Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disease due to the depletion of the neurotransmitter dopamine in basal ganglia. There is a scarcity of available therapies for motor and non-motor symptoms of PD. Zonisamide (ZNS) may be one such potential candidate to alleviate PD symptoms. It was serendipitously found to be useful for PD in a patient with both epilepsy and PD. Since then, there have been many clinical trials, case series, observational studies, and case reports published supporting the efficacy of ZNS in PD. This review focuses on the efficacy and usefulness of ZNS in various motor and non-motor symptoms of PD. A predefined inclusion and exclusion criteria were used for the search protocol and databases searched were PubMed, Cochrane Library, Ovid, and clinicaltrials.gov. Most of the randomized clinical trials used UPDRS III as the primary efficacy point and showed positive results favouring ZNS. This review shows that there is evidence of the efficacy of ZNS in motor symptoms as an adjunctive therapy to levodopa, but for non-motor symptoms, the evidence is lacking and needs further investigation.
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References
Reimers A, Ljung H (2019) An evaluation of zonisamide, including its long-term efficacy, for the treatment of focal epilepsy. Expert OpinPharmacother 20(8):909–915
Wilfong AA, Willmore LJ (2006) Zonisamide – a review of experience and use in partial seizures. Neuropsychiatr Dis Treat 2(3):269–280
Bermejo PE, Dorado R (2009) Zonisamide for migraine prophylaxis in patients refractory to topiramate. Clin Neuropharmacol 32(2):103–106
Moore RA, Wiffen PJ, Derry S, Lunn MP. Zonisamide for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;1(1):CD011241.
Dauphinais D, Knable M, Rosenthal J, Polanski M, Rosenthal N (2011) Zonisamide for bipolar disorder, mania or mixed states: a randomized, double blind, placebo-controlled adjunctive trial. Psychopharmacol Bull 44(1):5–17
McElroy SL, Kotwal R, Guerdjikova AI, Welge JA, Nelson EB, Lake KA, D’Alessio DA, Keck PE, Hudson JI (2006) Zonisamide in the treatment of binge eating disorder with obesity: a randomized controlled trial. J Clin Psychiatry 67(12):1897–1906
Rapoport AM, Bigal ME (2004) Preventive migraine therapy: what is new. Neurol Sci 25:s177–s185
Erkkinen MG, Kim MO, Geschwind MD (2018) Clinical Neurology and Epidemiology of the Major Neurodegenerative Diseases. Cold Spring Harbor Perspect Biol 10(4):a033118
Masuda Y, Ishizaki M, Shimizu M (1998) Zonisamide: pharmacology and clinical efficacy in epilepsy. CNS Drug Rev 4(4):341–360
Oki M, Kaneko S, Morise S, Takenouchi N, Hashizume T, Tsuge A et al (2017) Zonisamide ameliorates levodopa-induced dyskinesia and reduces expression of striatal genes in Parkinson model rats. Neurosci Res 122:45–50
Topçu Y, Bayram E, Özbal S, Yiş U, Tuğyan K, Karaoğlu P et al (2014) Zonisamide attenuates hyperoxia-induced apoptosis in the developing rat brain. Neurol Sci 35(11):1769–1775
Duty S, Jenner P (2011) Animal models of Parkinson’s disease: a source of novel treatments and clues to the cause of the disease. Br J Pharmacol 164(4):1357–1391
Arawaka S, Fukushima S, Sato H, Sasaki A, Koga K, Koyama S et al (2014) Zonisamide attenuates α-synuclein neurotoxicity by an aggregation-independent mechanism in a rat model of familial Parkinson’s disease. PLOS ONE. 9(2):e89076
Gluck M, Santana L, Granson H et al (2004) Novel dopamine releasing response of an anti-convulsant agent with possible anti-Parkinson’s activity. J Neural Transm 111:713–724
D’Amico D (2007) Antiepileptic drugs in the prophylaxis of migraine, chronic headache forms and cluster headache: a review of their efficacy and tolerability. Neurol Sci 28:S188–S197
Murata M, Horiuchi E, Kanazawa I (2001) Zonisamide has beneficial effects on Parkinson’s disease patients. Neurosci Res 41(4):397–399
Nakanishi I, Kohmoto J, Miwa H, Kondo T (2003) No to shinkei = brain and nerve. 55(8):685–689
Murata M, Hasegawa K, Kanazawa I (2004) The Japan Zonisamide Study Group. Randomized, double-blind study of zonisamide with placebo in advanced Parkinson’s disease. Mov Disord 19:P555. MovDisord 200419P555.
Murata M, Hasegawa K, Kanazawa I, Japan Zonisamide on PD Study Group (2007) Zonisamide improves motor function in Parkinson disease: a randomized, double-blind study. Neurology 68(1):45–50.
Kajimoto Y, Nakanishi I, Kondo Wakayama T (2008) I. One year follow-up study of the zonisamide (ZNS) efficacy on parkinsonism. MovDisord 23Suppl 1 214 Abstr
Murata M, Hasegawa K, Kanazawa I, Fukasaka J, Kochi K, Shimazu R et al (2015) Zonisamide improves wearing-off in Parkinson’s disease: a randomized, double-blind study. MovDisord Off J MovDisord Soc 30(10):1343–1350
Murata M, Odawara T, Hasegawa K, Iiyama S, Nakamura M, Tagawa M et al (2018) Adjunct zonisamide to levodopa for DLB parkinsonism: a randomized double-blind phase 2 study. Neurology 90(8):e664–e672
Cha P-C, Satake W, Ando-Kanagawa Y, Yamamoto K, Murata M, Toda T (2020) Genome-wide association study identifies zonisamide responsive gene in Parkinson’s disease patients. J Hum Genet 65(8):693–704
Bruno E, Nicoletti A, Filippini G, Quattrocchi G, Colosimo C, Zappia M (2017) Zonisamide for essential tremor. Cochrane database System Rev 8(8):CD009684
Song IU, Kim JS, Lee SB, Ryu SY, An JY, Kim HT, Kim YI, Lee KS (2008) Effects of zonisamide on isolated head tremor. Eur J Neurol 15(11):1212–1215
Sekimoto S, Oyama G, Izawa N, Ueno S, Jo T, Shimo Y, Nakajima A, Nakajima M, Umemura A, Arai H, Hattori N (2016) Effect of zonisamide on post-traumatic Holmes’ tremor. Neurol Clin Neurosci 4:184–185
Bermejo PE, Ruiz-Huete C, Anciones B (2010) Zonisamide in managing impulse control disorders in Parkinson’s disease. J Neurol 257(10):1682–1685
Ricca V, Castellini G, Lo Sauro C, Rotella CM, Faravelli C (2009) Zonisamide combined with cognitive behavioral therapy in binge eating disorder. Psychiatry Edgmont 6(11):23–28
Kinrys G, Vasconcelos e Sa D, Nery F (2007) Adjunctive zonisamide for treatment refractory anxiety. Int J Clin Pract 61(6):1050–3
White JR, Walczak TS, Marino SE, Beniak TE, Leppik IE, Birnbaum AK (2010) Zonisamide discontinuation due to psychiatric and cognitive adverse events. Neurology 75(6):513
Fox SH, Katzenschlager R, Lim S-Y, Ravina B, Seppi K, Coelho M et al (2011) The movement disorder society evidence-based medicine review update: treatments for the motor symptoms of Parkinson’s disease. MovDisord 26(S3):S2-41
Fox SH, Katzenschlager R, Lim S-Y, Barton B, de Bie RMA, Seppi K et al (2018) International Parkinson and movement disorder society evidence-based medicine review: update on treatments for the motor symptoms of Parkinson’s disease: treatment of motor symptoms in PD. MovDisord 33(8):1248–1266
Brodie MJ, Besag F, Ettinger AB, Mula M, Gobbi G, Comai S, et al (2016) Epilepsy, antiepileptic drugs, and aggression: an evidence-based review. Sibley DR, editor. Pharmacol Rev 68(3):563
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Atul Goel: study concept and design, acquisition of data, analysis and interpretation, writing of the manuscript.
Ramkumar Sugumaran: study supervision, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content.
Sunil K Narayan: study supervision, critical revision of the manuscript for important intellectual content.
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Goel, A., Sugumaran, R. & Narayan, S.K. Zonisamide in Parkinson’s disease: a current update. Neurol Sci 42, 4123–4129 (2021). https://doi.org/10.1007/s10072-021-05550-2
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DOI: https://doi.org/10.1007/s10072-021-05550-2