Secondary parkinsonism Health Article

Treatment

Treatment is aimed controlling symptoms. If the symptoms are mild, no treatment may be required.

If the condition is caused by a medication, the benefits of the medication should be weighed against the severity of symptoms and stopped or changed if they seem counterproductive.

Treatment of underlying conditions (such as stroke, infections) can reduce symptoms.

Medications may be used if symptoms interfere with the ability to perform daily activities. The medication, or dose, timing or combination of medications may need to be adjusted as symptoms change.

Many of the medications used to treat this condition can cause severe side effects, so monitoring and follow-up by the health care provider are important. Secondary parkinsonism tend to be less responsive to medical therapy than Parkinson's disease.

Medications include:

• Amantadine or anticholinergic medications
• Levodopa/carbidopa
• Dopamine agonists

Neupro is a new skin patch that contains the drug rotigotine. This medicine helps dopamine receptors in the brain work better. The patch is replaced every 24 hours. Neupro is approved for persons with early stage Parkinson's disease.

Additional medications include antihistamines, antidepressants, monoamine oxidase inhibitors, or others to help reduce symptoms or control the side effects of primary treatment medications.

Good general nutrition and health are important. Exercise should continue, with the level of activity adjusted to meet the changing energy levels that may occur. Regular rest periods and avoidance of stress are recommended, because tiredness or stress can make symptoms worse.

Physical therapy, speech therapy and occupational therapy may help promote function and independence, and may help maintain skills and positive attitude and minimize depression.

Simple aids such as railings or banisters placed in commonly used areas of the house, special eating utensils or other devices may be of great benefit to the person experiencing some difficulties with daily living activities.

Social work or other counseling services may help in coping with the disorder, and obtaining assistance as appropriate (such as safety equipment, Meals-on-Wheels, volunteer services or other assistance).

Support Groups

See: Parkinson's disease - support group

Expectations (prognosis)

The outcome varies and depends on the cause. If the disorder is caused by medications, it is potentially treatable. All other causes are not reversible and, to a greater or lesser degree, progressive.

Complications

• Disability, varying degrees
• Difficulty swallowing (eating)
• Difficulty performing daily activities
• Injuries from falls
• Side effects of medications
• Debilitation and associated conditions:
  • Malnutrition
  • Aspiration
  • Deep vein thrombosis

Calling your health care provider

Call your health care provider if symptoms of secondary parkinsonism develop, recur, worsen, or progress.

Call your health care provider if new symptoms appear in a person with this disorder, including possible side effects of medications: involuntary movements, nausea/vomiting, dizziness, changes in alertness/behavior/mood, severe confusion or disorientation, delusional behavior, hallucinations, loss of mental functions, or any other new symptoms that develop (see also information on potential side effects of the specific medication).

Discuss the situation with your health care provider if you are unable to care for the person at home (after initial treatment).

Prevention

The treatment of conditions that may cause secondary parkinsonism may decrease the risk of its development. Medication use should only be under the supervision of the health care provider and people with conditions that require long-term use of antipsychotics, like schizophrenia, should be carefully monitored to avoid development of irreversible secondary parkinsonism. Newer antipsychotic medications are less likely to cause secondary parkinsonism.

References

U.S. Food and Drug Administration. FDA Approves Neupro Patch for Treatment of Early Parkinson's Disease. Rockville, MD: National Press Office; May 9, 2007. Release P07-84.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 713-720.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:1612-1618.