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
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Gedetailleerde beschrijving
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.
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Saad A Malik, MBBS
- Telefoonnummer: +92-3005107713
- E-mail: saadazhar@live.com
Studie Locaties
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Punjab Province
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Lahore, Punjab Province, Pakistan, 54000
- Werving
- Mayo Hospital Lahore
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Onderonderzoeker:
- Ahsan Numan, FCPS,FAAN,FRCP,PhD
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Contact:
- Saad A Malik, MBBS
- Telefoonnummer: +92-3005107713
- E-mail: saadazhar@live.com
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Hoofdonderzoeker:
- Saad A Malik, MBBS
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Onderonderzoeker:
- Safia Bano, FCPS, PhD Scholar
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Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Beschrijving
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.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Dubbele
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
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Experimenteel: 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.
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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.
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Actieve vergelijker: 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.
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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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Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Change from Baseline in Total Tremor Subset Score of the MDS-UPDRS Part III at 2 Weeks
Tijdsspanne: 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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Secundaire uitkomstmaten
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Total Number of Side Effects
Tijdsspanne: 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
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Medewerkers en onderzoekers
Sponsor
Sponsor
Publicaties en nuttige links
Algemene publicaties
- 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.
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Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
- Synucleïnopathieën
- Neurologische manifestaties
- Hersenziekten
- Ziekten van het centrale zenuwstelsel
- Ziekten van het zenuwstelsel
- Neurodegeneratieve ziekten
- Bewegingsstoornissen
- Parkinson-stoornissen
- Basale ganglia-ziekten
- Dyskinesieën
- Pathologische aandoeningen, tekenen en symptomen
- Tekenen en symptomen
- Ziekte van Parkinson
- Tremor
- Heterocyclische verbindingen, 1-ring
- Heterocyclische verbindingen
- Piperidines
- Pyrrolidines
- Trihexyfenidyl
- Procyclidine
Andere studie-ID-nummers
Andere studie-ID-nummers
- 751/RC/KEMU
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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