July 10, 2018

Parkinson’s Disease Treatment – Non Pharmaceutical

Non-pharmaceutical Parkinson’s treatments’ is an umbrella term that denotes a spectrum of therapies and approaches. These from range from simple, yet easily applicable techniques through to novel treatments of a highly complex and experimental nature.

As noted in a previous article concerning pharmaceutical treatments, non-pharmaceutical treatments can be divided into 3 main categories, namely:

  • Holistic Treatments.
  • Surgical Treatments.
  • Unproven Treatments.

The following will outline various non-pharmaceutical treatments for Parkinson’s and this will be followed up with subsequent articles exploring each topic in greater depth.

HOLISTIC PARKINSON’S TREATMENTS

In general, this broad category can be divided into number of subcategories. However, bear in mind that from an holistic point of view, one’s physical and emotional well being are dynamically interlinked. For example, relaxation techniques can reduce muscle tension and spasms thereby improving one’s physical well being. Subsequently, less pain and discomfort produces a better state of mind and studies have shown that emotional well being directly impacts the immune system. Boosting the immune system will therefore improves one’s physical well being…and so the cycle continues:

Parkinsons Disease Treatments - Non Pharmaceutical

Therapies aimed at improving emotional well being.

An important aspect of this subcategory is aiming to empower the patient so that they can address their worries and concerns with people in a similar position. One’s quality of life can be improved on a practical level by sharing advice and tips but also, being able to chat to others with Parkinson’s can often be very therapeutic; the adage ‘a problem shared is a problem halved’ springs to mind. Therefore, included within this area would be things such as:

  • Support groups.
  • Group therapy and wellness programs.

Moreover, many people desire the opportunity to continue their career for as long as possible. It can be an important element concerning how people view their quality of life. In this regard, optimizing a patient’s ability to work can be achieved through:

  • Occupational therapy.

Therapies directed towards improving physical well being.

This area covers various physical therapy and exercise programs, such as:

  • Those tailored to be undertaken in specific locations or environments e.g. whilst sitting, laying in bed, out walking or when submerged in water etc. The aim is to maintain strength, flexibility and prevent muscle wastage.
  • A speech pathologist will be able to ascertain various issues related to the respiratory system , vocal box, associated muscles and general speech mechanism. They can provide advice on tackling other symptoms such as swallowing and choking problems, dribbling or dry mouth. Speech therapy can involve vocal/humming exercises aimed at improving breath and speech control through maintaining and developing abdominal and throat muscles. This can result in better pronunciation and a stronger voice.
  • Physiotherapy. Emphasis will often be placed on the face, jaw, stretching, bending and breathing exercises.
  • Massage. Aside from providing physical benefits such as relieving muscular tension, aches and pain or helping soft tissue injuries, there are many other advantages of an holistic nature e.g. reduce stress and anxiety, provide a sense of comfort etc.
  • Yoga. Improvements to do with body awareness and posture, flexibility and range of motion, better strength and control, as well as improved alertness and sleep patterns are just a few examples of positive traits attributed to Yoga undertaken by Parkinson’s patients.
  • Tai Chi is thought to improve balance and motor control for people with Parkinson’s disease. This helps with postural instability and reduce the risk of falling over.
  • Relaxation techniques improve both physical and mental well being and can make a difference with disrupted sleep patterns.

Therapies aimed at improving one’s diet.

Working with a dietitian can help address a number of common symptoms of Parkinson’s disease. For example:

  • Maintaining a healthy and balanced diet boosts the immune system. Aside from just feeling better, an healthy immune system can help reduce certain Parkinson’s symptoms e.g. risk of infections such as pneumonia. Furthermore, they may recommend taking supplements and provide specific instructions on how to take them.
  • A diet rich in fiber can help regulate the digestive system thereby reducing the common symptoms of constipation and bloating.
  • Swallowing and constipation issues can be reduced by cutting food into smaller portions. In addition, the risk of choking can be lessened by avoiding lying down during the first hour after eating.
  • They will make the patient aware of avoiding certain foods and ingredients which can interact adversely with conventional Parkinson’s medications e.g. adsorption can be affected by the food consumed (Levodopa should taken at least an hour after eating as high protein levels can reduce its uptake), or by other drugs taken (antacids can impede drug absorption through the stomach).

SURGICAL PARKINSON’S TREATMENTS

Surgical procedures for Parkinson’s disease include:

  • Electrode brain implants allow deep brain stimulation (DBS) and this approach is typically employed in the later stages of the condition. It can help with dyskinesia (tremors and involuntary movements) related issues. Pallidal Deep Brain Stimulation and Subthalamic Nucleus Deep Brain Stimulation are examples of this form of treatment.
  • Lesioning is the technique of destroying targeted areas of the brain to bring about symptomatic relief of dyskinesia. Examples targeting distinct regions of the brain include Pallidotomy, Thalamotomy and Subthalamotomy.
  • Experimental surgical techniques that are still in their infancy e.g. Neurotransplantation using dopamine producing fetal brain cells.

UNPROVEN PARKINSON’S TREATMENTS

This category is reserved for medications not yet proven by scientific evaluation i.e. insufficient evidence of their efficacy. Various substances and compounds have been proposed for having the potential to be effective for Parkinson’s disease, for example:

  • Antioxidants.
  • Anti-inflammatory drugs.
  • Estrogens.
  • Fatty acids.
  • Free radicals.

Parkinson’s Disease Treatment – Pharmaceutical

Although there is no cure for Parkinson’s at present, there does exist a range of Parkinson’s disease treatments that help address the various symptoms exhibited by the disease. As was noted in Parkinson’s disease early symptoms, the way a patient responds to a given treatment and the side effects they experience e.g. increased sweating or hallucinations, varies on an individual basis. This is why it is absolutely essential for a patient to be evaluated and monitored on an on-going basis and have their treatment tailored to their specific needs. Not only will it improve the quality of life of a patient but in certain cases, it may possibly help to minimize the rate of progression of the disease.

Parkinson’s disease treatments can be classified into the following 2 main groups:

Non-Pharmaceutical Parkinson’s Treatments

Non-Pharmaceutical treatments will be covered in more depth in a subsequent article but in summary, they can be subdivided into:

  • Holistic, including various therapies and dietary considerations
  • Surgery.
  • Treatments that may have possible benefits.

Pharmaceutical Parkinson’s Treatments

Classifying pharmaceutical treatments varies depending on one’s source of data. One must always remember that although pharmaceutical medication’s can improve an individuals symptoms significantly, as with any medication, there is always a balance to be achieved with possible side effects e.g. dizziness, constipation, altered mental state, raised heart beat etc. The following is one possible way of grouping the various drugs used in the treatment of Parkinson’s disease.

Parkinson's Disease Treatment - Pharmaceutical

Parkinson’s Disease Treatment – Pharmaceutical

Anticholinergics (referred to as Antimuscarinics)

Basic function:
A neurotransmitter functions as a chemical messenger between the nerve cells and in Parkinson’s disease, a lack of the neurotransmitter dopamine causes an imbalanced over activity of acetylcholine. Anticholinergics function by blocking the neurotransmitter acetylcholine in the central and the peripheral nervous system and therefore help minimize Parkinson’s symptoms associated with treating tremors, rigidity and postural abnormalities (Dystonia). Deadly Nightshade and Mandrake are examples of plants that contain anticholinergic alkaloids.

Examples of Anticholinergics medication:
Biorphen® contains the active ingredient orphenadrine hydrochloride, Cogentin® is the trade name for the compound benztropine mesylate.

COMT Inhibitors (Catechol O-methyltransferase)

Basic function:
This category of drugs inhibits the enzyme involved in degrading neurotransmitters and works to help prevent the breakdown of Levodopa. The effect to ensure that a more consistent supply of Levodopa and associated dopamine reaches the brain. It is for this reason that this category of drugs is always used in combination with Levodopa. The result is that the patient experiences greater continuity of symptom relief (less ‘off’ or ‘wearing off’ periods) and a reduced dosage of Levodopa being required and thus, less risk of associated dyskinesias

Examples of COMT Inhibitors medication:
Entacapone (Comtan®), Talcapone (Tasmar®)

Dopamine Agonists

Basic function:
These drugs mimic or behave like dopamine and work by stimulating dopamine receptors in the brain thus bypassing degenerative brain cells. Such drugs function in their own right and are not converted like Levodopa into dopamine. They are typically used in the early stages of Parkinson’s (prior to using Levodapa) and at the later stages (in combination with Levodopa) to improve symptom control.

Examples of Dopamine Agonists medication:
Celance® contains pergolide mesilate, Mirapex® (pramipexole dihydrochloride), Parlodel® (bromocriptine mesylate) and Requip® (ropinirole).

Levodopa or L-Dopa

Basic function:
Levodopa functions by being converted to dopamine in the brain and helps correct the characteristic lack of dopamine and resulting symptoms found in Parkinson’s patients.
Levodopa is currently considered the ‘gold star’ treatment for Parkinson’s and is normally reserved as the most powerful treatment.
Although the usage of Levodopa was a major advancement for Parkinson’s disease treatment, the long-term side effects from its usage are now being increasingly acknowledged e.g. dyskinesias (involuntary movements).

Examples of Levodopa medication:
Levodopa is available under various brand names such as Dopar® or Larodopar®
In addition, Levodopa is commonly used in combination with other drugs to increase its effectiveness e.g.
Sinemet® = Levodopa + Carbidopa (prevents Levodopa breakdown thus allowing lower doses of Levodopa to be used)
Prolopa® = Levodopa + Benserazide (allows lower doses of Levodopa to be used)

MAO B Inhibitors (Monoamine Oxidase B Inhibitors)

Basic function:
These drugs prevent the breakdown of both natural and Levodopa derived dopamine. The result is that a patient will require less Levodopa as its effect will last longer.

Examples of MAO B Inhibitors medication:
Rasagiline (Azilect®) can be used on its own or in conjunction with Levodopa; Selegiline (Eldepryl®) is used in addition to Levodopa/Carbidopa where its effectiveness has deteriorated and is available in a orally dissolving form called Zelapar®.

NMDA Blocking Drugs

Of the various types of NMDA Blocking Drugs, the uncompetitive channel blocker called Amantadine (Symmetrel®) is used for the treatment of Parkinson’s disease. It is considered a relatively weak therapy and can be used as a monotherapy (early stage Parkinson’s) or in combination with Levodopa (later stage Parkinson’s). It helps to tackle involuntary movement problems (dyskinesia).

Newer Drugs (Developmental/Experimental)

These include drugs such as Cannabinoids, Neuroimmunophilins and Riluzole (Rilutek®). Studies involving these drugs are on-going and determining their role and effectiveness in the treatment of Parkinson’s disease is still to be determined.

In the second part of Parkinson’s disease treatment, we will look at non-pharmaceutical treatments which include holistic (various therapies and dietary considerations), surgery and treatments whose benefits are still to be determined.

Parkinson’s Disease Prognosis

“Unfortunately, the results confirm you are suffering from Parkinson’s Disease” is a phrase etched into the minds of nearly all Parkinson’s patients. Once the initial shock passes, most people’s response is to consider the worse case scenario and think, “How long do I have left?”. Fortunately, with appropriate treatment, Parkinson’s disease prognosis is not as bleak as people first imagine.

Parkinson’s is typically a condition that deteriorates over time with involuntary movements becoming progressively problematic. However, it is not fatal in itself and with appropriate treatment and care, the majority of patients will usually have a normal life span with a reasonable quality of life. For example, some research has indicated the following interesting results:

Years of Parkinson’s  Mortality Rate
– compared to a  person of same age  without Parkinson’s
 5+   Lower
 10+   Lower
 15+   1.2X Higher
 20+   1.3X Higher

Mortality associated with Parkinson’s disease is usually termed co-mortality as it results not directly from the condition itself but from secondary complications. These are usually associated with motor related issues and reduced activity, or deteriorating involuntary movements and a lack of postural control. For example:

  • Falling.
  • Choking.
  • Ulceration/bed sores/pressure sores leading to septicemia.
  • Urinary tract infections and resulting kidney problems.
  • Pneumonia.
  • Strokes.

To achieve an optimal outcome, it is essential that the patient receives specialist management of their condition concerning both treatment and care. This is especially significant for a person who has Parkinson’s disease, given that the types of symptoms and their severity, the response to medication and the rate of disease progression varies significantly between individuals. For example, the rate of symptom progression can vary by as much as 20+ years between patients and the deterioration in medication effectiveness by 2-10+ years.

Parkinson's Disease Prognosis

Parkinson's Disease Prognosis | Achieve an optimal outcome through correct disease management

In fact, depending on the individual in question and their type of employment, Parkinson’s patients may be able to continue to work part part or full time in the early to mid stages of the disease. Health/safety legislation and insurance terms would impact both the Parkinson’s patient and their employer (especially if the job involved any danger) and usually the person would be required to have regular medical assessments to ascertain their suitability to continue to work. If both the patient and employer are able to work together on this issue, it might be possible for the individual to have their working environment adapted to their needs or be found suitable alternative work .

Therefore, at this point in time, the prognosis for most individuals means that they can expect to a lead long, productive life for many years following their Parkinson’s diagnosis. This will involve the person receiving ongoing specialist disease management so that both care and treatment are tailored to the individuals needs.

The outlook regarding Parkinson’s disease is an ever improving one. Not only will ongoing evaluation of existing therapies improve their efficiency but various new treatments and experimental drugs are under evaluation. In addition, we are now at the dawn of a new era of medicine regarding our ability to control and manipulate at the cellular and genetic level.  Research concerning stem cell therapy, genetic engineering and gene therapy has made significant advances in the last few years and offers considerable hope to patients suffering from a range of conditions, including Parkinson’s disease.

Following Parkinson’s disease prognosis, the next article in the series will look into the range of Parkinson’s treatments currently available, namely Parkinson’s disease treatment – Pharmaceutical