Treat Parkinson’s with medication

Treat Parkinson's with medication

There is still no cure for Parkinson’s, but with the proper treatment, the life expectancy of those affected can be extended, and the quality of life significantly improved. How exactly the treatment looks depends, among other things, on the patient’s age, the symptoms that occur, the stage of the disease and the tolerability of medication. However, the aim of Parkinson’s therapy is always to alleviate the patient’s symptoms and to maintain their independence for as long as possible.

Individual support essential

To achieve these goals, starting treatment that is specially tailored to the patient as early as possible is essential. Only through individual care can the various symptoms and the different rates of progression of the disease be adequately addressed.

Parkinson’s therapy is primarily based on taking medication. Speech therapists, physiotherapists and ergotherapists also play an essential role. If a patient does not respond to drug treatment, surgery may be considered.

 

Parkinson’s therapy with drugs

Since the cause of Parkinson’s disease is not known in most cases, only the trigger of the typical Parkinson’s symptoms – a dopamine deficiency in the brain – can be treated, and the patient’s symptoms can be alleviated. Certain medications can be used to compensate for the lack of dopamine in the brain – however, medication cannot prevent the dopamine-producing nerve cells from dying off.

Various types of medication can be used to alleviate the patient’s symptoms. While levodopa is a precursor to dopamine, dopamine agonists imitate the effect of the messenger substance. Some drugs inhibit dopamine breakdown in the body (MAO B inhibitors and COMT inhibitors). The doctor treating you will decide with the patient which medication will be used in each case. Criteria for the choice of medication include the age and state of health of the person concerned.

Treating Parkinson’s with levodopa

Levodopa is a dopamine precursor used to compensate for the lack of dopamine in the brain. This precursor substance must be used instead of dopamine since externally supplied dopamine cannot cross the blood-brain barrier and, therefore, cannot penetrate the brain.

However, this is possible for levodopa, and the substance can thus develop its effect in the brain after conversion into dopamine. However, the active ingredient is already partially broken down on the way to the brain, which is why levodopa is often combined with other drugs that prevent premature breakdown in the body.

Levodopa is the most effective therapy against Parkinson’s and is well tolerated, especially at the beginning of treatment. Ingestion usually improves the symptoms quickly, reduces muscle tension, and improves the speed of movement. Since illness-related complications can often be avoided by taking levodopa, the life expectancy of the patients usually increases significantly. The disadvantage, however, is that the administration of levodopa can sometimes lead to therapy complications.

 

Side effects of levodopa

The longer levodopa is taken, the more the duration of action usually decreases. The effect often wears off a few hours after ingestion. In contrast, the side effects often get worse over time. Sleep disorders, involuntary movements (dyskinesia) and cardiovascular disorders are pervasive. In addition, confusion can occur. For this reason, levodopa is usually only used in patients over 70 years of age.

Therapy with dopamine agonists

Because of the increasing side effects of levodopa, younger patients under the age of 70 are often given other drugs when starting treatment. These so-called dopamine agonists imitate the effect of dopamine and thus take over the task of the messenger substance. Compared to levodopa, dopamine agonists have the advantage that they do not lose their effectiveness over time. However, they are also less effective to begin with.

Unlike levodopa, the body needs to get used to the dopamine antagonists slowly, so the dose is slowly increased over several months. As a result, it takes longer at the beginning of therapy until the patient improves symptoms. If dopamine agonists are taken, unpleasant side effects such as abdominal pain, nausea and drowsiness occur more frequently. Specific dopamine agonists must not be prescribed for heart valve disease, as this can lead to connective tissue growth on the heart valves.

Treat Parkinson’s with MAO-B and COMT inhibitors.

While treatment with levodopa and dopamine agonists aims to replace the neurotransmitter dopamine, MAO-B and COMT inhibitors reduce the breakdown of dopamine. This happens because the dopamine-degrading enzymes are inhibited in their function. Due to the slowed-down degradation, dopamine can act longer in the brain, and the concentration of the messenger substance is increased.

While MAO-B inhibitors ensure that the dopamine-degrading enzyme is inhibited in the body, COMT inhibitors prevent the breakdown of levodopa. That is why COMT inhibitors and levodopa are often taken in combination.

 

Outpatient video-assisted Parkinson’s therapy.

If Parkinson’s disease progresses over time, the medication must be readjusted on an outpatient basis by a neurologist on-site or in a specialist clinic. An alternative to this is outpatient video-supported Parkinson’s therapy, which is currently still being developed. Its advantage lies in the fact that it enables precise observation of the patient’s motor skills, and possible fluctuations over the day can also be considered when adjusting the medication.

In outpatient video-supported Parkinson’s therapy, a video camera, a loudspeaker and a printer are installed in the Parkinson’s patient’s home. The patient now triggers one or more video recordings of two minutes each day. During this time, announcements from a neurologist can be heard over the loudspeaker, prompting the patient to perform specific movements.

The recording is then sent to the responsible doctor, who evaluates it. Once a certain number of video recordings have been made, the doctor draws up a therapy plan and gradually adjusts the medication. The patient can print out the current medication schedule every morning.

Video-supported Parkinson’s therapy usually lasts 30 days. Finally, the patient is examined again by a neurologist on site. The entire treatment, including the video recordings, is then handed over to the doctors in the hospital and the on-site neurologist so that it is available at any time in the future.

ON and OFF phases in Parkinson’s disease

The longer the therapy lasts, the more frequently there can be fluctuations in the effectiveness of the medication and, thus, motor complications. If the medication works well, the patient is mobile and has hardly any symptoms – this condition is referred to as the ON phase.

However, if the effect of the medication wears off, symptoms such as tremors, unsteady gait and muscle stiffness appear – this condition is called the OFF phase. If there is a frequent alternation of ON and OFF phases, the patient’s quality of life can suffer greatly. In such cases, a readjustment of the medication may be necessary.

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