About half of people living with Parkinson's disease complain of fatigue, and the odds of experiencing it increase as the disease progresses. Fatigue as a symptom can be addressed with stimulants in almost anyone regardless of whether they live with Parkinson's disease. One of the most common stimulants prescribed by physicians is methylphenidate, commonly known by its brand name Ritalin.
Some physicians have prescribed it to people with Parkinson's disease to address problems with fatigue, as well as spontaneous somnolence (falling asleep suddenly). Many patients have had positive experiences with methylphenidate, but prescribing it to people with Parkinson's disease is a little controversial. So a group of researchers from the University of Western Ontario in Canada, arranged a study to measure how well people with Parkinson's disease would respond to methylphenidate as a way to relieve some of the fatigue.
Ritalin's History
Ritalin, the brand name for methylphenidate, was approved by the U.S. Food and Drug Administration (FDA) in the 1950s to treat chronic fatigue, depression, psychosis associated with depression, narcolepsy, and to offset the sedating effects of other medications. During the 1960s, physicians experimented with Ritalin as a treatment for "hyperkinetic syndrome" in children and adolescents. We now refer to it as attention deficit hyperactivity disorder (ADHD), and it is often diagnosed and treated in adults. Ritalin and ADHD are still the sources of controversy. That controversy may affect neurologists' opinions about the safety and effectiveness of methylphenidate as a stimulant to address fatigue. It is understandable that physicians would exercise caution about prescribing a stimulant that is addictive, and carefully regulated by the FDA, the Drug Enforcement Agency (DEA), and other governmental agencies.
How The Canadian Study Worked
Researchers in the Canadian study recruited 36 patients with Parkinson's disease who tested positive for fatigue. They administered two questionnaires that measured their level of fatigue. For six weeks, 17 patients were assigned to receive three doses of methylphenidate each day, and 19 received a placebo three times per day. At the end of six weeks the administered the fatigue questionnaires again, and compared the improvement between the two groups.
Did Methylphenidate Really Help People with Parkinson's Disease?
When they tallied up the numbers on the two groups, they saw a remarkable decrease in fatigue in the group that had taken methylphenidate, and little improvement in the placebo group. Patients receiving the stimulant reported that their average fatigue scores lowered about 15 percent. For some people with Parkinson's disease, the benefits of Ritalin may be worth carefully considering the risks, as well as cutting through the stigma and red tape.
Methylphenidate is a moderately powerful prescription drug and has earned the designation as a Schedule II controlled substance, requiring more controls and restrictions on physicians who prescribe it, and patients who fill the prescriptions.
Source:
Movement Disorders, Published Online: August 2, 2007
