Saturday, September 21, 2019
Treatments of Parkinson’s diseases Essay Example for Free
Treatments of Parkinson’s diseases Essay Parkinson’s disease is a neurological condition that affects the sufferer’s mobility and also the speech. It affects the central nervous system leading to a person’s inability to control body movement and also speech. It is a disease whose treatment does not intend to cure it but instead, aims at controlling its manifestation. There are various ways in which this can be done. It may involve the use of drugs, performance of surgery and also physical exercise is encouraged. It progresses gradually from the early stages with mild symptoms to later stages with severe symptoms.            The disease is as a result of lowered formation and action of dopamine which is produced by the dopaminergic neurons found in the brain. This then led to the formation of drugs that will either increase the formation or mimic the actions taken by dopamine in the brain. This was important because an increase in the levels of dopamine would lead to a reduction of the effects of the disease. All the drugs used to control the disease all include dopamine as their main active agent regardless of how it works. Depending on which class of drugs it belongs to, it may either mimic or produce dopamine.            Among the earliest forms of treatments are the anticholinergics. These were used even before the introduction of levodopa which is the most widely used drug. The anticholinergics had very mild benefits when they were compared to the harmful side effects that followed its use. The side effects include having a dry mouth, urine retention which especially occurs among men, it also causes very severe constipation and nausea. There are some other side effects that occur that are more serious and are among the major reasons why the use of these drugs has become minimal. These include confusion memory loss and hallucination (http://www.mayoclinic.com).            The realization that the benefits realized were much less than the side effects it causes has led to the reduction of its prescription. Since some anti-depressants and antihistamine diphenhydramine tend to have the almost the same effects as the anticholinergics, some doctors prescribe them to older people who are suffering from Parkinson’s disease. Once an individual realizes that they are having hallucinations and the other severe symptoms, it is adviced that the use of the drug be stopped immediately.            Levodopa is drug that was introduced in 1967 and is currently the most commonly used drug. It is mostly addressed to as Sinemet and is used to help restore the control that one has over the muscles. It is referred to as a gold standard because it is introduced at the time when the symptoms are very mild at the onset of the disease. Once it gets into the body, it is converted inside the brain into dopamine. It therefore increases the level of dopamine that is found in the brain and counters the effects of the disease. (http://www.fdu.gov). the conversion to dopamine is what leads to the positive effects that a patient experiences when using the drug.            It however has very serious side effects which include nausea and dyskinesias (involuntary movement). This occurs because only a small percentage of it enters the dopaminergic neurons to be transformed into dopamine in the brain. The rest of it is transformed in to dopamine in the body. It therefore becomes necessary to use cardibopa which delays the metabolism of levodopa until it reaches the dopaminergic neurons in the brain. The combination hence helps reduce the side effects caused by the drug because once the metabolism takes place only in the brain it means that the side-effects are not felt as much as when it occurs in the body.  The other problem posed by the use of this drug is that its dosage needs to be increased over time. It has also been observed that it works on and off without any explained cause as to why this happens. This makes it unreliable because its effects are not constant and at times the patient gets violent attacks while still under medication. The various side effects and unreliability of levodopa leads to the necessity to combine it with various other drugs to make it more effective. Some of these drugs can be used on their own while others actually require to be used with the levedopa-cardibopa combination.            A cluster of drugs called dopamine agonists are usually used in a combination with the levodopa-cardibopa drugs. They can however also be used on their own. If used without the use of cardibopa-levodopa therapy, it can only be when the diseased has not progressed far and also only works well in younger adults. In other words it is used alone when the symptoms are mild and only in younger adults. This class of drugs does not produce or help in the production of dopamine but instead imitates the effects that dopamine has in the body. (http://www.mayoclinic.com). In other words, they tend to act on behalf of dopamine.            This class of drugs include; Apokyn, Requip, Parlodel and Mirapex. Parlodel used to be administered some time back but of late its use has become less. This is because it had very serious side effects that endangered the patient more than it benefited him/her. It would cause inflammation in the lungs and/or heart valves of the user and thus would lead to further deterioration of the patients’ health. In general this class of drugs has side effects that are almost similar to those of carbidopa-levodopa but with slight differences. The effects of having involuntary movement are reduced while those of hallucinations and/or sleepiness are increased.            The drug Mirapex takes up the role of dopamine in the body as it is one of the dopamine agonists. When it is used in the absence of levodopa-cardibopa, it causes a 30% improvement in the health of the patient. When used in combination, it is able to reduce the intake of the levodopa dosage by about 25%. Requip is also a dopamine agonist that can also be used either alone or with levodopa. When used together with levodopa, it can reduce the intake of the close by around 31%. The reduction of the dosage is on top of increased benefits to the patient (http://www.fda.gov). Catechol-o-methyltransferace inhibitors which are usually abbreviated as COMT inhibitors, are used block the enzymes that break down the levodopa into dopamine even before it reaches the brain thus causing severe side effects and minimal benefits to the patient. They can be used in combination with the levodopa-cardibopa therapy. The two main COMT inhibitors are Tasmar and Entacapone. Tasmar is rarely used because of its severe impact on the health of the user. It causes severe liver damage and hence is only used as a last resort if the patient has failed to respond to any other therapy (http://www.mayoclinic.com)            Stalevo is the result of a combination of cardibopa, levodopa and entacapone. Entacapone does not have side-effects as severe as those of tasmar and hence is preferred than tasmar. Its major side-effect is the involuntary movements experienced by the user. It works in conjunction with the cabidopa-levodopa therapy by increasing their availability. This is done by blocking the enzymes that break down the substance into dopamine until the drug is already in the brain. This then means that the effects of cabidopa-levodopa are prolonged because they occur only in the brain.            Selegiline also referred to as Eldepryl is another drug that can either be used with or without the presence of carbidopa-levodopa therapy. It works by preventing the metabolism of dopamine. It does this by slowing down the activity of one of the enzymes that metabolize dopamine. This is the monoamine oxidase B which is abbreviated as MAO-B. The use of selegiline has other positive effects like delaying the need of carbidopa-levodopa. When combined with carbidopa-levodopa it improves the effectiveness of the drug. It can however have some adverse toxic reactions when combined with Demerol which is a narcotic drug.            Apart from ingesting drugs, they can be administered through the skin through the use of a silicon-based patch. Rotigotine is a dopamine agonist drug that can be administered through the skin but can only be used in the early stages of the disease. This is called Neupro-rotigotine transdermal system. The patch requires to be changed every 24 hours. It works by stimulating the dopamine receptors in the body. Its side-effects include skin reaction where the patch is hallucinations, insomnia, drowsiness, sleep-attacks, nausea, vomiting and the most severe is the reduction in blood pressure once the person stands up (http://www.fda.gov).            Amantadine is another drug that is used in treatment of Parkinson’s disease but its use was discovered by accident. Initially it was to be an antiviral used in the treatment of influenza and was approved as such in 1976 by Food and Drug Administration. It was however discovered to provide relief if only short term when used alone in the early stages of the Parkinson’s disease. When it is combined with carbidopa-levodopa it can be used by those in the later stages. It has side effects that mostly involve swelling of the ankles and also turning the skin color to purple (http://www.mayodinic.com).            In every human beings body, there is the presence of coenzyme Q10 which is produced by the mitochondria. This enzyme is used in the transport of electrons so that they can gain energy from the oxygen inhaled. This is done in the process called cellular respiration. The levels of this enzyme are very low in those suffering from Parkinson’s disease. These people can therefore benefit greatly by having more of this enzyme which can only be done by taking supplements. This then aids in helping slows down the onset of the disease and these supplements can be brought from a pharmacist.            Apart from the use of drugs, there are various surgeries that can be used to control the effects of the disease. One of the surgeries is pallidotomy which involves the destruction of a small bit of the globus pallidus. This is because it is overactive in those suffering from Parkinson’s disease. It is done by drilling a small hole in the skull and using an electric probe to do the destruction. It can only be done when the patient is sedated but awake so as the judge his or her reactions to stimuli. It is done on one side of the brain at a time and may be done more than once if necessary. Its side effects mostly involves impaired speech (http://www.fda.gov)            Thalamotomy is another surgical procedure used in the control of Parkinson’s disease. It is only performed on those patients who are experiencing tremors in either the hand or the arm and these tremors become too severe to the point of disabling that person. It involves the destruction of a specific group of cells that are in the thalamus in the brain. It has been found to be successful in that it reduces or completely eliminates the tremors in around 90% of those who undergo the procedure (http://www.fda.gov).  There is also the presence of a gadget that can be equalized to the pacemaker used for cardio problems and is referred to as a â€Å"brain pacemaker†(http://www.fda.gov). This is a form of therapy is referred to as Active Tremor Control Therapy. It involves the surgical implantation of an insulated wire to the brain. It is placed in the thalamus region of the brain, the subthalamic nucleus, and also the globus pallidus area of the brain. It is referred to as a neurostimulator whose main task occurs in the process of a tremor occurring. The whole system includes three components which are: lead, extension and the neurostimulator. This system is referred to as Deep Brain Stimulation because it occurs directly inside the brain. A small hole is made in the skull and through it the lead is inserted into the brain. The lead is a very thin wire that is insulated. The tip of the lead is in contact with the area that has been targeted. Once it has been implanted, it is connected to the neurostimulator by the extension which is also an insulated wire (http://minds.nih.gov). The extension passes under the skin and moves from the head, to the neck, shoulder and finally to where the neurostimulator is located. The neurotransmitter is located either under the collarbone, in the abdomen or the lower chest area just directly under the skin. The neurotransmitter involves a battery pack that sends electrical impulses to the brain. This is done through the extension and finally the lead. When the person is undergoing tremors, he or she is supposed to pass a handheld magnet over the location of the neurostimulator. The electrical impulses that are sent by the neurostimulator work by blocking the electrical signals that are the cause of the Parkinson’s disease symptoms. These are dysfunctional brain signals and they are the cause of the tremors. This procedure is preferred because it does not destroy the nerve cells and hence when one wants to stop its use it is as easy as having the system surgically removed. This is then makes it possible for one to use it comfortably especially as it has minimal if any side effects. This system has no reported side effects as yet as it only involves inserting and removing a piece of wire in the brain. Works cited Henkel John, Parkinson’s Disease: New Treatments Slow Onslaught of Symptoms U.S Food and Drug Administration 1998. Retrieved on 22 November 2007 from http://www.fda.gov/fdac.features/19981498.html Mayoclinic.com Tools for healthier lives Parkinson’s disease Treatment April 12 2007 Retrieved on 22 November 2007 from http://www.mayoclinic.com/health/parkinsons-disease/DS00295/DSECTION=8 National Institute of Neurological Disorders and Stroke NINDS Deep Brain Stimulation For Parkinson’s Disease Information Page last update Nov 19 2007 Retrieved on 22 November 2007 from http://www.ninds.nih.gov/disorders/deep_brain_stimulation/deep_deep_stimulation.htm U.S Food and Drug Administration Neupro Patch for Parkinson’s Approved May 14 2007 Retrieved on 22 Nov 207 from http://www.fda.gov/consumer/updates/neupro051407.html
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