Comparison of Benzhexol and Procyclidine for Tremor in Tremor-Predominant Parkinson's Disease
Comparison of Effectiveness of Benzhexol and Procyclidine in Improving Tremor in Tremor Predominant Parkinson's Disease Patients
調査の概要
状態
状態
条件
条件
介入・治療
介入・治療
詳細な説明
This randomized clinical trial will compare the effectiveness of benzhexol and procyclidine in improving tremor in patients with tremor-predominant Parkinson's disease who are receiving levodopa therapy.
Eligible participants will be adults aged 40 to 70 years with clinically diagnosed Parkinson's disease, predominant tremor at presentation, Hoehn and Yahr stage 1, 2, or 3, and resting tremor while receiving levodopa/carbidopa monotherapy. Participants with cognitive or behavioral abnormalities, lower urinary tract symptoms, benign prostatic hyperplasia, angle-closure glaucoma, or cardiac disease will be excluded.
Participants will be randomly assigned to one of two treatment groups. Group A will receive benzhexol and Group B will receive procyclidine, in addition to their existing levodopa treatment. Benzhexol will be started at 2 mg on the first day, increased to 2 mg twice daily on day 4 and to 2 mg three times daily on day 7, with subsequent dose adjustment according to tremor response and tolerability. Procyclidine will be started at 2.5 mg three times daily on day 1, increased according to the protocol to a maximum of 5 mg three times daily by day 7, with subsequent dose adjustment according to tremor response and tolerability.
Motor symptoms will be assessed using Part III of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III). The primary assessment will focus on the total tremor subset score comprising the following eight items: postural tremor of the right hand, postural tremor of the left hand, rest tremor amplitude of the right upper extremity, rest tremor amplitude of the left upper extremity, rest tremor amplitude of the right lower extremity, rest tremor amplitude of the left lower extremity, rest tremor amplitude of the lip/jaw, and constancy of rest tremor.
Improvement will be assessed as the absolute change in the total tremor subset score from baseline, with the primary comparison made at the 2-week follow-up. The study aims to determine whether benzhexol provides at least similar improvement in tremor compared with procyclidine.
Participants will be assessed at baseline and at 2 weeks, 3 months, and 6 months after treatment initiation. MDS-UPDRS-III assessments will be performed by an independent observer, and adverse effects and tolerability of the study medications will be assessed and documented at follow-up visits.
The planned study enrollment is 88 participants, with 44 participants allocated to each treatment group. The study will be conducted in the Department of Neurology, Mayo Hospital, Lahore.
研究の種類
研究の種類
入学 (推定)
入学
段階
段階
- 適用できない
連絡先と場所
研究連絡先
研究連絡先
- 名前:Saad A Malik, MBBS
- 電話番号:+92-3005107713
- メール:saadazhar@live.com
研究場所
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Punjab Province
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Lahore、Punjab Province、パキスタン、54000
- 募集
- Mayo Hospital Lahore
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副調査官:
- Ahsan Numan, FCPS,FAAN,FRCP,PhD
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コンタクト:
- Saad A Malik, MBBS
- 電話番号:+92-3005107713
- メール:saadazhar@live.com
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主任研究者:
- Saad A Malik, MBBS
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副調査官:
- Safia Bano, FCPS, PhD Scholar
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-
参加基準
適格基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
説明
Inclusion Criteria:
- Diagnosed Parkinson's disease according to the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease, with predominant tremor at presentation.
- Hoehn and Yahr stage 1, 2, or 3.
- Any gender.
- Age 40 to 70 years.
- Receiving levodopa/carbidopa monotherapy for Parkinson's disease, with resting tremor present.
Exclusion Criteria:
- Cognitive or behavioral abnormalities.
- Lower urinary tract symptoms.
- Benign prostatic hyperplasia.
- Angle-closure glaucoma.
- Cardiac disease.
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:ダブル
アーム数
武器と介入
参加者グループ / アーム参加者グループ / アーム |
介入・治療介入・治療 |
|---|---|
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実験的:Benzhexol
Participants will receive benzhexol in addition to levodopa/carbidopa therapy.
Benzhexol will be started at 2 mg on day 1, increased to 2 mg twice daily on day 4 and to 2 mg three times daily on day 7.
The dose will subsequently be adjusted according to resolution of tremor or development of side effects.
If tremor resolves, benzhexol will be continued at the effective dose; if intolerable side effects develop, the dose will be reduced and subsequently stopped if side effects persist.
Participants will be followed for 6 months with assessments at baseline, 2 weeks, 3 months, and 6 months.
|
Benzhexol will be administered orally.
Treatment will start at 2 mg on day 1, increase to 2 mg twice daily on day 4, and increase to 2 mg three times daily on day 7.
The dose will subsequently be adjusted according to tremor response and tolerability.
Treatment will continue for up to 6 months unless stopped because of persistent intolerable side effects.
|
|
アクティブコンパレータ:Procyclidine
Participants will receive procyclidine in addition to levodopa/carbidopa therapy.
Procyclidine will be started at 2.5 mg three times daily on day 1, increased to 5 mg in the morning plus 2.5 mg in the afternoon and evening on day 3, then to 5 mg in the morning and afternoon with 2.5 mg in the evening on day 5, and finally up to 5 mg three times daily on day 7.
The dose will subsequently be adjusted according to resolution of tremor or development of side effects.
If tremor resolves, procyclidine will be continued at the effective dose; if intolerable side effects develop, the dose will be reduced and subsequently stopped if side effects persist.
Participants will be followed for 6 months with assessments at baseline, 2 weeks, 3 months, and 6 months.
|
Procyclidine will be administered orally.
Treatment will start at 2.5 mg three times daily on day 1, increase to 5 mg in the morning plus 2.5 mg in the afternoon and evening on day 3, then to 5 mg in the morning and afternoon with 2.5 mg in the evening on day 5, and finally up to 5 mg three times daily on day 7.
The dose will subsequently be adjusted according to tremor response and tolerability.
Treatment will continue for up to 6 months unless stopped because of persistent intolerable side effects.
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この研究は何を測定していますか?
主要な結果の測定
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Change from Baseline in Total Tremor Subset Score of the MDS-UPDRS Part III at 2 Weeks
時間枠:From Baseline to Week 2
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The total tremor subset score is the sum of Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III tremor items: postural tremor of the right hand, postural tremor of the left hand, kinetic tremor of right hand, kinetic tremor of left hand, rest tremor amplitude of the right upper extremity, rest tremor amplitude of the left upper extremity, rest tremor amplitude of the right lower extremity, rest tremor amplitude of the left lower extremity, rest tremor amplitude of the lip/jaw, and constancy of rest tremor.
The minimum score is 0 and maximum score is 40 for tremor subset scores with a lower score indicating better function.
Change from baseline will be calculated as the baseline total score minus the total score at 2 weeks, with a greater positive change representing greater improvement in tremor.
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From Baseline to Week 2
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二次結果の測定
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Total Number of Side Effects
時間枠:From Baseline to 6 months
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The total number of side effects reported or observed in participants in the benzhexol and procyclidine groups during the study will be recorded and compared between the two treatment groups.
Side effects will be assessed and documented during follow-up visits.
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From Baseline to 6 months
|
協力者と研究者
出版物と役立つリンク
一般刊行物
- Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N; Movement Disorder Society UPDRS Revision Task Force. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008 Nov 15;23(15):2129-70. doi: 10.1002/mds.22340.
- Ou Z, Pan J, Tang S, Duan D, Yu D, Nong H, Wang Z. Global Trends in the Incidence, Prevalence, and Years Lived With Disability of Parkinson's Disease in 204 Countries/Territories From 1990 to 2019. Front Public Health. 2021 Dec 7;9:776847. doi: 10.3389/fpubh.2021.776847. eCollection 2021.
- Habib, Md. Ahsan & Alamgir, ASM & Dey, Subash Kanti & Alam, Afroja & Asafuddoula, Ahmed & Rizvi, Abu. (2016). Effect of Trihexiphenidyl and Procyclidine for the management of resting tremor. Bangladesh Medical Journal. 44. 72-75. 10.3329/bmj.v44i2.27241.
- Sahoo LK, Holla VV, Batra D, Prasad S, Bhattacharya A, Kamble N, Yadav R, Pal PK. Comparison of effectiveness of trihexyphenidyl and levodopa on motor symptoms in Parkinson's disease. J Neural Transm (Vienna). 2020 Dec;127(12):1599-1606. doi: 10.1007/s00702-020-02257-0. Epub 2020 Oct 9.
- Barrett MJ, Sargent L, Nawaz H, Weintraub D, Price ET, Willis AW. Antimuscarinic Anticholinergic Medications in Parkinson Disease: To Prescribe or Deprescribe? Mov Disord Clin Pract. 2021 Oct 8;8(8):1181-1188. doi: 10.1002/mdc3.13347. eCollection 2021 Nov.
- Lees A, Tolosa E, Stocchi F, Ferreira JJ, Rascol O, Antonini A, Poewe W. Optimizing levodopa therapy, when and how? Perspectives on the importance of delivery and the potential for an early combination approach. Expert Rev Neurother. 2023 Jan;23(1):15-24. doi: 10.1080/14737175.2023.2176220. Epub 2023 Feb 10.
- Vazquez-Velez GE, Zoghbi HY. Parkinson's Disease Genetics and Pathophysiology. Annu Rev Neurosci. 2021 Jul 8;44:87-108. doi: 10.1146/annurev-neuro-100720-034518.
- Peng S, Liu P, Wang X, Li K. Global, regional and national burden of Parkinson's disease in people over 55 years of age: a systematic analysis of the global burden of disease study, 1991-2021. BMC Neurol. 2025 Apr 23;25(1):178. doi: 10.1186/s12883-025-04191-8.
研究記録日
主要日程の研究
研究開始 (推定)
研究開始
一次修了 (推定)
一次修了
研究の完了 (推定)
研究の完了
試験登録日
最初に提出
最初に提出
QC基準を満たした最初の提出物
QC基準を満たした最初の提出物
最初の投稿 (実際)
最初の投稿
学習記録の更新
投稿された最後の更新 (実際)
投稿された最後の更新
QC基準を満たした最後の更新が送信されました
QC基準を満たした最後の更新が送信されました
最終確認日
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
その他の研究ID番号
- 751/RC/KEMU
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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