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(12) United States Patent (10) Patent No.: US 7,030,108 B2 Richter Et Al

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(12) United States Patent (10) Patent No.: US 7,030,108 B2 Richter Et Al US00703 0108B2 (12) United States Patent (10) Patent No.: US 7,030,108 B2 Richter et al. (45) Date of Patent: Apr. 18, 2006 (54) COMBATING PARKINSON'S 4,062,848 A 12/1977 van der Burg ........ 260/268 PC DISEASE-RELATED MOVEMENT 4,968,692 A 1 1/1990 Linnoila et al. ............ 514,396 DSORDER 5, 198459 A 3/1993 Imperato et al. ............ 514,397 5,216,001 A 6/1993 Perregaard et al. ......... 514,323 (75) Inventors: Virginia Pact Richter, Chapel Hill, NC 5,288,749 A 2/1994 Meyer et al. ............... 514,414 (US); Thomas Giduz, Chapel Hill, NC 5.948,806 A 9/1999 Colpaert et al. ............ 514,397 (US) 6,281.207 B1 8/2001 Richter et al. ......... 514,214.02 (73) Assignees: Reed Richter, Chapel Hill, NC (US); FOREIGN PATENT DOCUMENTS Steven J. Hultquist, Raleigh, NC (US) WO WO94f13285 6, 1994 (*) Notice: Subject to any disclaimer, the term of this OTHER PUBLICATIONS patent is extended or adjusted under 35 Henry et al., Experimental Neurology, 151(2), 334-342 U.S.C. 154(b) by 267 days. (1998) (abstract).* Rawlow et al., European Journal of Pharmacology, 191 (3), (21) Appl. No.: 09/940,309 263-72 (1990) (abstract).* Davis et al., CNS Drugs, 5/5 (389-402) (1996) (abstract).* (22) Filed: Aug. 27, 2001 Lin-Shiau et al. Chemical Abstracts, Vol. 121, Abstract No. (65) Prior Publication Data 73678, 1994. US 2002fOO35057 A1 Mar. 21, 2002 * cited by examiner Related U.S. Application Data Primary Examiner Phyllis G. Spivack (63) Continuation of application No. 09/396,335, filed on (74) Attorney, Agent, or Firm—Steven J. Hultquist; Sep. 15, 1999, now Pat. No. 6,281.207. Intellectual Property/Technology Law (51) Int. Cl. (57) ABSTRACT A63/55 (2006.01) (52) U.S. Cl. ................................................. 514/214.02 (58) Field of Classification Search ............ 51421402. A method of combating movement disorder is disclosed in See application file for complete search history. a patient with Parkinson's disease comprising administering an effective amount of mirtazapine, a receptor antagonist for (56) References Cited 5HT and C receptors. U.S. PATENT DOCUMENTS 3,983,234 A 9, 1976 Sayers ........................ 424/250 14 Claims, No Drawings US 7,030,108 B2 1. 2 COMBATNG PARKINSONS referring to the genetically-based incidence of Such disease DISEASE-RELATED MOVEMENT state. Essential tremor is the most common type of tremor; DISORDER it can co-exist with PD tremor but is a categorically separate disease state. CROSS-REFERENCE TO RELATED Tremor is a pervasive movement disorder, for which few APPLICATION efficacious therapeutic agents presently exist, and there are many different types of this dyskinetic condition. This is a continuation of U.S. patent application No. A concise overview of tremor varieties is located at the 09/396.335 filed Sep. 15, 1999, and issued as U.S. Pat. No. World WideWeb site http://www.geocities.com/-shaky-mtl/ 6,281.207 on Aug. 28, 2001. 10 Newpage95.htm. Epidemiology charts for incidence of tremor are presented at the World Wide Web site http:// BACKGROUND OF THE INVENTION www.geocities.com/~shaky-mtl/Newpage 118.htm. In the area of therapeutic compositions for treatment of 1. Field of the Invention movement disorders, there are few agents with demonstrated The present invention generally relates to the treatment of 15 utility, and many of Such agents have unacceptable side movement disorders in a patient Suffering or Susceptible to effect profiles. same, by administration to a patient of an effective amount Considering the therapeutic agents that have been used or of a neurotransmission modulating composition. More spe proposed for treatment, beta-blockers such as Inderal have cifically, the invention relates to Such treatment using a been used for essential tremor. Some secondary drugs are neurotransmission modulating composition comprising a available, but they have generally poor efficacy. The mecha 5HT- and/or Cantagonist. nism of essential tremor is unknown and is probably not 2. Description of the Related Art related to dopamine, since essential tremor does not respond Movement disorders include a wide variety of disease to therapeutic agents that are generally used for treatment of states and physiological conditions. Examples include vari Parkinson's Disease. ous dyskinesias involving excessive or otherwise abnormal 25 Recently, implantable electrodes in the brain have been involuntary movement, which may vary significantly in rate, used as a therapeutic intervention for Parkinson's tremor. frequency, periodicity and progressionary character, and This approach, however, is expensive and requires invasive which may encompass disorders such as tremors, akathisias, techniques for placement in the basal ganglia and thalamus. asterixis, athetosis, choreaathetosis, tics, chorea/choreaform There is thus a compelling need in the art for efficacious movements, dystonias, spasticity, restless legs syndrome, 30 therapeutic agents to treat movement disorders in all their hyperkinetic movement disorders, hemibalismus, myoclo variant forms. nus, tardive dyskinesia and other types of dyskinesias. Tremors types are particularly varied, and include for SUMMARY OF THE INVENTION example Parkinsonian tremors, rubral tremors, post-trau matic tremors, drug-induced tremors (e.g. induced by 35 The present invention generally relates to a method of lithium or other drug agents), cerebellar tremors associated combating movement disorder in a patient experiencing or with lesions of the cerebellum or cerebellar outflow path Susceptible to same, by administering to the patient an way, Tourette syndromal tremors and other peripheral neu effective amount of a composition that is effective for ropathy-associated tremors. combating such movement disorder. These disorders, particularly dyskinetic conditions asso 40 In a specific aspect, the invention relates to a method of ciated with neurological impairment of the basal ganglia, are combating movement disorder in a patient experiencing or far from uncommon in the general population. Approxi Susceptible to same, by administering to the patient an mately 1.5 million people are estimated to suffer from effective amount of a neurotransmission modulating com Parkinsonian tremor or essential tremor in the United States position comprising a 5HT and/or Cantagonist. alone. The etiology of Such physiologic States is poorly 45 The composition in particular aspects may variously understood, involving striata comprising dopaminergic path comprise: ways whose transductional characteristics, neurotransmitter (a) a 5HT receptor antagonist, e.g., a 5HT2 and/or a 5HT3 components and receptor mechanisms are ill-defined but receptor antagonist; and/or constitute the focus of intensive research efforts directed to (b) an O. receptor antagonist, e.g., a noradrenergic and their elucidation. 50 serotonergic neurotransmission-enhancing/modulating Parkinson's tremor is a dyskinetic condition typically agent. presenting as a resting tremor that is less pronounced, for In another aspect, the 5HT receptor antagonist (5HT2 example, when a person lifts his/her hand. Parkinson's and/or a 5HT3 receptor antagonist) may also be an O. tremor sometimes responds to L-DOPA, the classical treat receptor antagonist. ment for the other symptoms of Parkinson's Disease (PD), 55 Preferably, the antagonist composition is one that does not but the tremor component is the most difficult symptom of mediate sedation in dosages effective for combating move the disease to treat effectively. ment disorder. Levodopa-induced dyskinesias occur later in Parkinson's The various therapeutic compositions of the invention Disease and are extremely handicapping. Such dyskinesias may additionally and optionally comprise any Suitable adju range from subtle undulating movements of the body to wild 60 vants, excipients, additives, carriers, solvents, additional uncontrollable Swinging movements of the limbs that can therapeutic agents (e.g., for conjoint treatment or therapy, literally knock a seated patient out of his or her chair and including for example one or more additional agents for often makes it impossible for patients to feed themselves or combating the movement disorder and/or a concurrent perform other basic tasks requiring rudimentary manual physiological condition), bioavailability enhancers, side dexterity and motor coordination. 65 effect Suppressing components, or other ingredients that do Essential tremor and familial tremor are the same disease not preclude the efficacy of the composition for combating state in physiological manifestation, with familial tremor movement disorders. US 7,030,108 B2 3 Another aspect of the invention relates to a method of example Parkinsonian tremors, action tremors and combating movement disorder in a patient experiencing or levodopa-induced dyskinesias. Susceptible to same, comprising administering to the patient The neurotransmission modulating composition an effective amount of a piperazinoazepine compound that is employed in the practice of the present invention may a receptor antagonist for at least one receptor selected from comprise any of a wide variety of 5HTantagonist and/or C. the group consisting of 5HT and C receptors. antagonist agents. Useful agents include: A further aspect of the invention relates to a method of (a) the compounds disclosed in U.S. Pat. No. 4,062,848 combating movement disorder in a patient experiencing or issued Dec. 13, 1977 to Willem Jacob van der Burg for Susceptible to same, comprising administering to the patient “Tetracyclic Compounds, the
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