Parkinson s Awareness Month. By Margeaux Amerine, Pharm.D. April is Parkinson's Awareness month, so today we will be discussing

Transcription

1 Parkinson s Awareness Month By Margeaux Amerine, Pharm.D. April is Parkinson's Awareness month, so today we will be discussing Parkinson's disease from diagnosis to treatment. Parkinson's disease is a progressive disorder of the nervous system that affects your movement. It belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamineproducing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50. Early symptoms of PD are subtle and occur Page 1 of 7

2 gradually. In some people the disease progresses more quickly than in others. As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions. There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD. Therefore the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose accurately. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases. The cause of Parkinson's disease is unknown, but several factors appear to play a role, including: Your genes. Researchers have identified specific genetic mutations that can cause Parkinson's disease, but these are extremely uncommon, except in rare cases with many family members affected by Parkinson's disease. However, certain gene variations (polymorphisms) appear to increase the risk of Parkinson's disease, but with a relatively small risk of for each of these genetic markers. Page 2 of 7

3 Environmental triggers. Exposure to certain toxins or environmental factors increase the risk of later Parkinson's disease, but the risk is relatively small. Risk factors for Parkinson's disease include: Age. Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk continues to increase with age. Heredity. Having a close relative with Parkinson's disease increases the chances that you'll also develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease. Sex. Men are more likely to develop Parkinson's disease than are women. Exposure to toxins. Ongoing exposure to herbicides and pesticides may put you at a slightly increased risk of Parkinson's disease. Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised. Your doctor also may recommend lifestyle changes, especially ongoing aerobic exercise. In some cases physical therapy that focuses on balance and stretching also is important. Page 3 of 7

4 Medications can help you manage problems with walking, movement and tremor by increasing your brain's supply of dopamine. However, dopamine can't be given directly, as it can't enter your brain. You may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms usually can continue to be fairly well controlled. Your doctor may prescribe medications, which may include: Carbidopa-levodopa (Parcopa). Levodopa, the most effective Parkinson's disease medication, is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa, which protects levodopa from premature conversion to dopamine outside your brain, which prevents nausea. Side effects include nausea or a drop in blood pressure when standing (may result in faintness). After years, as your disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane ("wearing off"). Also, you may experience involuntary movements (dyskinesia) after taking higher doses of levodopa. Your doctor may lessen your dose or adjust the times of your doses to control these effects. Page 4 of 7

5 Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in your brain. They aren't as effective in treating your symptoms as levodopa. However, they last longer and may be used with levodopa to smooth the sometimes off and on effect of levodopa. Dopamine agonists include pramipexole (Mirapex) and ropinirole (Requip). A short-acting injectable dopamine agonist, apomorphine (Apokyn), is used for quick relief. The side effects of dopamine agonists are similar to carbidopalevodopa, but also include hallucinations, swelling, sleepiness or compulsive behaviors such as hypersexuality, gambling and eating. If you're taking these medications and you start behaving in a way that's out of character for you, talk to your doctor. MAO B inhibitors. These medications include selegiline (Eldepryl, Zelapar) and rasagiline (Azilect). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme metabolizes brain dopamine. Side effects are uncommon, but may rarely include nausea or headaches. When added to carbidopa-levodopa, these medications can increase the risk of hallucinations. These medications can't be used in combination with most antidepressants or certain narcotics, due to potentially serious reactions. Check with your doctor before taking any additional medications with a MAO B inhibitor. Page 5 of 7

6 Catechol O-methyltransferase (COMT) inhibitors. Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down levodopa. The side effects are primarily those due to an enhanced levodopa effect, including an increased risk of involuntary movements (dyskinesias). Tolcapone (Tasmar) is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure. Anticholinergics. These medications were used for many years to help control the tremor associated with Parkinson's disease. Several anticholinergic medications are available, including benztropine (Cogentin) and trihexyphenidyl. However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination. Amantadine. Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson's disease. It also may be added to carbidopa-levodopa therapy for people in the later stages of Parkinson's disease, to help control involuntary movements (dyskinesia) induced by carbidopa-levodopa. Side effects may include a purple mottling of the skin, ankle swelling or hallucinations. Page 6 of 7

7 If you've received a diagnosis of Parkinson's disease, you'll need to work closely with your doctor and pharmacist to find a treatment plan that offers you the greatest relief from symptoms with the fewest side effects. Certain lifestyle changes also may help make living with Parkinson's disease easier. These include healthy eating, walking with care, and avoiding falls. Some types of alternative medicine may help people with Parkinson's disease, including: Coenzyme Q10, massage, acupuncture, tai chi, yoga, Alexander technique, meditation, and music therapy. Your Island Drug pharmacist is always available to answer questions about your Parkinson's medications or alternative therapies. Parkinson 's disease: National Institute of Neurologic Disorders and Strokes. sease.htm Parkinson's Disease: Mayo Clinic. the best option is no treatment. Page 7 of 7