Parkinson's Disease Medication Treatment

Diabetes Medications And Parkinsons

Parkinson’s Disease & Medication – What’s New

Because of the common cellular changes that happen between both conditions, medications for diabetes may reduce the impact of Parkinsons disease. Insulin actively crosses the blood-brain barrier and is produced in small quantities within the brain. Insulin is a neuroprotective hormone in the brain. Parkinsons disease reduces the actions of insulin. With this information, it follows that some medications used for the treatment of type 2 diabetes may have beneficial effects with Parkinsons disease.

A group of medications used in type 2 diabetes, GLP-1 agonists, may improve cognition and motor function in Parkinsons disease. GLP-1 is a naturally occurring hormone produced by cells lining our gut which is released when we eat. This natural hormone slows the gut motion and helps the pancreas release extra insulin. In type 2 diabetes, this hormone, also called an incretin hormone, does not work as efficiently as a person without diabetes. This group of injectable medications for type 2 diabetes produces the same and more potent response.

Much more research is needed to determine if GLP-1 agonists may be introduced to people living with diabetes and Parkinsons disease with dual benefits. Further research could determine if people with a significant risk of Parkinsons disease or cognitive decline may reduce the risk of onset.

Donna Itzstein Pharmacist, CDE

Parkinsons Symptoms Including Pain And Frequent Urination

Pain is a common cause of sleep disturbances in Parkinsons, says Horvat. A study published in June 2019 in the Journal of Pain Research found that about one-third of people with Parkinsons had clinically relevant sleep disturbances, and that central parkinsonian pain was the pain subtype that was most often associated with sleep issues.

Central pain can vary widely from person to person. It can feel like a constant burning or tingling that affects the whole body or it can be an intermittent sharp episode of pain, according to the Parkinsons Foundation.

You should definitely talk to your doctor if pain or Parkinsons symptoms are waking you up or keeping you up at night, to see what your treatment options may be, says Horvat.

Frequent urination can be a sign of several different things, and so its important to pay attention to any other symptoms you may also be having, she says.

Autonomic instability is often present in Parkinsons disease, which basically means the autonomic system is not firing regularly, as it should be, says Horvat. The autonomic system controls functions that keep you alive, including your heartbeat, breathing, and digestion.

This condition can lead to incontinence or urinary retention, she says. This is something to talk with your doctor about there are some medications that can be helpful.

Monoamine Oxidase B Inhibitors

Other PD medications work by inhibiting the enzymes involved in dopamine metabolism, which preserves the levels of endogenous dopamine. One such class is the MAO-B inhibitors. As is discussed above, MAO-B is one of the main enzymes involved in the breakdown of dopamine, and reducing the activity of this enzyme therefore results in increased dopaminergic activity within the striatum, mediated by endogenous dopamine . Their use relieves motor symptoms in PD patients, and as with dopamine agonists they may be used as an initial treatment option, to delay the need for levodopa therapy, to reduce the risk of levodopa-induced motor complications . While they are sometimes sufficient for control of symptoms in early disease, most patients ultimately require levodopa-based treatment. MAO-B inhibitors may also be used in combination with levodopa-based preparations, to allow for a reduction in the levodopa dose.

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Managing Your Symptoms With Medication

Almost all patients with Parkinsons disease eventually need to take medication to help with their motor symptoms. Several classes of medications are available and can be viewed here. Carbidopa/Levodopa remains the most effective symptomatic therapy and is available in many strengths and formulations. It also may be used in combination with other classes of medications including Dopamine Agonists, COMT Inhibitors, MAO Inhibitors, and Anticholinergic agents. Treatment is highly individualized and adjusted over time based on symptoms and side effects.

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.

Insomnia And Parkinsons Disease

Parkinsons disease comes with its fair share of challenges. Among the most frustrating symptoms of Parkinsons is insomnia, or difficulty sleeping. Research has found that the majority of people with PD experience trouble sleeping, and more than 3,000 members of MyParkinsonsTeam report difficulty sleeping as a symptom. Lack of regular sleep can have tremendous impacts on a persons quality of life. In fact, dealing with a sleep deficit can cause anyone to experience problems with memory and thinking.

Good, restful sleep is vital for people with Parkinsons, but it isnt always easy to get quality sleep. Luckily, there are some ways you can work toward combating insomnia with Parkinsons.

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Important Points About The New Medications

With multiple new medications available for the treatment of PD, there is more hope than ever that Parkinsons symptoms can be successfully managed for many years. A few things to consider:

For people whose symptoms are difficult to control, these new treatments are welcome additions to what was previously available and many people with PD have been using these new medications with significant benefit.
On the other hand, many of the newly-approved medications have the same mechanisms of action as older medications so they are not breaking new ground in treating symptoms.
In addition, for some people, the effect on symptoms may be mild or not substantial.

These caveats may mean that your physician has not suggested a medication change for you. It is also important to note that despite all the new medications, carbidopa/levodopa remains the most potent medication to treat the motor symptoms of PD.

If your doctor does choose to try one of the new options, there may be multiple paths that your doctor can take when contemplating a medication adjustment. Often trial and error is the only way to determine the best medication regimen for you, so you may need to practice some patience as you work together with your doctor to determine what works or doesnt work.

Education Regarding Parkinsons Disease And Managing Medications

A nurse with specialist training in PD can provide education and support to the person with PD and their caregiver. This may include:

monitoring the effects of changes to PD medications as recommended by the neurologist and liaising with the neurologist
providing education and support around the recommended PD medications and assist with the minimisation of side effects
providing individualised education for the person with PD and their caregivers to ensure optimal understanding and management of the various PD symptoms as the condition progresses
arranging referrals to other relevant health professionals within the specialist team

Dbs And Other Parkinsons Surgeries

Pharmacology – Parkinsons Disease, Levodopa meds nursing RN PN NCLEX

Deep Brain Stimulation , a well-known surgery for Parkinsons, helps manage some of the symptoms of Parkinsons disease. Without getting too technical, you can think of it like a pacemaker for the brain. The nerves in your brain communicate with each other through electrical impulses. Some of these brain electrical circuits are disrupted by Parkinsons they start to fire electrical impulses to each other at abnormal rhythms, causing miscommunication. During the DBS procedure, a neurosurgeon will insert very thin electrical wires into the brain that introduce electrical currents that reset brain circuits, similar to the way a heart pacemaker ensures that your heart beats at a healthier rhythm. Once the DBS is implanted, a neurologist will typically work with you over a series of visits to program the device to optimize control of your symptoms. This Parkinsons treatment is not right for everyone and should be discussed with your doctor. If you would like to learn more about DBS you can watch a video giving an overview of the subject by .

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How Does This Condition Affect My Body

Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.

Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.

When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.

As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.

Dopamine Agonist Withdrawal Syndrome

If you suddenly stop taking dopamine agonists, this can lead to dopamine agonist withdrawal syndrome, which can cause symptoms such as depression, anxiety or pain.

Any withdrawal from Parkinsons drugs needs to be done in a tapered way, under the supervision of a health professional.

Speak to your specialist for advice.

New Medications For Off Time

A number of new medications approved recently are designed to reduce OFF time. These medications fall into two major categories:

Medications that lengthen the effect of a carbidopa/levodopa dose
Medications that are used as needed if medication effects wear off

Well give specific examples below. In general, new medications that extend the length of a carbidopa/levodopa dose are used if OFF time is somewhat predictable and occurs prior to next dose. New medications that are used as needed are most beneficial when OFF time is not predictable.

New medications that lengthen the effect of a dose of carbidopa/levodopa

Previous restrictions on the intake of foods containing tyramine with selective MAO-B inhibitors have been relaxed by the Food and Drug Administration . However, MAO-B inhibitors can interact with other medications, such as certain antidepressants, nasal decongestants, and narcotic pain medications. Typically, if a person is undergoing a procedure in the hospital and is taking a selective MAO-B inhibitor, they are advised to stop the medication two weeks prior to the procedure and to restart it 1-2 weeks after the procedure to avoid any unintentional medication interactions.

New formulations of levodopa designed to be used as needed if medication effects wear off

Other medications used as needed if medication effects wear off

Not All Drugs In These Classes Will Cause Symptoms Of Parkinsonism

Whats the difference?

Drug-induced parkinsonism usually develops on both sides of the body, while typical Parkinsons disease does not. Also, drug-induced parkinsonism usually does not progress like typical Parkinsons.

Unlike Parkinsons, drug-induced symptoms usually go away after the drug is stopped. It may take several months, though, for the symptoms to completely stop. If the symptoms remain, then it is possible that the drug may have unmasked underlying Parkinsons disease.

Who is at risk?

Female: Women are twice as much at risk as men.
Elderly: Older people are more likely to be on multiple medications or to have underlying Parkinsons disease.
Those with a family history of Parkinsons disease.
People with AIDS.

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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.

What Types Of Sleep Problems Do People With Parkinsons Disease Have

Parkinsons disease affects every person differently. It also impacts sleep in different ways. People with Parkinsons may have:

Insomnia, finding it hard to fall asleep.
Fragmented sleep, waking up many times over the night.
Excessive daytime sleepiness, finding it hard to stay awake during the day.
Very vivid dreams, which may cause hallucinations or confusion after waking up.
Emotional dreams or nightmares, which may make you feel emotionally drained after waking up.

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Keep A Medicine And Symptoms Diary

Keeping a diary can help you to monitor your condition and keep track of your medicines. A diary can be a useful way of letting your doctor know what problems youre experiencing, any changes in your condition from day-to-day or over a period of time, and how well your medicine is controlling your symptoms. It can also help remind you of things you want to discuss during your appointment that you may otherwise forget. You can also use it to record any embarrassing issues that you want help with but find difficult to ask about. Here is some advice on the type of information you might want to keep track of if you have Parkinson’s yourself, or if you are caring for somebody else with Parkinson’s.

What Are The Side Effects Of Parkinson’s Drugs

Pharmacology – DRUGS FOR PARKINSON’S DISEASE (MADE EASY)

The most common reactions include nausea, vomiting, dizziness , sleepiness and visual hallucinations.

In the last few years, levodopa and dopamine agonists in particular have been associated with the emergence of behavioral changes such as impulse control disorders. These are characterized by failure to resist an impulse to perform certain actions.

Impulse control disorders include a range of behaviors such as compulsive gambling or shopping, hypersexuality, binge eating, addiction to the Internet or to other recreational activities. These activities are often pleasant in the moment, but over time may become harmful to you or to others. If you are experiencing these behaviours, tell your neurologist/doctor. Often the medication can be adjusted which can reduce or control the behaviour.

Care partners can play an important role in helping to identify when these behaviours occur. If you are a care partner, tell the person if you have noticed a change in his/her behaviour or personality and encourage him/him/her to speak with the doctor immediately so medication can be adjusted.

Important Points In Treatment

A variety of agents are useful in the treatment of various stages of Parkinson’s disease. Education and support are essential elements of the treatment at the beginning of Parkinson’s disease. Support includes the participation of the family and often will involve support groups. A program of regular exercise is important for the patient’s physical well-being and helps to promote emotional stability as well.

In addition, a number of other health problems can simulate Parkinson’s disease, and a number of drugs can have parkinsonian side effects. The physician will first evaluate the patient to ensure that drug effects or other diseases are not underlying the development of the tremor. Treatment is individualized to meet the specific needs of each patient. Selection of treatment will vary with the stage of the disease and the age of the patient.

Surgical Treatment

The disability caused by Parkinson’s disease has made it the focus of much research. A number of surgical operations have been tried. These have proven to be of help in only a minority of patients. Some forms of therapy for parkinsonism remain experimental and are controversial. Your physician is your best guide to the opportunities that might be suited to your individual needs.

The most effective treatment for Parkinson’s disease is still drug therapy. In a few patients who fail to respond to drug therapy or who cannot take the most useful drugs, the possibility of surgical treatment may be considered.

Treatment Options For Parkinsons

While there is no cure for Parkinsons at this time, there are a number of treatments that can ease symptoms. Parkinsons medications are the mainstay of treatment, but modalities are often used in combination. Physical, occupational and speech therapy can be critical to the treatment plan. Surgical options also have an important role for a subset of patients with Parkinsons disease. Finally, complementary therapies can be used to treat some Parkinsons disease symptoms. Your physician and other healthcare professionals can help you determine the best treatment plan for your symptoms.

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Treatment Of Parkinson’s Disease

Treatment of PD requires a multifaceted approach comprising pharmacological and nonpharmacological efforts. Considerable evidence suggests that patients should be encouraged to adopt a regular program of exercise from the time of diagnosis.

There are numerous other medications available to treat PD. Anticholinergic drugs are primarily used to treat tremor. Amantadine is a modestly effective agent for a variety of motor symptoms and can also reduce levodopa-induced dyskinesias. MAO-B and COMT inhibitors, by extending the duration of action of individual doses of levodopa, may be useful for treating motor fluctuations. Patients who cannot be satisfactorily controlled with medications alone are often treated surgically. Deep brain stimulation surgery of the STN or globus pallidus pars interna is associated with marked motor benefit in a large proportion of correctly selected patients due to high-frequency electrical stimulation of the stereotactically targeted structure. Pallidotomy has not often been utilized since the advent of DBS.

Stanley Fahn MD, … Peter Jenner BPharm , PhD, DSc, FRPharms, in, 2007

Parkinson’s Disease Medication Treatment