Treatment of Parkinson's disease
|

Enhancing Quality of Life: The Latest in Parkinson’s Disease Treatments

Introduction to the Treatment

Currently, for Parkinson’s disease, there is no definitive cure, that is, it can lead to complete and definitive healing. However, several treatments are available that allow you to check the symptoms resulting in an improvement of the general condition and, therefore, quality of life.

The therapeutic or, more precisely, symptomatic strategy (i.e. which does not act by removing the cause, but only by decreasing the intensity of the various disorders) must be established by the doctor, taking into account the severity of symptoms and of stage of the disease.

Protocol depending on the Phases of Parkinson’s Disease

The treatment of Parkinson’s disease is modulated based on the progression of the disorder. The basic principle is to start with low doses of drugs, and then possibly increase the quantity, replace them or combine them with other medicinesin case the desired effect is not obtained.

During the early stages of the disease, symptoms are generally mild and no type of drug treatment is necessary. However, it is advisable to monitor the progress of Parkinson’s disease with periodic check-ups with a specialist doctor.

Parkinson’s disease: what treatments are available?

Available treatments for Parkinson’s disease include:

  • Supportive therapies (physiotherapy, occupational therapy, etc.);
  • Pharmacological therapy;
  • Surgery (indicated only in selected cases).

In most cases, people with Parkinson’s disease respond well to treatment. In a minority of patients, however, the treatments are not equally effective and, over time, the degree of disability increases to the point of compromising the performance of normal daily activities in complete autonomy. However, therapeutic advances offer patients with Parkinson’s disease a life expectancy similar, or almost similar, to that of healthy people.

What’s Important to Know

  • From the onset of the first symptoms it is recommended consult a neurologist that can direct you towards the most appropriate therapeutic procedure for the individual case: it has been demonstrated that the early treatment it can help slow down the evolution of the disease;
  • Parkinson’s disease varies from subject to subject, both in terms of the number of symptoms and their intensity. The specialist prepares one personalized care strategy based on the characteristics of the disease. The therapeutic scheme must be reviewed and updated periodically, taking into consideration the clinical characteristics and comorbidities of the patient, the therapeutic objectives, the potential benefits and side effects of the different drugs.
  • Never neglect therapy, or suspend or modify it on your own initiative: Medications such as Levodopa are critical to the management of Parkinson’s disease.
Antiparkinsonian drugs

The purpose of drug therapy of Parkinson’s disease is to replace the dopamine deficit in the striatum, mimicking physiological stimulation. There Levodopa (commonly said L-Dopa) represents the main treatment and has the function of increasing the concentration of dopamine in the brain, essential for the control and coordination of body movements. Due to its chemical structure, the latter is not, in fact, able to cross the blood-brain barrier which, however, can be overcome by Levodopa.

Levodopa

There Levodopa (L-3,4-dihydroxyphenylalanine or L-dopa) is the physiological precursor of dopamine and, precisely for this reason, it is able to improve the symptoms; the drug works by trying to remedy the deficit that characterizes Parkinson’s disease. Levodopa is able to cross the blood-brain barrier and, once it reaches the brain, it is absorbed by nerve cells and transformed into dopamine.

Initially, therapy with Levodopa induces a clear improvement in symptoms: in this regard, we speak of a “therapeutic honeymoon”, which lasts from 2 to 5 years, where the therapy almost completely controls the disorders associated with Parkinson’s disease and the patient leads an almost normal life. Subsequently, however, a phase occurs in which there is a decrease in the effectiveness of Levodopa, consequently there is an aggravation of the symptoms of the disease. However, even today, compared to other available therapies, treatment with Levodopa is still associated with a greater improvement in motor function and a greater slowdown in the progression of disability. Furthermore, Levodopa is one of the best tolerated drugs, particularly in elderly individuals.

The therapeutic benefits of Levodopa are undisputed, but, when it reaches its maximum concentration in the blood, this drug is responsible for various problems, such as restlessness and disordered and uncontrollable movements (dyskinesias). Furthermore, at the beginning it can cause nausea, vomiting and drops in blood pressure. Unfortunately, the side effects of the drug partially limit its therapeutic potential: for this reason, it is not always prescribed at the first signs of Parkinson’s disease.

Complications associated with the use of the drug can be limited by:

  • On the dosage and the intervals between one administration and another;
  • Combining other medicines can improve the availability of L-Dopa in the body.

To overcome this problem, the following have been formulated:

  • Peripheral dopa decarboxylase inhibitors such as the carbidopa which must be administered in combination with Levodopa in order to improve its absorption and passage into the central nervous system (in practice, carbidopa prevents Levodopa from transforming into dopamine before reaching the brain).
  • Slow release preparations consisting of Levodopa in association with beserazide or with carbidopa in a ratio of 4:1.

Dopamine Agonists – Dopamine-Agonist Drugs

Dopamine agonists are drugs available in the form of tablets, patches and injections that mimic the action of endogenous dopamine (i.e. produced by the organism), binding to its receptors and activating them. However, their effectiveness is lower than that of Levodopa, which is why they are prescribed less frequently. Generally, dopaminergic drugs are indicated for patients with early-stage Parkinson’s disease whose motor symptoms do not affect quality of life.

The side effects of these drugs are different and include: hallucinations, hypotension, mental confusion, drowsiness, sudden falls of sleep, nausea or vomiting, tiredness and dizziness. Among the active ingredients belonging to this group of drugs that can be used in the treatment of Parkinson’s disease are pramipexole, rotigotine, ropinirole and apomorphine.

MAO-B inhibitors

Monoamine oxidase type B inhibitors (MAO-B), including selegiline, rasagiline and safinamide, represent another group of drugs for the treatment of Parkinson’s disease. These medicines inhibit enzymes that degrade dopamine (monoamine oxidase B) producing an increase in endogenous dopamine levels, allowing it to remain in the brain longer, and that taken in the form of Levodopa.

Generally, MAO-Bs are well tolerated, but, in some patients, they can cause side effects such as nausea, headache, abdominal pain and arterial hypertension.

Catechol-O-Methyl Transferase (COMT) Inhibitors

Another category of drugs used for Parkinson’s disease are inhibitors of catechol-O-methyltransferases (COMT), ubiquitous enzymes in the body located mainly in the cytoplasm and plasma membrane of post-synaptic cells.

Catechol-O-methyltransferase inhibitors increase the persistence of Levodopa in the blood and, consequently, in the brain: COMTs are involved in the central metabolism of dopamine and in the peripheral metabolism of Levodopa, consequently their inhibition determines a notable increase in peripheral and central levels of L-Dopa and a block of central catabolism of dopamine.

COMT inhibitors are used in the treatment of patients with Parkinson’s disease who show a fluctuating response to Levodopa, thanks to their ability to maintain more stable plasma levels of dopamine. Among the active ingredients used are entacapone and tolcapone.

Other Medicines

  • Anticholinergics: they act mainly to control tremor;
  • Amantadine And bromocriptine: they work by enhancing the presence of dopamine, effectively reducing dyskinesias and “freezing” episodes (sudden motor blocks that temporarily prevent you from moving your feet).

To know more:
Drugs for the treatment of Parkinson’s disease

Surgery and Other Treatments

Deep Brain Stimulation

In most cases, Parkinson’s disease is treated with drug therapy, but if this does not produce any beneficial effect, surgery may be indicated. deep brain stimulation.

This approach involves the implantation of a pacemaker, i.e. a generator of electrical impulses (very similar to the cardiac one), in a specific area of ​​the brain with the aim of stimulating the brain area damaged by the disease.

Although it does not allow the cure of Parkinson’s disease, deep brain stimulation significantly improves the symptoms (especially tremor), allowing the patient to better manage daily activities.

Symptomatic and Supportive Therapy

The supportive therapies, like motor rehabilitation, can improve the patient’s daily life, especially at the beginning and in the intermediate phases. Physiotherapy and occupational therapy can improve, through physical and practical exercises, the patient’s quality of life, trying to preserve their autonomy.

There Physiotherapy it can help people suffering from Parkinson’s disease, in particular, to alleviate muscle stiffness and joint pain, with improvement in mobility and walking. There occupational therapyinstead, it aims to identify practices to facilitate the activities of daily life in which the person affected by Parkinson’s disease encounters greater difficulties, such as dressing, taking care of personal hygiene or shopping.

There speech therapy aims to alleviate dysphagia and rehabilitate the voice, indicating any technological aids (e.g. computers). A speech pathologist can teach exercises that improve speech and swallowing.

The advice of expert professionals, such as psychologists or social workers, it can be useful in dealing with the emotional consequences of Parkinson’s disease.

Other articles on ‘Treatment of Parkinson’s disease’

  1. Diagnosis of Parkinson’s disease
  2. Parkinson’s disease
  3. Causes of Parkinson’s disease
  4. Parkinson’s disease – Symptoms of the disease
  5. Other Symptoms of Parkinson’s Disease
  6. Stages of Parkinson’s disease

 

Similar Posts