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TREATMENTS OF PARKINSON'S DISEASE

 

 
 

L-DOPA

The most widely used form of treatment is L-dopa in various forms. L-dopa is transfomed into dopamine in the dopaminergic neurons by L-aromatic amino acid decarboxylase (often known by its former name dopa-decarboxylase). However, only 1-5% of L-DOPA enters the dopaminergic neurons. The remaining L-DOPA is often metabolised to dopamine elsewhere, causing a wide variety of side effects. Due to feedback inhibition, L-dopa results in a reduction in the body's own formation of L-dopa. By this means L-dopa eventually becomes counterproductive.

SINEMET consists of L-dopa and Carbidopa (a dopa decarboxylase inhibitor that  helps to prevent the metabolism of L-dopa before it reaches the dopaminergic neurons). There is also a controlled release version, Sinemet CR, that spreads out the effect of the L-dopa. For more details go to Sinemet and Sinemet CR

MADOPAR consists of L-dopa and Benserazide (a dopa decarboxylase inhibitor that helps to prevent the metabolism of L-dopa before it reaches the dopaminergic neurons). There is also a controlled release version called Madopar CR that spreads out the effect of L-dopa. For more details go to Madopar and Madopar CR

RYTARY and NUMIENT both consist of L-dopa and Carbidopa (a dopa decarboxylase inhibitor that  helps to prevent the metabolism of L-dopa before it reaches the dopaminergic neurons). They both combine immediate release L-dopa with controlled release L-dopa. For more details go to Rytary and Numient

DUODOPA is a combination of L-dopa and Carbidopa, dispersed as a viscous gel. Using a patient-operated portable pump, the drug is continuously delivered via a tube directly into the upper small intestine, where it is rapidly absorbed. For more details go to Duodopa

PARCOPA consists of L-dopa and Carbidopa, the same as Sinemet, but is in orally disintegrating tablets. For more details go to Parcopa

STALEVO consists of L-dopa, Carbidopa and Entacapone (Comtan). For more details go to Stalevo. Entacapone (Comtan) inhibits the COMT enzyme, thereby prolonging the effects of L-dopa, and so has been used to complement L-dopa.

MUCUNA PRURIENS is a natural vegetable source of therapeutic quantities of L-dopa. For more details go to Mucuna pruriens

 

DOPAMINE AGONISTS

Dopamine agonists are drugs that mimic dopamine by stimulating the dopamine receptors. Besides the side effects they cause, dopamine agonists cause the dopamine receptors to become progressively less sensitive, thereby eventually increasing the symptoms. The most widely used dopamine agonists include :

APOMORPHINE (which is sold as Apokyn) is taken via injection or infusion. For more details go to Apokyn

BROMOCRIPTINE (which is sold as Parlodel). For more details go to Parlodel

CABERGOLINE (which is sold as Dostinex and Cabaser). For more details go to Dostinex

PRAMIPEXOLE (which is sold as Mirapex and Mirapex ER). For more details go to Mirapex and Mirapex ER

ROPINIROLE (which is sold as Requip and Requip XL). For more details go to Requip and Requip XL

ROTIGOTINE (which is sold as Neupro) is applied using a transdermal patch. For more details go to Neupro

 

MAO-B INHIBITORS

MAO-B inhibitors do not directly increase the formation of dopamine or its activity. MAO-B inhibitors instead reduce the symptoms by inhibiting monoamine oxidase-B (MAO-B), which reduces the breakdown of dopamine secreted by the dopaminergic neurons. MAO-B inhibitors cause widespread side effects. The most common MAO-B inhibitors are :

SELEGILINE (which is sold as Eldepryl). For more details go to Eldepryl 

RASAGILINE (which is sold as Azilect). For more details go to Azilect

SAFINAMIDE (which is sold as Xadago). For more details go to Xadago

 

COMT INHIBITORS

COMT inhibitors do not directly increase the formation of dopamine or its activity. COMT inhibitors instead reduce the symptoms by inhibiting COMT, which reduces the breakdown of dopamine secreted by the dopaminergic neurons. The most common COMT inhibitors are :

ENTACAPONE (which is sold as Comtan). For more details go to Entacapone.

OPICAPONE (which is sold as Ongentys). For more details go to Ongentys.

TOLCAPONE (which is sold as Tasmar). For more details go to Tolcapone.

 

ANTI-CHOLINERGICS

The excessive muscle contraction in Parkinson's Disease is caused when the cholinergic function, which increases muscle contraction, is more powerful than dopaminergic function, which decreases muscle contraction. Instead of increasing dopaminergic function which is what most treatments of Parkinson's Disease aim at achieving, Anti-cholinergics (anti-muscarinics) reduce cholinergic function. Several drugs in this category sometimes help relieve symptoms, particularly tremor.  Anti-cholinergics (Anti-muscarinics) cause very widespread side effects and so are not so commonly used.  They include :

BENZTROPINE (which is sold as Benztropine mesylate and Cogentin, which is injectable)  For more details go to Benztropine mesylate  and Cogentin

TRIHEXYPHENIDYL (which is sold as Artane and Trihexane) For more details go to Artane

BIPERIDEN (which is sold as Akienton) For more details go to Akineton

PROCYCLIDINE (which is sold as Kemadrin) For more details go to Kemadrin

 

SURGICAL TREATMENTS




DEEP BRAIN STIMULATION is the most effective form of surgery for Parkinson's Disease. It involves the use of electrodes that are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS uses a surgically implanted, battery-operated medical device, which is similar to a heart pacemaker and approximately the size of a stopwatch. It stimulates targeted areas in the brain that control movement.  For more information go to Deep brain stimulation
STEM CELL THERAPY aims to promote the reparative response of dysfunctional or injured tissue using stem cells or their derivatives. Researchers grow stem cells in a laboratory. The stem cells are manipulated to specialise into specific types of cells, such as dopaminergic neurons. The specialised cells can then be surgically implanted into the appropriate part of a person's brain. When stem cell surgery underwent formal clinical trials there was found to be little or no effect. For more information go to Stem cell therapy

 

 PHYSICAL THERAPY

GENERAL EXERCISE is often used in Parkinson's Disease for maintaining and improving mobility, flexibility, balance and a range of motion. The goal of therapy has been largely to help people maintain what motor capability they have for as long as possible and to help them adjust as their functional level declines. It usually involves repeating the physical action and concentrating on particular muscles during each exercise. For more information go to Exercise
  PHYSIOTHERAPY involves rehabilitation that remediates impairments and promotes mobility and function, through examination, diagnosis, prognosis, and physical intervention using physical therapy involving mechanical force and movements. It is usually carried out by physiotherapists. Moderate improvements can be obtained after regular sessions that are generally more effective than general exercise. For more information go to Physiotherapy
   

 

 

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