Yourlawyer.com (Parkinson's Disease News)

New Agent Orange Policy Will Make Disability Benefits Available to More Vets

Tue, 13 Oct 2009 00:00:00 -0700

A new proposal on Agent Orange health claims issued this week by the Department of Veterans Affairs will make it much easier for veterans injured by the toxin to make claims for disability payments and health care services. Under the proposal, three illnesses - B cell leukemias, such as hairy cell leukemia; Parkinson's disease; and ischemic heart disease - will be added to the growing list of illnesses presumed to have been caused by Agent Orange.

Agent Orange was widely used during the Vietnam War as a defoliant to remove enemy hiding places. According to The New York Times, Agent Orange was the most common herbicide used in the war. It contained one of the most toxic forms of dioxin, which has since been linked to some cancers.

According to a VA press release, between January 1965 and April 1970, an estimated 2.6 million military personnel who served in Vietnam were potentially exposed to sprayed Agent Orange. Many of those exposed to the toxin continue to suffer health problems.

The decision to add B cell leukemias, Parkinson's disease and ischemic heart disease to the roster of presumed Agent Orange illnesses brings the total number of ailments on the list to 15. Other presumed Agent Orange illnesses include:

Acute and Subacute Transient Peripheral Neuropathy
AL Amyloidosis
Chloracne
Chronic Lymphocytic Leukemia
Diabetes Mellitus (Type 2)
Hodgkin's Disease
Multiple Myeloma
Non-Hodgkin's Lymphoma
Porphyria Cutanea Tarda
Prostate Cancer
Respiratory Cancers, and
Soft Tissue Sarcoma (other than Osteosarcoma, Chondrosarcoma, Kaposi's sarcoma, or Mesothelioma)

Veterans who served in Vietnam during the war and who have a "presumed" illness don't have to prove an association between their illnesses and their military service. This "presumption" simplifies and speeds up the application process for benefits. According to the Times, it is estimated that about 200,000 veterans might seek benefits under the proposed change in policy.

According to The New York Times, the new Agent Orange policy will apply to some 2.1 million veterans who set foot in Vietnam during the war, including those who came after the military stopped using Agent Orange in 1970. It will not apply to sailors on deep-water ships, though VA says it plans to study the effects of Agent Orange on the Navy.

The decision to expand the list of presumed Agent Orange illnesses was based on an independent study released in July by the Institute of Medicine, the VA press release said.

Cholesterol Drugs Linked to Parkinsons

Mon, 15 Jan 2007 00:00:00 -0800

A new study published today has suggested a connection between statins (drugs used to lower cholesterol) and the development of Parkinson’s disease. Researchers at the University of North Carolina found that patients with low levels of LDL cholesterol are upward of three and a half times more likely to develop Parkinson’s disease than those with higher LDL levels. Their study was presented in Chemistry & Industry, the journal of the British Society of Chemical Industry (SCI).

The SCI contends that the new study “provides the strongest evidence to date” of a link between statins and Parkinson’s. Lead researcher Dr. Xuemei Huang announced her plans for a large 16,000-patient study in order to test the theory. (Doctors at Harvard University are also conducting a large-scale trial to examine the link.) Since statins have become perhaps the most popular medications in the world; Pfizer’s Lipitor alone accounts for more than $12 billion in annual sales--Huang fears a big surge in the number of Parkinson’s diagnoses during the next five years. By then, statins will have been in common usage for more than a decade.

High levels of LDL, or low-density lipoprotein, cholesterol (the “bad” cholesterol) are associated with increased risk of heart disease and stroke. Dr. Huang’s study examined 236 patients with different LDL levels and determined that those with the lowest levels were three and a half times more likely to have the disease than patients with higher levels. However, critics believe that the study has merely proven a “statistical association,” not any kind of causation.

In fact, some researchers believe that the association may be reversed: that Parkinson’s may actually cause low LDL levels. Even Huang herself declared that the benefits of statins in reducing LDL cholesterol far outweighed any Parkinson’s risk. Still, she is concerned that, because of the enormous number of patients taking statins worldwide, we may see a tremendous rise in Parkinson’s disease if indeed a definitive link is found between the cholesterol drugs and the disease.

Parkinson's meds, valve risk linked

Tue, 09 Jan 2007 00:00:00 -0800

The risk of heart valve damage with two drugs for Parkinson’s disease may be far greater than was known, new research suggests.

The drugs are not the main treatment for Parkinson’s, but one is also sometimes used to treat restless legs syndrome.

A study by Italian researchers found that roughly one-fourth of Parkinson’s patients taking pergolide or cabergoline, sold as Permax, Dostinex and other brands, had moderate to severe heart valve problems. Another study, by German doctors, found that users of either drug were five to seven times more likely to have leaky heart valves than those on other types of Parkinson’s medications. Both studies were reported in Thursday’s New England Journal of Medicine.

“This is an extraordinarily high risk,” said Dr. Bryan Roth, a pharmacology professor at the University of North Carolina at Chapel Hill.

“It’s a bad side effect. As far as I know, there are no medications that can reverse it,” and valve replacement surgery is the only solution, he said.

Roth had no role in the studies but directs a drug screening program for the National Institute of Mental Health. He also published a paper several years ago warning that these drugs appeared to trigger the same heart-related mechanism that the fen-phen diet combination did. The diet pills, sold as Pondimin and Redux, were pulled from the market in 1997 after they were linked to valve problems.

One of the Parkinson’s drugs: pergolide, sold as Permax and other brands also is used to treat restless legs syndrome. Cabergoline, sold as Dostinex, Cabaser and other names, is mostly used in Europe.

About half a million people had taken Permax during its first 14 years on the market when its developer, Eli Lilly and Co., added valve damage to the potential side effects listed on the package insert in 2003. But the company said the risk was extremely low five in 100,000 users.

Roth believed there were more cases, a theory he said the new studies confirmed.

“This is an example of, if you don’t look for it, you don’t see it,” said Dr. C. Warren Olanow, chairman of neurology at Mount Sinai School of Medicine in New York, who had no role in the work. The findings will lead more doctors to prescribe other Parkinson’s treatments, he said.

About 1.5 million Americans and 6 million people worldwide have Parkinson’s disease, which results in tremors, loss of muscle control and sometimes death.

It’s caused by a lack of the brain chemical, dopamine. The main treatment is levodopa, which spurs the body to make more dopamine. Pergolide and cabergoline often are given in addition to that drug or in place of it, especially if symptoms worsen over time.

In one study, Dr. Renzo Zanettini and others at the Instituti Clinici di Perfezionamento in Milan obtained echocardiogram images of the hearts of 155 patients taking various Parkinson’s medications and a comparison group of 90 healthy people.

Moderate to severe valve problems were seen in 23 percent of those on pergolide and nearly 29 percent of those on cabergoline but none of those on other Parkinson’s drugs and less than 6 percent of the comparison group. The study was paid for by the Milan clinic and two Parkinson’s foundations.

In the other study, Dr. Rene Schade and colleagues in Berlin and in Montreal used records from more than 11,400 Parkinson’s patients in the United Kingdom. The rate of newly diagnosed leaky valves was increased among pergolide and cabergoline users but not the others, they found. The Canadian government and a drug company provided partial support for the study. Many researchers in both studies have consulted for Parkinson drug makers.

Pergolide sales have dropped in recent years but still amounted to more than $10 million last year in the United States, according to IMS Health, a health care information firm.

The rights to Permax in the U.S. now belong to Valeant Pharmaceuticals of Aliso Viejo, Calif. A company statement said Permax is safe and effective, but Valeant is no longer promoting the product. All such drugs should be used “with caution,” the statement says.

Cabergoline is approved in the U.S. for treating a hormone problem, excessive prolactin in the blood, but not Parkinson’s.

Roth has been urging companies developing new drugs to test for the mechanism involved in the Parkinson and fen-phen pills, saying those that that have it shouldn’t be sold.

Research suggests link between pesticides and brain disease

Fri, 28 Jul 2006 00:00:00 -0700

Researchers at the University of North Dakota are quick to point out these are preliminary results covering one year of a planned four-year study. But Dr. Patrick Carr says there's clear evidence pesticide exposure at relatively low doses affect brain cells.

"Some areas of the brain displayed what I would call physical changes in other words, a loss of neurons in particular regions of the brain," says Carr. "In other regions of the brain you wouldn't notice a change in the number of cells present there, but now the cells that are present there are expressing chemicals in different amounts, compared to normal rats."

As an example, Carr found cells responsible for production of a substance called myelin were damaged or destroyed. Myelin is a substance made up of fats and proteins that encloses nerves. It helps transmit signals along the nerves. Loss of myelin causes nerve damage in neurological diseases such as multiple sclerosis.

Researchers studied six common pesticides. Carr says some rats were given a single large dose, while others were injected with small doses over a nine-month period.

"It's hard to then correlate that to what the average person that's working with pesticides would be exposed to," says Carr. "We're not at that position yet, where we can say this is comparable to what these people working with pesticides, short term or long term, are exposed to."

Dr. Carr hopes to have his results completely analyzed by next spring.

Gerald Groenwald, director of energy and environmental research, says there's clearly a need to continue and expand the research.

"What this research says is that we have started to open some doors and shine some light in a very objective fashion, a very comprehensive fashion, on this group of questions," says Groenwald. "And it says, more than ever, that this research is extremely important not only here in the Red River Valley, but basically globally."

Groenwald says other researchers are also looking at ways people are exposed to pesticides. He says people commonly think of being exposed to pesticides through contaminated water or food. But he believes the most efficient means of exposure is through tiny airborne particles of pollen.

Groenwald says some beneficial drugs are delivered as tiny particles, which are inhaled deep into the lungs.

He says researchers found tiny bits of pollen carried on the wind carry with them a load of pesticide.
"Frankly, if there is a link between pesticides and these diseases, I think the very fine pollen is the transport mechanism, and is in some cases you might say the smoking gun," he says.

Groenwald says because there are relatively few competing airborne pollutants in the Red River Valley, it's a perfect place to study airborne pesticide pollution.

Groenwald hopes to continue and expand the study over the next three years, depending on how much funding the research receives.

Health Canada Endorsed Important Safety Information on Remicade (Infliximab)

Thu, 27 Jul 2006 00:00:00 -0700

Centocor, Inc. and Schering Canada, Inc., in consultation with Health Canada, are informing health care professionals and the general public of important new safety information regarding Remicade (infliximab).

Remicade (infliximab) is a chimeric IgG monoclonal antibody known as a biological response modifier that is directed against the cytokine tumour necrosis factor-alpha (TNFalpha). It is indicated for the treatment of adults with rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriatic arthritis, and chronic plaque psoriasis.

New Safety Information

Remicade is not authorized for pediatric use in Canada.
Six (6) post-marketing cases of a rare type of lymphoma called hepatosplenic T-cell lymphoma (HSTCL) have been reported in pediatric and young adult patients taking Remicade for Crohn's disease.
Exposure to Remicade® ranged from 1 or 2 infusions to over 4 years of maintenance therapy, and five of the six cases resulted in death.
All cases reported concomitant or past use of other immunosuppressive agents, including azathioprine or 6-mercaptopurine. As a result, a causal relationship between Remicade and the development of HSTCL has not been clearly established.

The six reports of HSTCL in Crohn's disease patients documented ages ranging from 12 to 31 years, with five of the cases occurring in patients aged 12 to 19. Four of the six cases occurred in males. All reports originated from the United States, and one report was recently published in the literature.1

This disease is a very rare form of non-Hodgkin's lymphoma (NHL), which occurs most commonly in adolescent and young adult males, and there are only 150 cases published in the medical literature worldwide since the disease was first described in 1990.2 The disease usually presents as marked hepatosplenomegaly with bone marrow involvement and cytopenia, most commonly thrombocytopenia. Patients may have symptoms characteristic of B-cell lymphomas with fever, weight loss, and night sweats, but without lymphadenopathy or significant peripheral blood lymphocytosis. The clinical course of the disease is extremely aggressive, with a fatal outcome in most patients within 2 years of diagnosis.

Both azathioprine and 6-mercaptopurine are known mutagens, and azathioprine has been classified as a human carcinogen.3 There have also been three reports in the literature of HSTCL occurring in Crohn's disease patients receiving these drugs without Remicade. Because all cases described concomitant or past use of such agents, a causal association between Remicade® and HSTCL has not been clearly established. However, a role for Remicade in causing or exacerbating this disease cannot be excluded.

In Canada, approximately 38,000 patients have received Remicade since its launch in 2001, with 16,000 patients having received the product for Crohn's disease. Although lymphomas have been reported in Canada in patients receiving Remicade® for Crohn's disease and other indications, there have been no reports of HSTCL.

Information regarding the risk of lymphoma in patients receiving Remicade was also previously communicated to Canadian healthcare professionals in 2004.

Remicade is only authorized in Canada for the treatment of adult patients. The Canadian Product Monograph for Remicade® is being revised to include the above updated safety information.

Parkinson's and pesticide exposure

Fri, 21 Jul 2006 00:00:00 -0700

Although the causes of Parkinson's are not well understood, it has long been suspected that environmental factors play a large role.

Parkinson's disease, first described in the early 1800s by British physician James Parkinson as "shaking palsy," is among the most prevalent neurological disorders. In a recent article in Scientific American, "According to the United Nations, at least four million people worldwide have it; in North America, estimates run from 500,000 to one million, with about 50,000 diagnosed every year. These figures are expected to double by 2040 as the world's elderly population grows; indeed, Parkinson's and other neurodegenerative illnesses common in the elderly (such as Alzheimer's and amyotrophic lateral sclerosis) are on their way to overtaking cancer as a leading cause of death. But the disease is not entirely one of the aged: 50 percent of patients acquire it after age 60; the other half is affected before then. Furthermore, better diagnosis has made experts increasingly aware that the disorder can attack those younger than 40.

"As its 19th-century name suggests and as many people know from the educational efforts of prominent Parkinson's sufferers such as Janet Reno, Muhammad Ali and Michael J. Fox the disease is characterized by movement disorders. Tremor in the hands, arms and elsewhere, limb rigidity, slowness of movement, and impaired balance and coordination are among the disease's hallmarks. In addition, some patients have trouble walking, talking, sleeping, urinating and performing sexually."

A major cause may be pesticide exposure. According to research published in Annals of Neurology, people who have been exposed to pesticides are 70 percent more likely to develop Parkinson's disease than those who haven't. The results suggest that any pesticide exposure, whether occupationally related or not, will increase a person's risk of the disease. This means that using pesticides in the home or garden may have similarly harmful effects as working with the chemicals on a farm or as a pest controller.

The new study provides the strongest evidence to date of the link between pesticide exposure and Parkinson's. The work included over 143,000 men and women who completed extensive lifestyle questionnaires beginning in 1982, and follow-up surveys through 2001. All subjects were symptom-free at the beginning of the project, when they were asked about their occupation and exposure to potentially hazardous materials. Since then, 413 of them have developed confirmed cases of Parkinson's, with a greater incidence of the disease in those who spent time around pesticides. "Low-dose pesticide exposure was associated with a significant increase in risk for Parkinson's disease," says lead author Alberto Ascherio of the Harvard School for Public Health. "I think this is one reason to be careful about using pesticides in general."

Although the causes of Parkinson's are not well understood, it has long been suspected that environmental factors play a large role. Animal studies have shown that chemical compounds commonly used as pesticides can cause a degeneration of dopamine-producing neurons. In Parkinson's, a shortage of dopamine causes the disease's characteristic motor abnormalities, including muscle tremors and muscle rigidity. Previous small-scale human studies had suggested a link between pesticides and Parkinson's, but this new study is the first to establish a clear correlation in a large patient population.

The researchers also looked for links between Parkinson's and other environmental contaminants, including asbestos, coal dust, exhaust, formaldehyde and radioactive material. They found no correlation between the disease and any of the materials besides pesticides, however. Because of the design of the questionnaires, the study was not able to determine how the frequency, duration, or intensity of pesticide exposure affected the incidence of Parkinson's. The next step, according to Ascherio, is to figure out which class of chemicals is actually causing the disease, so that people can reduce their exposure. Karen Schrock, Johns Hopkins University.

So far researchers and clinicians have found no way to slow, stop or prevent Parkinson's. Although treatments do exist - including drugs and deep-brain stimulation - these therapies alleviate symptoms, not causes. In recent years, however, investigators have linked proteins to genetic underpinnings of the disease. Such findings are feeding optimism that fresh angles of attack can be identified.

Pesticides kill plants and insects; it takes no leap of faith to conclude that they might do something to humans.

Pesticide Dieldrin Linked to Increased Risk of Parkinson's Disease

Fri, 07 Jul 2006 00:00:00 -0700

A team of Emory University researchers has found a connection in laboratory mice between developmental exposure to the pesticide dieldrin (now banned from use) during gestation and lactation and an increased risk of developing Parkinson’s disease (PD). The findings are significant because most studies aimed at determining the disease process in PD have been focused on events occurring during adulthood, not during developmental stages.

The pesticide dieldrin was banned for most uses by the Environmental Protection Agency in 1974, then totally banned in 1987, according to the researchers. Dieldrin was most commonly used for insect control in crops and for termite control in home foundations. "While many pesticides have been banned from use today, they still remain in the soil and can take decades to break down, as in the case of dieldrin," says Gary Miller, PhD, neurotoxicologist, researcher in Emory's Center for Neurodegenerative Disease and associate professor in the Department of Environmental and Occupational Health, Rollins School of Public Health at Emory. "Because of dieldrin's lingering effects, our research focuses on the role of the environment and its effects on PD." Dr. Miller is the senior author on this paper.

"Although most people are diagnosed in mid- to late-life with Parkinson's, experimental evidence suggests that neurodegeneration begins long before clinical diagnosis of PD," says Dr. Miller. "Recent research has led to the idea that the etiology of a number of diseases may result from alterations occurring during development. Therefore, we decided to examine whether developmental exposure to dieldrin causes persistent changes to the dopaminergic system and whether these changes can result in increased susceptibility to Parkinson's."

Parkinson's disease is considered a disease of aging, occurring when a group of cells in an area of the brain called the substantia nigra begin to malfunction and die. These cells produce a chemical called dopamine, a neurotransmitter or chemical messenger, that sends information to the parts of the brain that control movement and coordination. When a person has Parkinson's disease, his or her dopamine-producing cells begin to die, leaving that person incapable of initiating and controlling movements in a normal way.

In the Emory study, the researchers administered 0.3 mg/kg, 1 mg/kg, 3 mg/kg of dieldrin or no dieldrin (placebo) every three days to pregnant mice throughout gestation and lactation.

"Through analysis of brain samples, we found the pesticide does not directly kill the dopamine neurons, but instead alters the dopamine neuron homeostasis or equilibrium to cause increased vulnerability to a parkinsonism-inducing toxin," Dr. Miller explains. The study also found the enhanced vulnerability affected male rodent offspring more so than female rodent offspring. The finding is consistent with that observed in the human population affected by PD, in that Parkinson's affects more men than women.

"We also noted that exposure to dieldrin during critical periods of development may lead to the imprinting of genes that regulate the proper formation and maintenance of function of the dopamine system," says Jason Richardson, PhD, co-author and postdoctoral fellow in the Miller laboratory. "This alteration may induce a silent state of dopamine dysfunction and an increased vulnerability of dopamine neurons later in life."

"The results from this study provide a potential molecular mechanism responsible for the association between dieldrin exposure and increased risk of PD and suggests that greater attention should be focused on the role of early life exposures and the development of PD," says Dr. Miller.

Pesticides exposure associated with parkinson's disease

Mon, 26 Jun 2006 00:00:00 -0700

In the first large-scale, prospective study to examine possible links between chronic, low-dose exposure to pesticides and Parkinson's disease (PD), researchers at the Harvard School of Public Health (HSPH) have shown that individuals reporting exposure to pesticides had a 70 percent higher incidence of PD than those not reporting exposure. No increased risk of PD was found from reported exposure to other occupational hazards, including asbestos, coal or stone dust, chemicals, acids, or solvents. The study will appear in the July issue of Annals of Neurology and also appears online via Wiley Interscience (www.interscience.wiley.com).

Previous studies had suggested a link between PD and low-level exposure to pesticides, though the data remains inconclusive. The researchers, led by Alberto Ascherio, associate professor of nutrition and epidemiology at HSPH, looked at data from the Cancer Prevention Study II Nutrition Cohort, a prospective study begun in 1992 by the American Cancer Society. Some 143,325 participants who responded to a follow-up survey in 2001 were included in the HSPH study. Researchers then contacted those individuals in the 2001 survey who reported a diagnosis of PD to ask if their medical records could be reviewed to confirm the diagnosis. Ultimately, Ascherio and his colleagues included in their study a total of 413 cases of PD with onset of symptoms and diagnosis after 1992.

The researchers used exposure data collected in 1982 from the CPS II mortality study, a study from which the Nutrition Cohort was drawn. Exposure to pesticides was reported by 5,203 men (8.2 percent) and 2,661 women (3.3 percent). Among those reporting exposure, after adjusting for age, sex, and other risk factors for Parkinson's disease, there was a 70 percent higher incidence of PD than among people who reported no exposure. Those reporting exposure were more likely to be male than female to report their occupation as farmer, rancher or fisherman and to be blue-collar workers, but none of these factors could account for the increased risk of Parkinson's disease, which was similar in men or women, and in non-farmers as well as farmers. The significant association between pesticide exposure and Parkinson's disease among individuals who are not farmers is most likely explained by use of pesticides at home or in gardening.

Future studies will need to examine which specific pesticides or classes of pesticides are likely to cause Parkinson's disease.

This study was supported by a grant from the Michael J. Fox Foundation and Kinetic Foundation. The participation of Michael Schwarzschild, a co-author, was supported by a grant from the National Institute of Environmental Health Sciences.

Pesticides link to Parkinson's in men

Thu, 15 Jun 2006 00:00:00 -0700

Mayo Clinic in Rochester, Minn., researchers have found pesticides increase the risk of developing Parkinson's in men.

"This confirms what has been found in previous studies: that occupational or other exposure to herbicides, insecticides and other pesticides increases risk for Parkinson's," says Dr. Jim Maraganore, Mayo Clinic neurologist and study investigator.

"What we think may be happening is that pesticide use combines with other risk factors in men's environment or genetic makeup, causing them to cross over the threshold into developing the disease. By contrast, estrogen may protect women from the toxic effects of pesticides."

Pesticide exposure did not increase the risk of Parkinson's disease in women, and no other household or industrial chemicals were significantly linked to the disease in either men or women.

Overall, the study, published in the journal Movement Disorders, found that the men with Parkinson's disease were 2.4 times more likely to have had exposure to pesticides than those who did not have Parkinson's.

Lawsuit in Cleveland asserts link between welding, nerve disease

Mon, 12 Jun 2006 00:00:00 -0700

In a closely watched case unfolding in federal court, a jury is being asked to take up an intriguing question that has confounded many medical researchers: Can welding fumes cause neurological diseases such as Parkinson's?

The lawsuit was brought by a former welder who suffers arm tremors and other movement problems that he says could be Parkinson's. Ernest G. Solis, 57, of Corpus Christi, Texas, is seeking unspecified damages from four welding rod makers.

It is the first trial among about 3,800 lawsuits from around the country that have been consolidated in federal court in Cleveland. Solis' case could set the ground rules for the other lawsuits.

At issue is whether manganese a chemical element found in vitamin supplements, tea, nuts and grain, as well as the fumes from burning welding rods can at high exposures lead to tremors or shaking, poor balance and difficulty walking and swallowing.

Companies that make welding equipment argue that any link between fumes and Parkinson's has not been established, and that in any case, warning labels and welding safety equipment minimize any risk.

"It's a really hot topic," said Alan Ducatman, chairman of community medicine at West Virginia University. "A lot of people weld and there is manganese in welding rods. Manganese is very bad stuff at very high doses. The problem is defining when doses are high enough to cause a neurological disease. That's what the research is all about."

Lawyers representing the plaintiffs point to a recent $1 million verdict for a welder in an Illinois case as an examples of what such lawsuits could cost the industry. Similar cases have gone to court individually around the country, with varying results.

Dr. Edward Baker, a University of North Carolina professor and director of the North Carolina Institute for Public Health, testified as the leadoff witness in Solis' case that extensive research has linked manganese fumes that emit from welding rods to neurological disorders.

The Parkinson's Disease Foundation says welding fumes are just one of the suspected but unconfirmed causes of the disorder, which afflicts nearly 1 million people in the United States.

"We don't know what brings it on," said Robin Elliott, the foundation's executive director. "If we knew that, we could know the cause, and then we'd be closer to finding a cure."

James Antonini, a toxicology researcher for the National Institute for Occupational Safety and Health, is leading research on the effects of welding-type fumes on rats to try to pin down a link.

"There's definitely not a final conclusion on it," he said. "There is a question whether manganese is even available enough in welding fumes to cause an effect."

In the scientific journal Neurology a year ago, Dr. Joseph Jankovic, director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor University's College of Medicine, questioned whether reliable or convincing evidence exists that welding is a risk factor for Parkinson's disease.

Jeff Weber, associate executive director of the Miami-based American Welding Society, said a study the group paid for two years ago did not draw a conclusive link to welding and Parkinson's disease. "My general impression is there is no great fear among most welders," Weber said.

Labels on packages of welding rods, the long, thin sticks that become the substance of a weld — warn that fumes may be hazardous but do not draw any link to Parkinson's. At factories, construction projects and repair shops, some welders use fans to blow away fumes. Others wear breathing devices.

Antonini said all welders would not have the same exposure risk. Some use higher concentrations of manganese than others, depending on the hardness needed in a weld. Some welders work in more confined spaces than others.

Richard Myers started welding when he was 15 and said he feels fine at age 59. He has made his 32-year-old son a partner in his small Cleveland-area business.

"I've worked in shops. I've done a lot of maintenance welding, all kind of different jobs," he said. "I do it on average eight to 10 hours a week. I always try to have a fan in the work area to blow fumes away."

Parkinson's medicine has odd side effect: Gambling

Wed, 01 Mar 2006 00:00:00 -0800

A 52-year-old married man had gambled away more than $100,000 when his wife finally asked for help.

She didn't call Gamblers Anonymous. Instead, she talked to the Mayo Clinic doctor who had been treating her husband for Parkinson's, an incurable brain disorder.

M. Leann Dodd of the Mayo Clinic in Rochester, Minn., and a team of neurologists identified 11 cases in which compulsive gambling had developed almost overnight in people who were taking medication for Parkinson's.

"Most of these patients had no idea this gambling problem was connected to their Parkinson's medication," Dodd says. She and her colleagues described the cases last year in the Archives of Neurology.

The study and others like it that suggest that Parkinson's medication might trigger a gambling urge for some patients serve as a warning for the estimated 1 million people in the USA who have the disease. But such research also might help millions of Americans who have a gambling habit.

"The research may teach us about pathological gambling in the general population," says Mark Stacy, a Duke University neurologist who outlined the evidence on Parkinson's and gambling Sunday at the World Parkinson Congress in Washington, D.C.

The growing body of research includes a study published in February in the Archives of Neurology. Ana Szarfman of the Food and Drug Administration used a computer program to search the FDA's national database to see whether there were any reports of gambling linked to prescription drugs.

Szarfman and her colleagues discovered 67 cases of gambling. Medications used to treat Parkinson's accounted for most of those, but one Parkinson's drug stood out: Pramipexole or Mirapex had 39 reports of gambling. This drug alone accounted for 58% of the cases of gambling reported to the FDA, says co-author P. Murali Doraiswamy, who is also at Duke University.

This study doesn't prove that Parkinson's drugs can trigger gambling. "We're not saying this is cause and effect," he says.

But the evidence so far does fit together with what is known about how these drugs affect the brain, Dodd says.

These drugs act on specialized receptors in the limbic system, a brain region that controls emotions. When it is overstimulated, it can lead to impulsive behaviors, such as compulsive gambling, according to a Mayo Clinic release.

Right now, the gambling problem seems to be a rare side effect of drugs that also offer relief for Parkinson's symptoms, Stacy says.

Second Parkinson's Drug, Requip, Blamed for Compulsive Gambling that Cost Retired Doctor $14 Million

Sun, 26 Feb 2006 00:00:00 -0800

Up until now, Mirapex has been the medication most often associated with the mounting medical evidence linking certain drugs used to treat Parkinson’s disease (PD) to the development of compulsive behavior, including pathological gambling.

Now, however, a second drug has been thrust into the same spotlight with the filing of a $14 million lawsuit by a retired doctor who claims that Requip, a drug very similar to Mirapex, turned him into a compulsive gambler.

Dr. Max Wells alleges in the action commenced in U.S. District Court in Austin, Texas, that his addiction made him a habitual high roller at Las Vegas casinos where he lost $7 million by late 2005 and another $7 million by January of this year.

As reported by The Oxford Press (Oxford, Ohio), the complaint names the drug’s manufacturer, GlaxoSmithKline (GSK – sued as SmithKline Beecham), the world’s second largest pharmaceutical company, and seven casinos, including Mandalay, Treasure Island, Bellagio, Wynn Las Vegas, Las Vegas Sands, Harrah's Las Vegas and Hard Rock Hotel.

At the heart of the doctor’s lawsuit is the Mayo Clinic study published last July in the Archives of Neurology that identified 11 Parkinson’s patients who developed a gambling habit while taking Mirapex or Requip between 2002 and 2004. After the study was released, 14 additional Mayo patients were diagnosed with the problem according to lead author Dr. M Leann Dodd, a psychiatrist at the Clinic.

Previously, in August 2003 in the journal Neurology, Drs. E. Driver-Dunckley, J. Samanta, and M. Stacey published an article entitled “Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease.”

That study found extreme cases of compulsive gambling in nine (of 1,884) patients using pramipexole (8 or 1.5%)) and pergolide (1 or 0.3%). Both results were well above the overall incidence rate of all PD patients of 0.05%. Both drugs that showed an increased risk were dopamine agonists (DA).

The Mayo Clinic study also analyzed the findings in five prior studies (including the 2003 Driver-Dunckley study) and confirmed that: “All of the commonly prescribed dopamine agonists have been associated with pathological gambling” with pramipexole being “disproportionately represented in both our series (82% of our patients) and in prior reports (59%).”

Mirapex (pramipexole dihydrochloride) is in the dopamine agonist class of drugs and is believed to work by mimicking the action of dopamine in the brain to help control the symptoms of Parkinson’s disease.

Dopamine also affects brain processes that control emotional responses and a person's ability to experience pleasure and pain. It is thought to play a role in addictive behavior.

As we previously reported, these medications present another example of drugs whose benefits come with a very high price tag for some patients. The ones who become addicted to gambling often wind up losing their life savings, fall deeply into debt, and even jeopardize or destroy their marriages or other personal or family relationships.

In the past, the victims of this harsh side-effect had no idea what had come over them. Their brain was literally taken over and their gambling became constant and compulsive. Simply stated, they were out of control and had no idea why. For these people, the situation was frightening and inexplicable.

As a result of this completely bizarre and damaging side-effect, many Mirapex and Requip users suffered long periods of debilitating and destructive behavior during which they were unaware that the drug was causing the problem and that it would cease if they discontinued taking it.

Mirapex is manufactured by German-based Boehringer Ingelheim Pharmaceuticals, the world's biggest family-owned drug company, in cooperation with New York-based Pfizer, the world's largest drugmaker. Its sales for 2004 topped $200 million in the U.S. alone.

.Boehringer Ingelheim lists "compulsive behaviors (including sexual and pathological gambling)" as a possible side effect associated with taking Mirapex. That seven-word phrase on page 17 of a 21-page highly technical document is all the warning that is given concerning the potentially detrimental side-effect.

While Boehringer-Ingelheim has repeatedly claimed there is no scientific evidence upon which to base the conclusion that Mirapex causes addictive or compulsive behavior, the multiple reputable studies on the subject would seem to indicate otherwise. In addition, the company revised its package insert to include the warning with respect to “compulsive behavior” despite its denial of the connection.

Now, additional evidence of the association between Mirapex and other dopamine agonists and impulsive behavior has appeared in the form of an analysis of adverse drug reports in the FDA’s database. Of the reports specifically dealing with compulsive gambling, 39 (58%) involved Mirapex.

The report, which analyzes these adverse events, appears in the February issue of Archives of Neurology. The authors include a psychiatrist, P. Murali Doraiswamy (Duke University), and three FDA scientists.

According to Dr. Doraiswamy: "When you combine this with other pieces of evidence, it seems highly suggestive that there is a causal relationship."

While the evidence is consistent with other findings linking dopamine agonists with an increased risk of impulsive behavior, the researchers claim to have found no similar reports involving antipsychotic drugs, which inhibit dopamine.

Boehringer Ingelheim has now backed off its hard line denial of a link just a bit by stating that it is working with Parkinson’s experts to “investigate the relationship if any.”

GSK claims that its drug, Requip, is appropriately labeled with respect to potential side-effects.
Dr. Wells claims that the casinos were aware that he had PD and that he was on medication for the disease while he was gambling.

Wells had originally been taking Mirapex for his PD but, when he noticed his occasional recreational gambling had become more serious, he told his doctor that he thought that drug might be the cause. His doctor changed his medication to Requip and increased the dosage.

Although Wells then began running up massive gambling losses and some $1.2 million in debts that remain unpaid, his wife remained unaware of the problem since she was not present when the losses occurred.

When Wells finally told his wife about the losses, the problem was brought to the attention of his physician. As soon as the Requip was stopped, so did the compulsive gambling.

The behavioral changes witnessed in some Parkinson’s patients whose therapy includes dopamine agonists can be wide-ranging indeed. On the mild side, some start buying lottery tickets and nothing more. Others, however, have been known to develop serious OCD (obsessive compulsive disorders) as well as aggressive sexual impulses, overeating, medication abuse, or pathological gambling.

Since these personality changes are dramatic and involve conduct that the patient has usually not exhibited in the past, relatives and associates should be aware of the potential problem and remain watchful for marked behavioral changes.

PD causes sufferers to gradually lose dopamine. Thus, they actually develop an aversion to the type of impulsive behavior associated with excess dopamine. When Mirapex, Requip, or another dopamine agonist is introduced, the behavioral changes in those adversely affected can be both quick and dramatic.

Currently, two major lawsuits against Boehringer Ingelheim and Pfizer have been commenced in federal court in California and in Superior Court in Ontario, Canada. They allege a number of addictive behaviors associated with Mirapex including gambling, shopping, having sex, eating, and engaging in other compulsive conduct.

It is likely that additional lawsuits will be commenced in the near future since the problem is as widespread as the locations of people who took Mirapex or Requip.

Gambler blames Parkinson's for his addiction

Fri, 24 Feb 2006 00:00:00 -0800

After gambling away $14 million, a retired physician from Austin, Texas, is making one last bet, that he'll recover his loss by suing casinos and the makers of his Parkinson's medication.

Dr. Max Wells says the drug company failed to warn patients that Requip and a similar drug called Mirapex could cause compulsive gambling. He also says Las Vegas casinos, including the Wynn, Bellagio and Harrah's, share the blame because they let him gamble, even though they knew he was on the medication and compulsive about it.

Dr. Wells' attorney, Tom Thomas, joined Tucker Carlson, on ‘Sitiuation’ to discuss his client’s case.

To read an excerpt from their conversation, continue to the text below. To watch the video, click on the "Launch" button to the right.

TUCKER CARLSON, HOST, ‘SITUATION’: Now, I understand that there's a likelihood that this medication did make your client compulsive about gambling; whether it made him a compulsive gambler is a different question. Let's just say that right off the top. I think it's possible.

TOM THOMAS, ATTORNEY FOR DR. MAX WELLS: Yes, there are some studies. Mayo Clinic published one in '05. There's been one as recently as three weeks ago. There's no doubt that in a number of these patients that they're compulsive gambling.

CARLSON: Yes, I absolutely believe it. But this guy lost $14 million. OK.

THOMAS: Yes. His life savings.

CARLSON: After about, say, a million dollars or $7 million or even, say, $10 million, why didn't he seek treatment?

THOMAS: It wouldn't have made any difference if it had been $100 million. If you've got a compulsion, you can't stop.

CARLSON: Well, you can tell other people you have a compulsion. Of course you can stop. I know a million compulsive drinkers. I know some compulsive gamblers who've stopped. I mean, there are a lot of people with compulsions who either control them or turn to other people to help them control them. Why didn't your client do that?

THOMAS: Because he's taking a drug. You can't control it when you're taking the drug that creates the compulsion. You can only control it by stopping to take the drug.

CARLSON: But he must have been aware that he was losing millions and millions and millions of dollars, correct?

THOMAS: You know, he was aware of it. But the compulsion overcame the feelings that you describe that most of us would have. You're importing or assuming and properly and understandably so a rational train of thought. That's one of the evils of this particular problem, is it destroys rationality. No rational person would squander $14 million in 10 months.

CARLSON: There's no question your client's insane, whether it's the drug's fault or not. Of course, you lose $14 million it's bad.

I'm just saying that people with compulsions to drink, to do drugs, to gamble, are not completely insane. They understand they're destroying themselves, and that's why many of them reach out to other people to help them. There is an element of free will in this disease, even if you're taking Parkinson's medication. So why didn't he do that?

THOMAS: There's not much of an element of free will when you're choosing between the only drug that will give you any normalcy in your life and a byproduct that you don't know is being created by that drug.

CARLSON: I guess I'm not going to ask you for a fifth time why he didn't go to Gamblers Anonymous. Why didn't his wife pipe up? Apparently, the Las Vegas casinos treated them like the whales they were, and sent them on a cruise to Alaska, and gave them all kinds of comps. She must have known.

THOMAS: She didn't know how much. If you've been to Las Vegas, you know wives don't gamble with husbands. And he had his own—their money separately. She didn't know.

CARLSON: Did a casino send your client on a cruise to Alaska?

THOMAS: They did. She knew that they were gambling money. She had no idea it was in the millions.

CARLSON: OK. Well, I'm sure she didn't. But I mean, she couldn't have imagined she was being sent on a cruise because her husband was winning at the craps table, correct?

THOMAS: I don't know what she imagined about that. She's a high school math teacher. I don't think she knows beans about it.

CARLSON: She does now.

THOMAS: She does now. And in fact, it was her ultimate questioning that led to Max's seeking some help where he was taken off the drug.

CARLSON: Wait. Just to go back to something you said. She's a math teacher you said?

THOMAS: Yes, she's a math teacher.

CARLSON: But not obviously, not a very good math teacher if she couldn't figure out that he was losing a lot of money.

THOMAS: Now, that's not so. You can't draw that conclusion if you don't know what's happening.

CARLSON: Well, because your case rests on the notion that he is notand his wife, by extension is not in any way responsible for losing all this dough. And I'm just suggesting that a math teacher and an aware human being might suspect that something was terribly wrong.

Where did the $14 million come from, anyway?

THOMAS: He sold his practice when he had to retire because of the Parkinson's.

CARLSON: Do you think there's any chance you're going to get this money back?

THOMAS: Sure there's a chance I'm going to get this money back.

CARLSON: From the casinos or from the drug company?

THOMAS: Both. The drug companies have an obligation to warn what they know about, if it's a threat, and they didn't do that. If they would had warned him, like anybody else, or most other drugs, then he could have gotten the help or taken the steps that he ultimately did once the warnings came out.

CARLSON: Finally, has any Las Vegas casino ever returned money to a person who claims he's a compulsive gambler?

THOMAS: You know, I don't know the answer to that. The ones that I do know about, the ones that went to final judgment, they did not. I do know there have been several settlements where they have, in fact.

CARLSON: Boy, if you win this, they're in deep trouble.

THOMAS: No, they really won't be. This is a very unique statute that we have in Texas that we're suing under. This isn't just generally saying give the money back because X, Y and Z. This is saying give the money back because we have a very specific statute in Texas that I think prohibits what happened here. So I can't imagine this case would ever repeat itself.

Doctor sues drug company, casinos after losing $14 million

Wed, 22 Feb 2006 00:00:00 -0800

When the retired doctor from Austin suddenly began spending big money at the casinos, the casinos assigned him a "host," and gave him first-class airfare to Las Vegas, free hotel suites and meals, and shopping trips for his wife, according to a lawsuit filed in federal court in Austin.

The casinos even gave him an Alaskan cruise, the lawsuit says.

The retired doctor, Max Wells, kept coming back, the lawsuit says and kept losing money. By the fall of 2005, Wells had lost $7 million, the lawsuit says. By January, another $7 million.

Now Wells is suing the casinos and a major drug company, claiming that the prescription drugs he was taking for Parkinson's disease set off a compulsive gambling spree.

Wells, 55, wants his money back. He declined to comment Tuesday.

His lawsuit, filed Friday, says the drug company didn't warn patients that the drug Requip could cause compulsive behavior. And it cites a 2005 Mayo Clinic study that found 11 Parkinson's patients who developed compulsive gambling habits while taking Requip and a similar drug called Mirapex. The gambling ceased for eight of the 11 when they stopped taking the drugs; test results were not available for the other three patients, the study said.

GlaxoSmithKline, which is referred to as SmithKline Beecham in the lawsuit the companies merged in 2000 said it had not yet been served with the lawsuit Tuesday.

"We will certainly investigate the allegations when we receive the complaint," said Mary Anne Rhyne, a company spokeswoman. "We believe the drug is appropriately labeled."

The lawsuit claims the casinos knew Wells, 55, had Parkinson's, a degenerative disorder which damages nerve cells and causes shaking, slowness and difficulty with balance. Wells told the casinos he had Parkinson's, said his lawyer, Tom Thomas with Winstead Sechrest & Minick in Dallas, and he "was taking the medication while he was gambling."

The lawsuit says the casinos should have been aware of the Mayo study, which Thomas said was heavily publicized in Las Vegas during the summer of 2005.

None of the seven casinos named in the lawsuit returned calls Tuesday. They include Mandalay, Treasure Island, Bellagio, Wynn Las Vegas, Las Vegas Sands, Harrah's Las Vegas and Hard Rock Hotel.

Wells, a retired pathologist, was first diagnosed with Parkinson's disease in 2000, according to the lawsuit. After taking Mirapex for several months in 2004, Wells "developed an irresistible compulsion to gamble," the lawsuit said.

Wells, who Thomas said had been an occasional gambler, lost several thousand dollars gambling in Las Vegas and on the Internet, according to the lawsuit. After he told his doctor that he thought Mirapex was causing him to gamble, his physician switched him to Requip and increased the dosage, the lawsuit said.

As Wells was losing $14 million which included about $1.2 million in IOUs called markers that Wells hasn't paid his wife was unaware of his losses because she wasn't gambling with him, Thomas said.

During the last week of January, Wells' wife began to question him and he confessed to the losses, the lawsuit said. When his doctor took him off Requip, his gambling compulsion stopped, Thomas said.

Despite the losses Wells claims, he's not bankrupt, Thomas said.

"I would say he hasn't lost the farm, but he's lost the ranch," he said.

Research Continue to Link Certain Parkinson's Drugs, Especially Mirapex, to Compulsive Gambling and Other Impulsive Behavior

Wed, 15 Feb 2006 00:00:00 -0800

As previously reported by newsinferno.com, the medical evidence has been mounting with respect to the rather odd connection between certain drugs used to treat Parkinson’s disease (PD), especially Mirapex, and the development of compulsive behavior including pathological gambling.

Last July, a Mayo Clinic study published in the Archives of Neurology that identified 11 Parkinson’s patients who developed a gambling habit while taking Mirapex or similar drugs between 2002 and 2004. After the study was released, 14 additional Mayo patients were diagnosed with the problem according to lead author Dr. M Leann Dodd, a psychiatrist at the Clinic.

Previously, in August 2003 in the journal Neurology, Drs. E. Driver-Dunckley, J. Samanta, and M. Stacey published an article entitled “Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease.”

That study found extreme cases of compulsive gambling in nine (of 1,884) patients using pramipexole (8 or 1.5%)) and pergolide (1 or 0.3%). Both results were well above the overall incidence rate of all PD patients of 0.05%. Both drugs that showed an increased risk were dopamine agonists (DA).

The Mayo Clinic study also analyzed the findings in five prior studies (including the 2003 Driver-Dunckley study) and confirmed that: “All of the commonly prescribed dopamine agonists have been associated with pathological gambling” with pramipexole being “disproportionately represented in both our series (82% of our patients) and in prior reports (59%).”

Mirapex (pramipexole dihydrochloride) is in the dopamine agonist class of drugs and is believed to work by mimicking the action of dopamine in the brain to help control the symptoms of Parkinson’s disease.

Dopamine also affects brain processes that control emotional responses and a person's ability to experience pleasure and pain. It is thought to play a role in addictive behavior.

Unfortunately, this is another drug whose benefits come with a very high price tag for some patients. The ones who become addicted to gambling often wind up losing their life savings, fall deeply into debt, and even jeopardize or destroy their marriages or other personal or family relationships.

In the past, the victims of this harsh side-effect had no idea what had come over them. Their brain was literally taken over and their gambling became constant and compulsive. Simply stated, they were out of control and had no idea why. For these people, the situation was frightening and inexplicable.

As a result of this completely bizarre and damaging side-effect, many Mirapex users suffered long periods of debilitating and destructive behavior during which they were unaware that the drug was causing the problem and that it would cease if they discontinued taking it.

Mirapex is manufactured by German-based Boehringer Ingelheim Pharmaceuticals, the world's biggest family-owned drug company, in cooperation with New York-based Pfizer, the world's largest drugmaker. Its sales for 2004 topped $200 million in the U.S. alone.

Boehringer Ingelheim lists "compulsive behaviors (including sexual and pathological gambling)" as a possible side effect associated with taking Mirapex. That seven-word phrase on page 17 of a 21-page highly technical document is all the warning that is given concerning the potentially detrimental side-effect.

While Boehringer-Ingelheim has repeatedly claimed there is no scientific evidence upon which to base the conclusion that Mirapex causes addictive or compulsive behavior, the multiple reputable studies on the subject would seem to indicate otherwise. In addition, the company revised its package insert to include the warning with respect to “compulsive behavior” despite its denial of the connection.

Now, additional evidence of the association between Mirapex and other dopamine agonists and impulsive behavior has appeared in the form of an analysis of adverse drug reports in the FDA’s database. Of the reports specifically dealing with compulsive gambling, 39 (58%) involved Mirapex.

The report, which analyzes these adverse events, appears in the February issue of Archives of Neurology. The authors include a psychiatrist, P. Murali Doraiswamy (Duke University), and three FDA scientists.

According to Dr. Doraiswamy: "When you combine this with other pieces of evidence, it seems highly suggestive that there is a causal relationship."

While the evidence is consistent with other findings linking dopamine agonists with an increased risk of impulsive behavior, the researchers claim to have found no similar reports involving antipsychotic drugs, which inhibit dopamine.

Boehringer Ingelheim has now backed off its hard line denial of a link just a bit by stating that it is working with Parkinson’s experts to “investigate the relationship if any.”

The behavioral changes witnessed in some Parkinson’s patients whose therapy includes dopamine agonists can be wide-ranging indeed. On the mild side, some start buying lottery tickets and nothing more. Others, however, have been known to develop serious OCD (obsessive compulsive disorders) as well as aggressive sexual impulses, overeating, medication abuse, or pathological gambling.

Since these personality changes are dramatic and involve conduct that the patient has usually not exhibited in the past, relatives and associates should be aware of the potential problem and remain watchful for marked behavioral changes.

PD causes sufferers to gradually lose dopamine. Thus, they actually develop an aversion to the type of impulsive behavior associated with excess dopamine. When Mirapex, Requip, or another dopamine agonist is introduced, the behavioral changes in those adversely affected can be both quick and dramatic.

Currently, two major lawsuits against Boehringer Ingelheim and Pfizer have been commenced in federal court in California and in Superior Court in Ontario, Canada. They allege a number of addictive behaviors associated with Mirapex including gambling, shopping, having sex, eating, and engaging in other compulsive conduct.

It is likely that additional lawsuits will be commenced in the near future since the problem is as widespread as the locations of people who took Mirapex.

Jerrold Parker, managing partner of Parker & Waichman, a law firm with considerable experience in pharmaceutical and medical malpractice litigation nationwide, told us after the release of the Mayo Clinic study that: “It is difficult to imagine how the manufacturers of Mirapex can maintain there is no scientific evidence to support the addiction link when several studies leave little doubt of the connection. In addition, it is rather amazing that when the manufacturers finally decided to add a warning regarding compulsive conduct to the product insert they chose to hide it in the middle of 21 pages of technical data.”

When asked to comment on the most recent research report, Mr. Parker stated: “The evidence is only growing stronger. The link between Mirapex, and the dopamine agonist class of drugs, and an increased risk of dangerous compulsive behavior is really undeniable. Only a radically conservative scientist and the drug’s manufacturer would still need more proof that a serious problem exists.

Controlling Your Impulses After Parkinson's Treatment

Mon, 06 Feb 2006 00:00:00 -0800

In identifying a new type brain disorder, Dr. James Parkinson described his first patient as a humble gardener who led a life of "remarkable temperance and sobriety." Such personality traits, as well as the doctor's name, are now synonymous with a condition that affects more than 1.5 million Americans.

Since Parkinson's was discovered, doctors have noticed that a number of people who go on to develop the disease tend to be cautious, morally resolute and uninterested in seeking out new experiences. Indeed, some studies suggest that smokers or alcohol drinkers are at a lower risk for Parkinson's.

But with the advent of powerful new treatments, researchers have seen a Jekyll and Hyde personality emerge as well. In study after study, patients who are treated for Parkinson's sometimes exhibit a range of unsettling characteristics, such as gambling, overeating and obsessive compulsive disorders. They may also abuse their medications and even make inappropriate sexual advances.

Overall, these types of behavior are rare. Only about five percent of patients treated for Parkinson's exhibit such impulse control problems. But these changes can be quite serious, especially if they lead to addiction or sexual harassment.

"There are different levels of severity," says Dr. Matthew Menza, a professor of psychiatry and neurology at the Robert Wood Johnson Medical School in New Jersey.

Some personality changes can be relatively harmless, such as starting to buy lottery tickets, as one of Menza's patients did. As long as this doesn't break the bank, there is little reason to alter treatment, he says. Others, however, may experience a much more dramatic transformation.

"You sometimes see very aggressive sexual impulses," says Menza. "This can be so out of character with what that person has ever done before."

The Wrong Kind of Reward

Such an odd shift in behavior, while not fully understood, seems to be based on the amount of dopamine circulating in the brain. This chemical is believed to act as a natural reward mechanism, helping to control how we define pleasure.

When dopamine is at a normal level, there is less of a need to seek outside stimulation. But when the chemical is out of kilter, researchers have found the people are prone to all kinds of vices, from obsessive eating to becoming addicted to drugs.

Parkinson's patients, who gradually lose dopamine because of the disease, have a natural aversion to these types of sensations, Menza says. This can quickly change when a person is given a dopamine-boosting drug.

"The same would probably be true for anyone who tried them," says Menza.

Those who need these medications face a range of problems. This past fall, a team from the Mayo Clinic found that Parkinson's patients who have never seriously gambled before were all of a sudden losing thousands of dollars at a casino after starting treatment. More recently, a team at Columbia University found that several of their patients had trouble resisting the urge to eat when taking Parkinson's medications, causing them to gain significant weight.

Treatment may be only part of the issue. Compared to 100 patients who used Parkinson's drugs without becoming addicted to them, those who abused their medications were more likely to be younger, drink alcohol, suffer from depression and exhibit more novelty-seeking traits to begin with, a new study from England found.

Attacking the Cause

So what should patients do? First off, experts say, is to recognize such problems exist. Although surgery and a variety of Parkinson's drugs have been linked to these side effects, the major culprit appears to be the so-called dopamine agonists, such as Requip and Mirapex, which are more potent than other medications. These drugs are favored by younger patients because they have a lower risk of long term complications than Sinemet, the mainstay of Parkinson's treatment.

Reducing the doses may help, but this raises the risk of uncontrolled tremors, says Menza. Dr. Daniel Weintraub, a professor of psychiatry and neurology at the University of Pennsylvania Medical School, says that the simple answer is to switch from a dopamine agonist to another medication.

For those who experience behavioral changes with treatment, various interventions are known to improve impulse control and fight addiction. Anti-psychotic medications can also help keep such troubling behavior in check. Ultimately, it's up to the patient to recognize that they are not acting like the person they've always been.

"When patients are taken off these drugs, they return to normal," says Weintraub.

Parkinson's drug linked to bizarre out-of-control urges

Sun, 01 Jan 2006 00:00:00 -0800

Faced with steady deterioration from Parkinson's disease, Jim Sweet leapt at the chance to try a new drug that promised to relieve the tremors brought on by the death of cells deep in his brain.

Like older Parkinson's medicines, Mirapex could bolster the fading supply of a critical brain chemical called dopamine. It was a blessing for Sweet until something unusual started happening.

First, he started buying things in eBay auctions a camera, a reclining leather chair, a big-screen TV, sunglasses, costume jewelry. He dived into online gambling, lottery tickets and penny stocks. Before long, he was disappearing for days to play slot machines near his home in Rancho Cucamonga, Calif.

He pawned his CD collection, his children's video game player and his wedding ring.

Gambling ''was something I could not turn off,'' said Sweet, a 45-year-old former middle school teacher.

Although Mirapex and similar dopamine drugs have helped thousands of Parkinson's patients, researchers are beginning to detect a small group for which the medicine seems to act like a jolt of electricity, triggering bizarre out-of-control urges.

MANY AFFECTED

According to a recent University of Toronto study, as many as one in 15 patients taking the drugs -- potentially thousands of people -- may have compulsive reactions.

An elderly California widower started wearing dresses, heels and lipstick; one man became obsessed with fast driving and abandoned his job to ride a Jet Ski up the California coast, according to a study by University of Southern California researchers.

People who claim their lives were shattered by their strange urges have filed lawsuits against drug makers. Although their compulsions disappeared after they stopped taking the drugs, some patients say they are still haunted by their experiences.

Sweet can only guess where his compulsion came from. He had barely been inside a casino before, although he remembered he and his wife once won $800 in Las Vegas. Thrilled, they bought an entertainment center for the family.

His life was happy until one day nine years ago when his left arm froze during a church league basketball game. Weeks later, his arm shook as he grasped the hand of a teammate to form a prayer circle.

They were the first signs of Parkinson's disease, which afflicts 500,000 to 1 million Americans, most of them elderly. Sweet was 38, the father of two young children.

Parkinson's is caused by the death of cells that produce dopamine, a neurotransmitter that carries messages along the brain's pathways. A shortage of the chemical causes poor coordination, shaking and bad balance. With time, symptoms include incontinence, difficulty talking and paralysis. There is no cure.

Sweet soon began taking the standard Parkinson's drug, levodopa, which is converted to dopamine in the brain.

The decades-old medicine carried some undesirable side effects, including involuntary tongue movements, grimacing and head bobbing. Sweet switched to Mirapex, marketed by German drug maker Boehringer Ingelheim.

The changes began in a matter of weeks, Sweet said.

MOUNTING DEBT

His wife, Kris, said she noticed him spending all his free time at the computer. For the first seven years of marriage, the couple never had a credit card balance. Now their debt was mounting from stock and online gambling losses.

''It was like being outside yourself, watching as you do these horrible things,'' he said. ``I was still Jim. I still cared. I was trapped inside my mind.''

Kris slept with her wallet under her pillow and hid her jewelry. ''I couldn't trust him,'' she said. ``I had to protect the family.''

At the University of California, Los Angeles, Dr. Jeff Bronstein, a neurologist, tried to rein in Jim's gambling with counseling and drugs. There was no improvement. Bronstein finally turned his attention to Jim's Parkinson's medication.

Around the United States, other doctors started noticing odd behaviors in their patients.

An August 2003 report in the journal Neurology linked the drugs to gambling in eight Arizona patients. Although the rate was the same as in the general population, the drug appeared to act as a trigger in patients, who stopped gambling when the medicine was discontinued.

Soon, a fuller picture emerged. At a meeting of the Movement Disorders Society in 2004, Dr. Jennifer Hui, a neurologist, and her colleagues at USC said patients' odd behaviors weren't limited to gambling.

What friends and families dismissed as quirky mid-life preoccupations or irresponsible behavior appeared to be drug-induced personality shifts, Hui said. She had patients who had become obsessed with golf, sex, home decoration and gardening.

The root of the phenomena, scientists suspect, relates to the complex role of dopamine in the brain. Not only does the chemical carry messages that convert thought to movement, but it also stimulates a part of the brain, the limbic region, that controls feelings of reward and well-being. Gambling, sex, addictive drugs and some habits, like playing video games, are known to stimulate the release of dopamine in the limbic region.

''Without dopamine we would never be addicted to cocaine, cigarettes, heroin or anything,'' said Northwestern University scientist D. James Surmeier.

Writing in Neurology last September, a team from the Mayo Clinic in Rochester, Minn., found that the dopamine drugs had a strong attraction to nerve cells found in large numbers in the limbic region and likely overstimulated the area.

Surmeier, a dopamine expert, called the link to cells in the limbic region ``a smoking gun.''

GAMBLING LINK

In February, a Food and Drug Administration study published in Neurology found a strong association between the drugs and pathological gambling, although the total number of complaints received by the agency was small.

Within the past year, the companies have added information about compulsive reactions to their package inserts. Boehringer Ingelheim said it was working with Parkinson's experts to investigate reports of pathological reactions.

For patients who need the drugs to manage the inexorable progression of Parkinson's, options are limited. Lowering drug doses seems to eliminate compulsions in some patients, doctors say. Other patients have channeled their obsessions into more productive behaviors.

Sweet, meanwhile, still can't completely forget the three years when gambling overwhelmed his life.

After doctors at UCLA took him off Mirapex, ''It was like a weight being lifted from my head,'' said Sweet, who recently settled a federal lawsuit against Boehringer Ingelheim and Pfizer Inc., which co-marketed Mirapex in the United States.

Studies and Lawsuits Point Accusing Fingers at the Parkinson's Drug, MIRAPEX, that Has Been Linked to Compulsive Gambling

Thu, 29 Dec 2005 00:00:00 -0800

It is admittedly an odd connection but there seems to be no real doubt that MIRAPEX, a drug used to treat Parkinson’s disease (PD), is also responsible for turning some of the patients who used it into gambling addicts.

In July, a Mayo Clinic study published in the Archives of Neurology that identified 11 Parkinson’s patients who developed a gambling habit while taking MIRAPEX or similar drugs between 2002 and 2004. Since the study was released, 14 additional Mayo patients have been diagnosed with the problem according to lead author Dr. M Leann Dodd, a psychiatrist at the Clinic.

Previously, in August 2003 in the journal Neurology, Drs. E. Driver-Dunckley, J. Samanta, and M. Stacey published an article entitled “Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease.”

That study found extreme cases of compulsive gambling in nine (of 1,884) patients using pramipexole (8 or 1.5%)) and pergolide (1 or 0.3%). Both results were well above the overall incidence rate of all PD patients of 0.05%. Both drugs that showed an increased risk were dopamine agonists (DA).

The Mayo Clinic study also analyzed the findings in five prior studies (including the 2003 Driver-Dunckley study) and confirmed that: “All of the commonly prescribed dopamine agonists have been associated with pathological gambling” with pramipexole being “disproportionately represented in both our series (82% of our patients) and in prior reports (59%).”

MIRAPEX (pramipexole dihydrochloride) is in the dopamine agonist class of drugs and is believed to work by mimicking the action of dopamine in the brain to help control the symptoms of Parkinson’s disease. Dopamine also affects brain processes that control emotional responses and a person's ability to experience pleasure and pain. It is thought to play a role in addictive behavior.

Unfortunately, this is another drug whose benefits come with a very high price tag for some patients. The ones who become addicted to gambling often wind up losing their life savings, fall deeply into debt, and even jeopardize or destroy their marriages or other personal or family relationships.

In the past, the victims of this harsh side-effect had no idea what had come over them. Their brain was literally taken over and their gambling became constant and compulsive. Simply stated, they were out of control and had no idea why. For these people, the situation was frightening and inexplicable.

As a result of this completely bizarre and damaging side-effect, many MIRAPEX users suffered long periods of debilitating and destructive behavior during which they were unaware that the drug was causing the problem and that it would cease if they discontinued taking it.

MIRAPEX is manufactured by German-based Boehringer Ingelheim Pharmaceuticals, the world's biggest family-owned drug company, in cooperation with New York-based Pfizer, the world's largest drugmaker. Its sales for 2004 topped $200 million in the U.S. alone.
.Boehringer Ingelheim lists "compulsive behaviors (including sexual and pathological gambling)" as a possible side effect associated with taking MIRAPEX. That seven-word phrase on page 17 of a 21-page highly technical document is all the warning that is given concerning the potentially detrimental side-effect.

While Boehringer-Ingelheim has repeatedly claimed there is no scientific evidence upon which to base the conclusion that MIRAPEX causes addictive or compulsive behavior, the multiple reputable studies on the subject would seem to indicate otherwise. In addition, the company revised its package insert to include the warning with respect to “compulsive behavior” despite its denial of the connection.

Currently, two major lawsuits against Boehringer Ingelheim and Pfizer have been commenced in federal court in California and in Superior Court in Ontario, Canada. They allege a number of addictive behaviors associated with MIRAPEX including gambling, shopping, having sex, eating, and engaging in other compulsive conduct.

It is likely that additional lawsuits will be commenced in the near future since the problem is as widespread as the locations of people who took MIRAPEX.

Jerrold Parker, managing partner of Parker & Waichman, a law firm with considerable experience in pharmaceutical and medical malpractice litigation nationwide, told us that: “It is difficult to imagine how the manufacturers of MIRAPEX can maintain there is no scientific evidence to support the addiction link when several studies leave little doubt of the connection. In addition, it is rather amazing that when the manufacturers finally decided to add a warning regarding compulsive conduct to the product insert they chose to hide it in the middle of 21 pages of technical data.”

Popular Parkinson's drug linked to gambling

Tue, 12 Jul 2005 00:00:00 -0700

Joe Neglia was a retired government intelligence worker with Parkinson’s disease when he suddenly developed what he calls a gambling habit from hell.

After losing thousands of dollars playing slot machines near his California home several times a day for nearly two years, Neglia stumbled across an Internet report linking a popular Parkinson’s drug he used with compulsive gambling.

“I thought, 'Oh my God, this must be it,”’ he said. Three days after stopping the drug, Mirapex, “all desire to gamble just went away completely. I felt like I had my brain back.”

A Mayo Clinic study published Monday in July’s Archives of Neurology describes 11 other Parkinson’s patients who developed the unusual problem while taking Mirapex or similar drugs between 2002 and 2004. Doctors have since identified 14 additional Mayo patients with the problem, said lead author Dr. M. Leann Dodd, a Mayo psychiatrist.

“It’s certainly enough for us to be cautious as we are using it,” Dodd said. “We wouldn’t want them to have some kind of financial ruin or difficulties that could be prevented.”

Compulsive gambling, sex and shopping

Dr. Leo Verhagen, a Parkinson’s specialist at Chicago’s Rush University Medical Center who was not involved in the study, says he and some colleagues all have a few patients who developed compulsive gambling while taking Mirapex, a drug that relieves tremors and stiffness. The behavior usually disappears when the drug dose is lowered, Verhagen said. He praised the Mayo article for raising awareness for doctors and patients.

Neglia, 54, now living in Millersville, Md., was not treated at Mayo or involved in the study. He said the problem is underreported “because of the embarrassment factor” and is one of several patients suing manufacturer Boehringer-Ingelheim Pharmaceuticals Inc., accusing the company of failing to adequately warn patients about the potential side effects.

AN attorney, who filed the lawsuit last year, said he’s spoken with more than 200 Mirapex patients who developed compulsive behaviors, including excessive gambling, sex and shopping. He is seeking to have the complaint certified as a nationwide class-action lawsuit. A similar suit has been filed in Canada, the attorney said.

Neglia said he has contacted the Food and Drug Administration but that the agency has failed to act on numerous adverse reaction reports about Mirapex. An FDA spokeswoman said the agency is examining the reports to determine if there’s any connection to the drug but declined to say how many it has received.

Katherine King O’Connor, a spokeswoman for the Ridgefield, Conn.-based Boehringer-Ingelheim Pharmaceuticals, said there’s no scientific evidence that Mirapex causes the problem. Still, the company revised Mirapex’s package insert earlier this year to include compulsive behavior among potential side effects after receiving “rare” reports all after the drug was approved for U.S. use in 1997, O’Connor said.

'Like a light switch being turned off'

Mirapex was among top-selling Parkinson’s drugs last year, with more than $200 million in U.S. sales, according to IMS Health, a pharmaceutical information and consulting firm.

Mirapex, or pramipexole, reduces tremors and the slow, stiff movements that are a hallmark of Parkinson’s disease. It belongs to a class of drugs that mimic the effects of dopamine, a brain chemical that controls movement and is deficient in Parkinson’s disease.

Mirapex targets dopamine receptors in a brain region associated with emotions that include pleasure and reward-seeking behavior, Dodd said. It can also cause extreme sudden sleepiness.

It is sometimes used alone or with the mainstay Parkinson’s drug, levodopa.

Though a few of the Mayo patients took related drugs, Dodd said most used Mirapex. They included a 68-year-old man who lost more than $200,000 at casinos over six months and a 41-year-old computer programmer who became “consumed” with Internet gambling, losing $5,000 within a few months.

Dodd said Mayo doctors now ask patients using the drugs if they have suddenly taken up gambling. Affected patients are usually switched to different drugs or doses, and the result is often dramatic, “like a light switch being turned off when they stopped the drug,” she said.

Popular Parkinson's Drug Linked to Gambling

Mon, 11 Jul 2005 00:00:00 -0700

Joe Neglia was a retired government intelligence worker with Parkinson’s disease when he suddenly developed what he calls a gambling habit from hell.

After losing thousands of dollars playing slot machines near his California home several times a day for nearly two years, Neglia stumbled across an Internet report linking a popular Parkinson’s drug he used with compulsive gambling.

“I thought, 'Oh my God, this must be it,”’ he said. Three days after stopping the drug, Mirapex, “all desire to gamble just went away completely. I felt like I had my brain back.”

A Mayo Clinic study published Monday in July’s Archives of Neurology describes 11 other Parkinson’s patients who developed the unusual problem while taking Mirapex or similar drugs between 2002 and 2004. Doctors have since identified 14 additional Mayo patients with the problem, said lead author Dr. M. Leann Dodd, a Mayo psychiatrist.

“It’s certainly enough for us to be cautious as we are using it,” Dodd said. “We wouldn’t want them to have some kind of financial ruin or difficulties that could be prevented.”

Compulsive gambling, sex and shopping
Dr. Leo Verhagen, a Parkinson’s specialist at Chicago’s Rush University Medical Center who was not involved in the study, says he and some colleagues all have a few patients who developed compulsive gambling while taking Mirapex, a drug that relieves tremors and stiffness. The behavior usually disappears when the drug dose is lowered, Verhagen said. He praised the Mayo article for raising awareness for doctors and patients.

Neglia, 54, now living in Millersville, Md., was not treated at Mayo or involved in the study. He said the problem is underreported “because of the embarrassment factor” and is one of several patients suing manufacturer Boehringer-Ingelheim Pharmaceuticals Inc., accusing the company of failing to adequately warn patients about the potential side effects.

A California attorney, who filed the lawsuit last year, said he’s spoken with more than 200 Mirapex patients who developed compulsive behaviors, including excessive gambling, sex and shopping. He is seeking to have the complaint certified as a nationwide class-action lawsuit. A similar suit has been filed in Canada..

Neglia said he has contacted the Food and Drug Administration but that the agency has failed to act on numerous adverse reaction reports about Mirapex. An FDA spokeswoman said the agency is examining the reports to determine if there’s any connection to the drug but declined to say how many it has received.

Katherine King O’Connor, a spokeswoman for the Ridgefield, Conn.-based Boehringer-Ingelheim Pharmaceuticals, said there’s no scientific evidence that Mirapex causes the problem. Still, the company revised Mirapex’s package insert earlier this year to include compulsive behavior among potential side effects after receiving “rare” reports — all after the drug was approved for U.S. use in 1997, O’Connor said.

'Like a light switch being turned off'
Mirapex was among top-selling Parkinson’s drugs last year, with more than $200 million in U.S. sales, according to IMS Health, a pharmaceutical information and consulting firm.

Mirapex, or pramipexole, reduces tremors and the slow, stiff movements that are a hallmark of Parkinson’s disease. It belongs to a class of drugs that mimic the effects of dopamine, a brain chemical that controls movement and is deficient in Parkinson’s disease.

Mirapex targets dopamine receptors in a brain region associated with emotions that include pleasure and reward-seeking behavior, Dodd said. It can also cause extreme sudden sleepiness.

It is sometimes used alone or with the mainstay Parkinson’s drug, levodopa.

Though a few of the Mayo patients took related drugs, Dodd said most used Mirapex. They included a 68-year-old man who lost more than $200,000 at casinos over six months and a 41-year-old computer programmer who became “consumed” with Internet gambling, losing $5,000 within a few months.

Dodd said Mayo doctors now ask patients using the drugs if they have suddenly taken up gambling. Affected patients are usually switched to different drugs or doses, and the result is often dramatic, “like a light switch being turned off when they stopped the drug,” she said.

Welding Rod Fumes Parkison Disease Side Effects Injury Attorney

Mon, 11 Jul 2005 00:00:00 -0700

Parkinson's Disease

There are more than 1 million Americans who live with Parkinson’s disease, with approximately 60,000 new cases diagnosed each year. Parkinson's disease falls into a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells.

The four primary symptoms of Parkinson’s disease are tremors, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may struggle with walking, talking, or completing other simple tasks.

Parkinson’s disease normally affects individuals over the age of 50. Initial symptoms of Parkinson’s disease are subtle and occur gradually. As the disease progresses, the shaking, or tremors, which affects the majority of patients may begin to interfere with daily activities. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.

Welders may have a higher-than-average rate of Parkinson's disease symptoms, the results of a new study suggest. Researchers found that among more than 1,400 welders from Alabama, the prevalence of Parkinson-like symptoms, including tremor, muscle rigidity and slowed movement, was 7 to 10 times higher than the norm for the general population.

In an earlier study of 15 career welders, the same investigators found that the men started suffering Parkinson's symptoms at an atypically early age, at age 46 on average, versus age 63 in a comparison group of non-welders. That led the researchers to speculate that an as yet unknown toxin in welding fumes might speed the onset of Parkinson's disease in people who would likely have developed the disease at an older age. That study, published in 2001, has since been cited in lawsuits against welding-rod manufacturers.

Late in 2003, a jury awarded $1 million to a plaintiff who claimed that years of inhaling toxic welding fumes caused his Parkinson's disease, and thousands of similar lawsuits have since been filed.

A new study scheduled to be released within the next week in England will serve to strengthen concerns that there is a clear link between insecticide exposure and Parkinson’s disease. The “Geoparkinson” study examined the backgrounds of 767 volunteer subjects in five countries who have Parkinson’s and 1,989 healthy control subjects with similar backgrounds.

Parkinson's Medications
Mirapex (Generic: Pramipexole) is a popular medication used to control tremors associated with Parkinson’s Disease. Mirapex is a dopamine agonist and works by mimicking the effects of the neurotransmitter dopamine. Dopamine helps people control their movements and increases feelings of happiness and satisfaction. Because Parkinson's Disease occurs because of a lack of dopamine in certain areas of the brain, Mirapex can help ease some of the symptoms associated with Parkinson’s. Mirapex has been linked to compulsive behaviors such as excessive gambling. Permax (pergolide) has been linked to heart valve leaks and damage. Dostinex (cabergoline) has also been linked to cardiac valvulopathy.

If you or a loved one worked as a Welder and were diagnosed with Parkinson's Disease as a result of being exposed to welding fumes, please fill out the form at the right for a free case evaluation by a qualified toxic substances lawyer. Additionally, if you took Parkinson's medications such as Permax, Mirapex or Dostinex, and you suffered serious side effects please fill out the form at the right for a free case evaluation by our defective drug lawyers.