Treatment and Forward Planning Care

Unfortunately, there is no known cure for Parkinson's and treatment is aimed at symptom control relief. This is established through medications. There are four main groups of medications, they are Levodopa, which actually is gold standard treatment still, even though it only came on the market between the '60s and '70s; dopamine agonists; inhibitors, of which there are two, that's a COMT inhibitor and that's an MAO-B inhibitor, and anticholinergic. Now, the first three, that's Levodopa, the dopamine agonists and the inhibitors, all concentrate on maintaining levels of dopamine and trying to raise the dopamine up to actually equate the acetylcholine level, as I previously mentioned, between the two levels to try and equal them up again. The anticholinergic actually do the opposite. So the anticholinergics are concentrated more so on the acetylcholine level, so that tries to not only see the acetylcholine so that that is no longer the dominant chemical above the dopamine.

There is no standardization to the medication initiation or what actually happens with the medications, because various medications can be used from the various groups in combination, depending on the person's need and presentation. This is why it's important that patients are reviewed every six to 12 months to actually not only review the disease progression and to enhance and support the diagnosis but also to monitor the medication being suitable at that particular time for that particular person. Unfortunately, with all medications, there are potential side effects associated with Parkinson's medication. These include nausea or vomiting, Dyskinesia and involuntary movement, hypertension, hallucinations, fluctuations in mobility and ability, known as wearing off and on off syndrome, and diatonic spasms potentially maybe affecting toes, feet, and the eyelids.

One of the most important things about medication is that no two people are the same. In fact, no two people's conditions are the same. So, individual regimes are set to suit the person's need. Various medications actually have different modes of action. With Madopar we have a dispensable, we have an ordinary and we have a controlled release. With Sinemet we have an ordinary and we have a controlled release. But they obviously have different strengths, but what's most important, because of the different modes of action, is the timing of the medication. And as I said previously, that's because it has been actually prescribed to suit the person and their activities of daily living. So ordinary preparations tend to be used over the course of the day, whereas disposable preparation because it has such a sharp peak, can be used to give a quick action, a quick release action. And then controlled release medications tend to be used more so overnight because they tend to give a small amount over a longer period of time. The disposable medication can give a sharp peak and sometimes, unfortunately, side effects can be exacerbated with the peak of the strength, and therefore this is where it is important that patients are monitored and reviewed in relation to the dosage that they take over the course of the day to try and maintain their activities of daily living, but not to give them the associated peak dose side effects.

In relation to the medications, obviously what we're trying to do is trying to establish normality for the individual, and normality in relation to what they can and cannot do. So at night, a lot of people with Parkinson's have a difficulty as previously mentioned, with rolling over in bed, but also they may need to get up at night to go to the toilet, another common issue associated with Parkinson's. So having a controlled release medication overnight can obviously help with those sorts of problems, I.e. Rolling over in bed, but also getting up to go to the toilet overnight.