The Effect of Methylphenidate on Non-motor Symptoms and Postural Control in Parkinson's Disease.

Condition(s) targeted: Parkinson's Disease

Intervention: Methylphenidate (Drug); Methylphenidate (Drug); Placebo 10 (Drug); Placebo 20 (Drug)

Phase: Phase 4

Status: Terminated

Sponsored by: Laval University

Official(s) and/or principal investigator(s):
Philippe Corbeil, PhD, Study Director, Affiliation: Laval University
Jaime McDonald, BScPhm, Study Director, Affiliation: Laval University
Emmanuelle Pourcher, MD, Principal Investigator, Affiliation: Québec Memory and Motor Skills Disorders Research Center

This project aims to determine if methylphenidate can improve deficits in attention and symptoms of orthostatic hypotension, two common non-motor symptoms, in patients with Parkinson's Disease. This project also seeks to evaluate the effect of methylphenidate on postural control in these patients, a debilitating motor symptom that places patients at an increased risk of falling. This study will build on existing data to support a new indication for the use of methylphenidate in Parkinson's Disease. Using standard and objective evaluations, this study will quantify the effect of methylphenidate at two doses on attention levels, orthostatic hypotension, and measures of postural control. Phase I of the study will compare methylphenidate 10mg three times daily to placebo and Phase II of the study, for those tolerating the lower dose in Phase I, will compare methylphenidate 20mg three times daily to placebo. By incorporating two different doses, the study also seeks to determine if any improvements are dose-related. Secondary endpoints will include safety assessments (adverse event monitoring and vital signs) performed every 30 minutes following supervised drug administration. Visual analog scales will be presented to each participant before treatment and following the final dose of each treatment to assess changes in fatigue. A secondary task will be added to postural tests to assess the influence of cognitive processes. It is hypothesized that methylphenidate will demonstrate a significant beneficial effect on all outcomes. It is projected that objective improvements will be observed following treatment with methylphenidate at both doses (10 and 20mg three time daily) when compared to placebo. It is further hypothesized that the effects will be dose-related and therefore more profound with higher doses.

Official title: Two-phase Randomized Controlled Trial of Low and Moderate Dose Methylphenidate for Non-motor and Postural Symptoms in Parkinson's Disease.

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome:

Conners' Continuous Performance Test-II score

Orthostatic drop - blood pressure in mmHg

Average speed of center of pressure oscillations

Total area of center of pressure oscillations

Secondary outcome:

Visual analog fatigue scale scores

Blood pressure (mmHg)

Heart rate

Number of errors recorded for 'Backward Digit Span' task

Minimum age: N/A. Maximum age: 75 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Patients with stages 2-3 Parkinson's disease as defined by the Hoehn &Yahr staging

system (Hoehn &Yahr, 1967).

- Age less than or equal to 75 years.

- Subjects who are willing and able to provide, in writing, informed consent.

- Subjects who are willing and able to be confined to the clinical research unit as

required by the protocol and to complete all procedures required on an outpatient basis. Exclusion Criteria:

- Subjects with evidence or history of clinically significant hematological, renal,

endocrine, pulmonary, gastrointestinal, cardiovascular, hepatic, psychiatric, neurological, or allergic disease (including drug allergies and excluding seasonal allergies).

- Subjects with a history of substance abuse or dependence or a positive urine screen

for drugs of abuse.

- A history of regular alcohol consumption exceeding 7 drinks/week for women or 14

drinks/week for men (1 drink = 5 ounces of wine or 12 ounces of beer or 1. 5 ounces of hard liquor) within 6 months of screening.

- Subjects with a documented allergy to methylphenidate or one of the product

excipients.

- Subjects with any medical condition affecting drug absorption (e. g. gastrectomy).

- Treatment with an investigational drug within 30 days or 5 half-lives (whichever is

longer) preceding the first dose of study medication.

- Use of a monoamine oxidase inhibitor or other interacting medication within the

preceding 14 days or 5 half-lives (whichever is longer).

- History of sensitivity to heparin or heparin-induced thrombocytopenia.

Laval University, Québec, Quebec G1V 0A6, Canada

Québec Memory and Motor Skills Disorders Research Center, Québec, Quebec G1S 2M2, Canada

Starting date: December 2010
Last updated: October 19, 2012