Parkinsonism medication

Despite these potential benefits, drug holidays are no longer used routinely because of their potential risk to the patient. Considering that these patients are in the advanced stages of Parkinson disease, discontinuing the anti-Parkinson medications even temporarily results in severe immobility, which can lead to problems such as venous thrombosis, pulmonary embolism, pneumonia, and other impairments that could increase morbidity and mortality.3 Hence, drug holidays may still be used on a limited basis in a few select patients with Parkinson disease, but this intervention is not used routinely at the present time. 

Psychosis is caused by a dopamine (neurotransmitter) imbalance in the brain. Antipsychotic medications (dopamine antagonists) block the D2 dopamine receptors, reducing the psychotic symptoms. Some antipsychotic medications block the chemoreceptor trigger zone and vomiting (emetic) center, producing an antiemetic effect. Blocking dopamine causes the side effects of Parkinsonism (see 15.24 Parkinsonism Medication). Psychosis is treated with antipsychotic medications. Categories of antipsychotic are ... 

Parkinsonism occurs as a metabolic disorder of the extrapyramidal tract involving dopamine. Namely, to keep the extrapyramidal tract functioning, a balance of the amount of acetylcholine (ACh) and dopamine is needed in Parkinsonism, dopamine is lacking. Thus, for the treatment of Parkinsonism, medication with anti-acetylcholine agents or with l-DOPA, the precursor of dopamine, in order to increase the amount of dopamine, is effective. 

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

Trihexyphenidyl (Artane) and benztropine (Cogentin) are prescription drugs used in the treatment both of Parkinson s disease and the extrapyramidal side effects produced by neuroleptic medication. They are occasionally abused for their mind-altering properties, which occur at toxic doses (Perry et al. 1978). Abusers often try to obtain these drugs by false representation of extrapyramidal symptoms, which are claimed to result from the use of phenothi-azines or other neuroleptics (Rubinstein 1978). 

The profound physiological effects of alkaloids have been known for centuries. For example, Socrates was put to death with an extract of hemlock, which contains a poisonous alkaloid, coniine. Other alkaloids have long been valued for their beneficial medical effects. Examples include morphine (a painkiller), quinine (used to treat malaria), and atropine (used to treat Parkinson s disease and in eye drops that dilate the pupils). 

As the disease progresses, most patients develop response fluctuations. Treatment is based on optimizing the pharmacokinetic and pharmacodynamic properties of Parkinson s disease medications. 

TABLE 29-1. Mechanism of Action and Dosing of Medications to Treat Parkinson s Disease1 2 16 25 29 31 36... 

Ahlskog JE. The Parkinson s disease treatment book. Partnering with your doctor to get the most from your medications. New York Oxford University Press, 2005. 

Anonymous. Treatment Guidelines from the Medical Letter. Drugs for Parkinson s disease. Med Lett 2004 2 41-46. 

Uncomplicated, with delirium, with delusions, and with depressed mood Dementia due to HIV disease Dementia due to head trauma Dementia due to Parkinson s disease Dementia due to Huntington s disease Dementia due to Pick s disease Dementia due to Creutzfeldt-Jakob disease Dementia due to a specific general medical condition (specify) Dementia that is substance-induced Dementia due to multiple etiologies Dementia not otherwise specified... 

If you look in the medical literature, you will often see the term placebo defined as a non-specific treatment. What does it mean to say that a treatment is not specific It could mean that the treatment is effective for many different disorders, rather than for only one particular condition. In this sense, placebos are indeed non-specific. Besides depression, placebos have been shown to affect anxiety, pain, ulcers, irritable bowel syndrome, Parkinson s disease, angina, autoimmune diseases, Alzheimer s disease, rheumatoid arthritis, asthma, gastric function, sexual dysfunction and skin conditions. We know this from the thousands of studies in which placebos have been used as control conditions, against which the effects of medication have been evaluated, and from studies that were specifically designed to assess the placebo effect. 

Goetz, Christopher G., Joanne Wuu, Michael P. McDermott, Charles H. Adler, Stanley Fahn, Curt R. Freed, Robert A. Hauser, Warren C. Olanow, Ira Shoulson, P. K. Tandon, Parkinson Study Group and Sue Leurgans, Placebo Response in Parkinson s Disease Comparisons among 11 Trials Covering Medical and Surgical Interventions , Movement Disorders 5 (2008) 690-99... 

Information from the US National Institute of Neurological Disorders and Stroke www.ninds.nih.gov/health and medical/disorders/parkinsons disease.htm... 

Medication history should be obtained to rule out drug-induced parkinsonism... 

A number of other conditions must also be excluded, such as medication-induced parkinsonism (e.g., induced by antipsychotics, phenothiazine antiemetics, or metoclopramide). Other diagnostic criteria include lack of other neurologic impairment. 

The potential contribution of stem cells to medical treatment lies in then-capability to differentiate and grow into normal, healthy cells. Using pluripotent stem cells, scientists are devising means to culture them in the laboratories and coax them to grow into various specialized cells. Rather than gene therapy, with stem cells we have the potential of cell therapy to repair our diseased tissues and organs. This will circumvent the lack of donor organs. Stem cells also provide the possibility for healthy cells to cure disabilities such as strokes, Parkinson s disease, and diabetes. 

Two neurodegenerative diseases will be considered in greater detail here, Alzheimer s disease and Parkinson s disease, due to the pertinence of herbal medications to their treatment. Also discussed in some detail are vascular dementia and normal aging. Other degenerative conditions may benefit from herbal medications, but have not received the amount of attention in research that the above conditions have. Of particular interest to many degenerative conditions are herbal medications with demonstrated antioxidant and neuroprotective effects. 

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