Parkinson's Disease
How is it treated?
Currently, there is no cure for Parkinson's disease. The goals of treatment are to minimize disability, reduce the possible side effects of drug therapy, and help the patient maintain the highest possible quality of life.
Mild symptoms that do not interfere with daily activities or disrupt work duties may not require medication. When prescription drugs are needed, they help to manage symptoms, but they cannot stop the disease from progressing. Often, when a drug no longer effectively controls symptoms, another drug may be added to existing therapy. Optimal management is highly individualized and is best determined by a doctor who specializes in the treatment of Parkinson's disease.
Medications currently used in Parkinson?s disease include levodopa, COMT inhibitors, dopamine agonists, amantadine, anticholinergics, and selegiline. Levodopa (Larodopa) is a common medication used in Parkinson?s disease that is converted to dopamine in the brain. Dopamine is used to transmit signals in the brain and allows for normal movements. Levodopa is often combined with carbidopa (Sinemet) which increases the amount of levodopa that goes to the brain.
COMT inhibitors include entacapone (Comtan) and tolcapone (Tasmar) and work by blocking the action of an enzyme in the body known as catechol-O-methyltransferase that breaks down dopamine. By inhibiting dopamine?s breakdown, COMT inhibitors are able to decrease the symptoms of Parkinson?s disease that result from decreased levels of dopamine.
Dopamine agonists such as bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip), and apomorphine (Apokyn) act like dopamine within the brain to reduce Parkinson?s disease symptoms.
Amantadine (Symmetrel) is an antiviral medication that was found to have benefit in Parkinson?s disease, although the mechanism is unknown. It is thought that amantadine may work by increasing the response of the brain to dopamine or releasing stored dopamine.
Anticholinergics used to treat Parkinson?s disease include benztropine mesylate (Cogentin), procyclidine (Kemadrin), biperiden (Akineton), and trihexyphenidyl. These drugs work by exerting a relaxing effect on the body.
Selegiline (Zalapar, Eldepryl, Emsam) is another option for patients suffering from Parkinson?s disease; however, its mechanism of action is unknown. Selegiline appears to inhibit the breakdown of dopamine, and is usually added to a patient?s therapy when the effectiveness of levodopa is decreased. Emsam is available as a patch, and Zelapar is available as disintegrating tablets.
Surgery remains the only option for those patients with severe or quickly-progressing Parkinson's disease who have failed all other therapies. In a surgical technique called pallidotomy, an electric probe is used to destroy a small, overactive portion of the brain that is thought to cause the symptoms of Parkinson's disease.
A thalamotomy is the removal of the thalamus region of the brain. The thalamus is responsible for involuntary movements; destroying it prevents involuntary movements. Although this type of surgery is rarely performed, it can be a last resort for patients who have disabling tremors in the hand or arm. However, the procedure does not relieve other symptoms of Parkinson's disease. .
Thalamic stimulation is another approach in the management of Parkinson's disease. In this procedure, an electrode wire is inserted into the thalamus. The other end of the wire is connected to a pulse generator, and the generator is placed under the skin in the chest area. This device can produce the benefit of thalamotomy without causing a wound or scars on the skin. Thalamic stimulation has shown to be very effective in the management of tremor in Parkinson's disease.
Deep brain stimulation (DBS) is a new, alternative procedure used to destroy small regions of the brain. A thin electrode implanted into the brain blocks brain waves that can cause uncontrollable movements. This procedure must be continued throughout the patient?s life. It is especially useful in patients that have severe symptoms associated with tremor, involuntary movements (dyskinesia), and problems with gait.
Drug classes used to treat Parkinson's Disease Anticholinergics for Parkinson's Disease COMT Inhibitors Combination Anti-Parkinson's Agents Dopamine Receptor Agonists Levodopa and Carbidopa MAO-B Inhibitors Miscellaneous Anti-Parkinson's Agents
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How is it treated?
