MANAGEMENT OF PARKINSON’S DISEASE

AAM. AMJATHMEDICINE 4TH BATCH FHCS-EUSL

Objectives

• To Understand the Goals in Management of Parkinson’s Disease.

• Describe the Pharmacological Intervention in Parkinson’s Disease.

• Describe the Non-Pharmacological Intervention in Parkinson’s Disease.

• Describe the Surgical Treatments in Parkinson’s Disease.

Goals of Management• Maintain the function• Avoid drug-induced complications

• In the Tx of PD,

BradykinesiaTremorRigidityAbnormal posture

Respond Early in illness

• But…

Cognitive symptomsHypophoniaAutonomic dysfunctionBalance difficulties

Respond Poorly

Pharmacological Management of Parkinson’s Disease.

Drugs used in PD1. Levodopa and Carbidopa2. Anticholinergics(Trihexyphenidyl, Benztropine)3. Amantadine4. Catechol-O-methyltransferase inhibitors (COMT

inhibitors5. Monoamine oxidase type B (MAO-B)(Give temporary relief from the symptoms of the disorder, but not arrest or reverse the neuronal degeneration. )

Pharmacological Therapy in early PD

• ‘Early disease’ refers to PD in people who have developed functional disability and require symptomatic therapy.

• There is no single drug of choice in the initial pharmacotherapy of early PD.

Options for initial pharmacotherapy in early PD

• The dose of levodopa should be kept as low as possible to maintain good function in order to reduce the development of motor complications.

• Beta blockers used in the symptomatic treatment of selected people with postural tremor in PD.

• Anticholinergics may be used as a symptomatic treatment typically in young people with early PD and severe tremor

Pharmacological therapy in later PD

• ‘Later disease’ refers to PD in people on levodopa who have developed motor complications.

• There is no single drug of choice in the pharmacotherapy of later PD.

• So, Adjuvant drugs are taken alongside with Levodopa for it.

• Ex: COMT inhibitors, MAO-B inhibitors, Dopamine agonist, Amantadine… etc.

Options for adjuvant pharmacotherapy in later PD

• Modified-release levodopa preparations may be used to reduce motor complications in people with later PD, but should not be drugs of first choice.

• MAO-B & COMT inhibitors may be used to reduce motor fluctuations and Amantadine may be used to reduce dyskinesia in people with later PD.

Non-Pharmacological Management of Parkinson’s Disease.

• It includes,

Rehabilitation.

Diet.

Physiotherapy

Speech & Language therapy

Occupational therapy

Rehabilitation

• PhysiotherapyIt helps to improve the,

a. Mobility.b. Flexibility.c. Strength.d. Gait speed.e. Aerobic capacity.f. Quality of life.

• Speech and language therapy

Particular consideration should be given to :a. improvement of vocal loudness and pitch range.

b. Ensuring an effective means of communication is maintained throughout the course of the disease.

c. review and management to support safety and efficiency of swallowing and to minimise the risk of aspiration.

• Occupational therapy

Particular consideration should be given to :a. maintenance of work and family roles, home care

and leisure activities.

b. improvement and maintenance of transfers and mobility.

c. improvement of personal self-care activities, such as eating, drinking, washing and dressing.

Diet

• Diet should include high fibre foods and plenty of water.

• When levodopa is introduced excessive proteins are discouraged due to competition between them to cross the BBB and intestine.

• So, To minimize interaction with proteins, levodopa is recommended to be taken 30 minutes before meals.

Surgical Treatment• In refractory cases, Surgical Tx is considered.• Deep-brain stimulation (DBS) is presently the

most used Sx method.• Here Subthalamic nucleus(STN) or Globus pallidus

interna (GPi) is stimulated. • I˚ : Patients who suffer disability resulting from

levodopa-induced motor complications.• CI : a) Cognitive Impairment.

b) Major Psy.illnesses c) Substantial medical comorbidities d) Advanced age