low levels of pesticides were 13 percent more likely to have Parkinson's compared to people who had never been exposed. And people exposed to high levels of pesticides were 41 percent more likely to develop the condition.

Dick's group also found that Parkinson's disease occurred 35 percent more often in people who had been knocked unconscious once compared with those who had never been knocked out, and more than two-and-a-half times more frequently in people who had been knocked out more often.

In terms of pesticides, the researchers don't know which compounds are most likely to increase the risk for Parkinson's, Dick said. More research is needed, he added.

One take-home message: avoiding head injury is a good way to cut Parkinson's risk. "This has implications for contact sports, particularly for things like boxing," Dick said.

One expert lauded the research.

"This study adds to a growing body of evidence that points toward an association between exposure to environmental issues being related to neurodegenerative diseases like Parkinson's disease," said Dr. Michael S. Okun, the medical director of the National Parkinson Foundation.

He speculated that environmental exposures may trigger genes that spur the illness. "In some way, environmental exposures are affecting a series of events that unfold in the human brain that result in neurodegenerative diseases," he said.

While the causes of Parkinson's aren't known, Okun believes that it is a combination of factors, such as a genetic predisposition for the disease, coupled with environmental triggers.

"It would be a mistake to assume that this is a disease linked directly to pesticides or linked directly to genes and to close the door on potential interactions between them," he said.

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FDA OKs drug patch to treat Parkinson's

The treatment options for patients with early Parkinson's expanded Wednesday with the approval of a new drug in patch form — a first for medicines to treat symptoms of the disease.

The once-daily Neupro patch contains a drug called rotigotine, which has not been sold before in the United States, the Food and Drug Administration said. The drug patch, made by Schwarz Pharma AG, is the first for the treatment of symptoms of Parkinson's disease.
Parkinson's disease results from the loss of dopamine-producing brain cells. Dopamine is crucial for the communication between cells that control muscle movement, which explains the trembling commonly seen in Parkinson's patients.

Rotigotine works by activating dopamine receptors in the brain, mimicking the neurotransmitter's effect.

The most common side effects for Neupro include skin reactions at the patch site, dizziness, nausea, vomiting, drowsiness and insomnia, the FDA said. Most are typical with this class of drugs.

Other potential safety concerns include sudden onset of sleep while engaged in activities such as driving or operating machinery, hallucinations and decreased blood pressure when standing up, the agency said.

An estimated 1 million people in the U.S. have Parkinson's, with an additional 60,000 cases diagnosed each year.

Belgium's UCB bought Germany-based Schwarz Pharma last year.

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Parkinson's treatment best for "younger" patients

In individuals older than 65 with severe Parkinson's disease, deep brain stimulation reduces motor complications but does not improve quality of life, a new study finds. But patients with severe Parkinson's disease who are younger than age 65 are apt to see both a lessening of motor disturbances and improvement in quality of life with the treatment.

Parkinson's disease is a progressive neurological disorder that causes tremor, muscle rigidity and movement problems. It is usually treated with medication. When that fails, deep brain stimulation may be an option. The technique involves electrodes implanted in the brain and electrically stimulated to ease movement problems.
"Lack of quality-of-life improvement ... raises the question of whether deep brain stimulation is appropriate for the parkinsonian population over 65 years old," Dr. Philippe-Pierre Derost from Hopital Gabriel Montpied, Clermont-Ferrand, France told Reuters Health.

Derost and associates investigated the effects, safety, and quality of life after deep brain stimulation in 87 patients with Parkinson's disease. Fifty-three of them were younger than 65 years of age, and 34 were 65 or older.

Both groups of patients experienced dramatic improvements in movement disturbances characteristic of Parkinson's disease, the authors report.

Unlike the younger patients, however, older patients showed a significant worsening on two tests that measure a person's capacity to perform daily chores.

Moreover, the results indicate, young patients fared significantly better than old patients in several quality-of-life dimensions, including mobility, activities of daily living, stigma, thinking, and communication.

In these five dimensions, young patients experienced improvements, while old patients showed only stabilization or worsening.

"The absence of improvement of quality of life in the old population was surprising since motor complications were reduced similarly in both groups of patients," Derost said.

The results of the current study "should lead us to exclude patients aged more than 65 years for deep brain stimulation," Derost suggested.

Nonetheless, some elderly patients did see favorable results, according to Derost. "Unfortunately, such predictive factors are still not identified," Derost said. "A study is being performed in our department to detect these potential predictive factors to help determine who should undergo deep brain stimulation."

SOURCE: Neurology, April 24, 2007.

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Exercise May Help Ward Off Parkinson's Disease

New research suggests more evidence of yet another benefit of regular exercise: It could keep Parkinson's disease at bay.

The study doesn't conclusively link exercise to better brain health, but scientists think the connection could be more than a fluke.

"The people who seemed to have a lower risk of disease were engaging in moderate to vigorous activity for two to three hours a week," said study leader Evan Thacker, a research assistant at the Harvard School of Public Health.
Parkinson's disease is a movement disorder that worsens over time and causes a variety of symptoms, including disruptions in movement, as neurons in the brain deteriorate. The cause of the disease is not known, and there is no cure, but drug therapy and surgery can help manage symptoms, according to the Parkinson' Disease Foundation.

An estimated 1.5 million Americans have the disease, and 60,000 new cases are diagnosed each year, according to the foundation. Among famous people who have the condition are the actor Michael J. Fox and former U.S. Attorney General
Janet Reno.

In what Thacker called the largest research project of its kind, researchers looked at the results of a federal cancer study that followed 63,348 men and 79,977 women from 1992 to 2001. Of the participants -- with an average age of 63 -- 413 of them developed Parkinson's disease.

The researchers looked at exercise levels and tried to determine if they affected the rate of Parkinson's disease after adjusting the numbers to reflect the possible influence of factors such as age, gender and smoking.

People who exercised more than 75 percent of their fellow study participants were 20 percent less likely to develop Parkinson's, compared to those who didn't exercise. The risk of the disease was 40 percent lower in those who took part in the highest levels of moderate to vigorous activity, defined as exercise such as jogging, lap swimming, tennis and bicycling, the study found.

However, there's one caveat -- the researchers found no indication that physical activity at age 40 affected the risk of developing Parkinson's.

The results were expected to be reported Monday at the American Academy of Neurology annual meeting, in Boston. As is often the case with research presented at conferences, the study has not been published in a medical journal or gone through the review process that journals require.

A previous study suggested a link between exercise and Parkinson's in men, but not in women, Thacker said. The new findings show both genders may benefit.

Still, he cautioned that his study isn't "the final word."

"We can't prove there was some other factor that caused people to be different," he said. "We can just do the best we can.

Thacker said it's still not clear why exercise might influence the development of Parkinson's. One possibility could be that exercise might affect chemicals in the blood that play a role in the development of the disease, he said.

Researchers at the University of Southern California have found evidence suggesting that exercise changes the way neurons release dopamine -- a crucial brain booster -- in mice, said Michael Jakowec, an assistant professor of neurology at the school.

Disruptions in dopamine production have been linked to Parkinson's.

According to Jakowec, both animal studies and brain imaging in humans will help scientists understand the effects of exercise on the brain.

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Studies line up on Parkinson's and pesticides link

Evidence that pesticides can cause Parkinson's disease is stronger than it has ever been after a meeting of experts who have put together links in animals and people, scientists say.

One study shows that farm workers who used the common weedkiller paraquat had two to three times the normal risk of Parkinson's, a degenerative brain disease that eventually paralyzes patients.

A second study shows that animals exposed to paraquat have a build-up of a protein called alpha-synuclein in their brains. This protein has been linked to Parkinson's in the past.
A third piece of the puzzle shows that this buildup of protein kills the same brain cells affected in Parkinson's.

"All of these pieces really look like they are coming together now," Dr. William Langston, founder of the non-profit Parkinson's Institute, told Reuters.

Langston and colleagues said they were energized by research presented at the Parkinson's Disease Environmental Research meeting in Monterey, California, earlier this month.

Parkinson's disease, which affects more than 1 million patients in the United States, is marked by the death of brain cells that produce dopamine.

Dopamine is a neurotransmitter, or message-carrying chemical, associated with movement. Drugs can delay symptoms for a while but there is no good treatment and no cure.

Farm workers are at especially high risk but links to pesticides have been difficult to document because years usually pass between a person's exposure to pesticides and the development of the disease.

Dr. Beate Ritz of the University of California at Los Angeles and Dr. Caroline Tanner of the Parkinson's Institute looked at 80,000 people in Iowa and North Carolina and found farm workers exposed to paraquat had twice the expected risk of Parkinson's over their lifetimes.

Exposure to another pesticide called dieldrin also raised the risk, the study, funded by the National Institute of Environmental Health Sciences, found.

A second study found similar effects in farm workers in central California.

BETTER DOCUMENTATION

What made the studies especially important was that pesticide exposure could be carefully documented through records of pesticide purchase, Langston said. Details will be published in a scientific journal later.

Dr. Donato Di Monte of the Parkinson's Institute gave paraquat to laboratory animals and found it caused a buildup of alpha-synuclein in the brain that killed the same neurons affected by people with Parkinson's disease.

"This increase in alpha-synuclein in the brain could be the missing link between the exposure to this agent and how this agent causes the disease," Di Monte said in a telephone interview.

"Maybe being exposed to paraquat may not be enough to cause the disease but increases the probability the disease may develop," Di Monte said.

Langston and Di Monte said inflammation also could be a factor.

"Give an animal a compound that creates a marked inflammation response in the body ... and months later the animal loses cells in same area of the brain that is associated with Parkinson's," Langston said.

"This suggests that systemic inflammation may somehow sensitize the brain."

Multiple concussions, which can cause inflammation in the brain, raise the risk of Parkinson's, Langston said.

Two other groups of people that have a higher-than-average risk of Parkinson's are health workers and teachers.

"At first glance that doesn't make sense," Langston said.

But both do have something in common -- frequent exposure to viruses.

It could be, Langston and Di Monte said, that if a person is exposed to a pesticide while his or her brain has inflammation, this greatly raises the risk of Parkinson's many years later.

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