Parkinson's Disease: Treatment, Symptoms, and Future Research

Parkinson's disease issues?

Dear Dr.
Jiang,
I previously consulted you about the issue of hand tremors.
After my father underwent examination at the hospital, the doctor diagnosed him with early-stage Parkinson's disease.
The dopamine transporter scan revealed an orange hue on the right side instead of the normal red.
Visually, his right thumb and index finger tremble, and his right hand does not swing much while walking; it is also stiff.
However, he does not exhibit shuffling gait or instability while walking.
Currently, he is taking half a tablet of Sinemet before each meal along with one tablet of Requip.

I would like to ask Dr.
Jiang:
1.
The doctor mentioned that with proper treatment, my father could maintain his current condition for at least twenty years, and some patients remain stable until they are eighty.
Given that my father is nearly fifty and his symptoms are likely in the first stage, is it truly possible to maintain this stage for such a long time with medication?
2.
Online resources indicate that levodopa used for Parkinson's disease has a "honeymoon period," but the duration varies widely.
Could you please clarify how long this honeymoon period typically lasts? Is it possible to extend it through exercise?
3.
The current dosage of half a tablet of Sinemet and one tablet of Requip was adjusted by the doctor during the last visit, as he felt the initial dosage was insufficient.
Initially, my father was taking half a tablet of Sinemet three times a day and one tablet of Requip at bedtime.
After the adjustment, my father feels that his right hand has become more agile and stronger, and there has been some improvement in his tremors and arm swing while walking, although the symptoms have not completely disappeared.
Should the initial dosage be adjusted until the symptoms are entirely resolved?
4.
I have learned online that long-term use of levodopa may lead to side effects such as motor fluctuations, on-off phenomena, and dyskinesias.
What is the likelihood of these side effects occurring? Is there anything that can be done at this stage to prevent these issues?
5.
I previously noted that Professor He Ying-Rui from Chung Shan Medical University was developing a Parkinson's disease medication based on ceftriaxone and mentioned a couple of years ago that phase II clinical trials were being conducted in various hospitals.
It seemed promising, but I have not heard any updates about this medication recently.
Have you heard any information regarding this?
I apologize for the trouble and greatly appreciate your assistance.
Thank you very much.

Xiao Hui, 20~29 year old female. Ask Date: 2021/08/07

Dr. Jiang Junyi reply Neurology

Hello,
Regarding the treatment of Parkinson's disease, it is usually related to the patient's lifestyle needs, and many patients in clinical practice do not achieve complete symptom relief.
It is recommended to focus on your father's health information to reduce the occurrence of cardiovascular diseases and the issues related to polypharmacy.
Many medications can also induce symptoms similar to Parkinson's disease, with the most common being antipsychotic medications used to treat psychiatric disorders, as well as antihypertensive medication reserpine and antiemetic medication metoclopramide (Primperan).
As for clinical trials, participation is typically suggested when first-line medications are ineffective.
Neurology departments in medical centers often have movement disorder specialists who have more experience in treating Parkinson's disease, so it is advisable to consult with an expert in this field.

Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.

Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2021/08/07

More Info

Parkinson's Disease (PD) is a progressive neurodegenerative disorder primarily affecting movement. It is characterized by the degeneration of dopamine-producing neurons in the substantia nigra, a part of the brain that plays a crucial role in coordinating movement. The disease typically manifests in individuals over the age of 50, but early-onset cases can occur. The symptoms of Parkinson's Disease include tremors, rigidity, bradykinesia (slowness of movement), and postural instability. In addition to motor symptoms, non-motor symptoms such as depression, anxiety, and cognitive changes are also prevalent.

Treatment Options
Currently, there is no cure for Parkinson's Disease, but various treatment options are available to manage symptoms effectively. The most common treatment involves the use of medications, particularly Levodopa (often combined with Carbidopa), which helps replenish dopamine levels in the brain. Other medications include dopamine agonists, MAO-B inhibitors, and anticholinergics, which can help alleviate symptoms, especially in the early stages of the disease.

1. Long-term Management: It is indeed possible for patients to maintain their current state for many years with appropriate treatment. Some patients have been known to maintain a relatively stable condition for decades. The key is regular follow-ups with a neurologist to adjust medications as needed and to monitor the progression of the disease.

2. Levodopa and the Honeymoon Period: The "honeymoon period" refers to the initial phase after starting Levodopa treatment when patients experience significant relief from symptoms. This period can last anywhere from a few months to several years, depending on the individual. Engaging in regular physical activity and rehabilitation can potentially prolong this period by maintaining mobility and overall health.

3. Medication Adjustments: It is not necessary for the medication to eliminate symptoms completely. The goal of treatment is to manage symptoms effectively and improve the quality of life. Adjustments to medication dosages should be based on the patient's response and side effects rather than aiming for complete symptom resolution.

4. Side Effects of Long-term Levodopa Use: Long-term use of Levodopa can lead to complications such as motor fluctuations (the "on-off" phenomenon) and dyskinesias (involuntary movements). The likelihood of these side effects increases with the duration of treatment. To mitigate these risks, it is important to follow a consistent medication schedule, maintain regular communication with healthcare providers, and consider adjunct therapies such as physical therapy.

5. Research on Ceftriaxone: Regarding the research conducted by Professor He Ying-Rui at Chung Shan Medical University, ceftriaxone has shown promise in preclinical studies for its neuroprotective effects in models of Parkinson's Disease. However, as of now, there may not be significant updates on the clinical trials. It is advisable to keep an eye on reputable medical journals or clinical trial registries for the latest information.

Conclusion
Parkinson's Disease presents a complex challenge, but with the right treatment and support, many patients can lead fulfilling lives. It is crucial for patients and their families to stay informed about the disease, engage in regular medical consultations, and explore supportive therapies such as physical and occupational therapy. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can significantly impact the quality of life for those living with Parkinson's Disease. If you have further questions or concerns, do not hesitate to reach out to healthcare professionals who specialize in movement disorders.

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