More About Carbidopa / Entacapone / Levodopa
1. Product Information. Stalevo 150 . Novartis Pharmaceuticals, East Hanover, NJ.
2. Product Information. Stalevo 50 . Novartis Pharmaceuticals, East Hanover, NJ.
3. Hauser RA Levodopa/carbidopa/entacapone . Neurology 62 : S64-71
4. Product Information. Stalevo 100 . Novartis Pharmaceuticals, East Hanover, NJ.
5. Giner V, Rueda D, Salvador A, Hernandez JC, Esteban MJ, Redon J Comments, opinions, and brief case reports: thrombocytopenia associated with levodopa treatment. Arch Intern Med 163 : 735-6
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Aspect : Relationship Between Weight Loss/malnutrition And Pd
It has long been recognized that there is a relationship between weight loss and PD. Amounting evidence support weight loss may begin at the early stage of PD, even several years before the diagnosis, and may be more pronounced in patients with greater disease severity . A prospective cohort study involving 10,812 men reported that subjects who lost 0.5 units of body mass index per decade during the follow-up time had more than a 2-fold risk for developing PD when compared with men having stable BMI . Given this considerable list of association between weight loss and PD, one is left asking: whether it is a chicken or egg problem?
Given the lengthy latency period of PD, it cannot be excluded that the observed weight loss before the diagnosis of PD may stem from subclinical effects of PD rather than an independent pathogenesis. That is to say, weight loss is the consequence of PD. There are ample evidences supporting the effect of PD on weight loss for this time being .
Figure 1. Postulated determinants of weight loss in PD. NPY, NeuropeptideY LC, locus coreruleus.
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Support For People Living With Parkinsons Disease
While the progression of Parkinsons is usually slow, eventually a persons daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinsons disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.
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Exercise For Constipation In Parkinsons Disease
Be guided by your doctor, but general suggestions include:
- Talk with your doctor, physiotherapist, exercise physiologist or healthcare professional when planning your exercise program.
- Aim for at least 30 minutes of exercise every day.
- Spend a few minutes warming up and cooling down. This could include marching in place or stretching.
- Start with the easiest exercises first. Slowly introduce the more difficult exercises as your fitness increases.
- Only exercise when other people are at home who can help if necessary.
- Remember: too little exercise and fluid intake with an increase in dietary fibre can worsen constipation for some people.
How Is Parkinson Disease Treated
Parkinson disease cant be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
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Why Do I Get Constipated
We are still learning about constipation in PD and why it happens. Here is what we know:
Parkinsons Disease
The same changes that occur in brain cells in Parkinsons disease may also occur in nerve cells in the spinal cord and the intestinal wall. These changes may slow down the muscles that push food through the intestines.
Medications
Medications used to treat PD in particular, the class called anticholinergics and the medication amantadine, used to treat dyskinesia are known for causing constipation. If you are on these medications, your healthcare provider may be able to reduce your dose or switch you to a different one. But for some people, the benefits of the medication outweigh the possibility of constipation.
Because people with Parkinsons disease experience difficulty with their movement, they often become less active. People with PD who increase their movement experience better overall functioning, which includes their digestive system.
Many people with Parkinsons disease limit their fluids to avoid making frequent trips to the bathroom. When a person drinks less liquid, the gut may not have the lubrication it needs to have a bowel movement, which contributes to constipation.
Genetic Predisposition
It is possible to have a family predisposition to constipation. Ask family members what solutions work for them. Your body may respond to the same strategies.
Individual Body Chemistry
What Are The Symptoms Of The Disease
The four primary symptoms of PD are:
- Tremor. Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. The tremor associated with PD has a characteristic rhythmic back-and-forth motion that may involve the thumb and forefinger and appear as a pill rolling. It is most obvious when the hand is at rest or when a person is under stress. This tremor usually disappears during sleep or improves with a purposeful, intended movement.
- Rigidity. Rigidity , or a resistance to movement, affects most people with PD. The muscles remain constantly tense and contracted so that the person aches or feels stiff. The rigidity becomes obvious when another person tries to move the individuals arm, which will move only in ratchet-like or short, jerky movements known as cogwheel rigidity.
- Bradykinesia. This slowing down of spontaneous and automatic movement is particularly frustrating because it may make simple tasks difficult. The person cannot rapidly perform routine movements. Activities once performed quickly and easilysuch as washing or dressingmay take much longer. There is often a decrease in facial expressions.
- Postural instability. Impaired balance and changes in posture can increase the risk of falls.
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Diagnosis Of Parkinsons Disease
There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinsons. Doctors usually diagnose the disease by taking a persons medical history and performing a neurological examination. If symptoms improve after starting to take medication, its another indicator that the person has Parkinsons.
A number of disorders can cause symptoms similar to those of Parkinsons disease. People with Parkinsons-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinsons, certain medical tests, as well as response to drug treatment, may help to better evaluate the cause. Many other diseases have similar features but require different treatments, so it is important to get an accurate diagnosis as soon as possible.
Can Parkinson’s Disease Be Cured
No, Parkinson’s disease is not curable. However, it is treatable, and many treatments are highly effective. It might also be possible to delay the progress and more severe symptoms of the disease.
A note from Cleveland Clinic
Parkinson’s disease is a very common condition, and it is more likely to happen to people as they get older. While Parkinson’s isn’t curable, there are many different ways to treat this condition. They include several different classes of medications, surgery to implant brain-stimulation devices and more. Thanks to advances in treatment and care, many can live for years or even decades with this condition and can adapt to or receive treatment for the effects and symptoms.
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Symptoms Of Parkinsons Disease
Parkinsons has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Muscle stiffness, where muscle remains contracted for a long time
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include:
The symptoms of Parkinsons and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward take small, quick steps and reduce swinging their arms. They also may have trouble initiating or continuing movement.
Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.
Addressing Practical Aspects Of Eating And Drinking
Some people with Parkinsons have problems chewing and swallowing. This can make it difficult to eat a diet with plenty of fibre. A speech and language therapist can give advice about this. Ask your GP, specialist or Parkinsons nurse for a referral. If it takes a long time to eat and your meal goes cold, eat smaller portions and go back for seconds that have been kept warm. You can also get special plates that keep your meals hot the Disabled Living Foundation has more information.
An occupational therapist will also be able to give you some tips and practical advice.
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Other Outcomes Of Pd Therapies On Gi Dysfunctions
Antiparkinsonian medication considerably hampers the evaluation of the potential correlation between GI dysfunctions and the severity of PD symptoms. An individual stabilized by drug therapy may indeed display a better overall condition than another patient with early PD, thus receiving a suboptimal treatment . Moreover, in some situations, addressing motor symptoms only may affect GI features both positively and negatively. Indeed, DAergic therapy may improve dysphagia and drooling but, on the other hand, might also worsen gastroparesis and reduce GI motility . However, since nausea and vomiting are often side effects of various medications, they can limit the use of the latter and, as a result, preempt the benefit of such medications on motors symptoms . Moreover, deep brain stimulation , which is widely used to treat motor symptoms, has been shown to have a potential impact on the manifestation of GI symptoms . According to some studies, constipation and deglutition are significantly improved after surgery in the subthalamic nucleus . However, there is no consensus on the putative effect of DBS on GI manifestations, as shown by reports that the latter neurosurgery does not improve dysphagia and drooling .
Over The Counter & Complementary Therapies
People with Parkinsons who seek relief from their symptoms may decide to explore complementary therapies, which can support or complement traditional medicine. While there are many kinds of complementary medicine, this section focuses on herbs, vitamins and supplements.
Page reviewed by Dr. Chauncey Spears, Clinical Assistant Professor and Dr. Amelia Heston, Movement Disorders Fellow at the University of Michigan.
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When Getting Dressed
- Allow yourself plenty of time to get ready. Avoid rushing.
- Select clothes that are easy to put on and take off.
- Try using items with Velcro instead of buttons.
- Try wearing pants and skirts with elastic waist bands. These may be easier than buttons and zippers.
Yoga uses targeted muscle movement to build muscle, increase mobility, and improve flexibility. People with Parkinsons may notice yoga even helps manage tremors in some affected limbs. Try these 10 yoga poses to help ease symptoms of Parkinsons.
How Is It Diagnosed
Diagnosing Parkinson’s disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes. However, most lab tests aren’t necessary unless you don’t respond to treatment for Parkinson’s disease, which can indicate you have another condition.
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Fecal Incontinence In Advanced Parkinsons Disease
Fecal incontinence is a very debilitating symptom that can occur in advanced PD and refers to the involuntary release of fecal matter.
Once again, fecal incontinence, especially if it is a new symptom, should be fully evaluated to determine if there is a cause unrelated to PD. Diseases of the gut such as inflammatory bowel disease or compression of the lower spine cord can be the reason.
If related to PD, there are typically two situations to consider. One possibility is that severe constipation with impacted bowel movement allows loose stool from higher up in the gastrointestinal tract to escape around the edges of the obstruction. In this situation, fecal incontinence could be a harbinger of bowel obstruction. Aggressive and continuous treatment of constipation can help avoid this potential scenario.
As with urinary incontinence, frequent and rapid exchange of dirtied incontinence products can keep skin intact and prevent infection.
Tips and Takeaways
Changes In Cognition And Parkinsons Disease
Some people with Parkinsons may experience changes in their cognitive function, including problems with memory, attention, and the ability to plan and accomplish tasks. Stress, depression, and some medications may also contribute to these changes in cognition.
Over time, as the disease progresses, some people may develop dementia and be diagnosed with Parkinsons dementia, a type of Lewy body dementia. People with Parkinsons dementia may have severe memory and thinking problems that affect daily living.
Talk with your doctor if you or a loved one is diagnosed with Parkinsons disease and is experiencing problems with thinking or memory.
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Emergencies And Complications Of Device
Device-aided therapies include deep-brain stimulation, levodopa-carbidopa intestinal gel, and apomorphine subcutaneous injections and infusion. These are indicated to treat response fluctuations, such as recurrent disabling offs and dyskinesias refractory to standard therapy. Deep-brain stimulation is also used for drug-refractory tremor. Emergencies and complications related to device-aided therapies are not uncommon, and require prompt medical attention since they are generally associated with significant aggravation of Parkinsons disease symptoms .
An algorithm approach for DBS efficacy loss. DBS, deep-brain stimulation LD, levodopa.
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.
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Diagnosis Of Constipation In Parkinsons Disease
Diagnosis of constipation may include:
- medical history
- detailed description of symptoms
- physical examination.
Medical problems other than Parkinsons disease can also cause constipation. Your doctor may wish to do tests to rule out other possible causes. The tests depend on the medical condition under investigation.
How Is Parkinson Disease Diagnosed
Parkinson disease can be hard to diagnose. No single test can identify it. Parkinson can be easily mistaken for another health condition. A healthcare provider will usually take a medical history, including a family history to find out if anyone else in your family has Parkinsons disease. He or she will also do a neurological exam. Sometimes, an MRI or CT scan, or some other imaging scan of the brain can identify other problems or rule out other diseases.
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Dietary Fibre For Constipation In Parkinsons Disease
Be guided by your doctor, but general suggestions include:
- Choose easy-to-eat fibrous foods such as soft fruits. Consider mashing or pureeing fruits to make them easier to eat. Make sure to include the skin, where most of the fibre is found.
- Eat at least two pieces of fruit and five serves of vegetables every day.
- Eat homemade vegetable soups.
- Sprinkle a tablespoon of bran, psyllium husks or chia seeds on your breakfast cereal or add the bran to baked products such as cakes. However, avoid bran if you have swallowing problems.
- Fibre supplements may be helpful, but you must drink enough fluids for these to work properly. Avoid fibre supplements if you have problems swallowing.
- Dont increase dietary fibre too quickly or youll risk bloating and abdominal cramps. If discomfort occurs, cut back your fibre intake, increase your fluid intake, apply a hot water bottle to your abdomen and see your doctor.
Adjust Your Drug Dose
Side effects like dyskinesia might be due to the amount of levodopa youre taking. Ask your doctor whether you can lower your dose enough to prevent side effects while still managing your Parkinsons symptoms. It might take some trial and error to get the dose just right.
Another option is to switch to an extended-release form of dopamine. Because the drug releases more slowly into your blood, it prevents the dopamine spikes and valleys that can trigger dyskinesia.
You might also need to add more of a drug. For example, adding extra carbidopa to levodopa can cut down on nausea.
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