Abstract
The biochemical pharmacology of parkinsonism and choreatic dis orders has been reviewed in relationship to recent observations in the synaptic pharmacology of dopaminergic systems. Despite the fact that parkinsonism is usually due to a failure of presynaptic dopamine input into the striatum, an identical clinical syndrome can result from postsynaptic striatal dysfunction. Although clinically identical, these two states differ both biochemically and pharmacologically. Presynaptic parkinsonism is associated with decreased dopamine turnover in the brain and responds to levodopa. Neither of these facts applies to postsynaptic parkinsonism
Denervation hypersensitivity has been proposed as a mechanism in the production of levodopa-induced dyskinesias and neurolepticinduced tardive dyskinesias. The role of chronic dopamine agonism in the former suggests that denervation hypersensitivity is not the only factor and raises the question that the treatment of parkinsonism with such agonists may inevitably be associated with dyskinesias and psychosis
Recent theories of the biochemical pharmacology of extrapyramidal movement disorders are largely derived from three separate sets of hypotheses:
-
1)
Dopamine and acetylcholine have antagonistic effects on striatal neurons and that the normal function of these neurons depends upon a balance of the influences of these two neurotransmitters.
-
2)
A shift of this balance such that there is a decrease in dopamine activity results in the signs and symptoms of parkinsonism. In most, if not all, of these patients this decrease is felt to come about as a result of decreased dopamine input (i.e., presynaptic dysfunction).
-
3)
A shift of this balance such that there is a relative in crease in dopaminergic activity results in choreatic movement disorders. This increase in dopaminergic activity is felt to be due to dysfunction of the striatal neurons (postsynaptic dysfunction). This is felt to be related to primary neuronal disease in Huntington’s chorea and to denervation hypersensitivity in tardive dyskinesias and levodopa-induced dyskinesias.
These basic concepts are based on a wide diversity of clinical and preclinical observations which have been reviewed extensively (üornykiewiczy 1966, Klawans, 1968, Klawans et al., 1970, Klawans, 1973). Rather than review these data once again, this review will focus on selected recent observations which serve to qualify and redefine these basic premises. We will focus on three particular issues:
-
1)
The occurrence of parkinsonism as a result of striatal cell dysfunction, i.e., postsynaptic parkinsonism.
-
2)
The role of chronic dopaminergic agonism in the pathogenesis of levodopa-induced hypersensitivity, i.e., agonist-induced hypersensitivity.
-
3)
Further observation on the development of denervation hypersensitivity within the central nervous system.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Aminoff, M.F., Wilcox, C.S., Woakes, M.M. and Kremer, M. (1973). Levodopa therapy for parkinsonism in the Shy-Drager syndrome. J. Neurol. Neurosurg. Psychiatry 36, 350–353.
Anden, N.E. (1970). Pharmacological and anatomical implications of induced abnormal movements with L-dopa. In L-Dopa and Park insonism (Barbeau, A. and McDowell, F.H., Eds), pp. 132–143. F.A. Davis, Philadelphia.
Andrews, J.M., Terry R.D. and Spataro, J. (1970). Striatonigral degeneration. Arch. Neurol. 23 ,319–327.
Barbeau, A. (1969). L-dopa and juvenile Huntington’s disease. Lancet 2 ,1066.
Barbeau, A., Marsh, H. and Gillo-Joffroy, L. (1971). Adverse clinical side effects of L-dopa therapy. In Recent Advances in Park inson’s Disease (McDowell, F.A. and Markham, C.H., Eds.), pp. 204–237. F.A. Davis, Philadelphia.
Bertler, A., Jeppson, P.G., Nordgren, L., et al. (1971). Serial determinations of homovanillic acid in the cerebrospinal fluid of parkinson patients treated with L-dopa. Acta Neurol. Scand. 47 ,393–402.
Bird, M.T. and Paulson, G.W. (1970). Early onset rigid Huntingtons chorea. Neurology (Minneap.) 20 ,400.
Carlsson, A. (1970). Biochemical implications of dopa-induced actions on the central nervous system, with particular reference to abnormal movements. In L-Dopa and Parkinsonism (Barbeau, A. and McDowell, F.H., Eds.), pp. 205–213. F.A. Davis, Philadelphia.
Chase, T.N. and Ng, L.K.Y. (1972). Central monoamine metabolism in Parkinson’s disease. Arch. Neurol. 27 ,486–491.
Costall, B. and Naylor, R.J. (1973). On the mode of action of apomorphine. Eur. J. Pharmacol. 21 ,350–361.
Ellinwood, E.H. (1967). Amphetamine psychosis. I. Description of the individuals and process. J. Nerv. Ment. Dis. 144 ,273–283.
Ernst, A.M. (1967). Mode of action of apomorphine and dexamphetamine on gnawing compulsion in rats. Psychopharmacologia (Bert.) 10, 316–323.
Fahn, S. and Breenberg, J. (1972). Striatonigral degeneration. Trans. Am. Neurol. Assoc. 97, 275–277.
Faurbye, A. (1970). The structural and biochemical basis of movement disorders in the treatment with neuroleptic drugs in extrapyramidal diseases. Comp. Psychiatry 11 ,205–224.
Fjalland, B. and Moller-Nielsen, I. (1974). Enhancement of methyl- phenidate-induced stereotypies by repeated administration of neuroleptics. Psychopharmacologia (Berl.) 34 ,105–109.
Gianutsos, G., Drawbaugh, R.B., Hynes, M.D. and Lal, H. (1974). Behavioral evidence for dopamine supersensitivity after chronic haloperidol. Life Sci. 14 ,887–898.
Godwin-Austen, R.B., Kantamarreni, B.D. and Curzon, G. (1971). Comparison of benefit from L-dopa in parkinsonism with increase of amine metabolites in the CSF. J. Neurosurg. Psychiatry 34 ,219–223.
Goetz, C. and Klawans, H.L. (1974). Studies on the interaction of reserpine, d-amphetamine, apomorphine, and 5-hydroxytryptophan. Acta Pharmacol. Toxicol. 34.,119–L30.
Greenfield, J.G. and Bosanquet, F.D. (1953). The brain stem lesion in parkinsonism. J. Neurol. Neurosurg. Psychiatry 16 ,213–226.
Gumpert, J., Sharpe, D. and Curzon, G. (1973). Amine metabolites in the cerebrospinal fluid in Parkinson’s disease and the response to levodopa. J. Neurol. Sci. 19 ,1–12.
Hornykiewicz, O. (1966). Dopamine (3-hydroxytyramine) and brain function. Pharmacol. Rev. 18 ,925–964.
Izumi, K., Inoue, N., Shirabe, T., Miyazaki, T. and Kuroiwa, Y. (1971). Failed levodopa therapy in striatonigral degeneration. Lancet 1 ,1355.
Jequier, E. and Dufresne, J.J. (1972). Biochemical investigations in patients with Parkinson’s disease treated with L-dopa. Neurology (Minneap.) 22 ,15–21.
Jonas, W. and Scheel-Kruger, J. (1969). Amphetamine-induced stereotyped behavior correlates with the accumulation of O-methy- dopamine. Arch. Int. Pharmacody. 177 ,379–386.
Klawans, H.L. (1968). The pharmacology of parkinsonism. Bis. Nerv. Syst. 29 ,805–816.
Klawans, H.L. (1973). The Pharmacology of Extrapyramidal Movement Disorders. S. Karger, Basel.
Klawans, H.L. (1975). Amine precursors in neurologic disorders and the psychoses. In Biology of Major Psychoses (Freedman, D.X., Ed.), pp. 259–272. Raven Press, New York.
Klawans, H., Itaki, M.M. and Sheuher, D. (1970). Theoretical of the use L-dopa in parkinsonism. Acta Neur. Scand. 46 ,409–441.
Klawans, H.L. and Margolin, D.I. (1975). Amphetamine-induced dopa- minergic hypersensitivity in guinea pigs. Arch. Gen. Psychiatry 32 ,725–732.
Klawans, H.L. and Rubovits, R. (1972). An experimental model of tardive dyskinesia. J. Neural Transm. 33 ,235–246.
Klawans, H.L. and Rubovits, R. (1975). The pharmacology of tardive dyskinesia and some animal models. In Proceedings of the IX Confress of the Collegium Internationale Neuropsychopharma cologicum (Boissier, J.R., Hippius, H. and Pichot, P., Eds.), pp. 58–67. Excerpta Medica, Amsterdam.
Klawans, H.L., Ilahi, M.M. and Ringel, S.P. (1971). Toward an under standing of the pathophysiology of Huntingtons chorea. Confin. Neurol. 33 ,297–303.
Klawans, H.L., Goetz, C., Westheimer, R. and Weiner, W.J. (1973a). 5-Hydroxytryptophan-induced behavior in intact guinea pigs. Res. Common. Chem, Pathol. Pharmacol. 5 ,555–559.
Klawans, H.L., Goetz, C. and Weiner, W.J. (1973b). 5-Hydroxytryptophan-induced myoclonus in guinea pigs and the possible role of serotonin in infantile myoclonus. Neurology (Minneap.) 23 ,1234–1240).
Klawans, H.L., Crosset, P. and Dana, N. (1975a). Effect of chronic amphetamine exposure on stereotyped behavior: Implications for pathogenesis of L-dopa-induced dyskinesias. In Advances in Neurology, vol. 9 (Calne, D.B., Chase, T.N. and Barbeau, A., Eds.), pp. 105–112. Raven Press, New York.
Klawans, H.L., D’Amico, D.J. and Patel, B.C. (1975b). Behavioral supersensitivity to 5-hydroxytryptophan induced by chronic methysergide pretreatment. Psychopharmacologia (Berl.) 44 ,297–300.
Klawans, H.L., Lupton, M.D. and Simon, L. (1976a). Calcification of the basal ganglia as a cause of levodopa resistant parkinsonism. Neurology (Minneap.) 26 ,221–225.
Klawans, H.L., D’Amico, D.J., Nausieda, P.A. and Weiner, W.J. (1976). The specificity of neuroleptic- and methysergide-induced behavioral hypersensitivity. Presented at the American Academy of Neurology Annual Meeting, April, 1976, Toronto, Canada.
Kramer, J., Fischman, V.S. and Littlefield, D.S. (1967). Amphetamine abuse — pattern and effects of high doses taken intravenously. J.A.M.A. 201 ,305–309.
Low, P.A., Allsop, J.L. and Halmayi, G.M. (1974). The rigid form (Westphal variant) treated with levodopa. Med. J. Aust. 1 ,393–394.
Nausieda, P.A., Crosset, P. and Klawans, H.L. (in press): Effect of chronic dopaminergic agonism on subsequent response to amphetamine and apomorphine. Encephale.
Ohye, C., Bouchard, R., Boucher, R. and Poirier, L.J. (1970). Spontaneous activity of the putamen after chronic interruption of the dopaminergic pathway. J. Pharmacol. Exp. Ther. 175 ,700–708.
Rajput, A., Kazi, D.A. and Rozdilsky, B. (1972). Striatonigral degeneration: Response to levodopa therapy. J. Neurol. Sci. 16 ,331–341.
Rinne, U.K., Sonninen, V. and Surtola, T. (1973). Acid monoamine metabolites in the cerebrospinal fluid of parkinson patients treated with levodopa alone or combined with a decarboxylase inhibitor. Eur. Neurol. 9 ,349–362.
Rubovits, R. and Klawans, H.L. (1972). Implications of amphetamineinduced stereotyped behavior as a model for tardive dyskinesia. Arch. Gen. Psychiatry 27 ,502–507.
Rylander, G. (1972). Psychoses and the punding and choreiform syndromes in addiction to central stimulant drugs. Psychiatr. Neurol. Neurochir. 75 ,203–212.
Sharpe, J.A., Newcastle, N.B., Lloyd, K.G., et al. (1973). Stria-tonigral degeneration. J. Neurol. Sci. 20 ,275–286.
Tarsy, D. and Baldessarini, R.J. (1974). Behavioral supersensitivity to apomorphine following chronic treatment with drugs which interfere with the synaptic function of catecholamines. Neuropharmacology 13 ,927–940.
Tarsy, D. and Baldessarini, R.J. (1976). The tardive dyskinesia syndrome. In Clinical Neuropharmacology (Klawans, H.L., Ed.), pp. 29–61. Raven Press, New York.
Trotter, J.L. (1973). Striatonigral degeneration, Alzheimer’s disease, and inflammatory changes. Neurolofy (Minneap.) 23 ,1211–1216.
Ungerstedt, U. (1971). Postsynaptic supersensitivity after 6-hydroxy dopamine induced degeneration of the nigrostriatal dopamine system. Acta Physiol. Scand. (Suppl.) 367 ,69–93.
Weiner, W.J. and Klawans, H.L. (1973). Failure of cerebrospinal fluid homovanillic acid to predict levodopa response in Parkin son’s disease. J. Neurol. Neurosurg. Psychiatry 36 ,747–752.
Weiner, W.J., Harrison, W.H. and Klawans, H.L. (1969). L-dopa and cerebrospinal fluid homovanillic acid in parkinsonism. Life Sci. 8 ,971–976.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1977 Plenum Press, New York
About this chapter
Cite this chapter
Klawans, H.L., Goetz, C., Nausieda, P.A., Weiner, W.J. (1977). Recent Advances in the Biochemical Pharmacology of Extrapyramidal Movement Disorders. In: Messiha, F.S., Kenny, A.D. (eds) Parkinson’s Disease. Advances in Experimental Medicine and Biology, vol 90. Springer, New York, NY. https://doi.org/10.1007/978-1-4684-2511-6_2
Download citation
DOI: https://doi.org/10.1007/978-1-4684-2511-6_2
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4684-2513-0
Online ISBN: 978-1-4684-2511-6
eBook Packages: Springer Book Archive