Medication
Although there is no cure for Parkinson’s disease, its symptoms can be treated with different types of medication. The first important decision facing the patient and their physicians is when to start treatment. When symptoms are extremely problematic, medication may not be necessary, particularly because there are signs that early treatment can increase the likelihood of side effects and other complications later. Treatment usually begins when symptoms interfere with work or handling household chores and other activities, or when it starts to have problems with walking and balance.
The medication used to treat Parkinson’s disease increases levels of dopamine in the brain and mimics the effects of dopamine. The most commonly used medicine for the treatment of Parkinson’s disease is levodopa (Doping, Larodopa), a drug that is converted to dopamine in the brain. Levodopa is usually prescribed along with carbidopa (Sinemet) to increase the amount of active drug that reaches the brain, while helping to limit side effects.
Almost all patients with Parkinson’s disease improve after they start taking levodopa. However, prolonged use of levodopa causes any side effects and complications in 75% of patients. Physicians often need to adjust the dose of levodopa and the time intervals between doses for the person to continue taking the drug.
There are several alternative medications that can be used alone or in combination with levodopa to treat Parkinson’s disease. For mild symptoms at onset of Parkinson’s disease, may be useful amantadine (Symmetrel) or anticholinergic drugs such as trihexyphenidyl (Artane, Trihexane, Trihexy) or benztropine (Cogentin). Amantadine stimulates the release of dopamine stored in the brain, but it could work for a short time in some patients. Anticholinergic drugs are particularly effective against the tremor, but can cause side effects such as confusion and hallucinations, especially in the elderly. In people with mild Parkinson’s disease, selegiline (Carbex, Eldepryl) may be beneficial when taken together with levodopa.
Drugs called dopamine agonists such as bromocriptine (Parlodel), pramipexole (Mirapex) and ropinirole (Requip) may be used alone to delay the need for levodopa, or may be taken together with levodopa to increase its effectiveness or reduce the amount of levodopa. Dopamine agonists act by mimicking the effects of dopamine. Most patients who begin only with a dopamine antagonist levodopa need to add the following years. To minimize side effects, first its use very low doses and gradually increased. Larger patients may be especially sensitive to these drugs, which can cause symptoms of confusion, hallucinations and feelings of weakness due to low blood pressure.
The drugs called COMT inhibitors (inhibitors of catechol-O-methyltransferase) can also be used along with levodopa. COMT inhibitors, COMT inhibitors such as entacapone (Comtan) and tolcapone (Tasmar), block the enzyme that breaks down dopamine and levodopa, which prolongs the action of dopamine in the brain and increases the effectiveness of levodopa. When adding a COMT inhibitor, the physician usually decreases the dose of levodopa.
Depression is a common problem in people with Parkinson’s disease and many patients may benefit from treatment with antidepressant medications. Symptoms of depression include not only a depression or crying, but also decreased appetite, sleep disturbance (especially early morning awakening), decreased interest in pleasurable activities, decreased energy level and thoughts of worthlessness guilt or suicide.
In addition to drug treatment, some patients with Parkinson’s disease find that regular exercise and a balanced diet helps improve your overall sense of wellbeing and body control.
Surgery
Surgery are used when patients fail to respond sufficiently well to medication. Surgical options include deep brain stimulation electrodes after performing brain mapping, precise destruction of targeted areas in the brain responsible for most of the symptoms that cause problems. A very controversial procedure that seems very promising is the transplantation of fetal brain tissue. The cells can make dopamine transplant a nonviable fetus or a genetically engineered brain tissue and grew up in a culture medium.
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