Currently, there is close to one million people living with Parkinson’s disease in the US. Parkinson’s is a chronic and progressive movement disorder that affects the central nervous system, often causing tremors that worsen over time. The cause of Parkinson’s is still unknown, though scientists have identified age as a risk factor. People over the age of 60 have a two to four percent risk of developing Parkinson’s, compared to one to two percent among the general population. Although there is no cure, there are a variety of treatment options available to help those affected manage symptoms.
Parkinson’s disease results when vital nerve cells in an area of the brain called the substantia nigra, which is largely responsible for reward and movement, begin to malfunction. Some of these nerve cells produce dopamine, a neurotransmitter that helps in relaying messages about movement and coordination.
As the disease progresses, the brain produces less dopamine, which affects the person’s ability to control movements. Though symptoms vary between individuals, common symptoms include tremor of the hands, arms, legs, jaw, and face; bradykinesia or slowness of movement; rigidity or stiffness of the limbs and trunk; and impaired balance and coordination.
Treatment plans depend on the degree of functional impairment, the degree of cognitive impairment, the person’s ability to tolerate medication, and the physician’s recommendations. Let’s explore some of the medications a physician may prescribe for a patient with Parkinson’s disease.
Parkinson’s Disease: Medications
Carbidopa-levodopa. Levodopa is a natural chemical that converts to dopamine in the brain. It is the most effective Parkinson’s disease medication. When it is combined with carbidopa, which protects levodopa from premature conversion to dopamine outside of the brain, it prevents or lessens side effects, which may include nausea or lightheadedness. As the disease progresses, and after years of use, the benefit from levodopa may become less stable.
Carbidopa-levodopa infusion. Duopa is a drug made up of carbidopa and levodopa, and it is administered through a feeding tube that delivers the medication directly to the small intestine in a gel form. Duopa is for patients in the more advanced stages who still respond to carbidopa-levodopa, but who have a less stable response to treatment. It is continually infused, so blood levels of the two drugs remain constant. Placement of the tube requires a small surgical procedure, and risks include the tube falling out or infections at the infusion site.
Dopamine agonists. Unlike levodopa, dopamine agonists don’t convert into dopamine. Instead, they mimic the effects of dopamine in the brain. They aren’t as effective as levodopa in treating symptoms, but they last longer and may be used in combination with levodopa to smooth the treatment response. The side effects of dopamine agonists are similar to those of carbidopa-levodopa, but also include hallucinations, sleepiness, and compulsive behaviors such as hypersexuality, gambling, and over-eating.
MAO-B inhibitors. These medications include selegiline (Eldepryl, Zelapar) and rasagiline (Azilect). They help prevent the breakdown of dopamine in the brain by inhibiting the enzyme monoamine oxidase B (MAO-B), which metabolizes dopamine. Side effects may include nausea or insomnia. When MAO-B Inhibitors are added to carbidopa-levodopa, these medications increase the risk of hallucinations. These medications are not typically used in combination with most antidepressants or certain narcotics due to potentially serious but rare reactions.
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 dopamine. Side effects, including an increased risk of involuntary movements known as dyskinesias, often result from an enhanced levodopa effect.
Anticholinergics. These medications were used for many years to help control the tremor associated with Parkinson’s disease. The 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 may also be given with carbidopa-levodopa therapy during the later stages of Parkinson’s disease to control dyskinesias induced by carbidopa-levodopa.
More Treatment Options
It is important that every individual living with Parkinson’s has a personalized therapy program specifically designed for them. In some instances, this may include a surgical procedure known as deep brain stimulation (DBS). In DBS, electrodes are implanted into a specific part of the brain, and they are connected to a generator implanted in the chest that sends electrical pulses to the brain to reduce symptoms. DBS can be effective for late-stage Parkinson’s or for individuals who don’t see much success with medication.
Impairments in motor function advance rapidly in the earlier stages of the disease and more slowly during the later phase. Medications have greatly improved motor functions and each person’s ability to maintain their independence. Disabilities associated with Parkinson’s are often a result of cognitive effects, which affects individuals over the age of 70 more.
Skilled care can prevent early nursing home placement for an individual living with Parkinson’s disease and is most often provided in the home. Aside from physical and emotional support, nurses can educate patients and their families, manage and administer medications, and provide other skilled medical services.
If your loved one is living with Parkinson’s disease, a licensed nurse can provide skilled medical care, affording you peace of mind. Call us today at 650-462-1001 to learn more about our skilled nursing services.
Sources
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“Parkinson’s Disease and Related Movement Disorders Center,” University of Maryland Medical Center, 2016.
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“Parkinson’s Disease – Treatments and Drugs,” Mayo Clinic, July 7, 2015
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