Parkinson’s disease is a neurodegenerative disorder characterized by tremors, rigidity, and bradykinesia (slowed movement). Symptoms often start in one limb or side of the body and gradually spread. A hallmark feature is resting tremor (shaking when limbs are inactive), which distinguishes it from conditions like essential tremor (action tremor during movement). Patients may also experience non-motor symptoms, including:
- Constipation
- Swallowing difficulties
- Excessive drooling
- Oily skin (seborrhea)
- Psychological issues such as depression, cognitive decline, dementia, sleep disturbances, and hallucinations.
Principles of Pharmacotherapy
- Start Low, Go Slow: Begin with the smallest effective dose and gradually increase based on symptom control.
- Aim for Functional Independence: Prioritize improving daily living abilities over complete symptom resolution.
- Combination Therapy: Use adjunct medications to enhance dopamine efficacy, reduce dosage, and minimize long-term side effects like motor fluctuations.
- Personalized Treatment: Tailor therapy to age, symptom severity, side effect tolerance, and financial constraints.
Medication Options
1. Anticholinergics
- Use: Early-stage tremor-dominant patients. Avoid in those with cognitive impairment.
- Example: Trihexyphenidyl (Artane®), 1–2 mg, 3 times daily.
2. Dopamine Replacement Therapy
- Gold Standard: Levodopa combined with a decarboxylase inhibitor (e.g., carbidopa/levodopa). Effective for rigidity, bradykinesia, and drooling.
3. Dopamine Agonists
- First-line for Young Patients: Used alone early or as levodopa adjuncts.
- Bromocriptine: Start at 1.25 mg/day, gradually increase to 10–20 mg/day.
- Piribedil (Trastal®): 150–200 mg/day (controls resting tremors).
- Pramipexole: Titrate from 50 μg/day to an optimal dose (divided into 3 doses).
4. MAO-B Inhibitors
- Neuroprotective Potential: Enhances levodopa effects.
- Example: Selegiline, starting at 5 mg/day (morning dose), up to 10 mg/day.
5. COMT Inhibitors
- Address Motor Fluctuations: Reduces “wearing-off” and “on-off” phenomena in levodopa therapy.
6. Amantadine
- Early Symptom Relief: Improves rigidity and bradykinesia temporarily (effects fade after months).
Other Therapies: NMDA receptor antagonists, neurotrophic factors.
Share this content:
1 comment so far