I attended a Parkinson’s Disease Information Day named ‘What’s New in PD’ at Royal North Shore Hospital a few weeks ago. Highly esteemed Neurologists, Movement Disorder Specialists and PD Nurses discussed the latest in medications and advanced therapies.
Whilst there is no cure for Parkinson’s disease, medications are used to manage its symptoms. Symptoms are caused by a lack of dopamine, a neurotransmitter involved in controlling movement. Medications can help with both motor and non-motor symptoms. They include:
– Those that replace dopamine in the brain (eg Madapar, Sinemet).
– Those that stimulate current dopamine receptors to fire better (eg Sifrol).
It can take 6-12 months working with a Neurologist to establish a stable medications regime. Medications tend to work best in the first 0-3years of taking them.
Several advanced therapies are used when oral medications no longer achieve consistent control over symptoms. Some people describe ‘on’ and ‘off’ periods, where there is either not enough dopamine to control symptoms or too much causing involuntary movements (dyskinesias). Advanced therapies commonly used include:
– Apomorphine pump: delivery of medications into the bloodstream via a pump injected under the skin.
– Duo-dopa: delivery of medications in gel formation into the intestine.
– Deep brain stimulation: delivery of electrical impulses into targeted areas of the brain via electrodes to disrupt the current circuit.
It can be difficult to decide what medications or advanced therapies to start and when to start them. Your Neurologist is the best person to discuss this with. One of the Professors at the PD Day highlighted that Neurologists are now recommending starting medications and advanced therapies much earlier in diagnosis. Whereas in the past it was often delayed until later in the disease progression (when people became bed bound or were falling and freezing), current views are that starting medications early helps people achieve the best possible function and quality of life at every stage of the disease. This can mean helping to keep them at work or in sport. Not having medications can actually place people at more risk of complications, such as falling and breaking a hip due to symptoms not being managed appropriately. Advanced therapies are also being considered and used earlier, as soon as ‘on’ and ‘off’ periods can’t be modified by changing medications.
From an exercise point of view, having medications on board allows clients to access much more amplitude and power in their movements. These components are essential in the exercises involved in our PD Warrior Program, as they specifically address the symptoms of PD and help clients push past their self-selected movement pace. This all helps to drive neuroplasticity and neuro-protection to slow the progression of the disease.
If you or someone you know has PD, whether you are medicated or not, come and get assessed at ARC. You could become a PD warrior along with many others and join the fight against PD!