Early Parkinson's Disease: Treatment Options and Prognosis

Parkinson's disease

Hello Doctor, my father is nearly 50 years old and recently started experiencing tremors in his right hand.
He also walks with his body close to his side and does not swing his arms much.
Last month, he visited the China Medical University Hospital, where the doctor diagnosed him with Parkinson's disease.
During the assessment of dopamine levels in his brain, a reduction in dopamine was noted, with the color indicating approximately in the orange-yellow range.
The doctor mentioned that medication treatment could maintain his condition for at least twenty years, and some patients have maintained their condition for thirty to forty years.
If he continues to take his medication, this disease is not expected to progress to a severe stage.
The doctor prescribed "half a tablet of Sinemet (25/100) along with one tablet of Requip," to be taken three times a day.
I would like to ask the doctor the following questions:
1.
I have seen online that long-term use of levodopa can lead to dyskinesia and fluctuations in medication effects.
Other early-stage patients are treated with dopamine agonists alone to avoid these fluctuations.
Since my father's symptoms are likely early-stage Parkinson's disease, is it acceptable to start levodopa this early? Should I discuss adjusting his treatment with the doctor? Or is this dosage appropriate for early-stage treatment?
2.
The doctor indicated that his condition could be maintained for at least twenty years, possibly even thirty to forty years.
However, I have not found similar information in my research.
Can medication really maintain this condition for such a long time?
3.
I read online that if the disease progresses to the middle or later stages, the effectiveness of dopamine may diminish, and deep brain stimulation might be considered.
Is it certain that his symptoms will worsen to the point of needing this surgery, or is there a chance that medication could continue to maintain his condition?
4.
My father is relatively young among the Parkinson's population.
Is the rate and degree of disease progression slower compared to older patients?
I apologize for the numerous questions, and I appreciate your help.
Thank you very much.

A-Liang, 20~29 year old female. Ask Date: 2021/07/30

Dr. Cai Zongzhang reply Neurology

Hello, A-Liang! Delaying the use of levodopa and reducing the dosage can postpone the onset of dyskinesia.
It is recommended to discuss medication options with your physician.

Reply Date: 2021/07/30

More Info

Understanding early Parkinson's disease, its treatment options, and prognosis is crucial for patients and their families. Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized primarily by motor symptoms such as tremors, rigidity, and bradykinesia (slowness of movement). The disease is caused by the degeneration of dopamine-producing neurons in the substantia nigra, a part of the brain that plays a key role in movement control.

Treatment Options
1. Levodopa (L-DOPA): This is the most effective medication for managing Parkinson's symptoms. It is converted into dopamine in the brain, helping to alleviate motor symptoms. In early stages, starting treatment with a low dose of L-DOPA, as prescribed in your father's case, is common. Concerns about long-term use leading to motor fluctuations and dyskinesias (involuntary movements) are valid; however, starting treatment early can help maintain quality of life. The goal is to find a balance between managing symptoms and minimizing side effects.

2. Dopamine Agonists: These medications mimic dopamine's effects in the brain and can be used as an alternative to L-DOPA, especially in younger patients. They may help delay the need for L-DOPA and reduce the risk of developing dyskinesias. However, they can have side effects such as impulse control disorders.

3. Other Medications: MAO-B inhibitors and COMT inhibitors can also be used to enhance the effects of L-DOPA or provide symptom relief.

Prognosis
Regarding the prognosis, it is indeed possible for patients to maintain their functional status for many years with appropriate treatment. While the disease is progressive, advancements in treatment have allowed many patients to lead active lives for decades. Your father's doctor’s statement about maintaining his condition for 20 to 40 years is supported by clinical experience, although individual outcomes can vary widely based on factors such as age at onset, overall health, and adherence to treatment.

Disease Progression and Surgical Options
1. Progression: Not all patients will experience severe progression of symptoms. Some may remain stable for many years, while others may experience more rapid declines. The rate of progression can be influenced by factors such as age at diagnosis, genetic predispositions, and overall health. Younger patients, like your father, may experience a slower progression compared to older patients.

2. Deep Brain Stimulation (DBS): This surgical option is typically considered for patients with advanced Parkinson's disease who experience motor fluctuations that are not adequately controlled by medication. Not all patients will require this intervention, and many can manage their symptoms effectively with medication alone for a significant period. The decision to pursue DBS is based on individual circumstances, including the severity of symptoms and the patient's response to medication.

Conclusion
In summary, early intervention with medications like L-DOPA is crucial for managing Parkinson's disease symptoms effectively. While concerns about long-term use are valid, starting treatment early can significantly improve quality of life. Regular follow-ups with a neurologist specializing in movement disorders are essential to monitor the disease's progression and adjust treatment as necessary. Open communication with your father's healthcare team about any concerns regarding medication and treatment options is vital for optimizing his care.

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