Parkinson's Disease Clinical Trial
Official title:
Phase II Clinical Trial of Ipratropium Bromide Spray as a Treatment for Sialorrhea in Patients With Parkinson's Disease
A phase II double blind clinical trial investigating the effects of ipratropium spray versus placebo spray in patients with Parkinson's disease.
Background: Excessive drooling of saliva (sialorrhoea) is a common complication of
Parkinson's disease (PD). Unfortunately current medications, which rely on anticholinergic
properties, often induce systemic side effects, such as confusion, hallucinations or urinary
retention.
Aim: We therefore hypothesise that local application of an anticholinergic aerosol spray into
the mouth would reduce sialorrhea in PD without inducing systemic side-effects.
Method: A double blind, randomised, placebo-controlled cross-over trial of the muscarinic
antagonist, ipratropium bromide in patients with bothersome drooling in idiopathic
Parkinson's disease. All patients are recruited from the Movement Disorders Clinic, Toronto
Western Hospital and informed consent is obtained. Patients are randomised to receive
ipratropium bromide, 1- 2 metered doses (sprays) of active drug (21 micorgram per metered
dose) or matching placebo, up to a maximum of 4 times per day, in a double-blind, cross-over
design using randomisation tables. Total treatment length is two weeks for each limb of the
study with a 1-2 week wash out period. The primary outcome measure is an objective measure of
saliva production. Dental rolls are inserted into the mouth for 5 min and the patient
instructed not to swallow and sit upright. The weight of dental rolls before and after
insertion is calculated as a measure of saliva production. The secondary outcome measures are
subjective measure of saliva where patients or caregivers record the level of saliva
production each day for the 2 weeks of each treatment using validated subjective rating
scales which assess drooling severity and frequency. In addition, parkinsonism is rated using
the UPDRS parts I - IV and adverse events are recorded. The scores for measured saliva
production following ipratropium bromide and placebo treatment will be compared using
appropriate paired t-tests. Results from the scales assessing the subjective measures of
saliva production and UPDRS ratings will be compared via paired non-parametric Wilcoxon
matched pairs test. 20 patients will be recruited.
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