Parkinsons Disease – Treatment Principles

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

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 Gerpen, 2014]} From the circulation, levodopa eventually make…

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

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 dyskinesias.^{[Hametner et al., 2010]}

In a patient experienci…

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 side effects are tolerable.^{[Obeso et al., 2000]} Beyond this ‘h…

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 of PD during this time is to optimise the administration of …

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 less potent than levodopa in reducing parkinsonian motor s…

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 levodopa in the body, thus prolonging their therapeutic eff…

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 levodopa in the body, thus prolonging their therapeutic effe…

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…

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 to providing only partial and temporary relief.^{[Prizer & Br…}

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 order to increase adherence rates, the patients themselves sh…

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 dyskinesia.^{[Stochi, 2014]}

‘Wearing-off’ is one of the more t…