Managing Parkinson's Disease: Medication Challenges and Control Strategies

Q: Managing Parkinson's Disease: Medication Challenges and Control Strategies

Hello： The tremors associated with Parkinson's disease are mostly resting tremors, which can typically be temporarily controlled by willpower or by maintaining a tense posture (such as raising the legs). <br>However, once the individual relaxes, the tremors reappear, which is ref

Medication Issues in Parkinson's Disease

Hello Doctor: I was diagnosed with Parkinson's disease this August.
Currently, I am experiencing frequent and significant tremors in my left foot, and during severe episodes, my big toe tends to curl inward.
Additionally, I have muscle soreness in my buttocks and my feet sweat.
Most of the time, I have to stand because lying down puts pressure on my buttocks, which exacerbates the tremors.
The doctor prescribed me levodopa 100 mg and carbidopa 25 mg to be taken three times a day, starting with 100 mg each time and increasing by 50 mg every twenty-one days until reaching 200 mg.
However, since starting the medication, the tremors have not improved, and I have noticed that they become more severe when I am anxious.
Although I have been taking serotonin as well, the effect has been limited.
I initially thought the dosage of the dopamine medication was insufficient, but even when I increased to 150 mg each time, the tremors did not lessen.
Doctor, is this a dosage issue, or does this medication simply not work for me? Additionally, is it possible to temporarily control the tremors of Parkinson's with willpower to stop my foot from shaking? If I can control it, does that mean it is not Parkinson's? Thank you.

Ray, 50~59 year old female. Ask Date: 2021/10/05

Dr. Hong Weibin reply Neurology

Hello: The tremors associated with Parkinson's disease are mostly resting tremors, which can typically be temporarily controlled by willpower or by maintaining a tense posture (such as raising the legs).
However, once the individual relaxes, the tremors reappear, which is referred to as re-emergent tremor, a characteristic feature of Parkinsonian tremors.
If the tremors do not respond well to dopamine treatment, the addition of anticholinergic medications may be considered.
It is advisable to discuss this with your physician during your follow-up visit.
If the response to medication is still inadequate, deep brain stimulation of the thalamus may ultimately be considered.
Hong Wei-bin

Reply Date: 2021/10/05

More Info

Managing Parkinson's Disease (PD) can be a complex and challenging process, particularly when it comes to medication management and symptom control. Your experience with the medication regimen, specifically with levodopa (often combined with carbidopa), is not uncommon among individuals diagnosed with PD.
Levodopa is the most effective medication for managing the motor symptoms of Parkinson's disease, particularly bradykinesia (slowness of movement) and rigidity. However, it is important to understand that the effectiveness of levodopa can vary significantly from person to person. In your case, despite increasing the dosage, you are still experiencing significant tremors and discomfort. This could be due to several factors, including the progression of the disease, the presence of other underlying conditions, or even the way your body metabolizes the medication.

The phenomenon you describe, where tremors worsen during periods of anxiety, is also quite common in PD patients. Stress and anxiety can exacerbate motor symptoms, leading to increased tremors and muscle stiffness. This suggests that managing anxiety may be an important aspect of your overall treatment plan. Cognitive-behavioral therapy (CBT), mindfulness practices, and relaxation techniques can be beneficial in managing anxiety and may help in reducing the severity of your tremors.

Regarding your question about whether the medication is ineffective or if the dosage is simply insufficient, it’s essential to have an open dialogue with your neurologist. They may consider adjusting your medication regimen or exploring additional therapies. For instance, some patients benefit from adjunct medications such as dopamine agonists (like pramipexole or ropinirole) or MAO-B inhibitors (like rasagiline), which can help enhance the effects of levodopa or provide symptom relief on their own.

As for the ability to control tremors through willpower, it is important to note that Parkinson's disease is characterized by involuntary movements, which are not easily controlled by conscious effort. While some patients report temporary relief through focused concentration or specific movements, this is not a reliable or sustainable method of managing symptoms. The tremors are a result of neurochemical imbalances in the brain, primarily involving dopamine pathways, and thus require pharmacological intervention for effective management.

In addition to medication, physical therapy can play a crucial role in managing symptoms of Parkinson's disease. A physical therapist can work with you to develop a tailored exercise program that focuses on improving mobility, strength, and balance, which can help mitigate some of the physical challenges you are facing. Occupational therapy may also be beneficial in adapting daily activities to enhance your quality of life.

Lastly, it is essential to maintain regular follow-ups with your healthcare provider to monitor your symptoms and medication effectiveness. Parkinson's disease is a progressive condition, and treatment plans often need to be adjusted over time. Engaging with support groups or counseling services can also provide emotional support and practical advice from others who are experiencing similar challenges.

In conclusion, managing Parkinson's disease requires a comprehensive approach that includes medication management, physical and occupational therapy, and psychological support. Open communication with your healthcare team is vital to finding the most effective strategies for your individual situation.

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