2021
Quantitative digital clock drawing test as a sensitive tool to detect subtle cognitive impairments in early stage Parkinson's disease
Schejter-Margalit T, Kizony R, Shirvan J, Cedarbaum J, Bregman N, Thaler A, Giladi N, Mirelman A. Quantitative digital clock drawing test as a sensitive tool to detect subtle cognitive impairments in early stage Parkinson's disease. Parkinsonism & Related Disorders 2021, 90: 84-89. PMID: 34416663, DOI: 10.1016/j.parkreldis.2021.08.002.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overCase-Control StudiesCognitionCognitive DysfunctionFemaleGenotypeGlucosylceramidaseHumansLeucine-Rich Repeat Serine-Threonine Protein Kinase-2MaleMental Status and Dementia TestsMiddle AgedMutationNeuropsychological TestsParkinson DiseaseReproducibility of ResultsROC CurveSensitivity and SpecificityConceptsColor Trails TestSubtle cognitive declineClock Drawing TestCognitive AssessmentCognitive profileCognitive declineCognitive testsDigital clock drawing testStandardized neuropsychological testsDrawing TestDigital cognitive assessmentSubtle cognitive impairmentCurrent standardized testsClock-drawing testEarly cognitive declineMontreal Cognitive AssessmentTrails TestNeuropsychological testsSubtle impairmentsHealthy controls
2020
Metabolic syndrome does not influence the phenotype of LRRK2 and GBA related Parkinson’s disease
Thaler A, Shenhar-Tsarfaty S, Shaked Y, Gurevich T, Omer N, Bar-Shira A, Gana-Weisz M, Goldstein O, Kestenbaum M, Cedarbaum JM, Orr-Urtreger A, Giladi N, Mirelman A. Metabolic syndrome does not influence the phenotype of LRRK2 and GBA related Parkinson’s disease. Scientific Reports 2020, 10: 9329. PMID: 32518334, PMCID: PMC7283235, DOI: 10.1038/s41598-020-66319-9.Peer-Reviewed Original ResearchConceptsMetabolic syndromeParkinson's diseaseLRRK2-NMCLRRK2-PDComponents of MSGBA-Parkinson diseaseMetabolic componentsProdromal Parkinson's diseaseHigh triglyceride levelsIdiopathic Parkinson's diseaseGBA-NMCGBA-PDElevated triglyceridesBlood pressureLRRK2 carriersProdromal featuresTriglyceride levelsPD groupDiseaseDisease statesLaboratory test resultsPrediabetesSyndromeHigh rateTriglycerides
2019
Randomized phase I clinical trial of anti–α‐synuclein antibody BIIB054
Brys M, Fanning L, Hung S, Ellenbogen A, Penner N, Yang M, Welch M, Koenig E, David E, Fox T, Makh S, Aldred J, Goodman I, Pepinsky B, Liu Y, Graham D, Weihofen A, Cedarbaum JM. Randomized phase I clinical trial of anti–α‐synuclein antibody BIIB054. Movement Disorders 2019, 34: 1154-1163. PMID: 31211448, PMCID: PMC6771554, DOI: 10.1002/mds.27738.Peer-Reviewed Original ResearchConceptsParkinson's disease participantsΑ-synucleinHealthy volunteersParkinson's diseaseHuman-derived monoclonal antibodiesSingle-dose cohortsMost adverse eventsFurther clinical developmentImmunotherapy targetingStudy drugAdverse eventsFavorable safetySingle doseNeuronal dysfunctionSerum ratioDisease progressionCerebrospinal fluidClinical developmentPharmacokinetic parametersPharmacokinetic profileSerum exposureLaboratory assessmentMonoclonal antibodiesDiseaseDose rangeFeasibility and safety of lumbar puncture in the Parkinson's disease research participants: Parkinson's Progression Marker Initiative (PPMI)
Prakash N, Caspell-Garcia C, Coffey C, Siderowf A, Tanner C, Kieburtz K, Mollenhauer B, Galasko D, Merchant K, Foroud T, Chahine L, Weintraub D, Casaceli C, Dorsey R, Wilson R, Herzog M, Daegele N, Arnedo V, Frasier M, Sherer T, Marek K, Frank S, Jennings D, Simuni T, Marek K, Siderowf A, Seibyl J, Coffey C, Tanner C, Tosun-Turgut D, Simuni T, Shaw L, Trojanowski J, Singleton A, Kieburtz K, Toga A, Mollenhauer B, Galasko D, Poewe W, Foroud T, Poston K, Sherer T, Chowdhury S, Frasier M, Kopil C, Arnedo V, Marek K, Daegele N, Casaceli C, Dorsey R, Wilson R, Mahes S, Seibyl J, Salerno C, Coffey C, Caspell-Garcia C, Toga A, Crawford K, Foroud T, Casalin P, Malferrari G, Weisz M, Orr-Urtreger A, Trojanowski J, Shaw L, Singleton A, Foroud T, Foroud T, Montine T, Foroud T, Russell D, Tanner C, Simuni T, Dahodwala N, Mollenhauer B, Galasko D, Poewe W, Giladi N, Factor S, Hogarth P, Standaert D, Hauser R, Jankovic J, Saint-Hilaire M, Richard I, Shprecher D, Fernandez H, Brockmann K, Rosenthal L, Barone P, Espay A, Rowe D, Marder K, Santiago A, Bressman S, Hu S, Isaacson S, Corvol J, Martinez J, Tolosa E, Tai Y, Politis M, Smejdir D, Rees L, Williams K, Kausar F, Williams K, Richardson W, Willeke D, Peacock S, Heim B, Mirelman A, Sommerfeld B, Freed A, Wakeman K, Blair C, Guthrie S, Harrell L, Hunter C, Thomas C, James R, Zimmerman G, Brown V, Mule J, Hilt E, Ribb K, Ainscough S, Wethington M, Ranola M, Santana H, Moreno J, Raymond D, Speketer K, Carvajal L, Carvalho S, Croitoru I, Garrido A, Payne L, Viswanth V, Severt L, Facheris M, Soares H, Mintun M, Cedarbaum J, Taylor P, Biglan K, Vandenbroucke E, Sheikh Z, Bingol B, Fischer T, Sardi P, Forrat R, Reith A, Egebjerg J, Hillert G, Saba B, Min C, Umek R, Mather J, De Santi S, Post A, Boess F, Taylor K, Grachev I, Avbersek A, Muglia P, Merchant K, Tauscher J. Feasibility and safety of lumbar puncture in the Parkinson's disease research participants: Parkinson's Progression Marker Initiative (PPMI). Parkinsonism & Related Disorders 2019, 62: 201-209. PMID: 30738748, PMCID: PMC8978879, DOI: 10.1016/j.parkreldis.2018.12.025.Peer-Reviewed Original ResearchConceptsParkinson's Progression Markers InitiativeProgression Markers InitiativeAdverse eventsLumbar punctureParkinson's diseasePD participantsBaseline lumbar puncturePhone one weekSerial lumbar puncturesCommon adverse eventsRelated adverse eventsCerebrospinal fluid analysisEarly Parkinson's diseaseLow back painLongitudinal observation studyPPMI participantsUnderwent collectionBack painOverall incidenceDopaminergic deficiencyProgression biomarkersFemale genderSafety dataHealthy volunteersHigh incidence
2018
FDG PET Parkinson’s disease-related pattern as a biomarker for clinical trials in early stage disease
Matthews DC, Lerman H, Lukic A, Andrews RD, Mirelman A, Wernick MN, Giladi N, Strother SC, Evans KC, Cedarbaum JM, Even-Sapir E. FDG PET Parkinson’s disease-related pattern as a biomarker for clinical trials in early stage disease. NeuroImage Clinical 2018, 20: 572-579. PMID: 30186761, PMCID: PMC6120603, DOI: 10.1016/j.nicl.2018.08.006.Peer-Reviewed Original ResearchConceptsHealthy controlsDisease-related patternsParkinson's diseaseYahr stagePD patientsClinical trialsParkinson's disease-related patternFluorodeoxyglucose positron emission tomographyGender-matched healthy controlsEarly-stage Parkinson's diseaseMild PD patientsEarly-stage diseaseFDG-PET scansMotor symptom scoresPositron emission tomographyStage diseaseMotor symptomsSymptom scoresFDG-PETDisease stagePD progressionLentiform nucleusParacentral gyrusSymptom evaluationPD subjects
2015
Item response theory analysis of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised in the Pooled Resource Open-Access ALS Clinical Trials Database
Bacci ED, Staniewska D, Coyne KS, Boyer S, White LA, Zach N, Cedarbaum JM, Consortium T. Item response theory analysis of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised in the Pooled Resource Open-Access ALS Clinical Trials Database. Amyotrophic Lateral Sclerosis And Frontotemporal Degeneration 2015, 17: 157-167. PMID: 26473473, DOI: 10.3109/21678421.2015.1095930.Peer-Reviewed Original ResearchConceptsAmyotrophic Lateral Sclerosis Functional Rating Scale-RevisedPooled Resource Open-Access ALS Clinical Trials DatabaseClinical trials databasesTrials databasesAmyotrophic Lateral Sclerosis Functional RatingModern test theory approachesLevel of disabilityALSFRS-R itemsMean ageDisability levelFunctional ratingGross motorDisability severitySevere disabilityPatientsConfirmatory factor analysisItem response theory analysisTreatment effectsDisabilityDomain itemsItem response categoriesResponse categoriesALSFRSInstrument's specificitySpecificity
2012
Safety, tolerability and pharmacodynamics of a skeletal muscle activator in amyotrophic lateral sclerosis
Shefner J, Cedarbaum JM, Cudkowicz ME, Maragakis N, Lee J, Jones D, Watson ML, Mahoney K, Chen M, Saikali K, Mao J, Russell AJ, Hansen RL, Malik F, Wolff AA, Team F. Safety, tolerability and pharmacodynamics of a skeletal muscle activator in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis And Frontotemporal Degeneration 2012, 13: 430-438. PMID: 22591195, DOI: 10.3109/17482968.2012.684214.Peer-Reviewed Original ResearchConceptsAmyotrophic lateral sclerosisSingle dosesGlobal ImpressionLateral sclerosisFast skeletal muscle troponin activatorFrequent adverse eventsDose-related fashionLimb muscle strengthMaximum voluntary ventilationDose-dependent benefitMeasures of enduranceAdverse eventsPulmonary functionVoluntary ventilationGeneral fatigueTroponin activatorMuscle strengthPharmacodynamic markersHandgrip endurancePatientsRandom orderMaximal strengthDosesTolerabilityFurther studies
2011
A phase 2 randomized trial of ELND005, scyllo-inositol, in mild to moderate Alzheimer disease
Salloway S, Sperling R, Keren R, Porsteinsson AP, van Dyck CH, Tariot PN, Gilman S, Arnold D, Abushakra S, Hernandez C, Crans G, Liang E, Quinn G, Bairu M, Pastrak A, Cedarbaum JM. A phase 2 randomized trial of ELND005, scyllo-inositol, in mild to moderate Alzheimer disease. Neurology 2011, 77: 1253-1262. PMID: 21917766, PMCID: PMC3179648, DOI: 10.1212/wnl.0b013e3182309fa5.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAgedAged, 80 and overAlzheimer DiseaseAmyloid beta-PeptidesApolipoprotein E4Dose-Response Relationship, DrugDouble-Blind MethodFemaleFollow-Up StudiesHumansInositolMagnetic Resonance ImagingMaleMental Status ScheduleMiddle AgedPeptide FragmentsPlatelet Aggregation InhibitorsTime FactorsTreatment OutcomeConceptsNeuropsychological test batteryAlzheimer's diseaseDose-ranging phase 2 studyAlzheimer's Disease Cooperative Study-ActivitiesClass II trialsClinical efficacy outcomesCSF biomarker resultsScyllo-inositol concentrationsPhase 2 studyPrimary efficacy analysisHigh-dose groupDaily Living ScaleBrain ventricular volumeCoprimary endpointsEarly discontinuationEfficacy outcomesII trialADCS-ADLDose groupEfficacy analysisAcceptable safetyAβx-42Living ScaleOptimal doseTreatment groups
2010
Phase 1 Study of Aflibercept Administered Subcutaneously to Patients with Advanced Solid Tumors
Tew WP, Gordon M, Murren J, Dupont J, Pezzulli S, Aghajanian C, Sabbatini P, Mendelson D, Schwartz L, Gettinger S, Psyrri A, Cedarbaum JM, Spriggs DR. Phase 1 Study of Aflibercept Administered Subcutaneously to Patients with Advanced Solid Tumors. Clinical Cancer Research 2010, 16: 358-366. PMID: 20028764, PMCID: PMC4211604, DOI: 10.1158/1078-0432.ccr-09-2103.Peer-Reviewed Original ResearchConceptsAdvanced solid tumorsSolid tumorsDrug-related grade 3Vascular endothelial growth factor trapDose of afliberceptDose-escalation studyDose-proportional increaseInjection site reactionsPhase 1 studyManageable side effectsVascular endothelial growth factorWarrants further evaluationFavorable pharmacokinetic profileProgression of diseaseNovel antiangiogenic agentsEndothelial growth factorCommon toxicitiesStable diseasePulmonary embolismCerebral ischemiaSubcutaneous dosesSafety profileSingle doseSite reactionsSubcutaneous formulation
2009
An exploratory study of the safety, tolerability and bioactivity of a single intravitreal injection of vascular endothelial growth factor Trap-Eye in patients with diabetic macular oedema
V D, Nguyen QD, Shah SM, Browning DJ, Haller JA, Chu K, Yang K, Cedarbaum JM, Vitti RL, Ingerman A, Campochiaro PA. An exploratory study of the safety, tolerability and bioactivity of a single intravitreal injection of vascular endothelial growth factor Trap-Eye in patients with diabetic macular oedema. British Journal Of Ophthalmology 2009, 93: 144. PMID: 19174400, DOI: 10.1136/bjo.2008.138271.Peer-Reviewed Original ResearchConceptsVEGF Trap-EyeDiabetic macular edemaSingle intravitreal injectionVascular endothelial growth factor (VEGF) Trap-EyeExcess foveal thicknessFoveal thicknessIntravitreal injectionOptical coherence tomographyMacular edemaUnrelated serious adverse eventsMedian baseline BCVASerious adverse eventsBaseline BCVAETDRS lettersAdverse eventsRetinal thicknessVisual acuityOcular toxicityOutcome measuresBCVAMedian improvementPatientsCoherence tomographyAdditional studiesObservation period
2006
A Phase I Trial of an IV-Administered Vascular Endothelial Growth Factor Trap for Treatment in Patients with Choroidal Neovascularization due to Age-Related Macular Degeneration
Nguyen QD, Shah SM, Hafiz G, Quinlan E, Sung J, Chu K, Cedarbaum JM, Campochiaro PA, Group C. A Phase I Trial of an IV-Administered Vascular Endothelial Growth Factor Trap for Treatment in Patients with Choroidal Neovascularization due to Age-Related Macular Degeneration. Ophthalmology 2006, 113: 1522.e1-1522.e14. PMID: 16876249, DOI: 10.1016/j.ophtha.2006.05.055.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overChoroidal NeovascularizationDose-Response Relationship, DrugFemaleFluorescein AngiographyHumansInfusions, IntravenousMacular DegenerationMaleMaximum Tolerated DoseMiddle AgedReceptors, Vascular Endothelial Growth FactorRecombinant Fusion ProteinsRetinaTomography, Optical CoherenceVisual AcuityConceptsVascular endothelial growth factor trapAge-related macular degenerationVEGF TrapRetinal thicknessVisual acuityMacular degenerationEarly Treatment Diabetic Retinopathy Study protocolNeovascular age-related macular degenerationDiabetic Retinopathy Study protocolPlacebo-controlled clinical trialDoses 2 weeksDose-limiting toxicityPhase I trialMean percent changeVEGF receptor 1Optical coherence tomographyAdverse eventsI trialDose groupChoroidal neovascularizationStudy protocolClinical trialsStudy populationMultiple administrationsTherapeutic window
2005
NT-3 promotes nerve regeneration and sensory improvement in CMT1A mouse models and in patients
Sahenk Z, Nagaraja HN, McCracken BS, King WM, Freimer ML, Cedarbaum JM, Mendell JR. NT-3 promotes nerve regeneration and sensory improvement in CMT1A mouse models and in patients. Neurology 2005, 65: 681-689. PMID: 16157899, DOI: 10.1212/01.wnl.0000171978.70849.c5.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAnimalsCharcot-Marie-Tooth DiseaseDisease Models, AnimalDouble-Blind MethodFemaleHumansMaleMiceMice, Neurologic MutantsMice, NudeMice, TransgenicMiddle AgedMyelin ProteinsNerve RegenerationNeurotrophin 3Pilot ProjectsRecovery of FunctionSciatic NeuropathySural NerveTransplantation, HeterologousTreatment OutcomeConceptsNeuropathy Impairment ScoreNT-3 groupNT-3 treatmentNeurotrophin-3Placebo groupAnimal modelsNerve regenerationNude mice axonsQuantitative muscle testingSural nerve biopsyPrimary outcome measurePeripheral myelin proteinPilot clinical studyTooth type 1ANerve biopsyMuscle testingAxonal regenerationClinical studiesImpairment scoresOutcome measuresPreclinical studiesMouse modelEndpoint measuresElectrophysiologic measurementsNude mice
2003
Neurotrophin-3 Improves Functional Constipation
Parkman HP, Rao SS, Reynolds JC, Schiller LR, Wald A, Miner PB, Lembo AJ, Gordon JM, Drossman DA, Waltzman L, Stambler N, Cedarbaum JM. Neurotrophin-3 Improves Functional Constipation. The American Journal Of Gastroenterology 2003, 98: ajg2003312. PMID: 12818279, DOI: 10.1111/j.1572-0241.2003.t01-1-07477.x.Peer-Reviewed Original ResearchConceptsComplete bowel movementsNeurotrophin-3Bowel movementsColon transitFunctional constipationChronic constipationStool frequencyPlacebo-controlled phase II studyTransient injection site reactionsConstipation-related symptomsFrequent adverse eventsPhase II studyThird of patientsInjection site reactionsEnd of treatmentDose-related effectsConstipated subjectsBowel functionPrimary endpointAdverse eventsII studyImproved symptomsWeekly dosingNeurotrophic factorConstipation
2000
Recombinant human neurotrophic factors accelerate colonic transit and relieve constipation in humans
Coulie B, Szarka L, Camilleri M, Burton D, McKinzie S, Stambler N, Cedarbaum J. Recombinant human neurotrophic factors accelerate colonic transit and relieve constipation in humans. Gastroenterology 2000, 119: 41-50. PMID: 10889153, DOI: 10.1053/gast.2000.8553.Peer-Reviewed Original ResearchConceptsNeurotrophic factorStool frequencyColonic transitR-metHuBDNFHealthy subjectsBrain-derived neurotrophic factorHuman brain-derived neurotrophic factorHuman gut motilityOverall colonic transitPassage of stoolRecombinant human brain-derived neurotrophic factorGastrointestinal motor functionSmall bowel transitInjection site reactionsWeeks of treatmentNeurotrophic factor 3Neurotrophin administrationBowel transitRandomized studyGut motilityColonic emptyingSite reactionsMotor functionConstipationHealthy people
1999
A retrospective study of percutaneous endoscopic gastrostomy in ALS patients during the BDNF and CNTF trials
Kasarskis E, Scarlata D, Hill R, Fuller C, Stambler N, Cedarbaum J, in the . B. A retrospective study of percutaneous endoscopic gastrostomy in ALS patients during the BDNF and CNTF trials. Journal Of The Neurological Sciences 1999, 169: 118-125. PMID: 10540019, DOI: 10.1016/s0022-510x(99)00230-0.Peer-Reviewed Original ResearchConceptsPercutaneous endoscopic gastrostomyALS patientsEndoscopic gastrostomyClinical statusRetrospective studyVital capacityNutritional interventionNutritional supplementationRetrospective analysisPEG insertionPatientsBDNF studiesRate of declineDisease statusEarly interventionMarked reductionWeight lossGastrostomyCNTFInterventionReduction of functionSequential measurementsDaysStatusDysphagiaThe ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function
Cedarbaum J, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, Nakanishi A, . B. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. Journal Of The Neurological Sciences 1999, 169: 13-21. PMID: 10540002, DOI: 10.1016/s0022-510x(99)00210-5.Peer-Reviewed Original ResearchConceptsALS Functional Rating ScaleAmyotrophic lateral sclerosisFunctional Rating ScaleRating ScaleALSFRS-R scoreProgression of disabilitySickness Impact ProfileQuality of lifeVentilatory supportImpact ProfileRespiratory functionLateral sclerosisQuality of functionStrong internal consistencyAdditional assessmentInternal consistencyRating instrumentStrong determinantOrthopneaDyspneaSclerosisPatientsDysfunctionRespiratory
1998
Prognostic indicators of survival in ALS
Stambler N, Charatan M, Cedarbaum J. Prognostic indicators of survival in ALS. Neurology 1998, 50: 66-72. PMID: 9443459, DOI: 10.1212/wnl.50.1.66.Peer-Reviewed Original ResearchConceptsStudy entrySerum chlorideMuscle strength lossBaseline demographic characteristicsLength of survivalRisk of mortalityClinical laboratory testsGreater weight lossCiliary neurotrophic factorRecombinant human ciliary neurotrophic factorHuman ciliary neurotrophic factorPlacebo groupPulmonary functionSymptom onsetPrognostic factorsMulticenter studyShorter survivalVital capacityNeurotrophic factorPrognostic indicatorRespiratory acidosisSurvival timeProbability of survivalDisease severityWeight loss
1993
The effect of L-dopa infusions with and without phenylalanine challenges in parkinsonian patients: plasma and ventricular CSF L-dopa levels and clinical responses.
Woodward WR, Olanow CW, Beckner RM, Hauser RA, Gauger LL, Cedarbaum JM, Nutt JG. The effect of L-dopa infusions with and without phenylalanine challenges in parkinsonian patients: plasma and ventricular CSF L-dopa levels and clinical responses. Neurology 1993, 43: 1704-8. PMID: 8414016, DOI: 10.1212/wnl.43.9.1704.Peer-Reviewed Original ResearchConceptsL-DOPAMotor responseLarge neutral amino acidsVentricular CSF concentrationsAdvanced Parkinson's diseaseL-DOPA infusionL-DOPA levelsClinical responseParkinsonian patientsCSF concentrationsOral administrationNeutral amino acidsParkinson's diseaseInfusionPatientsPhenylalanine challengeReliable predictorCSFVDiseaseBrainDurationResponsePlasmaLevelsAdministration
1992
Clinical and Pharmacokinetic Aspects of High Dose Oral Baclofen Therapy
Aisen M, Dietz M, Rossi P, Cedarbaum J, Kutt H. Clinical and Pharmacokinetic Aspects of High Dose Oral Baclofen Therapy. Journal Of Spinal Cord Medicine 1992, 15: 211-216. PMID: 1431867, DOI: 10.1080/01952307.1992.11761520.Peer-Reviewed Original ResearchConceptsHigh-dose baclofenDesk ReferenceAdequate symptomatic reliefDosage of baclofenPotential renal insufficiencyTreatment of spasticityPattern of prescriptionPeak plasma levelsPhysicians' Desk ReferenceBaclofen levelsBaclofen therapyNeurogenic bladderRenal insufficiencySymptomatic reliefBlood levelsMuscle relaxantsPlasma levelsPharmacokinetic aspectsRenal clearanceClinical practiceBaclofenPatientsPilot studyPrior reportsUseful role
1991
Dopamine sulfate in ventricular cerebrospinal fluid and motor function in Parkinson's disease.
Cedarbaum J, Olanow CW. Dopamine sulfate in ventricular cerebrospinal fluid and motor function in Parkinson's disease. Neurology 1991, 41: 1567-70. PMID: 1922797, DOI: 10.1212/wnl.41.10.1567.Peer-Reviewed Original ResearchConceptsAdvanced Parkinson's diseaseDopamine sulfateParkinson's diseaseDopamine sulfate levelsLevodopa/carbidopaTime of transplantationPeak plasma concentrationAvailability of dopamineVentricular cerebrospinal fluidSulfate levelsClinical improvementMotor fluctuationsOmmaya reservoirSingle doseExogenous levodopaParkinsonian brainMotor functionPlasma concentrationsLateral ventricleCerebrospinal fluidAdrenal medullaLevodopaPatientsDiseaseDopamine