Treatment for Parkinson's: Wh... Video Transcript

Participants

, Abraham Lieberman MD, Warren Olanow M.D., F.R., Dee Edward Silver MD

Summary

Parkinson disease has effective treatments that replace dopamine in the brain. Although these Parkinson's drugs are effective, they may cause motor complications known as dyskinesias and lose their effectiveness as the disease progresses. Learn about symptoms and treatments for Parkinson's symptoms.

Webcast Transcript

C. WARREN OLANOW, MD: When people first develop Parkinson's disease, it often can present as a mild tremor and can cause them more social embarrassment than real disability in terms of their performing activities of daily living. As the disease progresses, however, they can experience more severe disability, primarily related to stiffness, slowness, problems in thinking and problems with walking and balance.

ANNOUNCER: Parkinson disease is a tough and potentially disabling condition. What makes it tougher is that it's progressive and lasts a lifetime.

C. WARREN OLANOW, MD: The good side is that modern treatments have been very effective at maintaining the independence of patients with Parkinson's disease, minimizing the amount of disability that they experience and permitting them to lead a relatively normal life for many years after the diagnosis.

DEE EDWARD SILVER, MD: The idea that we like to do is to get appropriate medicine early, give treatment when it's really needed if there's functional impairment or the patient isn't doing well in their activities of daily living.

ANNOUNCER: Parkinson disease depletes the supply of a brain chemical called dopamine. Science has created several treatments to address that loss. One such treatment re-supplies the brain with the use of l-dopa. But this comes at a cost.

C. WARREN OLANOW, MD: When you give levodopa to a patient, there's no question but that it really is a superior treatment. But there are limitations. One are involuntary movements in which patients experience writhing, dance-like movements, or chorea. We call these dyskinesia, and these are different than the involuntary movements that occur in Parkinson's disease.

ANNOUNCER: Another class of drugs called dopamine agonists didn't produce dyskinesias, but studies have shown their effect on Parkinson's symptoms isn't as potent as l-dopa

DEE EDWARD SILVER, MD: The l-dopa group, they were better from a motor standpoint and they did better in their activities of daily living.

ANNOUNCER: Controlling symptoms and motor side effects are factors that weigh heavily in the choice of initial Parkinson disease therapy.

C. WARREN OLANOW, MD: What I typically do in patients is start them on a dopamine agonist, maintain them on the agonist for as long as they can be satisfactorily controlled, and then introduce levodopa.

In contrast, if you have a patient who is older, who has cognitive impairment, in those instances go directly to initial therapy with levodopa.

ANNOUNCER: Trying to deliver the punch of l-dopa without the side effects has always been a goal.

DEE EDWARD SILVER, MD: What we think now with drugs which combine l-dopa, carbidopa and entacapone, allowing a greater delivery of the medicine in a more continuous manner, especially the dopamine, that we will have continuous stimulation and that will reduce, also, development of dyskinesias.

ANNOUNCER: As Parkinson disease progresses, it is common for medication effects to decrease. New drugs may lessen those gaps.

DEE EDWARD SILVER, MD: The combination drugs, I think, have a great opportunity here to help us deliver a better continuous dopamine, and I think that's going to help us with activities of daily living

ANNOUNCER: Since Parkinson disease is a lifetime condition, it's promising that effective treatments can be useful for many years.