These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Parkinson’s- Life Expectancy and Quality
Question: What is the life expectancy and quality of life for persons afflicted with Parkinson’s Disease?
Answer: Parkinson’s Disease, like many neurologic diseases, is a disease that is hard to predict. Its usual course is very gradual so that diagnosis is sometimes difficult because of the slow progression. Often it is only after treatment that the family and sometimes ones physician recognizes that the disease has been slowly progressing for several years. Some patients have rapid progression of the disease, other progress more slowly. Generally, the progression is slow. Treatment does not seem to affect the progression although this has been difficult to accurately test. The quality of life is usually affected by the difficulty with motor activity. Falling and difficulty performing usual daily activities usually frustrate the patient and family. About 10-15% of patients will experience dementia with Parkinson’s and this will dramatically affect their life. However, most patients do not experience loss of mental ability.
Levodopa w/Carbidopa Eldepryl
Question: My grandfather has been diagnosed with Parkinson’s. The drugs that have been prescribed are as follows: Levodopa w/Carbidopa Eldepryl. Looking in different web sites, I have not found any information, pertaining to Parkinson’s, that these drugs are used?!
I am curious if these drugs help the disease or just relieve some of the symptoms of the disease. What is the most common drug prescibed for Parkinson’s. Also, he is a very small man, he has had many re-occurring asthma and bronchitis episodes. Any information would be greatly appreciated.
Answer: Levodopa w/ carbidopa is Sinemet, and is perhaps the most frequently used medication in the treatment of Parkinson’s disease. It does not cure the patient of the condition, but it can be very helpful in reducing the symptoms of stiffness, slowness of movement, and tremor. Eldepryl likewise is a very common medication used in the treatment of Parkinson’s disease. It is used in hopes of preventing much progression of the disease though this assertion is still somewhat controversial. It has some minimal Sinemet-like action but is used not so much for what it can do for the patient, but rather for its potential to possibly slow down the process whereby nerve cells are dying. Any medication that one anticipates using must be checked for its appropriateness for the situation and whether it would interfere with any other medications that are already being used.
Parkinson’s- Emotional Support
Question: I have a close friend with Parkinson’s Disease. He is going to have to quit working because of the debilitative effects of this illness. He is understandably upset about this turn of events. As a kidney transplant patient and a person with a degenerative muscle disease, I do understand how difficult it is to deal with these major life changes. What can I do to provide him with emotional support and add to his feelings of dignity.
Answer: When I am trying to provide emotional support in my practice, I always focus on how I would prefer to be treated. First, I acknowledge that I cannot ever truly understand the feelings if I have not “walked in those shoes”. This does not, however, prevent me from feeling empathy. Second, I try to validate any feelings that an individual has. This means accepting without criticism any feeling as OK and valid. This approach will commonly allow an entry into ones emotional side. The most common problem I see is a difficulty by most people to discuss their feelings. This can sometimes be addressed by starting conversations in the “I” mode. That is, a statement like “When I had my kidney transplant I felt very_______”. This is an approach that often works for me in my practice.
Parkinson’s Treatment
Question: I am early onset PD, 43 years old, diagnosed 4 years, taking Artane and Eldepryl. My tremor is becoming more noticeable socially and writing at work a problem. I worry about starting a levadopa based treatment because of the side effects, eg dysninesia. What options do I have?
Answer: The treatment of Parkinson’s Disease has over the years had certain fads; drug holidays, high dose Parlodel. Currently there is much enthusiasm to avoid using Sinemet until it is absolutely necessary. Using Amantadine, Artane and Eldepryl represent ways of treating the Parkinson’s patient without using Sinemet. The question that the patient must always answer for the physician is whether these methods work, and are you, the patient, satisfied with the level of treatment? While Sinemet is not good at treating tremor (as compared to the anti-cholinergic) it, nonetheless, has some ability to reduce tremor. Other options for the tremor patient is to explore other anti-cholinergic medications and to be examined to make sure that you have not developed an action tremor which is treated differently.
NADH Treatment and Parkinson’s Disease
Question: On an Internet Parkinson’s Disease newsgroup, I keep reading about something called NADH. There have been favorable comments from those who’ve tried it. As a long-term patient with PD, I am very interested in it. Is it “snake oil” or is there something to it? Any info would be greatly welcomed.
Answer: Few literature citations are found in regards to this treatment. NADH is a co-enzyme found naturally in the body. There have been a flurry of reports of its benefits to Parkinson’s patients when given intravenously. Of note, these reports seem to come from primarily the Birkmayer Institute for Parkinson’s Therapy, Vienna, Austria. A report in 1994 from the Dept. of Neurology, University Hospital, Linkoping, Sweden, found no sustained benefit from this therapy. The reviwer had actually never heard of this therapy prior to researching this topic. I would consider this therapy is as of yet an unproven benefit.
Parkinson’s Disease
Question: What is the benefit of waiting for as long as possible to start using Sinemet when the patient is 43 years old? If the patient does start Sinemet how soon can he hope to see results in lessening of the tremor and more fine motor control and increased writing ability?
Answer: Sinemet does nothing to arrest or slow the progression of Parkinson’s Disease. In some patients, side-effects develop which appear to be either dose or time-related. These side-effects are usually difficult to treat. Consequently, most physicians delay the treatment of Parkinsons until the tremor is disabling. Once begun, the medication works within one to two days if at the correct dosage.
