Because there is no cure for Parkinson’s Disease, treatment
for the disorder is primarily symptom management. Treatment must figure in age,
symptoms, stage of disease and level of physical activity. Treatment should be
started when symptoms begin to interfere with daily life.
Remember that Parkinson’s Disease destroys the brain cells
that produce dopamine and it is this reduction in dopamine that causes most of
the (motor) symptoms of PD. So treatment is usually aimed at increasing the
amount of dopamine circulating in the body. Dopamine cannot be given to a
person directly because it cannot reach the brain. This is due to something
called the blood brain barrier. The brain is very selective about what it
allows to pass through it via the blood and dopamine is not allowed by itself.
However, there is a drug that can pass the blood brain barrier and once it is
in the brain it can be converted to dopamine and thus increase the levels in
the brain – relieving symptoms! This medication is called Levodopa. We’ll focus
on this medication for the treatment of PD because it is considered the most
effective. Levodopa is given mostly in pill form but now there are trials of a
gel form administered with a pump attached directly to the small intestine. It has
to be administered with a drug called Carbidopa that keeps the drug intact
until it reaches the brain so that it doesn’t get broken down by the body
before it needs to be. These drugs are particularly effective for the symptom
of bradykinesia (slowed movement) and rigidity.
Levodopa does have some side effects. The most common are
nausea, sleepiness, dizziness and headache. Serious side effects include
confusion, hallucinations and psychosis but if the person begins on a low does that
is gradually increased, these side effects are rare. Levodopa is a quick acting
drug and sometimes the effects wear off before a person with PD receives their
next dose. This may cause some unpleasant motor symptoms such as jerking and
muscle spasms. This is more likely to occur in individuals who have been taking
Levodopa for long periods of time (upwards of 5 years). Also with long term use
and progression of the disease, doses of Levodopa will have to be adjusted and
slowly increased. Eventually sensitization may occur where the drug is no
longer as effective. It is important to monitor symptoms and doses of the drug
to ensure the best outcome.
The main objective in treatment of PD is to reduce the
symptoms that interfere with daily life. If the medication that the person is
taking has unpleasant side effects that also interfere with daily life, it is a
judgment call on behalf of the patient, their family and the health
professional whether or not to continue with the medications. There is a lot of
trail and error when it comes to symptom management.
Some other medications that can be used to help ease
symptoms include:
- Dopamine agonists- directly stimulate dopamine receptors in the brain
- Monoamine oxidase inhibitors (MAOIs)- prevent dopamine from being broken down by blocking the effect of the enzymes that normally break it down.
- Anticholiergic medications- reduce tremor symptoms
- Treating Parkinson’s Disease requires symptom management and not just of the typical motor symptoms. Antidepressants, stool softeners and sleep medications may also be given.
Deep brain stimulation (DBS) is also a way to treat PD but
it’s a little bit more invasive and usually used to treat later stages of the
disease. It requires surgical placement of electrodes that send electrical
pulses into the part of the brain involved in Parkinson’s Disease. It is
thought that the stimulation reduces symptoms associated with PD by
inactivating the parts of the brain that cause symptoms.
Watch this video to see one man’s
journey through DBS. It’s lengthy but very interesting.
If video does not appear, please click on link to view it!
References:
Deep Brain Stimulation Surgery to treat Parkinson's Disease
(2013). Youtube. Retrieved from https://www.youtube.com/watch?v=MEBdXbZ5CDM
Tarsy, D. (2015). Pharmacologic treatment of Parkinson
disease. UptoDate. Retrieved from http://www-uptodate-com.offcampus.lib.washington.edu/contents/pharmacologic-treatment-of-parkinson-disease?source=search_result&search=treatment+of+parkinsons+disease&selectedTitle=1~150
Tarsy, D. (2014). Patient information: Parkinson disease
treatment options — medications (Beyond the Basics). UptoDate
Understanding Parkinson’s Disease- Diagnosis and Treatment (2015).
WebMD. Retrieved from http://www.webmd.com/parkinsons-disease/guide/understanding-parkinsons-disease-treatment
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