Parkinsons Disease – Treatment Principles

The presentation covers the current treatment and medications for Parkinson’s Disease.

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Once swallowed, orally-administered levodopa moves down the gastrointestinal tract – a process sometimes delayed in PD due to impaired gastric motility – until it is absorbed into the blood via the duodenum.^{[van G…}

The slide shows the mechanism of action of levodopa, when taken in combination with a dopa decarboxylase inhibitor.

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Although levodopa has been a major success story for the management of PD, it does have some limitations, such as the development of dopa-related response fluctuations (both motor and non-motor) and drug-induced d…

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Levodopa is the major symptomatic therapy for PD and provides benefit to virtually all patients.^{[Obeso et al., 2000]} During the so-called ‘honeymoon’ period, the effects of levodopa tend to be long-lasting and sid…

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Motor complications, such dyskinesia and motor fluctuations, can greatly worsen the quality of life of patients, particularly during mid to late PD.^{[Chapuis et al., 2005]} One of the priorities for the management o…

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Dopamine agonists play a major role in the treatment of PD.^{[Factor, 2008]} They act by directly stimulating intact postsynaptic receptors in the brain linked to motor control.^{[Müller, 2012]} Although they tend to be…

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Patients who are experiencing ‘wearing-off’ may benefit from taking a monoamine oxidase type B inhibitor (MAO-B inhibitor).^{[Factor, 2008; Stochi, 2014]} MAO-B inhibitors inhibit the breakdown of either dopamine or …

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Patients who are experiencing ‘wearing-off’ may benefit from taking a catechol-O-methyltransferase inhibitor (COMT inhibitor).^{[Factor, 2008; Stochi, 2014]} COMT inhibitors inhibit the breakdown of dopamine and of l…

Certain non-dopaminergic agents help to reduce dyskinesias through an indirect mechanism,^{[Factor, 2008]} but have the limitation of worsening side effects, such as hallucinations and psychosis, in some individuals.^{[Müller, 2012]} A newer non-dopaminergic agent has been rece…

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- The primary emphasis of the care of patients with PD should focus on maximising their quality of life and reducing disability.^{[Prizer & Browner, 2012]} Conventional medical and surgical therapies are still limited …

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- With the exception of tremor symptoms, tailored exercise and physical activity therapies have been shown to improve all the prominent motor symptoms experienced by individuals with PD.^{[Borrione et al., 2014]} In or…

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Although levodopa and dopamine agonists are initially able to control motor symptoms effectively, eventually most patients will start to develop motor complications, which comprise ON– OFF motor fluctuations and d…