New guideline shows advice on 3 drugs for early treatment of Parkinson’s disease

The guidelines for the treatment of movement problems in people in the early stages of Parkinson’s disease have been updated.

New treatment recommendations from the American Academy of Neurology focus on dopamine drugs, which increase dopamine levels or mimic the effects of dopamine.

Parkinson’s disease is a movement disorder that occurs when nerve cells in the brain fail to make enough dopamine.

The new directive updates treatment recommendations published in 2002.

“We carefully reviewed the available research on the effectiveness and possible risks of drugs for treating motor symptoms in people with early-stage Parkinson’s disease and found that levodopa is generally the best first treatment for these symptoms. Said Dr Tamara Pringsheim, lead author of the updated guideline.

She is Professor of Clinical Neuroscience at the University of Calgary in Alberta, Canada.

The guideline says neurologists should counsel patients on the benefits and risks of initial treatment with three treatment options: levodopa, a drug that is converted to dopamine in dopamine agonists in the brain; drugs that mimic the effects of dopamine; and monoamine oxidase B inhibitors, or MAO-B, drugs that prevent an enzyme called MAO-B from breaking down dopamine.

Levodopa treatment is better at reducing motor symptoms in patients with early-onset Parkinson’s disease than dopamine agonists or MAO-B inhibitors, according to the guideline published this week in the journal Neurology.

“Still, there are side effects with levodopa as well as other medications, so it is important that a person newly diagnosed with Parkinson’s disease discusses all options with their neurologist before deciding on the best treatment plan. for her, “Pringsheim added in an AAN statement. Release.

Levodopa is more likely than dopamine agonists to cause dyskinesia – involuntary and erratic writhing movements of the face, arms, legs, or trunk – during the first five years of treatment, but rates of severe or severe dyskinesia debilitating were low during this period.

The guideline states that neurologists should prescribe the lowest effective dose of levodopa to maximize benefit and minimize the risk of dyskinesia.

Although dopamine agonists are less likely to cause dyskinesia, they are more likely to cause impulse control disorders, such as compulsive gambling, eating, shopping, or sexual activity, as well as hallucinations. , as directed.

They are also associated with a greater risk of excessive daytime sleepiness, so people whose jobs require driving or operating heavy machinery may face greater problems due to these side effects, the directive warns.

He also indicated that patients are more likely to stop their treatment due to side effects when taking dopamine agonists and MAO-B inhibitors than when taking levodopa, and that Patients taking MAO-B inhibitors are more likely to require additional treatment within two to three years. .

“Choosing to start medication is a collaborative decision between a person with Parkinson’s disease, their neurologist and their caregiver,” said Pringsheim.

“The right medication will depend on a person’s symptoms, age and life circumstances. They are encouraged to discuss the potential benefits and side effects of drug options with their neurologist and healthcare team,” said Pringsheim.

More information

The Parkinson Foundation has more on Parkinson’s disease.

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