Thursday, August 18, 2022

Medical Treatment For Parkinson’s Disease

Start A Dopamine Agonist First

Complementary and Alternative Medical Treatments in Parkinsons Disease

Despite the unequivocal superiority of levodopa, initial dopamine agonist treatment is often advocated., This primarily relates to concerns for later-developing unstable levodopa responses, with dyskinesias and motor fluctuations. Note however, that this is an age-related phenomenon. These are indeed a considerable problem in the very young among patients with PD onset before age 40, both the dyskinesia-risk, and fluctuation-risk is over 95% after five years on levodopa., However, more than 80% of PD patients present after age 60, and in this age group, dyskinesia and fluctuation risks are markedly less. For those between ages 60-70, the dyskinesia risk after 5 years of levodopa is 26% it drops to 16% after age 70.

It should also be noted that the published data on dyskinesia and fluctuation risks are incident data these are frequencies regardless of severity, persistence, or whether they were easily treated. In fact, these problems are quite treatable, and sometimes are mild and do not require treatment. Thus, in one community-based study, the risk of dyskinesias that could not be adequately controlled with medication adjustments was only 12% after ten years of levodopa therapy.

What Is The Outlook For Persons With Parkinsons Disease

Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

The future is hopeful. Some of the research underway includes:

  • Using stem cells to produce new neurons, which would produce dopamine.
  • Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
  • Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

Should Levodopa Be Delayed

Levodopa therapy works best during the first decade of PD. Some authors argue that you can “save” these best responses for later by deferring treatment. However, the likely reason that the earlier levodopa responses are more gratifying relates to the natural progression of PD. Thus, the Lewy neurodegenerative process is relentless, not only causing further nigral neuron loss, but also extending into widespread non-dopaminergic brain regions., Trying to “save” the best responses may simply translate into missed opportunities and needless early disability. Moreover, patients initially rendered house-confined due to under-treatment may be difficult to subsequently return to an active lifestyle.

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Risks And Benefits For People With Pd

There are risks and benefits associated with the use of cannabis for people with PD. Benefits include a possible improvement in anxiety, pain management, sleep dysfunction, weight loss and nausea. Potential adverse effects include: impaired cognition , dizziness, blurred vision, mood and behavioral changes, loss of balance and hallucinations. Chronic use of marijuana can increase risk of mood disorders and lung cancer.

Neurosurgical Treatments Of Parkinsons Disease

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It is beyond the scope of this manuscript to comprehensively review neurosurgical treatment of PD. Only a brief review will be provided here and the reader is referred to other published literature on for additional information about this important therapeutic strategy. The renewed interest in surgical treatment of movement disorders has been stimulated in part by improved understanding of the functional anatomy underlying motor control, as well as refinement of methods and techniques in neurosurgery, neurophysio logy, and neuroimaging .

Besides thalamotomy and pallidotomy, another promising surgical approach for the treatment of tremors and other movement disorders is high-frequency DBS via electrodes implanted in the VIM nucleus of the thalamus, GPi, STN or other subcortical nuclei. The mechanism of electrical stimulation is not known, but the following explanations have been offered: 1) disruption of the network , 2) depolarization block, 3) preferential activation of inhibitory neurons, and 4) a functional ablation by desynchronizing a tremorogenic pacemaker.

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Treating Parkinsons With Complementary Medicine

Complementary medicine incorporates many different practices that can be used alongside conventional medicine to try to ease PD symptoms. There is typically not as much rigorous data to support the use of complementary medicine techniques, as compared to conventional medicine, but many patients find them helpful. These include yoga and massage.

What Are The Different Stages Of Parkinsons Disease

Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.

In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

Early stage

Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.

Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.

Mid stage

Mid-late stage

Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.

Advanced stage

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Stay Safe With Your Medicines

Read all labels carefully.

  • Tell all your health care providers about all the medicines and supplements you take.
  • Know all the medicines and foods youâre allergic to.
  • Review any side effects your medicines can cause. Most reactions will happen when you start taking something, but thatâs not always the case. Some reactions may be delayed or may happen when you add a drug to your treatment. Call your doctor right away about anything unusual.
  • Use one pharmacy if possible. Try to fill all your prescriptions at the same location, so the pharmacist can watch for drugs that might interact with each other.
  • You can use online tools to see if any of your medicines wonât work well together.

You have the right and responsibility to know what medications your doctor prescribes. The more you know about them and how they work, the easier it will be for you to control your symptoms. You and your doctor can work together to create and change a medication plan. Make sure that you understand and share the same treatment goals. Talk about what you should expect from medications so that you can know if your treatment plan is working.

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Medical Marijuana And Legislation By State

Patient-Centered Care for Parkinson’s Disease

Thirty-five states and Washington, DC have passed legislation allowing the use of marijuana-based products.

In some states where medical marijuana is legalized, consumers must register to possess and use cannabis. Other states require consumers to acquire a document from a physician stating that the patient has an approved condition. Under federal law doctors cannot prescribe cannabis, but many states authorize them to issue certifications that allow patients to obtain medical marijuana.

PD is listed as a qualifying condition for medical marijuana in Connecticut, Florida, Illinois, Louisiana, Massachusetts, Michigan, Mississippi, Missouri, New Hampshire, New Mexico, New York, Ohio, Pennsylvania and West Virginia.

Medical marijuana is legal in Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia and Washington, DC.

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What Medications Are Used To Treat Parkinsons Disease

Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.

Medications combat Parkinsons disease by:

  • Helping nerve cells in the brain make dopamine.
  • Mimicking the effects of dopamine in the brain.
  • Blocking an enzyme that breaks down dopamine in the brain.
  • Reducing some specific symptoms of Parkinsons disease.

Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .

What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

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Inhibition Of Dopa Decarboxylase: Carbidopa Benserazide

When levodopa was first introduced in the late 1960’s, large doses were necessary to overcome the rapid degradation by dopa decarboxylase . Moreover, dopamine generated in the circulation by peripheral dopa decarboxylase, crossed into the brainstem chemoreceptive trigger zone, provoking nausea and vomiting. The addition of the dopa decarboxylase inhibitors in the early 1970’s was a huge advance in the treatment of PD and they have become the standard of treatment. The two available decarboxylase inhibitors, carbidopa and benserazide are largely interchangeable with no apparent advantages of one over the other. A conventional dosage of each is 25 mg, formulated with 100 mg of levodopa.

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Levodopa and carbidopa . Levodopa is the most commonly prescribed medicine for Parkinsonâs. Itâs also the best at controlling the symptoms of the condition, particularly slow movements and stiff, rigid body parts.

Levodopa works when your brain cells change it into dopamine. Thatâs a chemical the brain uses to send signals that help you move your body. People with Parkinsonâs donât have enough dopamine in their brains to control their movements.

Sinemet is a mix of levodopa and another drug called carbidopa. Carbidopa makes the levodopa work better, so you can take less of it. That prevents many common side effects of levodopa, such as nausea, vomiting, and irregular heart rhythms.

Sinemet has the fewest short-term side effects, compared with other Parkinsonâs medications. But it does raise your odds for some long-term problems, such as involuntary movements. An inhalable powder form of levodopa and the tablet istradefylline have been approved for those experiencing OFF periods, OFF periods can happen when Parkinsonâs symptoms return during periods between scheduled doses of levodopa/carbidopa.

People who take levodopa for 3-5 years may eventually have restlessness, confusion, or unusual movements within a few hours of taking the medicine. Changes in the amount or timing of your dose will usually prevent these side effects.

Dopamine agonists. These drugs act like dopamine in the brain. They include pramipexole , rotigotine , and ropinirole , .

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Should The Dose Of Levodopa Be Restricted

Some authors advise conservative dosing with levodopa perhaps this might translate into better responses years later. In clinical practice, however, it is apparent that many PD symptoms tend to respond in an all-or-none manner, as if there is a dose threshold. Thus, restricting the dose may translate into inadequate benefit, contrary to our above goals of maximizing activity and QoL. Only a single clinical trial has assessed this, comparing “low dose” carbidopa/levodopa to optimal dosing . After six years, parkinsonism in the low dose group was poorly controlled and moreover, there were not dramatic differences in the frequencies of levodopa fluctuations or dyskinesias. The authors concluded that dose restriction was not beneficial, early or later.

In clinical practice, optimal individual levodopa doses vary among patients. However, it seems rational to identify the dose that works the best in any given patient and utilize that. Unlike narcotics, where the doses must be continuously increased to maintain an effect, the optimal individual dose of levodopa tends to remain fairly constant in any given patient over years. Obviously, more frequent doses may eventually be required to counter levodopa wearing-off effects, but not progressively higher individual doses.

Intestinal Infusion Pump For Delivery Of Duodopa

Duodopa is a gel form of levodopa and is used to treat severe motor fluctuations with prolonged and disabling off times and troublesome dyskinesia.

A PEG-J tube is inserted into the intestine via a stoma or hole in the stomach wall. A cassette containing the gel is inserted into a pump worn by the person that is programmed to deliver the gel at the required rate.

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Surgery For Parkinsons Disease

Based on the severity of the condition and the medical profile, the doctor may recommend surgery as one treatment option for Parkinson’s disease.

There are several types of surgery that may be performed that can help patients with Parkinson’s disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms.

There are three types of surgeries that may be performed for Parkinson’s disease, including the following:

It is important to remember that surgery may help with symptoms of Parkinson’s disease, but does not cure the disease or stop the progression of the disease.

What Is Medical Marijuana

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Medical marijuana is cannabis that’s prescribed by a physician to treat or provide relief for a medical condition.

There are around 400 chemicals in the cannabis plant, and more than 60 of them are referred to as cannabinoids. The high marijuana users get is primarily due to the most psychoactive cannabinoid in the plant called tetrahydrocannabinol, or THC.

Cannabinol, or CBD, is the other cannabinoid, which is used in medical marijuana. CBD does not cause a high when taken alone and, in fact, moderates the psychoactive effects. Research is being done to determine how medical marijuana can help treat or relieve symptoms of various diseases, including Parkinson’s disease.

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Impulsive And Compulsive Behaviours

People who experience impulsive and compulsive behaviours cant resist the temptation to carry out an activity often one that gives immediate reward or pleasure.

Behaviours may involve gambling, becoming a shopaholic, binge eating or focusing on sexual feelings and thoughts. This can have a huge impact on peoples lives including family and friends.

Not everyone who takes Parkinsons medication will experience impulsive and compulsive behaviours, so these side effects should not put you off taking your medication to control your symptoms.

If you have a history of behaving impulsively you should mention this to your GP, specialist or Parkinsons nurse.

Asking your specialist to make changes to your medication regime or adjusting the doses that you take is the easiest way to control impulsive and compulsive behaviours. So, if you or the person you care for is experiencing this side effect, tell your healthcare professional as soon as possible before it creates large problems.

If you are not able to get through to your healthcare professional straight away, you can call our Parkinsons UK helpline on 0808 800 0303.

We have advice that can help you manage impulsive and compulsive behaviours as well as information on what behaviour to look out for.

Lsvt Loud And Lsvt Big For Parkinsons Patients

Lee Silverman Voice Treatment, or LSVT, is an intense treatment protocol to help slow the decline of motor and speech skills in patients who have Parkinsons disease. There are two types of LSVT therapy: LSVT LOUD and LSVT BIG. We offer both at The Rehabilitation Center of Penn Highlands Healthcare.LSVT programs are specifically designed to treat symptoms of Parkinsons disease. Patients with Parkinsons who start speaking softer or slower can benefit from LSVT LOUD, which uses vocal exercises to help them speak louder and more clearly. LSVT BIG helps gait and movement problems through outpatient physical therapy and occupational therapy to help patients have smoother, safer movements. LSVT is available at:The Rehabilitation Center at Penn Highlands Clearfield offers both LSVT BIG AND LSVT LOUD. Call 814-768-2285 for information. The Rehabilitation Center at Penn Highlands Elk offers LSVT LOUD. Call 814-788-8490 for information.

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