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

Parkinson's disease issues?

Dear Dr.
Jiang,
I previously consulted you regarding my father's hand tremors.
After he underwent examinations 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 remains stiff while walking, with minimal arm swing; however, there are no signs of shuffling gait or instability.
Currently, he is taking half a tablet of Sinemet before each meal and one tablet of Requip.

I would like to ask you the following questions:
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.
Considering my father is nearly fifty and his symptoms are approximately at stage one, is it truly possible to maintain this stage for such a long time with medication?
2.
Online sources state 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 during the last visit because the doctor felt the initial dosage was insufficient.
Previously, he 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, although they have not completely disappeared.
Should the initial dosage be adjusted until the symptoms completely resolve?
4.
I have learned that long-term use of levodopa may lead to side effects such as motor fluctuations, the on-off phenomenon, and dyskinesia.
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 using ceftriaxone and mentioned a phase II clinical trial being conducted in various hospitals a few years ago, which seemed promising.
However, I have not heard any updates about this medication recently.
Have you come across any information regarding this?
I apologize for the inconvenience and greatly appreciate your assistance.
Thank you very much.

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

Dr. Jiang Junyi reply Neurology

Dear Ms.
Hsiao-Hui,
Regarding your concerns about your father's future, it is indeed difficult to address each question individually.
However, the key point is to avoid the apoptosis of dopamine neurons.
In addition to medication, certain neuroprotective dietary options can be beneficial, such as green tea and Coenzyme Q10.
Furthermore, I recommend looking up information related to "Neuroprotection" for suggestions on preventing cardiovascular diseases in daily life, which can help reduce disease progression.
Currently, National Taiwan University Hospital has established the "Taiwan Parkinson's Disease Association" (http://www.pdcare.org.tw), where many individuals with similar experiences can share information about the disease and their personal experiences.
As for the clinical trials you mentioned, I am not a specialist in movement disorders and do not have patients participating in relevant clinical trials.
Thank you for your inquiry, and feel free to discuss any related questions further!
Wishing you good health and peace,
Dr.
Chih-Yi Chiang, Taoyuan Hospital

Reply Date: 2021/08/08

More Info

Parkinson's Disease (PD) is a progressive neurodegenerative disorder primarily affecting movement. It is characterized by a range of motor symptoms, including tremors, rigidity, bradykinesia (slowness of movement), and postural instability. The disease is caused by the degeneration of dopamine-producing neurons in a specific area of the brain called the substantia nigra. This loss of dopamine leads to the hallmark symptoms of Parkinson's Disease.

Treatment and Management of Parkinson's Disease
1. Medication: The cornerstone of PD treatment is pharmacotherapy, primarily involving dopaminergic medications. Levodopa (often combined with carbidopa) is the most effective treatment for managing motor symptoms. It works by replenishing the brain's dwindling supply of dopamine. However, patients may experience a phenomenon known as the "honeymoon period," where symptoms improve significantly after starting treatment, but this can diminish over time. The duration of this honeymoon phase varies widely among individuals, typically lasting from a few years to over a decade, depending on various factors, including disease progression and individual response to medication.

2. Adjusting Medication: As the disease progresses, medication dosages may need to be adjusted. It's not uncommon for patients to require changes in their medication regimen to manage symptoms effectively. The goal is not necessarily to eliminate symptoms completely but to achieve a balance that allows for optimal functioning in daily life. In the early stages, it is often possible to maintain a good quality of life with minimal medication, but as the disease advances, more aggressive treatment may be required.

3. Side Effects: Long-term use of levodopa can lead to side effects such as motor fluctuations (the "on-off" phenomenon), dyskinesias (involuntary movements), and other complications. The likelihood of experiencing these side effects increases with the duration of treatment. To mitigate these risks, doctors often recommend a careful titration of medication, regular follow-ups, and possibly the introduction of adjunct therapies, such as dopamine agonists or MAO-B inhibitors, to optimize treatment and minimize side effects.

4. Physical Therapy and Exercise: Engaging in regular physical activity is crucial for managing Parkinson's Disease. Exercise can help improve mobility, balance, and overall quality of life. It may also have neuroprotective effects that could potentially slow disease progression. Patients are encouraged to participate in tailored exercise programs that focus on strength, flexibility, and aerobic conditioning.

5. Emerging Treatments: Research is ongoing into new treatments for Parkinson's Disease. The work by Professor He Ying-Rui on ceftriaxone, an antibiotic that has shown promise in preclinical studies for neuroprotection in PD, is an exciting development. However, as of now, the clinical application of this research is still in the trial phase, and further studies are needed to establish its efficacy and safety in humans.

Psychological and Social Considerations
Parkinson's Disease can significantly impact a patient's psychological well-being and social interactions. Patients may experience depression, anxiety, and feelings of isolation due to their symptoms. It is essential for caregivers and family members to provide emotional support and encourage open communication about feelings and concerns. Professional mental health support, such as counseling or support groups, can also be beneficial.

Conclusion
In summary, while Parkinson's Disease is a chronic and progressive condition, with appropriate medical management, lifestyle adjustments, and support, many patients can maintain a good quality of life for many years. Regular follow-ups with healthcare providers, adherence to medication regimens, and active participation in physical and mental health activities are vital components of managing this complex disease. If you have further questions or concerns about specific treatment options or emerging therapies, it is always best to consult with a neurologist or a movement disorder specialist who can provide personalized guidance based on the latest research and clinical practices.

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