Parkinson’s disease management

No established disease modifying or neuroprotective therapy presently exists.

The occurrence of motor fluctuations and dyskinesias in response to anti-Parkinson medications, and the unpredictable deterioration of motor functions in the off medication state and dyskinesias in the on medication state may render patients disabled for many hours each day.

There is no evidence that delaying levodopa or dopaminergic therapy has any benefit or that levodopa is toxic.

The initiation of medications occur when patients experience functional impairment or social embarrassment from their disease symptomatology.

If the disease and motor symptoms are mild but require therapy, an initial monoamine oxidase type B inhibitor such a selegiline or rasagiline may be tried before moving to more potent treatments such as a dopamine agonist or levodopa.

In early Parkinson’s disease a small symptomatic benefit is demonstrated by monoamine oxidase type B inhibitors.

Anti-cholinergic medications a more effective than placebo in improving motor functions in PD, but their benefits for tremor are inconclusive.

Beta blockers such as propranolol may improve parkinsonian tremor and motor function.

Clozapine improves Parkinson’s disease tremor.

Amantadine results for efficacy is not clear

For more seriously impaired PD patients levodopa or a dopamine agonist is administered.

Trials demonstrate levodopa provides the greatest symptomatic benefit.

Levodopa associated with fewer side effects such as edema, somnolence, impulse control disorders, freezing and hallucinations than dopamine agonists.

Dopamine agonists are have fewer dopaminergic motor complications of dyskinesia than levodopa.

Dopamine agonists usually initiated in individuals younger than 60 years since dyskinesia more common in younger patients.

The early advantage of dopamine agonists over levodopa decreases over time.

Most patients use more than one medication to receive combined benefits while avoiding adverse effects from high doses of a single medicine.
Exercise is the most common rehabilitative therapy with stretching, strength training, and aerobic exercises.
Physical, occupational and speech therapy are all prescribed early in PD.
Deep brain stimulation of the subthalamic nucleus or the Globus pallidus internus  is an established treatment for Parkinson’s disease.
Focused ultrasound ablation, a noninvasive, externally employed sonication energy, allows for ablative surgery without the need of craniotomy, and can focus on brain lesions and is potentially safer than  radiofrequency surgery.

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