Govindan Gopinathan, M.D.

Migraine: Its recognition and treatment
Weinberg M.A.; Maloney W.J.; Gopinathan G.
2008 ;33(1):32-37, U. S. pharmacist
Individuals with chronic pain that lasts for more than three to six months may experience multiple types of pain in the head and neck region, including headache and facial pain. Approximately 18% of women and 6% of men suffer from some form of frequent headaches, and many cases go undiagnosed and undertreated. Headaches have a major socioeconomic impact on society. This article will review the classifications and pathogenesis of migraine, various pharmacologic and nonpharmacologic treatments, and the pharmacist's role in patient education
— id: 81055, year: 2008, vol: 33, page: 32, stat: Journal Article,

INTERNAL CAROTID-ARTERY DISSECTION CAUSED BY EXERCISE - 3 CASE-REPORTS
SILLER, KA; RILES, TS; GOPINATHAN, G
1993 AUG ;34(2):318-319, Annals of neurology
— id: 63775, year: 1993, vol: 34, page: 318, stat: Journal Article,

Mesulergine: a dopamine agonist with novel properties in Parkinson's disease
Lieberman, A N; Gopinathan, G; Pasternack, P; Goldstein, M
1990 ;53:533-537, Advances in neurology
— id: 122194, year: 1990, vol: 53, page: 533, stat: Journal Article,

Randomized double-blind cross-over study of Sinemet-controlled release (CR4 50/200) versus Sinemet 25/100 in Parkinson's disease
Lieberman, A; Gopinathan, G; Miller, E; Neophytides, A; Baumann, G; Chin, L
1990 ;30(2):75-78, European neurology
Sinemet-controlled release (CR4) consisting of 50 mg carbidopa/200 mg levodopa was compared with Sinemet 25/100 in 24 Parkinson's disease (PD) patients during a 16-week double-blind cross-over study. The mean age of the patients was 66.2 years, their mean duration of PD was 9.3 years. All of the patients had response fluctuations consisting mainly of the 'wearing-off' phenomenon. Some of the patients also experienced the 'on-off' phenomenon. All patients were evaluated using the unified Parkinson disease rating scale. The following significant differences were noted on Sinemet CR4. More patients noted a decrease in dyskinesias and response fluctuations; more patients experienced a decrease in stage when 'on'; more patients were 'on' longer during the day, and more patients were globally improved. The mean number of doses per day were significantly less on Sinemet CR4 (mean 5.0, range 3-8) than on Sinemet 25/100 (mean 6.2, range 4-11 doses/day). The mean dose of levodopa in Sinemet CR4 was 1,186 +/- 458 mg and the mean dose of carbidopa was 797 +/- 115 mg. The mean dose of levodopa in Sinemet 25/100 was 873 +/- 304 mg and the mean dose of carbidopa was 218 +/- 76 mg. This study indicates that Sinemet CR4 is a useful addition for patients with response fluctuations
— id: 122193, year: 1990, vol: 30, page: 75, stat: Journal Article,

Deprenyl in the treatment of symptom fluctuations in advanced Parkinson's disease
Golbe LI; Lieberman AN; Muenter MD; Ahlskog JE; Gopinathan G; Neophytides AN; Foo SH; Duvoisin RC
1988 Feb;11(1):45-55, Clinical neuropharmacology
Deprenyl, a selective inhibitor of monoamine oxidase, type B, which is free of the 'tyramine effect,' may ameliorate symptom fluctuations in advanced Parkinson's disease (PD). We randomized 96 patients with marked symptom fluctuations at three centers to receive either deprenyl 5 mg b.i.d. or placebo in parallel fashion in addition to a previously optimized levodopa/carbidopa (Sinemet) regimen. Disability was recorded hourly at home by patients 3 days weekly during the 2-week baseline and the 6-week treatment period. Disability during the 'on' state was assessed each week by examination. Mean hourly self-assessment of gait improved in 28 of 50 patients (56%) receiving deprenyl (mean degree of improvement 0.25 points on a 0-2 scale) and in 14 of 46 (30.4%) taking placebo (mean 0.15). Mean hourly overall symptom control improved in 29 (58%) taking deprenyl (mean 0.34) and in 12 (26.1%) taking placebo (mean 0.15) (p less than 0.01 for each parameter). No significant improvement occurred in the objective quality of the 'on' state with deprenyl. Mean daily Sinemet dosage decreases were 17% in the deprenyl group and 7% in the placebo group. Adverse effects included nausea, light-headedness, dyskinesias, and hallucinations, all of which abated after the Sinemet dose was reduced. We conclude that deprenyl is of moderate benefit in a majority of patients with symptom fluctuations complicating PD and is generally well tolerated
— id: 65763, year: 1988, vol: 11, page: 45, stat: Journal Article,

D-1 and D-2 agonists in Parkinson's disease
Lieberman AN; Goldstein M; Gopinathan G; Neophytides A
1987 Aug;14(3 Suppl):466-473, Canadian journal of neurological sciences
We have evaluated 5 DA agonists-bromocriptine, lergotrile, lisuride, pergolide, and mesulergine in studies encompassing 278 patients with advanced PD. In most of our patients the DA agonist was added to levodopa. Most of our patients were no longer satisfactorily responding to levodopa. Previous attempts at managing these patients by changing the dose of levodopa (increasing or decreasing it), the treatment schedule, or the ratio of levodopa to carbidopa or by temporarily discontinuing levodopa [drug holiday] were unsuccessful. The majority of our patients had diurnal fluctuations in performance, either 'wearing off' or 'on-off' phenomena. The addition of a DA agonist resulted in a decrease in parkinsonian disability in most patients and a decrease in the severity of the diurnal fluctuations in performance. Improvement in many patients was maintained for at least 2 years. Adverse effects included mental changes, dyskinesias, orthostatic hypotension, and nausea. All of the adverse effects were reversible when the agonist was decreased or discontinued. As a group the agonists behaved similarly but individual patients often responded better to one agonist than another. The main role of agonists is in combination with levodopa in the treatment of patients with early PD who have not yet developed dyskinesias or diurnal fluctuations in performance
— id: 11383, year: 1987, vol: 14, page: 466, stat: Journal Article,

Deprenyl versus placebo in Parkinson disease: a double-blind study
Lieberman, A N; Gopinathan, G; Neophytides, A; Foo, S H
1987 Dec;87(12):646-649, New York state journal of medicine
— id: 122199, year: 1987, vol: 87, page: 646, stat: Journal Article,

Advanced Parkinson's disease: use of partial dopamine agonist, ciladopa
Lieberman, A; Gopinathan, G; Neophytides, A; Pasternack, P; Goldstein, M
1987 May;37(5):863-865, Neurology
Ciladopa is a partial dopamine agonist that is effective in patients with advanced Parkinson's disease who are no longer satisfactorily responding to levodopa. Thirty-one patients participated in a double-blind randomized study of ciladopa (added to levodopa) versus placebo. Among 21 patients randomized to treatment with ciladopa and levodopa, there was a 32% decrease in symptoms on the Modified Columbia University Disability Scale. This change was significant, p less than or equal to 0.05. Eight of the 21 patients (38%) improved by at least 50%. The mean number of hours 'on' increased by 20%. This change was significant, p less than or equal to 0.05. Five of the 21 patients (24%) were on for at least 4 hours more than at baseline. Dyskinesias were not increased. The mean dose of ciladopa was 19.5 mg/d. The mean dose of levodopa in Sinemet was decreased by 10%. Studies with ciladopa in humans had to be discontinued because of the occurrence of microscopic testicular tumors in some rodents. Although improvement in patients taking ciladopa was modest, there were few adverse effects. These results are encouraging, because two other partial agonists are now available, and they may be as effective as ciladopa
— id: 122201, year: 1987, vol: 37, page: 863, stat: Journal Article,

Efficacy of pergolide and mesulergine
Lieberman, A N; Gopinathan, G; Neophytides, A
1986 ;25(2):86-90, European neurology
The activity of pergolide, a clavine ergolene, and mesulergine, an 8-alpha amino ergoline, were compared in 18 patients with advanced Parkinson's disease. All of the patients were no longer satisfactorily responding to levodopa, and 16 patients had diurnal oscillations in performance. Pergolide, mean dose 2.7 mg, when added to levodopa resulted in a significant (27%) decrease in Parkinson disability and a significant improvement in diurnal oscillations in performance (136% increase in hours 'on'). Twelve of the 18 patients (67%) improved. However, after 2 years pergolide was discontinued in all of the patients because of decreased efficacy, adverse effects, or both. At this time, mesulergine, mean dose 9.3 mg., when added to levodopa resulted in a significant (37%) decrease in Parkinson disability and a significant improvement in diurnal oscillations (61% increase in hours 'on'). Twelve of the 18 patients (67%) improved. Adverse effects (dyskinesias) were less with mesulergine than with pergolide. A declining response to one agonist does not preclude a successful response to another agonist of a different class
— id: 122205, year: 1986, vol: 25, page: 86, stat: Journal Article,

Management of levodopa failures: the use of dopamine agonists
Lieberman, A N; Gopinathan, G; Neophytides, A; Goldstein, M
1986 ;9 Suppl 2:S9-21, Clinical neuropharmacology
In the past decade, dopamine agonists have emerged as important treatment options for patients with Parkinson's disease. Originally, dopamine agonists were used only in patients with advanced disease in whom the response to levodopa had decreased (levodopa failures). The decreased response to levodopa, usually associated with diurnal oscillations in performance and the 'wearing-off' and 'on-off' phenomena, is secondary to disease progression with continued degeneration of the nigrostriatal neurons. In addition, chronic levodopa treatment itself may contribute to the decreased drug response and the diurnal oscillations in performance. Dopamine receptor agonists bypass the degenerating nigrostriatal neurons and directly stimulate the striatal dopamine receptors. Dopamine receptor agonists also permit a reduction in the dose of levodopa. Five ergoline dopamine agonists--bromocriptine, lergotrile, pergolide, lisuride, mesulergine, and the nonergoline agonist, ciladopa--have undergone clinical trials in Parkinson's disease. In 10 years, we treated a total of 278 patients with advanced Parkinson's disease, a declining response to levodopa, and diurnal oscillations in performance with five ergoline dopamine agonists (in addition to levodopa). The mean duration of treatment was one year (with a range of 1-60 months). Improvement was noted in 140 (50%) of our patients. Adverse effects necessitating discontinuation of the agonist occurred in 131 patients (46%). We compared our results with those of others who, unlike us, began treatment with a dopamine agonist earlier, using the agonist alone or adding it to levodopa before the response to levodopa had decreased. Many of the patients so treated had mild or moderate Parkinson's disease. A total of 1,599 patients were treated with ergoline dopamine agonists. Of these patients, 976 (61%) improved, while 407 (25%) experienced adverse effects. We believe that a greater number of these patients improved and fewer experienced adverse effects, in comparison to our patients, because the patients had less advanced disease
— id: 122206, year: 1986, vol: 9 Suppl 2, page: S9, stat: Journal Article,

Use of carbidopa as an adjuvant to levodopa/carbidopa therapy in patients with Parkinson's disease
Lieberman, A N; Gopinathan, G; Neophytides, A; Pasternack, P
1986 Dec;86(12):655-656, New York state journal of medicine
— id: 122203, year: 1986, vol: 86, page: 655, stat: Journal Article,

MANAGEMENT OF LEVODOPA FAILURES - THE USE OF DOPAMINE AGONISTS
Lieberman, AN; Gopinathan, G; Neophytides, A; Goldstein, M
1986 Jul;9(7):S9-S21, Clinical neuropharmacology
— id: 31323, year: 1986, vol: 9, page: S9, stat: Journal Article,

The use of pergolide and lisuride, two experimental dopamine agonists, in patients with advanced Parkinson disease
Lieberman AN; Leibowitz M; Gopinathan G; Walker R; Hiesiger E; Nelson J; Goldstein M
1985 Sep;290(3):102-106, American journal of the medical sciences
Pergolide, an experimental dopamine agonist, was administered to 56 patients with advanced Parkinson disease who were no longer satisfactorily responding to levodopa, including 45 patients with diurnal oscillations in performance: 'on-off' phenomena. Lisuride, an experimental dopamine agonist was administered to 63 patients with advanced Parkinson disease. Pergolide or lisuride, when added to levodopa, resulted in a significant decrease in disability in both the 'on' and the 'off' period, and an increase in the number of hours in which patients were 'on'. Forty-one of 56 patients (73%) improved on Pergolide. Thirty-seven of 63 patients (59%) improved on lisuride. Mean dose of pergolide was 2.5 mg. (range 0.2 to 10.0 mg.). Mean dose of lisuride was 2.6 mg. (range 0.2 to 5.0 mg.). Pergolide was discontinued in 18 patients because of adverse effects, including an organic confusional syndrome (six patients), dyskinesias (four patients) and cardiovascular abnormalities (three patients). Lisuride was discontinued in 26 patients because of adverse effects, including an organic confusional syndrome (15 patients), dyskinesias (five patients) and vasospasm (two patients). Pergolide was discontinued in nine patients and lisuride in 12 because of a lack of effect or a declining effect. Both drugs are equally useful in patients with advanced Parkinson disease
— id: 61608, year: 1985, vol: 290, page: 102, stat: Journal Article,

ON OFF PHENOMENON IN PARKINSONS-DISEASE
GOPINATHAN, G; LIEBERMAN, AN; NEOPHYTIDES, A; GOLDSTEIN, M
1984 ;311(3):192-192, New England journal of medicine
— id: 40932, year: 1984, vol: 311, page: 192, stat: Journal Article,

Combined use of benserazide and carbidopa in Parkinson's disease
Lieberman AN; Goldstein M; Gopinathan G; Neophytides A; Hiesiger E; Walker R; Nelson J
1984 Feb;34(2):227-229, Neurology
The pharmacokinetics of levodopa differs when it is combined with benserazide or carbidopa. Peak dopa levels are higher, occur sooner, but decline more rapidly with benserazide. Although many patients respond better to one drug than the other, we sought to exploit the differences in pharmacokinetics by giving both drugs to the same patient. Benserazide was combined with carbidopa in 38 patients who were experiencing a diminished response to carbidopa, including 22 patients with diurnal oscillations in performance, 'wearing off' or on-off phenomena. Previous attempts to change the dose, sequence, or ratio of levodopa to carbidopa in these patients had been unrewarding. Ten of the patients improved on the combination of benserazide and carbidopa, with a 30% decline in disability. The mean dose of levodopa:carbidopa before benserazide was 910:100 (9 to 1 ratio); the mean dose of levodopa:benserazide was 355:90 (4 to 1 ratio). The mean dose of levodopa:carbidopa + benserazide was 925:155 (6 to 1 ratio). The combination of carbidopa with benserazide is useful in some parkinsonian patients
— id: 61609, year: 1984, vol: 34, page: 227, stat: Journal Article,

Long-term treatment with pergolide: decreased efficacy with time
Lieberman AN; Goldstein M; Leibowitz M; Gopinathan G; Neophytides A; Hiesiger E; Nelson J; Walker R
1984 Feb;34(2):223-226, Neurology
We studied the effect of pergolide (combined with levodopa) in 17 patients with Parkinson's disease, including 15 with 'wearing off' or on-off phenomena, who had been taking pergolide for at least 2 years. Mean duration of the study was 27.8 months. All 17 patients improved initially, but the improvement later faded. Mean disability score, which decreased initially by 60% (significant), was decreased only by 20% after 2 years (not significant). Wearing off and on-off phenomena, which improved initially, became prominent again. Four patients lost all the improvement, nine patients lost much of the improvement, and four maintained much of the improvement. Mean dose of pergolide was 2.2 mg (range, 0.8 to 5.0 mg)
— id: 61610, year: 1984, vol: 34, page: 223, stat: Journal Article,

Deprenyl in the treatment of Parkinson's disease. A specific type B monoamine oxidase inhibitor
Lieberman AN; Gopinathan G; Neophytides A; Hiesiger E; Nelson J; Walker R; Goodgold A
1984 Jan;84(1):13-16, New York state journal of medicine
— id: 61611, year: 1984, vol: 84, page: 13, stat: Journal Article,

Should dopamine agonists be given early or late? A review of nine years experience with bromocriptine
Lieberman, A N; Gopinathan, G; Hassouri, H; Neophytides, A; Goldstein, M
1984 Feb;11(1 Suppl):233-237, Canadian journal of neurological sciences
Experience with bromocriptine in 106 patients treated over nine years was reviewed. Most of the patients were already being treated with levodopa (combined with a peripheral decarboxylase inhibitor). These patients, after having initially achieved a good response to levodopa, were no longer responding satisfactorily. Most of the patients were also experiencing diurnal oscillations in performance: 'wearing off' and 'on-off' phenomena. In these patients previous attempts at changing the dose (increasing or decreasing) or changing the scheduling of levodopa had been unsuccessful. Bromocriptine was added to levodopa beginning at a dose of 5 mg/day, and each week was increased by another 5 mg/day. At a dose of bromocriptine of at least 25 mg/day, there was a decrease in disability in the majority of patients with a decrease in the severity of the diurnal oscillations in performance (especially 'wearing off' phenomena). In most patients, the addition of bromocriptine resulted in an approximately 10% reduction in the dose of levodopa. The majority of patients sustained their improvement at least one year. In some patients improvement was sustained for up to five years. The therapeutic efficacy of bromocriptine was limited in many patients by the occurrence of adverse effects including mental changes, dyskinesias, orthostatic hypotension, and nausea. These adverse effects could often be minimized by reducing the dose of bromocriptine or levodopa. All adverse effects were reversible upon stopping the drug. We have found bromocriptine to be a valuable adjunct in the treatment of these patients
— id: 122209, year: 1984, vol: 11, page: 233, stat: Journal Article,

Pergolide and lisuride in advanced Parkinson's disease
Lieberman, A N; Gopinathan, G; Neophytides, A; Leibowitz, M; Goldstein, M
1984 ;40:503-507, Advances in neurology
In a retrospective study, treatment with lisuride was compared to pergolide in 25 patients with advanced PD in whom the response to levodopa had diminished. Sixteen patients had wearing off and/or ON-OFF phenomena. Lisuride or pergolide, when added to levodopa, resulted in comparable and significant decreases in disability in both ON and OFF periods; pergolide resulted in a greater increase in the number of hours in which patients were ON. Adverse reactions were comparable on both drugs. However, patients who developed an adverse reaction on one drug did not necessarily develop the same reaction on the other drug. Both lisuride and pergolide are effective anti-Parkinson drugs
— id: 122210, year: 1984, vol: 40, page: 503, stat: Journal Article,

The effects of pergolide on the cardiovascular system of 40 patients with Parkinson's disease
Leibowitz, M; Lieberman, A N; Neophytides, A; Gopinathan, G; Goldstein, M
1983 ;37:121-130, Advances in neurology
The effect of pergolide, a semisynthetic ergot alkaloid, on the cardiovascular system of 40 patients with Parkinson's disease (PD) was evaluated. The mean daily dose of pergolide was 2.4 mg (range, 0.1 to 10 mg). The mean duration of follow-up was 6 months (range, 2 weeks to 20 months). The 40 patients were selected only on the basis of severe PD. All 13 patients in the first part of the study underwent 1 to 5 days of Holter monitoring before starting pergolide. Monitoring was then carried out for an additional period of between 2 and 10 weeks while the patients were on pergolide. Seven of the 13 patients manifested repetitive ventricular rhythms. These were isolated and unassociated with increases in premature ventricular contractions. The dose at which the RVRs occurred was a function of the presence or absence of heart disease. The changes occurred below 3 mg/day in patients with heart disease and above 3 mg/day in patients without heart disease. Pergolide was discontinued in three of the patients with heart disease. It was concluded that pergolide may, in the diseased heart, predispose to RVRs. In the second part of the study, Holter monitoring was carried out only at the discretion of the cardiologist, and five patients were so monitored. None of these patients was rejected from the study. Only one patient (with heart disease) of the 27 patients in the second part of the study experienced an arrhythmia. This consisted of an increase in PVCs on 4 mg/day of pergolide. Pergolide was discontinued. Eight of the 40 patients in these early dose-ranging studies experienced orthostasis, two with syncope, immediately on addition of pergolide (0.1 to 0.4 mg) to levodopa. The orthostasis could be eliminated in all but two patients by reducing or discontinuing levodopa
— id: 122213, year: 1983, vol: 37, page: 121, stat: Journal Article,

Further studies with lisuride in Parkinson's disease
Lieberman AN; Goldstein M; Gopinathan G; Leibowitz M; Neophytides A; Walker R; Hiesiger E
1983 ;22(2):119-123, European neurology
Lisuride was administered to 63 patients with advanced Parkinson's disease (PD) who were no longer satisfactorily responding to levodopa. The group included 40 patients with 'on-off' phenomena. Lisuride alone (13 patients) or combined with levodopa (50 patients) resulted in a 34% decrease in PD disability as assessed in the 'on' period, a 16% decrease in disability as assessed in the 'off' period, and a 96% increase in the numbers of hours in which patients were 'on' (from 5.5 to 10.8 h). All of these changes were significant (p less than or equal to 0.001). 37 of the 63 patients (59%) improved at least one-stage on lisuride. The major adverse effect limiting the use of lisuride was the occurrence of an organic confusional syndrome. This was related, in part, to the presence of an underlying dementia and to the concurrent use of anticholinergic drugs
— id: 61613, year: 1983, vol: 22, page: 119, stat: Journal Article,

Bromocriptine and lisuride in Parkinson disease
Lieberman AN; Gopinathan G; Neophytides A; Leibowitz M; Walker R; Hiesiger E
1983 Jan;13(1):44-47, Annals of neurology
Lisuride was compared with bromocriptine in 25 parkinsonian patients in whom the response to levodopa had diminished; 19 had 'wearing off,' 'on-off' phenomena, or both. At the time bromocriptine was added to levodopa, the mean age of the patients was 62.7 years and mean disease duration was 8.9 years. Disability decreased by 34% in the on period and by 20% in the off period, and the number of hours the patients were on increased from 9.6 to 12.8. All these changes were significant (p less than or equal to 0.01 to 0.05). Bromocriptine, however, had to be discontinued in 11 patients because of adverse effects. In the remaining 14 patients, bromocriptine was eventually discontinued because of decreased efficacy. Mean dose of bromocriptine was 55 mg (range, 20 to 100 mg). At the time lisuride was added to levodopa the patients were older (65.4 years), had had the disease longer (11.4 years), and were more disabled. Nonetheless, disability decreased in the on period by 33% and in the off period by 17%, and the number of hours the patients were on increased from 3.9 to 8.9. All these changes were significant (p less than or equal to 0.01 to 0.05). The mean dose of lisuride was 2.8 mg (range, 0.6 to 5.0 mg). Lisuride was discontinued in 8 patients because of adverse effects. Both bromocriptine and lisuride are useful in managing patients with advanced Parkinson disease whose response to levodopa has diminished. While it is presently not possible to state which of the drugs is more effective, ultimately their usage will probably be determined by their relative cost
— id: 61612, year: 1983, vol: 13, page: 44, stat: Journal Article,

Comparative efficacy of pergolide and bromocriptine in patients with advanced Parkinson's disease
Lieberman, A N; Neophytides, A; Leibowitz, M; Gopinathan, G; Pact, V; Walker, R; Goodgold, A; Goldstein, M
1983 ;37:95-108, Advances in neurology
Treatment with pergolide was compared with bromocriptine in 25 patients, all of whom were also receiving levodopa and in all of whom the response to levodopa had diminished. All 25 patients had 'on-off' phenomena. At the time bromocriptine was added to levodopa, the mean age of the patients was 61.8 years, mean duration of disease was 9.0 years, and mean duration of levodopa treatment was 6.1 years. For the group as a whole, disability as determined in the 'on' period decreased by 36%, from 28.7 to 18.5; and 11 patients improved at least one stage. Disability as determined in the 'off' period decreased by 25%, from 59.5 to 44.4. The number of hours in which patients were 'on' increased by 62%, from 7.1 to 11.5. All of these changes were significant (p less than or equal to 0.05). Bromocriptine had to be discontinued in nine patients (eight because of mental changes). In the remaining 16 patients, bromocriptine was eventually discontinued because of diminishing efficacy. Mean dose of bromocriptine was 50 mg (range, 10-100 mg), and mean duration of treatment was 23 months (range, 2-65 months). At the time of their treatment with pergolide, the patients were older, 65.5 years, had the disease longer, 12.7 years, and were more disabled. Nonetheless, for the group as a whole, disability score as determined in the 'on' period decreased significantly by 40%, from 43.5 to 26.3, and 14 patients improved at least one stage. Disability as determined in the 'off' period decreased significantly by 21%, from 69.0 to 54.8. The number of hours in which patients were 'on' increased significantly by 224%, from 3.4 to 11.0 hr. The mean dose of pergolide was 2.1 mg (range, 0.1-10.0 mg), and the mean duration of treatment was 6.2 months (range, 0.5-20 months). Pergolide was discontinued in eight patients: three because of asymptomatic tachyarrhythmias of unknown clinical significance (detected only by Holter monitoring); two because of orthostatic hypotension; and two because of mental changes. Although pergolide appears to be more potent than bromocriptine because of its greater effect in a larger number of patients at a more advanced stage of their disease, both drugs are useful, and both enhance our ability to manage patients with PD
— id: 122212, year: 1983, vol: 37, page: 95, stat: Journal Article,

Acquired immunodeficiency syndrome: cerebral computed tomographic manifestations
Whelan, M A; Kricheff, I I; Handler, M; Ho, V; Crystal, K; Gopinathan, G; Laubenstein, L
1983 Nov;149(2):477-484, Radiology
CT examination of the central nervous system was performed in 19 patients with acquired immunodeficiency syndrome (AIDS). Eighteen patients were homosexuals, and five drug abusers. Parenchymal and meningeal inflammations were seen in patients with intracranial manifestations of the disease. The most common demonstrable lesion in the parenchyma was toxoplasmosis, which produced ring enhancement, solid enhancement, and nonenhancing focal edema. The most common meningeal inflammation was cryptococcosis, which was diagnosed by examination of the cerebrospinal fluid and did not show specific CT changes. It is concluded that toxoplasmosis and cryptococcosis should be the first diagnostic consideration in patients with neurologic findings who have a history of homosexuality and/or intravenous drug abuse and previous unusual infections or anergy. A delayed contrast scan, single or double dose, appears to be the most accurate method of outlining the total extent of disease thereby helping to locate the best biopsy site for pretreatment diagnosis. Empirical institution of toxoplasmosis therapy is recommended in those cases in which CT findings are consistent with toxoplasmosis and the biopsy shows only nonspecific encephalitis. A biopsy of every parenchymal lesion is not considered necessary
— id: 99474, year: 1983, vol: 149, page: 477, stat: Journal Article,

Further studies with pergolide in Parkinson disease
Lieberman AN; Goldstein M; Gopinathan G; Leibowitz M; Neophytides A; Walker R; Hiesiger E; Nelson J
1982 Oct;32(10):1181-1184, Neurology
Pergolide was administered to 56 patients with advanced Parkinson disease who were no longer satisfactorily responding to levodopa. The group included 45 patients with on-off phenomena. Pergolide, when combined with levodopa, resulted in a 44% decrease in disability as assessed in the on period, a 15% decrease in disability as assessed in the off period, and a 148% increase in the number of hours in which patients were on (from 4.6 +/- 0.3 hours to 11.4 +/- 0.6 hours). All these changes were significant at 1%. Forty-one of the 56 patients (59%) improved when pergolide was added to levodopa. Mean dose of pergolide was 2.5 mg (range, 0.2 to 10.0 mg). Mean duration of the study was 13 months (range, 1 day to 34 months). Maximum improvement occurred within 2 months and began to decline, usually after 6 months. The major adverse effects necessitating discontinuing pergolide were the occurrence of an organic confusional syndrome (six patients), increased dyskinesias (four patients), and cardiovascular abnormalities (three patients). Nine patients discontinued pergolide because of a lack of effect or declining effect
— id: 61614, year: 1982, vol: 32, page: 1181, stat: Journal Article,

The use of pergolide, a potent dopamine agonist, in Parkinson's disease
Lieberman, A N; Goldstein, M; Neophytides, A; Leibowitz, M; Gopinathan, G; Walker, R; Pact, V
1982 Jul;32(1):70-75, Clinical pharmacology & therapeutics
Pergolide, a semisynthetic ergoline and a potent long-acting adenylcyclase-linked dopamine agonist, was given to 40 patients with advanced Parkinson's disease whose response to levodopa had diminished considerably. The group included 31 patients with marked diurnal oscillations in performance ('wearing off' and/or 'on-off' phenomena). Pergolide alone (7 patients) or combined with levodopa (33 patients), resulted in a reduction in disability (P less than or equal to 0.01) as assessed in both the patients' 'on' and 'off' periods. Pergolide also resulted in an increase (P less than or equal to 0.001) in the number of hours in which patients were on from 3.8 (+/-0.4) to 11.9 (+/-0.9). The mean daily dose of pergolide was 2.4 mg (range 0.1 to 10.0). The mean duration of the study was 12 mo (range 1 to 24). Pergolide is effective in Parkinson's disease and will change the management of patients whose response to levodopa has diminished
— id: 122216, year: 1982, vol: 32, page: 70, stat: Journal Article,

Treatment of "on-off" phenomena with lithium
Lieberman, A; Gopinathan, G
1982 Oct;12(4):402-402, Annals of neurology
— id: 122215, year: 1982, vol: 12, page: 402, stat: Journal Article,

The use of lisuride, a potent dopamine and serotonin agonist, in the treatment of progressive supranuclear palsy
Neophytides, A; Lieberman, A N; Goldstein, M; Gopinathan, G; Leibowitz, M; Bock, J; Walker, R
1982 Mar;45(3):261-263, Journal of neurology neurosurgery & psychiatry
Seven patients with progressive supranuclear palsy were treated with lisuride. Mean age was 62 years (range, 52 to 68 years), and duration of disease was 4.4 years (range, 1 to 7 years). All seven had been treated with levodopa/carbidopa and three with bromocriptine; four had, at one time, shown a partial response to levodopa. One patient had also shown a partial response to bromocriptine. Lisuride was used alone in four patients, and combined with levodopa/carbidopa in three patients. Mean dose of lisuride was 2.5 mg (range, 1.5 to 5.0 mg). Mean duration of treatment was 4 months (range, 1 to 10 months). While two patients showed a reduction in rigidity, one in tremor and two in bradykinesia, in only one of them was there an overall improvement. It is postulated that the relative lack of response to lisuride may be due to a loss of both the dopaminergic and serotonergic receptors in progressive supranuclear palsy
— id: 122217, year: 1982, vol: 45, page: 261, stat: Journal Article,

Cardiac effects of pergolide
Leibowitz, M; Lieberman, A; Goldstein, M; Neophytides, A; Kupersmith, M; Gopinathan, G; Mehl, S
1981 Dec;30(6):718-723, Clinical pharmacology & therapeutics
We examined the effect of pergolide, a semisynthetic ergot alkaloid, alone or combined with carbidopa and levodopa (Sinemet), on the cardiac rhythm of 12 patients with Parkinson's disease. The patients were selected on the basis of severe Parkinson's disease and stable cardiac rhythm as determined by 1 to 5 days of Holter monitoring. Monitoring was then carried out for an additional period of between 2 and 10 wk while the patients were on pergolide. Seven of the 12 patients had repetitive ventricular rhythms (RVRs). These were isolated, infrequent, and not associated with increases in premature ventricular contractions. The dose at which the RVRs occurred may be a function of the presence or absence of heart disease, but the significance of RVRs remains to be determined
— id: 122218, year: 1981, vol: 30, page: 718, stat: Journal Article,

Lisuride combined with levodopa in advanced Parkinson disease
Lieberman, A N; Goldstein, M; Leibowitz, M; Neophytides, A; Gopinathan, G; Walker, R; Pact, V
1981 Nov;31(11):1466-1469, Neurology
Lisuride, a semisynthetic ergoline and potent central dopamine and serotonin agonist, was combined with levodopa in 20 patients with advanced Parkinson disease who were no longer responding satisfactorily to levodopa, including 14 patients with 'on-off' phenomena. Every patient who completed the 8-week trial improved significantly (p greater than or equal to 0.01), with a decrease in all symptoms. The mean dose of lisuride was 2.4 mg per day. The dose of levodopa (mg of levodopa in Sinemet) was reduced from 1030 to 920 mg. Among the patients with 'on-off' phenomena, there was a significant increase in the time in which they were 'on' (mobile) from 4.6 to 9.6 hours. In 5 of 10 patients who have been on lisuride for at least 1 year, there has been no decline in efficacy
— id: 122219, year: 1981, vol: 31, page: 1466, stat: Journal Article,

Use of lisuride in advanced Parkinson's disease. Potent dopamine and serotonin agonist
Lieberman, A N; Goldstein, M; Neophytides, A; Leibowitz, M; Gopinathan, G; Goodgold, A; Pact, V; Walker, R
1981 Nov;81(12):1751-1755, New York state journal of medicine
— id: 122220, year: 1981, vol: 81, page: 1751, stat: Journal Article,

"FURTHER-STUDIES WITH LISURIDE, A POTENT DOPAMINE AND SEROTONIN AGONIST, IN PATIENTS WITH PARKINSONS-DISEASE WHO ARE NO LONGER SATISFACTORILY RESPONDING TO LEVODOPA"
LIEBERMAN, A; GOLDSTEIN, M; NEOPHYTIDES, A; LEIBOWITZ, M; GOPINATHAN, G; KUPERSMITH, M
1981 ;29(2):261-261, Clinical pharmacology & therapeutics
— id: 40264, year: 1981, vol: 29, page: 261, stat: Journal Article,

Bromocriptine in Parkinson's disease: report on 106 patients treated for up to 5 years
Lieberman, A N; Kupersmith, M; Neophytides, A; Gopinathan, G; Casson, I; Durso, R; Foo, S H; Khayali, M; Tartaro, T; Goldstein, M
1980 ;23:245-253, Advances in biochemical psychopharmacology
— id: 122226, year: 1980, vol: 23, page: 245, stat: Journal Article,

Evaluation of Parkinson's disease
Lieberman, A; Dziatolowski, M; Gopinathan, G; Kupersmith, M; Neophytides, A; Korein, J
1980 ;23:277-286, Advances in biochemical psychopharmacology
An examination was developed for patients with PD. The four major signs--rigidity, tremor, bradykinesia, and gait disorder--were assessed through a series of specific maneuvers. Each sign was allocated a number of points reflecting its relative value. The scores for each of the major signs were added to yield a total score. There was a correlation between total score and stage of PD. Involuntary movements, functional disability, and dementia were assessed separately. The examination could be performed rapidly without special equipment and was particularly useful in evaluating patients exhibiting the 'on-off' effect
— id: 90087, year: 1980, vol: 23, page: 277, stat: Journal Article,

Bromocriptine in Parkinson disease: further studies
Lieberman AN; Kupersmith M; Gopinathan G; Estey E; Goodgold A; Goldstein M
1979 Mar;29(3):363-369, Neurology
Bromocriptine was administered to 66 patients with advanced Parkinson disease (PD) and increasing disability despite optimal treatment with levodopa/carbidopa (Sinemet). Forty-five patients tolerated at least 25 mg per day of bromocriptine (the 'adequately treated' group) in addition to Sinemet and had significantly decreased rigidity, tremor, bradykinesia, gait disturbance, and total score, but increased involuntary movements. Twenty-five of these 45 patients improved by at least one stage. Among the 45 patients, 27 had 'on-off' effects, and in 19 the 'on-off' effects decreased on bromocriptine. The mean dose of bromocriptine in adequately treated patients las 47 mg, permitting a 10 percent reduction in the dose of levodopa. Twelve adequately treated patients received bromocriptine for at least 1 year, and 8 continued for longer than this. Bromocriptine was discontinued in 29 of 66 patients because of adverse effects, including mental changes (14 patients) and involuntary movements (9 patients). All adverse effects were reversible. Despite adverse effects, expense, and scarcity, bromocriptine, when added to levodopa, is useful in patients with advanced disease who no longer respond satisfactorily to levodopa, and for whom no other treatment is available
— id: 63264, year: 1979, vol: 29, page: 363, stat: Journal Article,

Lergotrile in Parkinson disease: further studies
Lieberman, A N; Gopinathan, G; Estey, E; Kupersmith, M; Goodgold, A; Goldstein, M
1979 Feb;29(2):267-272, Neurology
Lergotrile was administered to 53 patients with advanced Parkinson disease (PD), who had increasing disability despite optimal treatment with levodopa/carbidopa (Sinemet). Thirty-nine patients who could tolerate at least 20 mg per day lergotrile (thus considered 'adequately treated') had significant descreases in rigidity, tremor, bradykinesia, gait disturbance, and total score without increased involuntary movements. Twenty-one of these 39 patients improved by at least one stage. Among the 39 patients, 23 had 'on-off' effects, and in 13 of these the 'on-off' effects decreased on lergotrile. The mean daily dose of lergotrile in adequately treated patients was 49 mg, permitting a 10 percent reduction in the dose of levodopa. Lergotrile was discontinued in 33 of the 53 patients because of adverse effects, including hepatotoxicity (11 patients), mental changes (12 patients) and orthostatic hypotension (8 patients). Although lergotrile, when added to levodopa, has a definite antiparkinsonian effect, the incidence of adverse effects, particularly hepatotoxicity, makes it unlikely that this ergot alkaloid will become widely available for the treatment of PD. Analogues of lergotrile have been synthesized, and it is hoped that they will duplicate the antiparkinsonian effect of this drug without its toxicity
— id: 122229, year: 1979, vol: 29, page: 267, stat: Journal Article,

Comparative effectiveness of two extracerebral DOPA decarboxylase inhibitors in Parkinson disease
Lieberman, A; Estey, E; Gopinathan, G; Ohashi, T; Sauter, A; Goldstein, M
1978 Sep;28(9 Pt 1):964-968, Neurology
In four patients with Parkinson disease, we compared carbidopa combined with levodopa (Sinemet) and benserazide combined with levodopa (Madopar). All of these patients had responded to treatment, first with levodopa and then with Sinemet; after 6 years two continued to show a good response, while two developed marked 'on-off' phenomena. Clinically, Sinemet and Madopar were similar; however, DOPA levels were higher, but with a shorter half-life, on Madopar. The higher DOPA levels may have been offset by the shorter half-life, resulting in no clinical change. DOPA levels were lower and half-life was shorter in patients with on-off phenomena. These differences may be responsible in part for the on-off phenomena
— id: 122230, year: 1978, vol: 28, page: 964, stat: Journal Article,

Treatment of Parkinson's disease with lergotrile mesylate
Lieberman, A; Estey, E; Kupersmith, M; Gopinathan, G; Goldstein, M
1977 Nov 28;238(22):2380-2382, JAMA
Lergotrile mesylate, an ergot alkaloid derivative and putative dopamine agonist, was effective in the majority of patients with Parkinson's disease who were showing signs of disease progression despite treatment with levodopa combined with a peripheral decarboxylase inhibitor (carbidopa). Among 20 patients completing a six-month trial, there was a significant (P less than .01) reduction in rigidity, tremor, bradykinesia, gait disturbance, and total score when lergotrile was added to levodopa plus carbidopa. Mean daily dose of lergotrile mesylate was 52 mg, and the mean daily dose of levodopa was reduced by 15%. Abnormal involuntary movements were decreased on addition of lergotrile and reduction in levodopa while mental changes and orthostatic hypotension were increased. Elevations in serum transaminase levels were noted in three patients. The ergot alkaloids promise to be an important new class of antiparkinsonian drugs
— id: 122233, year: 1977, vol: 238, page: 2380, stat: Journal Article,