The dopamine transporter: importance in Parkinson's disease

JG Nutt, JH Carter, GJ Sexton - Annals of Neurology: Official …, 2004 - Wiley Online Library
JG Nutt, JH Carter, GJ Sexton
Annals of Neurology: Official Journal of the American Neurological …, 2004Wiley Online Library
The dopamine transporter (DAT) may be the single most important determinant of
extracellular dopamine concentrations. The importance of DAT in Parkinson's disease (PD)
in which DAT may be reduced by 50 to 70% is unclear. We have examined the effects of
methylphenidate (MPD), an inhibitor of DAT, administered alone or with levodopa, on
parkinsonism measured with tapping and walking speeds, dyskinesia, subjective effects,
and vital signs. MPD in oral doses of up to 0.4 mg/kg was well tolerated. Administered alone …
Abstract
The dopamine transporter (DAT) may be the single most important determinant of extracellular dopamine concentrations. The importance of DAT in Parkinson's disease (PD) in which DAT may be reduced by 50 to 70% is unclear. We have examined the effects of methylphenidate (MPD), an inhibitor of DAT, administered alone or with levodopa, on parkinsonism measured with tapping and walking speeds, dyskinesia, subjective effects, and vital signs. MPD in oral doses of up to 0.4mg/kg was well tolerated. Administered alone, MPD produced no objective improvement of parkinsonism. MPD, 0.4mg/kg orally, coadministered with 2‐hour levodopa infusions at 0.5 or 1.0mg/kg/hr increased the percentage of patients responding to the 0.5mg/kg/hr dose and prolonged the response to levodopa infusions as measured by tapping and walking speeds. Dyskinesia was prolonged in proportion to the increase in antiparkinson actions but severity was not increased. MPD decreased the hypotensive response to levodopa. In conclusion, MPD appeared to have no effect given alone but potentiated the effects of levodopa, particularly doses at threshold for clinical effects. These observations indicate that the residual DAT is functional in PD and is a potential target for symptomatic therapy of PD.
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