Parkinson’s disease was first described by James Parkinson in 1817. Nearly 100, 000 Canadians from all ethnic backgrounds are affected with this disabling condition. Although most people affected are over the age of 55 years, it has been known to occur in young people as well. It is a neurodegenerative disease and involves the loss of brain cells capable of producing dopamine. Dopamine is a neurotransmitter; a chemical which carries signals between the nerves in our brain. Dopamine helps facilitate the movement of our body, the deficiency of which results in slowness of the different movements of body which is one of the cardinal feature of Parkinson’s. Although there isn’t a cure for Parkinson’s yet, you can live with the disease for years. It progresses at a different rate for every person.
Parkinson’s is diagnosed by history and physical examination done by a physician. There are no x-rays or laboratory tests that can be used to verify this disease. A neurologist may observe you for a period of time to make sure the symptoms are consistent.
Major symptoms of Parkinson’s include a tremor which usually starts on one side of the body in hand, arm or leg while in resting position, slowness of movements in performing activities of daily life, shuffling, slow speed of walking and rigidity or stiffness of the muscles.
As the disease progresses other symptoms including fatigue, small sized hand writing, reduced facial expression, drooling, imbalance difficulty turning, freezing of gait, falls, stooped posture, constipation, sleep disturbances, speech and swallowing problems, memory and cognitive dysfunction, depression, anxiety, pain, sensory disturbances, decreased sense of smell, urinary bladder and sexual dysfunction, dry skin and postural dizziness may become more prominent. Discussing these symptoms with your doctor is very important.
Medications and rehabilitation are the primary treatments used to lessen the symptoms. However as the disease progresses, quantity and dosage of medications need to be adjusted. In selected cases, surgery can also be an option. Medications may have some side effects as well. Rehabilitation includes physical, speech, and occupational therapy. Physical therapy helps mobility, flexibility and balance whereas speech therapy helps with voice control and swallowing. Occupational therapy focuses on easing everyday activities. Exercise such as yoga and tai chi can also be very beneficial.
Drug therapy is the mainstay of the treatment of Parkinson’s and should be begin before or when symptoms of Parkinson’s start affecting your normal activities of life. This may vary person to person and depends on a number of factors such as your age, symptoms at the onset, the side of body involved (dominant vs non-dominant) and your lifestyle. A working person may need to be started on drug therapy earlier than someone who is retired because of difficulty in carrying out activities related to employment as a result of Parkinson’s. Overall, only you can make the decision of when to start medications and the advice of your doctor should also be taken into consideration.
There are many different types of medications used for Parkinson’s and some have potential side effects as well. It is important to keep in mind that these drugs will not stop the progression of the disease. However, they will reduce your symptoms, so you are better able to carry out your daily activities. The medications must only be used as prescribed. Therefore, it is imperative to update your doctor about the medications which are effective Do not adjust your dosages without the approval of your doctor.
This is just a summary of the medications used but you should strictly follow the advice of your doctor about the medications and treatment of your condition.
This drug helps to improve the speed of movements and reduce muscle rigidity. Once it enters the brain, it is converted into dopamine. Different formulations of Levodopa include levodopa / benserazide or Prolopa, levodopa / carbidopa or Sinemet and Sinemet CR Drugs such as carbidopa and benserazide block the peripheral metabolism of levodopa and help in reducing Levodopa’s side effects such as nausea, dizziness, and decreased appetite. Other side effects include involuntary movements or dyskinesias and hallucinations. The effectiveness of Levodopa may decrease as the disease progresses, so larger dosages may be needed in advanced stages of Parkinson’s.
Currently available COMT inhibitor is Entacapone or Comtan. This drug is used to improve the effectiveness of Levodopa. It prevents a certain enzyme from breaking down Levodopa thus prolonging the life of Levodopa in the body. Its side effects consist of involuntary movements, diarrhea and change in urine color.
The commonly used dopamine agonists include Pramipexole or Mirapex ®, Ropinirole or ReQuip®, Rotigotine or Neupro®. These work by stimulating dopamine receptors in the brain. Levodopa and Dopamine Agonists have almost similar side effects except nausea and hallucinations may occur more frequently with Dopamine Agonists. Other side effects include ankle swelling, daytime drowsiness which may be of sudden onset and interfere with driving. Behavioral side effects include compulsive gambling, shopping, eating and hypersexuality.
These include Selegeline or Eldepryl® and Rasagiline or Azilect®. These drugs reduce the symptoms of Parkinson’s by preventing the breakdown of dopamine. Selegiline or Eldepryl can act as a stimulant which may cause insomnia, otherwise, the side effects are similar to Levodopa.
The effect of this drug is carried out by increasing dopamine release, blocking a specific receptor for glutamate in the brain and possibly by anticholinergic mechanisms. It helps the tremor, may also help slowness and rigidity in the early stages of Parkinson’s. This also helps dyskinesias which are involuntary movements caused by Levodopa and therefore may be used in the advanced stages of Parkinson’s. Its side effects include urinary retention, skin blotches, hallucinations and swelling of feet.
These include Trihexyphenidyl or Artane® and Trihexbenztropine or Cogentin®. These drugs may be used to treat the tremor in the early stage of Parkinson’s. They work by restoring the balance between dopamine and acetylcholine. Acetylcholine is also a neurotransmitter found in the brain. They can cause many side effects including memory problems and therefore there use is limited.
The medications should be taken at the right time in right dosage. Keeping track of when the medication was effective and when it wasn’t, making notes of the side effects, sharing this with your doctor at regular intervals leads to a better treatment. You should use the same pharmacy consistently, so they have a record of your medication history. Thus, there is less of a chance you will buy a prescription free product that may interfere with your drug treatment.
Always try to drink a glass of water with each dose of your medication. This will help the absorption process of the medication. Also, you should swallow controlled-release tablets without chewing them. Thus, the contents will be able to reach their target destination more efficiently.