Treatment of Parkinson’s disease

  Parkinson’s disease is a neurodegenerative disorder commonly seen in middle-aged and elderly people, characterized clinically by resting tremor, muscle rigidity and motor retardation, and impaired postural regulation. Currently, there are no curative drugs for Parkinson’s disease, and most effective treatments are symptomatic. Studies have shown that patients who start treatment early after the onset of the disease have significantly better self-care, mobility and quality of life than patients who start medication 4-6 years after the onset of the disease.  The drug treatment regimen for Parkinson’s disease takes into account the patient’s age, the severity of the disease, cognitive function, response to medications, and the patient’s financial ability. Patients with early onset Parkinson’s disease, such as those under 50 years of age, may be considered for dopamine agonists or monoamine oxidase B inhibitors, such as Tysudar, Senfro, and Sertraline, etc. Most patients require dopamine agents after 1 to 2 years of onset. If the patient has cognitive impairment, dopamine may be used directly. In patients over 70 years of age or with mental retardation, dopamine agonists may be used in preference to dopamine agents because of their side effects. If the effect of dopamine agonists alone is not good, a combination of dopamine agonists or catechol-oxygenation-methyltransferase inhibitors or monoamine oxidase type B inhibitors may be considered.  Most of the drugs used in the treatment of Parkinson’s disease have some side effects at the beginning of their application, and the symptoms of digestive tract are the most common, so the application of each anti-PD drug should take a “titration” approach: that is, start with a small dose, slowly increase the dose, and gradually titrate to the lowest effective dose within the range of tolerable side effects, in order to extend the years of symptom control as much as possible. The dose should be titrated to the lowest effective dose, within the tolerable side effect range, for as long as possible.  Although levodopa is the ideal drug for PD, the drug’s “honeymoon period” is mostly about 5 years, after which complications such as decreased efficacy, fluctuating symptoms, and allodynia occur. When this is not resolved even with medication adjustments, appropriate surgical treatment may be considered.