I know many of us have been following the nicotine patch discussion in the Dr. Paneri thread. The patch for PD has been in Phase II clinical trial and study completion is just around the bend May 2013. It strikes me that if it was not efficacious, they would have reported that by now? Not sure how that works, anyway....

I have been skeptical as I have a friend with PD who smokes. Maybe not enough direct nicotine absorption for him, who knows?

When the rather conservative American Academy of Neurology freely posts a full-text journal article on the benefits of an unconventional or off-label treatment, I take notice. This approach must have some merit for many of us!

Growing List of Positive Effects of Nicotine Seen in Neurodegenerative Disorders

Thought this info warranted a new thread for discussion. Note the AAN does not endorse prescribing the patch but points out risk factors are "weak".

Laura

Laura, I think what we are going to find is that it's the amount of nicotine that makes the difference...in the protocol Vlliers wrote about, she is taking 31mg of nicotine and said some folks go up to 84mg...by any calculation, even 31mg is a boatload of nicotine! That would be almost 5 of the 7mg patches for the lowest dose I've read about, wow.

It's pretty clear to me from her posts that the amount that helps one person may not be the same as what helps another, and then of course you have to factor in the toxicity factor Mrs. D mentioned, too much for your body height/weight and metabolism, and you can get poisoned.

But this is amazing that the AAN publicly has expressed this view. I wonder if our neuro will mention this at our next appt....we'll see.

I am hopeful, but that is a lot of nicotine to be on for years. I would think there are yet to be discovered side effects at higher doses. Plus we have to be on it everyday so it becomes a matter of tolerating two meds or can Sinemet be eliminated? I think Villiers said he was on more Sinemet now. The article did say it was great for dyskinesia. I am thinking maybe this is MJF's secret...hard to believe that it is Amantadine.

Why does height factor in to metabolism?

Laura

Found this article. It is dated but includes titration levels. Patient maintained benefit for 23 months of study. Most interesting is that the patient did not have a robust response to levodopa, so she was considered atypical. This seems to further substantiate that dopamine is but one part of what is happening with our brains.

Nicotine may relieve symptoms of Parkinson's Disease.


Found this table which sums up research results of multiple trials and is dated 2009:

Clinical trials shows variable effectiveness of nicotine in improving Parkinson’s disease symptoms
Overall, nicotine treatment improved symptoms in 6/10 studies [45, 46, 49-52], but not in the remaining 4 studies.
Improvement in Parkinson’s disease symptoms did not correlate with type of nicotine formulation used, that is, with
the patch, gum, smoking,
There were no consistent links between duration of administration (days to wks) and improvement in any of the studies.
A decline in Parkinson’s disease symptoms was linked to high nicotine dosing.
Improvement correlated with study design, with benefit in 5/6 of the open label studies, although not in one. By contrast, there were positive effects in symptoms in only 1/4 of the double-blinded studies, with no benefit in the other 3 trials.
Conclusion: Beneficial effects on Parkinson’s disease symptoms may be associated with high dose nicotine. Alternatively, nicotine-mediated improvement in Parkinson’s disease symptoms may be due to a placebo effect.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815339/

Possibly, but wasn't MJF a smoker? Did he quit? Maybe he started back up and that's why he is doing better? Does anyone know?

http://www.sri.com/about/people/maryka-quik

you'd think that with all the trials that have occurred we would have more anecdotal reports if it helped. you know, people that were in the trials that are still using a patch? recently went to a pd support meeting and met about 10 pd'ers, first thing we talked about was what meds/supplements we were taking.

Not necessarily. Duodopa works but we rarely hear a thing. In my experience, this is the only place where people look out for one another in this way. Most PWP stick strictly to what their docs tell them; hence, your experience at the support meeting. We are rare breed here.

IF you look at the AAN link, that very same researcher you linked to is quoted in the article. There are case studies going back some some 18 years showing efficacy of the patch with PD. How long is it going take scientists to figure out how to target the specific receptors? It all has to be gove funded because their is no real profit potential. In other words Dr. Quik (note the irony in her name) is looking for a way to target the patch just for PD and make it profitable. The AAN has all but admitted it works, at least for dyskinesia.

Laura

This may have been mentioned before, but if this is so good for PD, wouldn't the tobacco companies be all over it, developing their product to help? While they may not have as much money as GSK et al., they have more, I would think, than most PD orgs, and would be in a pretty good position to do a trial. Why haven't we heard anything from their end?

One of my concerns about using nicotine patches for PD is the possibility of addiction.

[1] says this can be avoided by using coconut oil.

The status of coconut oil is uncertain following the reported failure of the cogane trial. But, this connection with nicotine and, therefore, indirectly to dopamine does suggest that it may have some effect.

Reference

[1] Kusnandar Anggadiredja, Anggraini Barlian, Yangie Dwi Marga Pinang and Dian Anggraeny, 2011. Virgin Coconut Oil Prevents Nicotine Dependence and Relapse. International Journal of Pharmacology, 7: 664-669.

DOI: 10.3923/ijp.2011.664.669

URL: http://scialert.net/abstract/?doi=ijp.2011.664.669

John

The takeaway from the report below, I think, is that nicotine may be neuroprotective and can reduce dyskinesia but there is no evidence that it can restore lost neurons. Has anyone used a nicontine patch or chewing gum along with sinemet and was there any effect?


This report is on Medscape. Membership is free.

Can Nicotine be Used Medicinally in Parkinson's Disease?

Claire Thiriez, Gabriel Villafane, Frédérique Grapin, Gilles Fenelon, Philippe Remy, Pierre Cesaro
Abstract

The risk of Parkinson's disease is reduced by cigarette smoking, which raises some unanswered questions. Nicotine, a major component of tobacco smoke, could exert either nonreceptor-mediated biological effects or, more importantly, act on the different subtypes of nicotinic brain receptors, in particular those associated with the nigrostriatal dopaminergic pathway. There is now robust experimental evidence for a neuroprotective effect of nicotine upon dopaminergic neurons. By contrast, in animal models of Parkinson's disease, nicotine alone has slight or no motor effects. However, nicotine may modulate dopamine transmission and has clear motor effects when associated with L-DOPA, reducing L-DOPA-induced dyskinesias. Clinical trials have yielded inconclusive results thus far and are hampered by different designs and small cohorts. Ongoing studies address either symptomatic motor or nonmotor symptoms, or neuroprotection. There is still no agreement on the daily dosage of nicotine or the method of administration. Together, these data suggest that nicotine or nicotinic receptor drugs have therapeutic potential for Parkinson's disease, although the specific treatment regimens remain to be determined.
Motor Effects

Administration of nicotine alone or in combination with an agonist of D2 receptors has slight or no motor effect in animals with nigrostriatal damage. By contrast, it can increase the motor effect when coadministered with L-DOPA methyl ester.[20] Moreover, motor effects can be reversed by nicotine receptor antagonists.[2,21] The presynaptic nicotinic receptors, which regulate dopamine release, seem to be involved in these actions.[21,22] In more recent experiments using a blinded motor evaluation, nicotine alone did not improve motor impairment, nor influence the motor effects of L-DOPA in Parkinsonian rats or in Parkinsonian monkeys.[23,24] However, in the same experimental series, administration of nicotine in the drinking water reduced the occurrence of dyskinesias by 50%.[23,24]
Neuroprotection

Besides in vitro studies, numerous results indicate a neuroprotective effect of nicotine against various lesions (mechanical lesions, 6-hydroxydopamine and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine [MPTP]).[3,20] Of particular interest is the neuroprotective effect against a slow MPTP-induced neurodegenerative lesion in monkeys.[25] However, when nicotine is administered in animals with a completed lesion, no curative effect is observed, neither in rodents nor in monkeys.[26] The mechanisms of this neuroprotective effect remain unknown: some are reversed by nicotine receptor antagonists or may not appear in knockout mice lacking α4β2 receptor subtypes.[27] A potential increase of trophic factors may involve nicotinic receptors, whereas antioxidant or other neuroprotective mechanisms are not mediated by receptors.[2,3] A direct action on brain mitochondria could involve a reduction of the synthesis of reactive oxygen species by complex 1.[28] It has also recently been shown that nicotine and hydroquinone inhibit α-synuclein aggregation.[29] The molecular mechanism of neuroprotection may involve phosphorylation of Akt and upregulation of Bcl2 and Bclx.[30]
Thus, experimental data indicate that chronic nicotine administration has a motor effect – particularly on dyskinesias – and a neuroprotective effe