Parkinson's disease medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
The mainstay of therapy for motor symptoms of Parkinson disease are:
- Levodopa: This drug is the most effective in controlling motor symptoms in PD patients.[1][2] If we use levodopa alone, it will convert to dopamine in the peripheral circulation, so we combine it with a decarboxylase inhibitor like carbidopa to prevent this. The ratio of carbidopa_levodopa in tablets are 10/100, 25/100 or 25/250.[3][4] The adverse effects of this drug includes elevated serum homocysteine, low levels of vitamin B12, elevated methylmalonic acid and sensorimotor peripheral neuropathy.[5][6][7][8] It can also cause motor fluctuations, dyskinesia, cramps and dystonia.[9][10] One of the concerns regarding long term use of levodopa is that it may be increase the rate of dopamine neurons degeneration[11] but other studies demonstrated that it does not damage neurons.[12][13]
- Dopamine agonists: Dopamine agonist such as bromocriptine, pramipexole and ropinirole are proved to be effective in managing motor symptoms of PD patients.[14] At first, the use of dopamine agonist were limited t the condition where there is reduced levodopa response or when we had disturbing levodopa complications[15][16] but since dopamine agonists have fewer side effects, some experts suggest using these drugs as the first line therapy especially for PD patients under 60 years old.[17] The adverse effects of dopamine agonist are nausea, vomiting, sleep disorders, confusion and peripheral edema.[18]
- Monoamine oxidase (MAO) B inhibitors:
- Anticholinergic agents:
- Amantadine:
- Catechol-O-methyl transferase (COMT) inhibitors:
- Estrogen:
- Other agents:
Treatment choices for some of the nonmotor symptoms of PD are:
- Psychosis:
- Dementia:
- Daytime sleepiness:
- Fatigue:
- Depression:
- Constipation:
- Sialorrhea:
- Rhinorrhea:
- Sexual dysfunction:
- Ortostatic hypotention:
References
- ↑ Connolly BS, Lang AE (2014). "Pharmacological treatment of Parkinson disease: a review". JAMA. 311 (16): 1670–83. doi:10.1001/jama.2014.3654. PMID 24756517.
- ↑ Ferreira JJ, Katzenschlager R, Bloem BR, Bonuccelli U, Burn D, Deuschl G, Dietrichs E, Fabbrini G, Friedman A, Kanovsky P, Kostic V, Nieuwboer A, Odin P, Poewe W, Rascol O, Sampaio C, Schüpbach M, Tolosa E, Trenkwalder C, Schapira A, Berardelli A, Oertel WH (January 2013). "Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease". Eur. J. Neurol. 20 (1): 5–15. doi:10.1111/j.1468-1331.2012.03866.x. PMID 23279439.
- ↑ "Parcopa: a rapidly dissolving formulation of carbidopa/levodopa". Med Lett Drugs Ther. 47 (1201): 12. January 2005. PMID 15706700.
- ↑ Ondo WG, Shinawi L, Moore S (December 2010). "Comparison of orally dissolving carbidopa/levodopa (Parcopa) to conventional oral carbidopa/levodopa: A single-dose, double-blind, double-dummy, placebo-controlled, crossover trial". Mov. Disord. 25 (16): 2724–7. doi:10.1002/mds.23158. PMID 20925074.
- ↑ Toth C, Brown MS, Furtado S, Suchowersky O, Zochodne D (October 2008). "Neuropathy as a potential complication of levodopa use in Parkinson's disease". Mov. Disord. 23 (13): 1850–9. doi:10.1002/mds.22137. PMID 18785232.
- ↑ Toth C, Breithaupt K, Ge S, Duan Y, Terris JM, Thiessen A, Wiebe S, Zochodne DW, Suchowersky O (July 2010). "Levodopa, methylmalonic acid, and neuropathy in idiopathic Parkinson disease". Ann. Neurol. 68 (1): 28–36. doi:10.1002/ana.22021. PMID 20582991.
- ↑ Ceravolo R, Cossu G, Bandettini di Poggio M, Santoro L, Barone P, Zibetti M, Frosini D, Nicoletti V, Manganelli F, Iodice R, Picillo M, Merola A, Lopiano L, Paribello A, Manca D, Melis M, Marchese R, Borelli P, Mereu A, Contu P, Abbruzzese G, Bonuccelli U (September 2013). "Neuropathy and levodopa in Parkinson's disease: evidence from a multicenter study". Mov. Disord. 28 (10): 1391–7. doi:10.1002/mds.25585. PMID 23836370.
- ↑ Uncini A, Eleopra R, Onofrj M (May 2015). "Polyneuropathy associated with duodenal infusion of levodopa in Parkinson's disease: features, pathogenesis and management". J. Neurol. Neurosurg. Psychiatry. 86 (5): 490–5. doi:10.1136/jnnp-2014-308586. PMID 25168395.
- ↑ Calabresi P, Di Filippo M, Ghiglieri V, Tambasco N, Picconi B (November 2010). "Levodopa-induced dyskinesias in patients with Parkinson's disease: filling the bench-to-bedside gap". Lancet Neurol. 9 (11): 1106–17. doi:10.1016/S1474-4422(10)70218-0. PMID 20880751.
- ↑ Aquino CC, Fox SH (January 2015). "Clinical spectrum of levodopa-induced complications". Mov. Disord. 30 (1): 80–9. doi:10.1002/mds.26125. PMID 25488260.
- ↑ Olanow CW, Agid Y, Mizuno Y, Albanese A, Bonuccelli U, Bonucelli U, Damier P, De Yebenes J, Gershanik O, Guttman M, Grandas F, Hallett M, Hornykiewicz O, Jenner P, Katzenschlager R, Langston WJ, LeWitt P, Melamed E, Mena MA, Michel PP, Mytilineou C, Obeso JA, Poewe W, Quinn N, Raisman-Vozari R, Rajput AH, Rascol O, Sampaio C, Stocchi F (September 2004). "Levodopa in the treatment of Parkinson's disease: current controversies". Mov. Disord. 19 (9): 997–1005. doi:10.1002/mds.20243. PMID 15372588.
- ↑ Rajput AH (2001). "The protective role of levodopa in the human substantia nigra". Adv Neurol. 86: 327–36. PMID 11553992.
- ↑ Parkkinen L, O'Sullivan SS, Kuoppamäki M, Collins C, Kallis C, Holton JL, Williams DR, Revesz T, Lees AJ (October 2011). "Does levodopa accelerate the pathologic process in Parkinson disease brain?". Neurology. 77 (15): 1420–6. doi:10.1212/WNL.0b013e318232ab4c. PMID 21917769.
- ↑ Olanow CW, Watts RL, Koller WC (June 2001). "An algorithm (decision tree) for the management of Parkinson's disease (2001): treatment guidelines". Neurology. 56 (11 Suppl 5): S1–S88. PMID 11402154.
- ↑ Fahn S (December 1996). "Is levodopa toxic?". Neurology. 47 (6 Suppl 3): S184–95. PMID 8959987.
- ↑ "International symposium on early dopamine agonist therapy of Parkinson's disease". Arch. Neurol. 45 (2): 204–8. February 1988. PMID 3341935.
- ↑ Marras C, Lang A (May 2008). "Invited article: changing concepts in Parkinson disease: moving beyond the decade of the brain". Neurology. 70 (21): 1996–2003. doi:10.1212/01.wnl.0000312515.52545.51. PMID 18490620.
- ↑ Stowe RL, Ives NJ, Clarke C, van Hilten J, Ferreira J, Hawker RJ, Shah L, Wheatley K, Gray R (April 2008). "Dopamine agonist therapy in early Parkinson's disease". Cochrane Database Syst Rev (2): CD006564. doi:10.1002/14651858.CD006564.pub2. PMID 18425954.