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Treatment Methods What methods of treatment are available for persons with Parkinson's disease? A knowledgeable physician can offer patients much in the way of medical management and supportive therapies. It is important that the physician be compassionate and sensitive to the individual patient's needs as well. PD patients must be candid in sharing symptoms and concerns with their physicians to gain optimal benefit from the doctor/patient relationship. Many Parkinson symptoms can be controlled with currently available medications. Levodopa (also called L-dopa), the active anti-Parkinson drug in Sinemet and its generic brands, is the single most beneficial drug to relieve symptoms of Parkinson's disease. Levodopa is a short-acting drug that enters the brain and is converted into dopamine, the neurotransmitter that is low in PD. Levodopa is combined with another drug called "carbidopa", which enhances L-dopa's action in the brain and minimizes side effects such as nausea. (Approximately 12% of patients experience mild nausea with Sinemet, which usually subsides after a few weeks.) Low-dose Sinemet is commonly started when the patient experiences enough inconvenience or incapacity from PD symptoms to interfere with his or her ability to carry out normal activities. Maximal results are obtained the first few years on this medication, although most patients continue to get benefit for many years. With long-term use, some patients notice a shorter duration of action from each dose (known as the "wearing off" phenomenon), and some can develop an "on-off" effect in which symptoms may come and go at unpredictable intervals. Other medications are also used to treat Parkinson's disease, as solo agents or in combination with Sinemet. Selegiline, marketed as Eldepryl in the U.S., may offer some relief from early Parkinson symptoms, and research is still ongoing to determine if it might also have some neuro-protective benefit. Amantadine (Symmetrel) is an anti-viral drug that also provides an anti-Parkinson effect; it is most frequently used to widen the "therapeutic window" for Levodopa when used in combination with Sinemet. Benadryl, Artane, and Cogentine are brand names for anti-cholinergic agents that may be prescribed to treat tremors. While effective, these drugs can have side effects such as dry mouth, burred vision, urinary retention and constipation which limits their use in older adults. Bromocriptine (Parlodel) and Pergolide (Permax) are dopamine agonists. These drugs enter the brain directly at the dopamine receptor sites, and are often prescribed in conjunction with Sinemet to prolong the duration of action of each dose of levodopa. They may also reduce levodopa-induced involuntary movements called "dyskinesias". The physician slowly titrates a dopamine agonist to a therapeutic level, then gradually decreases the levodopa dose to minimize dyskinesias. Two new dopamine agonists, Ropinirole (Requip) and Pramipexole (Mirapex), have shown great promise in extensive clinical trials. Both have lower side-effect profiles than others available in the U.S. Tolcaponc (Tasmar) and Entacapone, drugs classified as COMT (catechol-0-methyl-transterase) inhibitors are near the end of clinical trials. Their mechanism of action is totally different than that of dopamine agonists. When COMT activity is blocked, dopamine remains in the brain for a longer period of time. These two medications offer new options to treat PD. Medications used singly or in combination can significantly enhance motor performance and treat other symptoms of Parkinson's disease. However, there is currently no agent known to prevent or cure the disease. Research funded by agencies such as the NPF and major pharmaceutical firms has been very successful over the past decade in providing more and better medications to improve the quality of life for Parkinson patients. There is realistic hope for a cure in the foreseeable future from medication advances or surgical innovations. Early efforts with adrenal medulla transplants and fetal tissue implantation, led to more sophisticated procedures such as thalamotomy for tremor, and pallidotomy to reduce overall Parkinson disability. One of the latest advances in neurosurgery is controlled trials with deep brain stimulation, wherein an electrode is planted deep within the brain and controlled by the patient with an on/off magnetic device. Most physicians agree that brain surgery is a reasonable option only for patients who are no longer responsive to optional medication management. Other research involving genetically-engineered cells, and brain derived neurotrophic factors (BDNF), is equally exciting. Allied health interventions--physical therapy (PT), occupational therapy (OT), which includes training and assist devices to simplify activities of daily living such as bathing, dressing, eating, performing chores, and speech therapy (ST)--can contribute immeasurably to a patient's ability to stay strong and mobile, avoid falls, accomplish necessary tasks, and communicate effectively. Psychotherapy (counseling) for patients and care partners can be helpful. Many families experience that stressful adjustment reactions, anxiety or depression arise in the family living with Parkinson's disease. Spouses, children, and friends of persons with Parkinson's disease also need some special attention and guidance. There are networks of support groups throughout the world that provide education and support services for families learning to live with PD. It's helpful to make contact with people who have experienced similar symptoms and reactions to the challenges of living with chronic illness. Contact NPF for referral to the nearest support group. It is imperative that caregivers take care of their own health and personal needs as well as assisting their loved one with Parkinson's disease if the family unit is to be maintained and nurtured. |
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| Treatment Methods / Parkinson's
Index / Diet / Patient Should Know / Things To Remember
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