This article was shortened for my blog, a longer version can be found at www.whelehans.ie or call in to Whelehans pharmacy Mullingar
Parkinson's disease is a long-term disorder of caused by
the degeneration of dopamine generating cells in the mid-section of the brain.
Its cause is unknown. Symptoms gradually worsen over time. The main symptoms
are stiffness, shaking (tremor) and slowing of movement. There is no cure but treatment can slow down
its progression and can provide good relief of symptoms for several years in
most patients. Modern treatment options means that people with Parkinson’s can
have a normal or near normal life expectancy.
Profile
of patients
Parkinson’s usually develops in people over the age of 50
and is rare in people under 50. It affects about 5 in 1,000 people in their 60s
about 40 in 1,000 people over 80. Men are one and a half times more likely to
get Parkinson’s than women.
Causes
With Parkinson’s, cells in the substantia nigra (the main
messaging area in the brain for controlling muscles) become damaged and die
over time. Dopamine, the main neurotransmitter becomes depleted due to
degeneration of this area which causes Parkinson symptoms.
Symptoms
The three main symptoms are slowness of movement,
stiffness and tremor.
Slowness of movement People may mistake this as a normal
part of aging which means diagnosis is delayed in many cases. With time, normal
walking becomes difficult and Parkinson’s patients often develop a 'shuffling'
type of walk with difficulty in starting, stopping, and turning.
Stiffness of muscles (rigidity) is when the muscles become
tense with the arms and legs tending not to swing as easily.
Tremor is common symptom of Parkinson’s. Not
all patients with Parkinson’s have tremor. About 30% of Parkinson’s patients do
not suffer from tremor initially but it always develops as the condition
progresses. It usually affects the
fingers, thumbs, hands, and arms but can affect any part of the body. Tremor is
worse when resting.
The speed in which symptoms become worse varies from
person to person. It can take several years before symptoms become bad enough
to affect routine tasks and quality of life. Other symptoms which can develop
include difficulty with balance and posture. Further symptoms include inability
to perform facial expressions like smiling or frowning; reduced blinking;
difficulty with fine movements such as using a scissors, tying shoelaces,
opening and closing buttons, zipping up and difficulty with writing (handwriting
tends to become smaller). There can be a slowdown in speech leading to a
monotone voice and swallowing difficulties can develop leading to pooling of
saliva in the mouth.
Treatment
There is no cure for Parkinson’s but treatments can ease
symptoms and slow progression. It can take 8 to 10 weeks from the start of
treatment before the patient notices improvement in symptoms.
Levodopa
Levodopa tends to give a good improvement in symptoms.
Levodopa is converted to dopamine in the brain. The dose is started low but
tends to be increased to control symptoms. Levodopa is always used in
combination with another medicine to prevent side effects (either benserazide
or carbidopa). Brands available include Madopar® and Sinemet®.
Side effects from Levodopa tend to be rare at low doses. Nausea is the most
common side effect. Other side effects which may occur include vomiting,
dizziness, low blood pressure; however these often ease after a few days of
use. Levodopa can also cause movement disorders (head nodding, jerking and
twitches) if used at too high a dose. The effect of Levodopa tends to wear off
over time, usually over a period of 3 to 5 years.
Dopamine agonists
Dopamine agonists mimic dopamine. Ropinirole (Requip®), pramipexole
(Mirapexin®) and rotigotine (Neupro® patch) are used most
commonly. Initial side-effects are similar to levodopa (nausea, vomiting and
dizziness) however side-effects tend to ease within a few days or weeks.
Despite being slight less effective than Levodopa, one potential advantage of
them as compared with levodopa is that they have less risk of causing movement
disorders (described above). A dopamine agonist may be used in combination with
levodopa as the condition gets worse. In trials comparing levodopa and dopamine
agonists, symptoms of Parkinson’s improved with levodopa by about 40 to 50% as
compared with approximately 30% with dopamine agonists.
Monoamine oxidase-B inhibitors
Sometimes used as alternative to levodopa for early
Parkinson’s. They include selegiline (Eldepryl®) and rasagiline
(Azilect®). They work by blocking the effect of monoamine-oxidase-B
(MAOB) in the brain, a chemical that prevents the breakdown of levodopa and
dopamine. Blocking the effect of MAO-B means the effect of dopamine lasts
longer. MAOBs are often used in combination with levodopa as the condition
progresses.
Other medication used for Parkinson's
disease
Catechol-O-methyltransferase (COMT) inhibitors have
become available in the last 20 years. Entacapone (Comtess® and also
an ingredient in Stalevo®) is an example. A COMT inhibitor is often
added to levodopa (as it increases its effect) when levodopa is not controlling
symptoms sufficiently alone or where the effect of levodopa wears off. This is
why Stalevo® has grown in popularity in recent years.
Non Drug options
A physiotherapist can advise and help with movement. They
will concentrate on posture, walking and exercises, thus maximising the length
the person can move and manage independently. An occupational therapist can
advise on areas that will make the person’s day to day living easier to manage
and will advise on home adaptations and devices which can simplify tasks that
become difficult due to the condition. A speech and language therapist can help
if difficulties with speech, swallowing or saliva occur; these difficulties
normally only occur later on in the condition.
Surgery
Surgery will not cure Parkinson’s but may help ease
symptoms when medicines are not working well. An example is chronic deep brain
stimulation, a technique that involves putting a pulse generator (like a heart
pacemaker) in the chest wall. Clinical trials are still underway for this
therapy as long-term safety of this surgery is not certain so it is rarely used
at the moment.
Practical tips
Limit caffeine intake as caffeine can act as a diuretic
and increase the frequency of urination. Decrease fluids to either two hours
before bedtime, this will reduce waking up at night to use the bathroom. Sleep
deprivation can exacerbate symptoms of Parkinson's. At night, a portable urinal
and or bedpan can be an alternative to getting out of bed to make trips to the
bathroom which can be difficult. The shower area should be fitted with at least
two handrails.
It is easier to get up from a high chair than from a low
couch. Consider using Velcro fasteners instead of buttons; carrying a walking
stick when out can increase confidence if unsteadiness is a problem. Use an
electric toothbrush and razor to make brushing your teeth and shaving easier.
There are many utensils designed for people living with disability which can
make everyday chores like eating, preparing food easier, grooming and cleaning
easier. Examples include reaching devices, electric jar openers, modified cups
and utensils for ease of holding and use, the list is limitless. Ask your
occupational therapist or pharmacist for more details.
Longer term outlook
Symptoms tend to get worse with time but the speed of
progression may vary significantly from person to person. Many do not need
treatment initially as symptoms may be relatively mild. When symptoms become
worse, medication can give several years of good or reasonable control of the
symptoms. It is difficult to predict how quick the condition will progress.
Some people may only have mild symptoms 20 years after diagnosis with other
being disabled after only 10 years.
Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591. You can also e-mail queries to info@whelehans.ie.
