Abstract Details

Title Outcomes from a Large Clozapine Parkinson's Registry

Topic Movement Disorders

Presentation(s) P01 - (-)

Poster/Presentation
Number 068

Objective

Background Clozapine has emerged as an attractive alternative among the new generation atypical antipsychotics for the treatment of Parkinson's psychosis.

Design/Methods An IRB approved eight year retrospective chart review was conducted at the University of Florida (UF). The UF INFORM patient database and clinical records were queried for patients diagnosed with idiopathic Parkinson's disease or Parkinsonism who developed psychosis and were subsequently treated with clozapine. Patients with a diagnosis of tardive dyskinesia, tardive dystonia, tardive akathisia and Huntington's disease were excluded. General characteristics including age,gender and hoehn and yahr stages were collected.

Results A total of 53 patients were treated with clozapine of which 32 had idiopathic Parkinson's disease, 4 had Parkinsonism (2 multiple system atrophy, 1 Lewy body disease and 1 without a specific diagnosis). In the idiopathic PD cohort 23/53 (43%) were male. The age ranged from 45 to 87.Thirteen of the 32 (42%) patients with PD remained on clozapine and reported improvement in hallucinations with a mean treatment duration of 18 months (SD 19.2). Among those with atypical Parkinsonism one (25%) reported benefit from hallucinations. Details of the cohort will be presented including reasons for discontinuation, and symptoms best addressed by Clozapine.

Conclusions Clozapine is effective in treating a subset of refractory psychosis associated with Parkinson's disease. However clozapine was less tolerated and less effective in addressing psychosis associated with Parkinsonism. The study was limited because of a lack of randomization or blinding and also limited by a lack of head to head comparison with another atypical antipsychotic such as quetiapine. Despite the limitations of this retrospective review, clozapine should be considered as a potential drug for treating refractory psychotic symptoms associated with PD.

Authors/Disclosures
Nawaz Hack, MD (University of Texas Rio Grande Valley) PRESENTER	Dr. Hack has nothing to disclose.
	No disclosure on file
Angela Hardwick, MD	No disclosure on file
Nikolaus McFarland, MD, PhD, FAAN (University of Florida)	Dr. McFarland has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sutter Health. Dr. McFarland has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ONO Pharmaceuticals. Dr. McFarland has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Ferrer. The institution of Dr. McFarland has received research support from NIH, Michael J. Fox Foundation, Huntington Disease Society for America, CurePSP, and Mission MSA.. Dr. McFarland has received publishing royalties from a publication relating to health care.
Aparna Wagle-Shukla, MD, FAAN (UF Fixel)	Dr. Wagle-Shukla has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Encora. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Supernus. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Tremor research group. The institution of Dr. Wagle-Shukla has received research support from NIH. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving as a reviewer with NIH.
Jose Ramon Rodriguez	No disclosure on file
Michael S. Okun, MD, FAAN (University of Florida)	Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.
Lloyd H. Kasper, MD (Dartmouth Medical School)	No disclosure on file
Marco Capobianco, MD	No disclosure on file

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