Ucb S.a. · EURONEXT:UCB
Ucb — Technical Presentation (2009)
25 slides from Ucb's technical presentation, 2009
Slide 1: Sexual dysfunction in Parkinson's Disease
Sexual dysfunction in Parkinson’s Disease Fabio Baronti Tschugg, Switzerland GPSRC CNS 177 0709 RTG 1
Slide 2: Sexual dysfunction in PD
Sexual dysfunction in PD • Few F systematic t ti studies t di • Results contradictory and incomplete To view notes click on notes tab GPSRC CNS 177 0709 RTG 2
Slide 3: Studies on sexual function in PD
Studies on sexual function in PD Mean age Sample size Koller et al. Clin Neuropharmacol p 1990;13:461–3 ; 67 36M, 14F Brown et al. J Neurol Neurosurg Psychiatry 49 23M, 11F 1990;53:480–6 Wermuth et al. Acta Neurol Scand 1995;92:55–8 50 15M, 10F Basson et al. Parkinsonism Relat Disord 1996; 2:177–85
Slide 4: Individuals experiencing a change in sexual function after PD onset
Individuals experiencing a change in sexual function after PD onset (n=1338) (n 1338) Man has PD (n=1008x2) Woman has PD (n=330x2) Sexual drive ↓ Arousal ↓ Orgasm ↓ Ejaculation praecox //vaginismus g Sexual aversion 0 10 20 30 40 0 10 20 30 40 % of population % of population Patients Partners Adapte
Slide 5: Sexual dysfunction in PD – qualitative overview
Sexual dysfunction in PD – qualitative overview • Common in both men and women with PD (30–85%) (30 85%) • Relevant impact on QoL (of patients and partners) Men Women Both sexes • ↓ Vaginal • ↓ Sexual S lddrive i • ↓ Erection sensitivity • ↓ Arousal • ↓ Ejacul. control • Vaginismus • ↓ Orgasms in •
Slide 6: Sexual dysfunction: mechanisms?
Sexual dysfunction: mechanisms? • Physical h l problems bl • Neurobiological damage • Psychological aspects • Pharmacological effects GPSRC CNS 177 0709 RTG 6
Slide 7: Dopamine: a 'sexy' transmitter
Dopamine: a ‘sexy’ transmitter • Preclinical evidence – I hibit prolactin Inhibits l ti release, l thus th increasing i i libid libido – Stimulates oxytocin neurons, involved in sexual drive, consummation and reward – Released in the medial preoptic p eoptic area a ea before befo e and during d ing
Slide 8: Dopamine: A 'sexy' transmitter
Dopamine: A ‘sexy’ transmitter 1970 1978 …approximately 50% of patients reported an increased sexual interest that was not related to improvement in locomotor function … GPSRC CNS 177 0709 RTG 8
Slide 9: Autonomic disturbances
Autonomic disturbances • PD is a multisystem disease (e.g. degeneration of amygdala, intermedio-lateral columns, sympathetic and parasympathetic ganglia) li ) • Sexual disturbances are very early symptoms of multiple system t atrophy t h (MSA) • Anatomical substrate unclear GPSRC CNS 177 0709 RTG 9
Slide 10: PD: more than sexual impairment
PD: more than sexual impairment • Decreased mobility: e.g. ability to self-stimulate, caress partner, or move hips during intercourse • Impaired sexual self-image: awareness of altered physical appearance, inability to facially express emotions or to sexually ll satisfy ti f partner, t drooling, d l
Slide 11: Therapy? Men
Therapy? • Sexual desire (often) preserved Men • Erectile,, orgasmic g and ejaculatory j y difficulties Frustration → potential use of unregulated substances To view notes click on notes tab GPSRC CNS 177 0709 RTG 11
Slide 12: Therapy of erectile dysfunction
Therapy of erectile dysfunction • Exclude E l d other th causes – Pelvic disease, testosterone deficiency – Vascular (establish whether spontaneous erections occur or perform prostaglandin E1[PGE1] test) – Depression – Drugs GPSRC CNS 177 0709 RTG 12
Slide 13: Drugs inhibiting sexual function
Drugs inhibiting sexual function • Alcohol, tobacco smoking, marijuana, opiates, barbiturates • Anti-androgens, estrogens, luteinising hormone releasing hormone analogues • Alpha- and beta-blockers, calcium channel blockers, angiotensin- converting enzyme-inhibitors, clonidine, reserpine, thiazide d
Slide 14: Therapy of erectile dysfunction
Therapy of erectile dysfunction • Evaluate E l t safety f t – Coronary artery disease – Symptomatic hypotension – History of priapism – Dementia GPSRC CNS 177 0709 RTG 14
Slide 15: Therapy options for erectile dysfunction
Therapy options for erectile dysfunction • Options O ti – Phosphodiesterase type 5 inhibitors, e.g. sildenafil 25–100 mg, vardenafil, tadalafil. N.B.: hypotension, congestive heart failure, diuretic therapy, history of myocardial infarction/cardiovascular incident, renal/hepatic disease, gastroesoph
Slide 16: Therapy options for erectile dysfunction
Therapy options for erectile dysfunction • Options: O ti – PGE1 (intracavernous [i.c.] or intrauretral) • No sexual arousal needed: very reliable, less satisfactory • 2–1000 μg (N.B.: burning) – Dopamine p agonists g ((oral or p parenteral)) – Vacuum-constriction devices, prostheses – Alpha-blockers
Slide 17: Hypersexuality
Hypersexuality • Most common with dopamine agonists • Dose-dependent • Possibly more common in young men • Frequency up to 22%1 • Also observed after pallidotomy or subthalamic nucleus deep brain stimulation and (in relation to dopaminergic therapy) in MSA and restless leg syndrome • Often p part of
Slide 18: Hypersexuality
Hypersexuality • Excessive E i libid libido • Obsessive masturbation • Excessive buying/viewing/collecting of pornographic material, voyeurism • Excessive use of sex phone line or prostitution services • Inappropriate sexual behaviour May lead to aberrant, criminal or immoral/antisocial actions GPSR
Slide 19: Hypersexuality: therapy?
Hypersexuality: therapy? • Reduce/discontinue dopamine agonists, agonists monoamine oxidase inhibitors • Levodopa monotherapy • Dose reduction • Clozapine, quetiapine • Medroxyprogesterone (reduced testosterone production tthrough oug luteinizing ute g hormone o o e inhibition) bto ) • Spironolacton
Slide 20: Patients want more information about sexual problems
Patients want more information about sexual problems particularly from their physician 100 Patients ulation (%) 80 Partners 60 Popu 40 20 Others Adapted from Beier et al. Fortschr Neurol Psychiatr 2000;68:564–75 [German] To view abstract, click Abstracts link above GPSRC CNS 177 0709 RTG 20
Slide 21: Rating scales assess more than sexual function
Rating scales assess more than sexual function • SCOPA-Aut SCOPA A t (SCales (SC l for f Outcome O t in i PArkinson’s PA ki ’ disease di – AUTonomic 23 items)1 – No differences between PD and controls during validation study • PIMS (Parkinson’s IMpact Scale, 10 items)2 – Partner’s Partner s situatio
Slide 22: Summary: sexual dysfunction in PD
Summary: sexual dysfunction in PD • Common C (30 (30–85%) 85%) • Severe impact on quality of life • Should be routinely addressed by health professionals • Pharmacological treatment sometimes helpful • Although g less frequent, q hypersexual yp behaviour may y have destructive consequences and must
Slide 23: Question 1. Routinely, what do PD patients and their partners complain of most often?
Question 1. Routinely, what do PD patients and their partners complain of most often? A) Reduced sexual activity It Although is not truereduced that sexualsexual B) Hypersexuality activity complaints and hypersexuality are Hypersexualityrare,isbut thought Female are partners both equally ofcommon pa
Slide 24: Question 2. In your daily routine with PD patients, the issue of sexuality mostly emerges because:
Question 2. In your daily routine with PD patients, the issue of sexuality mostly emerges because: A) Patient’s/partner’s question Currently, few physicians B) Physicians actively ask Correct Some -physicians this is the are use questionnaires or most asking common theirwaypatients that this and sca
Slide 25: Copyright statements
Copyright statements Slide 5 ©2000, reproduced with permission from Georg ©2000 Thieme Verlag KG Slide 21 ©2000, reproduced with permission from Georg Thi Thieme V l Verlag KG 25