Journal of Parkinsons disease and Alzheimers disease
Review Article
Amantadine for the Treatment of Parkinson’s Disease and its Associated Dyskinesias
Butterworth Roger F*
Department of Medicine, University of Montreal, Canada
*Address for Correspondence: Butterworth Roger F, Professor of Medicine, University
of Montreal, Montreal, Qc, Canada 45143 Cabot Trail,
Englishtown, NS, B0C 1H0, Canada; E-mail: rb@enceph.com
Submission: 1- July- 2020;
Accepted: 5- August- 2020;
Published: 7- August- 2020
Copyright: © 2020 Butterworth RF. This is an open access article
distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Abstract
Disturbances of motor function characteristic of Parkinson’s
Disease (PD) are commonly treated with L-Dopa. However, prolonged
treatment commonly results in L-Dopa-Induced Dyskinesias (LIDs)
with high negative impact on patient’s quality of life that seriously
limits the use of L-Dopa. Amantadine, like L-Dopa, is effective for
the replenishment of defective dopamine production in PD by
mechanisms involving increased synthesis and decreased synaptic
reuptake with consequent improvements of the patient’s motor
symptoms. Results of RCTs and meta-analyses continue to support
the claim that amantadine is effective for the treatment of early
or stable PD. Preclinical and clinical studies reveal that LIDs result
from modifications of corticostriatal (glutamatergic) and nigrostrial
(dopaminergic) connectivity resulting from the relative over-activation
of NMDA receptors, a phenomenon shown to occur in patients with
LIDs using Positron Emission Tomography. In addition to its beneficial
actions in restoring dopaminergic function, amantadine is a potent
non-competitive NMDA receptor antagonist and, as such, affords a
potentially effective agent for the treatment for LIDs. Indeed, beneficial
effects of amantadine for the treatment of LIDs have been described
in multiple Randomized Controlled Trials (RCTs) using a range of wellestablished dyskinesia rating scales over the last two decades and
extended-release formulations of amantadine have also been found
to be effective. Confirmation of clinical efficacy of amantadine for the
treatment of LIDs has been complemented by the results of systematic
reviews and meta-analyses that include a Movement Disease Society
(MDS)-commissioned evidence-based update of treatment options.
Treatment of PD patients with amantadine during the COVID-19
pandemic could be advantageous since, in addition to its ability to
correct the movement disorder and dyskinesias, amantadine has the
potential to limit replication of SARS-CoV-2, the virus responsible for
COVID-19.