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A double blind randomized controlled trial to assess efficacy of bromocriptine in cirrhotic patients with hepatic parkinsonism.

Liver Int. 2018 Dec 16;:

Authors: Sahney A, Sharma BC, Jindal A, Anand L, Arora V, Vijayaraghavan R, Dhamija RM, Kumar G, Bhardwaj A, Sarin SK

Abstract
BACKGROUND: Parkinsonism like features can be seen in cirrhotics, possibly related to alterations in brain dopamine metabolism, transport and receptor integrity at basal ganglia. Hepatic parkinsonism [HP] is often not suspected and only ammonia reducing therapies are given to such patients. We investigated the efficacy and safety of bromocriptine, a dopaminergic agent, in patients with HP.
PATIENTS AND METHODS: Cirrhotics were screened for presence of extrapyramidal symptoms and were diagnosed as HP if any two of tremor, bradykinesia and/or rigidity were present, supported by MRI brain showing T1 hyperintensities in basal ganglia and substantia nigra. Patients were randomized to receive placebo (Gr A, n=22) or bromocriptine (Gr B, n=24) for 12 weeks. Complete, partial and non-response were defined as 30%, 10%-30% and <10% reduction respectively in Unified Parkinson’s Disease Rating Scale (UPDRS) motor score.
RESULTS: Of 1016 cirrhotics, 50 (4.9%) had HP. Patients in two treatment groups were comparable for MELD score, arterial NH3 and frequency of porto-systemic shunts. Bromocriptine therapy for 12 weeks resulted in improvement in rigidity, tremors, bradykinesia and gait compared to placebo with complete and partial response in 7 versus none (29.1%, 0%, p<0.01) and 12 versus one (50%, 4.5%, p<0.01) patients. Prolonged and more severe motor symptoms were associated with non-response to bromocriptine therapy. There were no major side-effects in either treatment group.
CONCLUSIONS: Hepatic parkinsonism is seen in ~5% cirrhotics. Bromocriptine is a safe and effective therapy for these patients and is more effective in mild to moderate hepatic parkinsonism. This article is protected by copyright. All rights reserved.

PMID: 30554466 [PubMed – as supplied by publisher]

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