Aminopyridines and Acetyl-DL-leucine: New Therapies in Cerebellar Disorders

Kalla, Roger; Strupp, M. (2019). Aminopyridines and Acetyl-DL-leucine: New Therapies in Cerebellar Disorders. Current neuropharmacology, 17(1), pp. 7-13. Bentham Science Publishers 10.2174/1570159x16666180905093535

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Cerebellar ataxia is a frequent and often disabling syndrome severely impairing motor functioning and quality of life. Patients suffer from reduced mobility, and restricted autonomy, experiencing an even lower quality of life than, e.g., stroke survivors. Aminopyridines have been demonstrated viable for the symptomatic treatment of certain forms of cerebellar ataxia. This article will give an outline of the present pharmacotherapy of different cerebellar disorders. As a current key-therapy for the treatment of downbeat nystagmus 4-aminopyridine (4-AP) is suggested for the treatment of downbeat nystagmus (5-10 mg Twice a day TID), a frequent type of persisting nystagmus, due to a compromise of the vestibulo-cerebellum. Studies with animals have demonstrated, that a nonselective blockage of voltage-gated potassium channels (mainly Kv1.5) increases Purkinje- cell (PC) excitability. In episodic ataxia type 2 (EA2), which is frequently caused by mutations of the PQ-calcium channel, the efficacy of 4-AP (5-10 mg TID) has been shown in a randomized controlled trial (RCT). 4-AP was well tolerated in the recommended dosages. 4-AP was also effective in elevating symptoms in cerebellar gait ataxia of different etiologies (2 case series). A new treatment option for cerebellar disease is the amino-acid acetyl-DL-leucine, which has significantly improved cerebellar symptoms in three case series. There are on-going randomized controlled trials for cerebellar ataxia (acetyl-DL-leucine vs placebo; ALCAT), cerebellar gait disorders (SR-form of 4-AP vs placebo; FACEG) and EA2 (sustained-release/SR-form of 4-AP vs acetazolamide vs placebo; EAT2TREAT), which will provide new insights into the pharmacological treatment of cerebellar disorders.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Kalla, Roger

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1570-159X

Publisher:

Bentham Science Publishers

Language:

English

Submitter:

Panagiota Milona

Date Deposited:

20 Feb 2019 09:15

Last Modified:

20 Feb 2019 09:16

Publisher DOI:

10.2174/1570159x16666180905093535

PubMed ID:

30182858

Uncontrolled Keywords:

4-aminopyridine Cerebellar ataxia acetyl-DL-leucine aminopyridines central vestibular disorders downbeat nystagmus episodic ataxia type 2.

URI:

https://boris.unibe.ch/id/eprint/124712

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