What Is Parkinsons Disease
Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.
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Pain Relievers And Other Options
If youre in pain, your healthcare provider may suggest you take over-the-counter pain relief medications such as Motrin , Aleve or aspirin. These medications may work to relieve minor aches and pains that you experience from your Parkinsons disease due to immobility, stiffness, and rigidity.
However, your healthcare provider may want to try some other remedies first. These options include:
- Adjusting your Parkinsons medications. Since pain can be caused by the muscle-related symptoms of Parkinsons disease, its possible that it can be managed by adjusting the medications prescribed to manage those symptoms. Your healthcare provider is the best judge of whether this is possible, and how to accomplish it.
- Exercise. Again, most persistent pains in Parkinsons are due to the motor problems associated with the condition. An exercise program can help you alleviate those motor problems, which should, in turn, cause the accompanying aches and pains to diminish. Talk to your healthcare provider about starting such an exercise program.
Other options to treat pain in Parkinsons disease include massage, physical therapy, and stretching.
Managing Medication Interactions And Side Effects
All prescribed medications can have potential side effects, including those used to treat Parkinsons. Some things you think are symptoms of Parkinsons may actually be side effects of medication. Some peoples side effects will have a big impact on their lives and have to be kept under control along with the symptoms.
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Full List Of Medications Approved For The Treatment Of Parkinsons Disease In The Usa
Below is a full list of Parkinsons medications that have been approved to treat Parkinsons in the United States. This material is intended to provide you with information. It should not be used for treatment purposes, but rather as a source for discussion with the patients own physician. Work with your physician to determine which medications are best for you, and know the risks and benefits of each.
| Generic Name |
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Impulsive And Compulsive Behaviour
A small number of people taking levodopa have problems with impulsive or compulsive behaviour. This can also be called impulse control disorder. It affects a much smaller percentage of people taking levodopa than those taking dopamine agonists, but it is still a possible side effect. Further information is available at Compulsive and impulsive behaviour.
Another potential problem is dopamine dysregulation syndrome, where someone with Parkinsons might be tempted to take more of their Parkinsons medication than they are prescribed. If you think this is happening to you or the person you are caring for, tell your GP, specialist or Parkinsons nurse right away.
It is important that all people with Parkinsons are monitored for any potential risk of impulsive and compulsive behaviour while being treated with levodopa.
People with Parkinsons, their carers, friends and family members should work with healthcare professionals to monitor any changes in behaviour. If you start to experience these symptoms, you should discuss it with your specialist or Parkinsons nurse immediately. You should not stop taking the medication.
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Drugs For Parkinsons: The Shocking Side Effects
There are 2 main categories of drugs for Parkinsons Disease, and both have powerful side effects: levodopa, which makes many patients shaky with dyskinesia, and dopamine agonists, which can make turn people into gamblers, sex addicts or hit them with sleep attacks including when theyre driving. This is the story of DA.
At least 1 million people in the US and an estimated 10 million worldwide live with Parkinsons, making it the second most common neurodegenerative disorder . Parkinsons disease, a disorder of the central nervous system, is caused by a degeneration of nerve cells in certain parts of the brain that produce a neurotransmitter called dopamine. Dopamine, commonly known for its role in controlling the brains reward and pleasure center, is partly responsible for starting a circuit of messages that coordinate normal movement.
In the absence of dopamine, the neurons called dopamine receptors in the brains striatum are not adequately stimulated. In simple language, as a persons brain slowly stops producing dopamine, a person has less and less ability to regulate his or her movements, body, and emotions. The result is impaired movement with tremors, slowness, stiffness or balance problems. Lesser known symptoms include depression, apathy and dementia.
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How Parkinsonism Differs From Parkinsons Disease
Parkinsons disease is one of many types of parkinsonism. Its caused by a loss of cells in the part of your brain that produces the neurotransmitter dopamine.
Parkinsons disease and the different types of parkinsonism progress in different ways. Some may progress more rapidly than Parkinsons disease. Others, like secondary parkinsonism, may be reversible.
The conditions also respond differently to treatments. For instance, someone who has a type of parkinsonism may not respond to the drug levodopa, which is commonly used for Parkinsons disease.
It can be hard to tell the difference between types of parkinsonism. Heres a look at some of the identified categories of parkinsonism with their typical symptoms and treatments.
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Causes Of Parkinsons Disease
The specific cause of Parkinsons is unknown. It may have both genetic and ecological components. Some researchers believe that viruses can set off Parkinsons too.
Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have actually been related to Parkinsons.
Irregular proteins called Lewy bodies have likewise been discovered in the brains of individuals with Parkinsons. Researchers do not know what role, if any, Lewy bodies play in the advancement of Parkinsons.
While theres no recognized cause, research study has determined groups of people who are most likely to establish the condition, which include:
- Sex. Men are one and a half times most likely to establish Parkinsons than women.
- Race. According to research study, theres a higher prevalence of Parkinsons in white people compared with Black or Asian people. Geographical location may be one factor for a higher threat.
- Age. Parkinsons generally appears in between ages 50 and 60 years. It just occurs before 40 years old in about four percent of cases.
- Family history. Individuals who have close member of the family with Parkinsons disease are most likely to develop Parkinsons disease.
- Toxins. Direct exposure to specific contaminants may increase the risk of Parkinsons illness.
- Head injury. Individuals who experience head injuries may be more likely to establish Parkinsons disease.
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Parkinsonism Vs Parkinsons Disease
Parkinsonism refers to a cluster of symptoms that mimic the movement problems caused by Parkinsons disease. Its sometimes referred to as atypical Parkinsons disease, secondary parkinsonism, or Parkinsons plus.
Parkinsons disease is a chronic, neurodegenerative brain disorder. In addition to problems with movement, Parkinsons disease causes non-motor symptoms that arent caused by drug-induced parkinsonism. They include:
Another key difference between drug-induced parkinsonism and Parkinsons disease is symmetry. Drug-induced parkinsonism usually affects both sides of the body equally. Parkinsons disease affects one side of the body more than the other.
Parkinsonism can be caused by medications, repeated head trauma, and environmental toxins. It can also be caused by neurological disorders, including Parkinsons disease. Other neurological conditions that cause parkinsonism include:
- progressive supranuclear palsy
These medications dont cause resting tremors. Rather, they cause:
- Action tremors. These occur in a body part thats moving, not a body part thats resting.
- Postural tremors. These occur when a body part is forced to withstand gravity, such as when arms are outstretched or legs are raised.
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Some Disadvantages Of Comt Inhibitors
These drugs can increase the side effects caused by levodopa, notably dyskinesias , nausea and vomiting.
If these side effects increase after starting the drug, people should raise the issue with their healthcare professional, as reducing the levodopa dose can often help.
COMT inhibtors will discolour urine making it a reddish-brown colour. Some people also experience diarrhoea which may occur some months after commencing the medication.
Be aware that other drugs for Parkinsons or other conditions can affect the action of COMT inhibitors. The combination of apomorphine and entacapone needs careful supervision.
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The Pharmacology Of Cannabis
The two primary components of marijuana are delta-9-tetrahydrocannibinol and cannabidiol . THC and CBD act on the cannabinoid receptors type 1 and type 2 , which are primarily found throughout the nervous system and on cells of the immune system. The way that THC and CBD acts on these two receptors is different and may help explain the different effects mediated by each of these compounds. For example, THC is the psychoactive component of marijuana and causes alterations in perception and mood. CBD, on the other hand, can reduce anxiety and may have anti-inflammatory properties.
The various compounds present in different marijuana plants and their variable effects on the CB1 and CB2 receptors make cannabis studies difficult to conduct. When researchers study the effects of a medication, dosages are controlled and often set to a specific number of milligrams. When testing medical marijuana, the dosage administered can vary dramatically depending on the plant and method of administration.
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How Anticholinergics Work
These medications block the action of acetylcholine, a chemical messenger that is found in your body. Acetylcholine helps to send messages from your nerves to your muscles.
In the brain, there is normally a balance between the activity of dopamine and the activity of acetylcholine. But in Parkinsons a deficiency in the brain of the neurotransmitter dopamine causes over-activity of acetylcholine. Anticholinergics work by blocking acetylcholines activity to restore this balance and help reduce your Parkinsons symptoms.
What Are The Causes
Drug-induced parkinsonism is caused by medications that reduce dopamine levels in the brain. Dopamine is a neurotransmitter that works to control bodily movements.
Dopamine is also part of the brains reward system. It helps you feel pleasure and enjoyment, and it supports your ability to learn and focus.
Medications that bind to and block dopamine receptors are called dopamine antagonists. These medications arent used to treat Parkinsons disease. Rather, theyre used to treat other conditions that might seriously impact your quality of life.
If your doctor has prescribed a medication that causes unwanted side effects, you may have options. You may also decide that the side effects are worth it if the medication effectively treats your condition.
Some medications that cause drug-induced parkinsonism include:
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What Medications Are Used To Treat Parkinson’s Symptoms
Since many of the motor symptoms of Parkinsons are the result of a lack of dopamine in the brain, most drugs used to treat Parkinsons are aimed at temporarily replenishing or imitating dopamine. The following list is a guide to medications approved by Health Canada to treat symptoms of Parkinsons1. Speak to your doctor for detailed information regarding effectiveness and side effects of a particular drug.
Levodopa
- Converted into dopamine in the brain and stored in nerve cells to replace depleted dopamine
- Combined with another drug, carbidopa or benzerazide, allows more levodopa to get to the brain and reduces side effects
- Helps improve muscle rigidity and movement
- Side effects include dyskinesias
- Over years of use, may be associated with wearing off
Dopamine Agonists
- Mimics or imitates action of dopamine
- Can be used as initial treatment or with levodopa in advanced stages
- Side effects include sleepiness, hallucinations, leg swelling and obsessions with food, sex and activities such as shopping, gambling and Internet use Amantadine
- Enhances dopamine release and blocks glutamate, a brain transmitter
- Used to treat early symptoms
- Can reduce dyskinesias and improve wearing off
Dopamine Agonist
COMT Inhibitors
An Approach To The Treatment Of Parkinsons Disease
No treatment can arrest or slow neurodegeneration in Parkinsons disease. The aim is to relieve symptoms and avoid the complications of therapy.
Early Parkinsons disease
Many studies have shown that early treatment with dopamine agonists reduces the incidence of dyskinesia.1Fewer motor fluctuations were shown in some but not all of the studies. We recommend a dopamine agonist as the first treatment in younger patients who have mild disease and no cognitive deficit. It is necessary to add levodopa within 1-5 years in most patients. In more severe disease, treatment begins with levodopa but a dopamine agonist may be added to keep the daily dose of levodopa in the lower range if there is no cognitive deficit. Dopamine agonists are used infrequently and with caution in patients more than 70 years old because of the risk of neuropsychiatric adverse effects and postural hypotension. They are contraindicated in the presence of dementia.
Isolated resting tremor is rarely disabling, but if it interferes with function it can usually be managed with levodopa. When this is ineffective at low to moderate doses, the addition of an anticholinergic can sometimes be useful.
Patients with motor fluctuations
Role of physical therapy and surgery
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Dopaminergic Features And Their Treatment
Patients with PD usually present with features indicative of degeneration of nigrostriatal pathways. A useful clinical definition for PD is asymmetric onset of an akinetic rigid syndrome with resting tremor and a good response to levodopa. When applied by neurologists with an interest in movement disorders, this definition has a pathological correlation exceeding 98%. When treatment is considered appropriate, and this is a topic discussed in detail below, a variety of options is available. The use of dopaminergic drugs improves motor function, significantly reduces both the morbidity and mortality of PD, and improves quality of life.
Levodopa remains the drug most commonly used in PD. It is very effective in improving bradykinesia and rigidity, and in practice remains the gold standard against which other drugs are judged. Some studies, predominantly in vitro, have suggested that levodopa may be toxic. However, such data are conflicting, and some laboratory studies have suggested a growth factor-like effect for levodopa. Overall, the pre-clinical evidence for levodopa toxicity is not convincing and there are no data to indicate that any toxic action is of clinical relevance.
Table 1
Percentage of patients remaining on dopamine agonist monotherapy at years 14 and years 15 during treatment trials
How Anticholinergics Are Used
These medications are older and are not used very often for Parkinsons today. Sometimes they are prescribed for reducing tremor and muscle stiffness. They can be used on their own, especially in the early stages of your Parkinsons when symptoms are mild, before levodopa is prescribed.
Anticholinergics can also be used with levodopa or a glutamate antagonist. They are taken as tablets or as a liquid.
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Editorial Sources And Fact
- Parkinsons Disease: Diagnosis & Treatment. Mayo Clinic. December 8, 2020.
- Pringsheim T, Day GS, Smith DB, et al. Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee. Neurology. November 15, 2021.
- Levodopa and Carbidopa. MedlinePlus. June 15, 2018.
Contraindicated Drugs For Parkinsons Patients
More than two dozen drugs should not be taken by Parkinsons patients because they alter the brains dopamine system. Always let your neurologist know before you have surgery, so he or she can work with your medical team to keep your Parkinsons in control. View a list of drugs that Parkinsons patients should not take.
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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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Medications To Avoid Or Use With Caution
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Before making any decisions about treatment of Parkinsons disease, you will want to learn about the different types of medications available for Parkinsons disease and discuss the pros and cons of each with your physician. It may help to know that there is no right answer, and if you try something that doesnt work for you, you can always adjust your plan.
To learn more about adjusting medication plans, view our webinar on What to Do When Your Medications Stop Working.
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