Objective: We evaluated using the questionnaire to investigate the frequency of lower urinary tract symptoms (LUTSs) in Parkinson’s disease at our clinic. For patients with severe LUTs, istradefylline was administered and the effect was observed.

Background: After a long clinical course, bladder dysfunction would be a major clinical issue in patients with Parkinson’s disease (PD). Although the LUTs　in PD  is well known, it has not been thoroughly investigated due to the lack of time in actual examination. Several reports suggest anti-PD treatments may influence bladder control.  Istradefylline, a novel non-dopaminergic selective adenosine A2A receptor antagonist, was approved in Japan in March 2013. According to recent reports, istradefylline improves motor symptoms as well as LUTS of PD patients.

Method: The patients enrolled are PD patients undergoing treatment at our clinic. In order to analyze LUTs and QOL, we employed the International Prostate Symptom Score (IPSS), QOL score, and Overactive Bladder Symptom Score (OABSS). OABSS and I-PSS were performed on each patient, and the frequency of lower urinary tract symptoms was investigated.  In addition, patients with OABSS number of 8 or more were judged as severe.  Of patients who got consent with severe illness, 20 mg of isradifylline was administered for 1 month, and OABSS and I-PSS were then administered to evaluate the effect on LUTs.

Results: n the survey of LUTs frequency 147 outpatients were enrolled. There were 45 patients who had moderate degrees of IPSS total number of 8 or more. There were 39 patients who had severe degrees of OABSS total number of 8 or more. For the administration test of isradifylline, 12 patients participated. There were 4 males and 8 females. The OABSS total number (9.33 to 6.08), urgency (3.08 to 1.75) and urge urinaly　incontinence (3.00 to 1.42) were improved significantly after treatment with istradefylline.  The IPSS total number (9.64 to 7.00)  and filling questionnaire number (6.55 to 4.45) were improved significantly after treatment with istradefylline.

Conclusion: The frequency of LUTs in our department is about 25%. Use of a medical questionnaire is effective for detecting LUTs. Some antiparkinsonian drugs may be effective for bladder dysfunction.　Adenosine A2A receptor antagonists are useful as a new pharmacological treatment for overactive bladder in patients with PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-frequency-of-lower-urinary-tract-symptoms-in-patients-with-parkinsons-disease-and-clinical-efficacy-of-istradefylline/