Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
20 September 2006

UPDATE ON PARKINSON’S DISEASE

            It is estimated that about 1% of the population over age 60 have Parkinson’s disease. This tragic disease begins slowly as the patient develops increasing stiffness.  The stiffness is caused by an inability to coordinate the muscles of the arms and legs.  Normally as a person flexes their arm, the muscles on the back of the arm release and allow an easy motion for the arm.  But with Parkinson’s disease, the message to relax the muscles on the back of the arm as the arm is flexed never gets there.  Thus the two muscle groups on the back and the front of the arm oppose each other causing constant tension in the muscles on both sides of the arm.  This fighting themselves is very fatiguing for both muscle groups.  In addition, since the muscles never relax, they begin to hurt and pain is a part of Parkinson’s disease. 

            Multiple falls, difficulty walking, slowness of motion and sleep disturbances follow.  Over the course of 3-5 years these symptoms progress.  Very frequently patients with Parkinson’s disease become so infirmed that care in a nursing facility becomes necessary.  Very heroic spouses and children will frequently try to care for a Parkinson’s disease patient at home.  But eventually, family care frequently fatigues or a broken hip occurs and the person will eventually be in a nursing facility.

            Fortunately, the diagnosis of Parkinson’s disease can often be made before the condition progresses to a crippling level.  Recently, a new drug has come on the market that has the promise of slowing the progression of Parkinson’s disease especially if the drug is started early.

The new drug is called rasagiline (trade name Azilect).  It is now approved for prescription and especially for use in the early phases of the disease when it may have a protective effect. 

            To review the treatments available for Parkinson’s disease, most physicians start with a drug called levodopa/carbidopa (Sinemet).  Sinemet is no longer made by Merck Pharmaceuticals who originated it.  But the name was so entrenched over many years that at least the name persists.  There are suspicions that the use of Sinemet may actually cause a progression of the disease.  Many physicians now favor a different class of drugs.

            Several years ago, a group of drugs called “dopamine agonists” came on the market.  Among these were two drugs called bromocriptine and pergolide.  These have now been almost completely supplanted because of side effects that they cause.

            The dopamine agonists most commonly used now are called ropinirole (Requip) and pramipexole (Mirapex).  These drugs are more expensive than Sinemet but seem to have the advantage of many fewer side effects and perhaps a preservative effect preventing the progression of the Parkinson’s disease process.

            Two other drugs that are used as helpers are called entacapone (Comtan) and tolcapone (Tasmar).  These drugs are not used alone but as helpers for Mirapex and Requip.

            Mentioned above was a drug called rasagiline.  This drug works independently of all of those above and maybe the best answer to this time for preventing progression of the disease.

            Supportive measures that are important in the care of patients with Parkinson’s disease include adequate nutrition.  Chewing can be very difficult and can cause malnutrition which frequently leads to weakness and falls.  Being willing to use a cane, a crutch or a walker when ambulating can prevent falls and the tragic outcome of a broken hip.

            With medications, a supportive environment, and care to avoid accidents Parkinson’s disease can be slowed and function maintained over an extended period of time.  The healthcare professionals at your local clinics are aware of the challenge of Parkinson’s disease and how to help with it.