Optimal treatment of Parkinson’s disease should focus on exercise

  During the China tour of Professor Werner Poewe, President of the European Chapter of the Movement Disorders Society, Professor Poewe emphasized that “Parkinson’s disease treatment should also focus on the delay of motor complications in addition to the control of motor and non-motor symptoms.”  Professor Poewe pointed out that non-ergot dopamine receptor agonists such as Morpholino® (pramipexole) are increasingly well documented in clinical data as first-line agents for the treatment of Parkinson’s disease, with significant advantages over levodopa-based agents in delaying the onset of motor complications and effectively controlling both motor and non-motor symptoms (depression) in Parkinson’s disease, receiving the 2011 Movement Disorders Society ( MDS) Evidence-Based Medicine recommendation and is listed as a double A recommended drug in the European Federation of Neurology (EFNS) Parkinson’s Disease Treatment Guidelines.”  Parkinson’s disease is a progressive disease that severely affects the lives of patients. The disease does not usually remit naturally, and in some cases the disease progresses rapidly, severely affecting life and work in a matter of months or years, eventually confining them to their homes and hospital beds, and drastically reducing their quality of life. With the increasing trend of aging in society, the prevalence of Parkinson’s disease is increasing in China.  Epidemiological surveys show that the number of Parkinson’s disease patients in mainland China is estimated to have reached 2 million, seriously threatening the physical and mental health of middle-aged and elderly people in China. However, compared to other developed countries, the treatment rate of Parkinson’s disease patients in China is very low, even in first-tier cities such as Beijing and Shanghai, the treatment rate is less than 40%, and in rural and remote areas is even lower.  Among the drugs used in traditional Parkinson’s disease treatment, levodopa drugs are effective in controlling tremor and other motor symptoms, but the limitations of these drugs appear after a period of medication. 30-40% of patients develop “end-of-dose phenomenon” and “switch phenomenon” after 2 years of treatment. Complications of movement such as “end-of-dose phenomenon” and “switch phenomenon” occur after 2 years of treatment. Among patients who develop the disease at a younger age, 90% develop motor complications after 5 years of treatment. Moreover, the risk of motor complications was directly related to levodopa dose.  The CALP-PD study showed that the risk of motor complications was significantly reduced in the pramipexole initiation group compared to the levodopa initiation group after 4 years, with an approximately 63% reduction in the risk of isokinetic disorders and an approximately 32% reduction in the risk of end-of-dose phenomena.  The Chinese Parkinson’s disease treatment guidelines have also clearly stated that: in early Parkinson’s disease, non-ergot dopamine agonists are currently promoted as the drug of choice, especially for young patients in the early stages of the disease; in mid- to late-stage Parkinson’s disease, dopamine agonists can be used as add-on therapy to levodopa to control motor complications.  In addition, the dose of medication used for Parkinson’s disease treatment is also of concern. Professor Zhang Zhenxin, an executive member of the Movement Disorders Society Asia Pacific, an advisory member of the Parkinson’s and Movement Disorders Group of the Neurology Branch of the Chinese Medical Association, and a professor of neurology at Peking Union Medical College Hospital, pointed out in an interview that the dose of dopamine receptor agonists in China is lower than the international level, and that the conventional dose of Senfuro® (pramipexole), for example, is generally less than or equal to 0.75 mg for patients in China. While European and American patients are mostly 1.5 to 4.5 mg.  Professor Zhang Zhenxin analysis pointed out that “there are many reasons for this, on the one hand, because of the perception of doctors, the lack of awareness of the dose of drugs to achieve optimal efficacy; another important reason is that many regions have strict upper limits on the amount of drugs dispensed to patients at a time, patients can only be dispensed up to one or two weeks of drugs per visit.”  ”Parkinson’s patients have extreme mobility problems, and the disease requires long-term medication, it is very unrealistic to go to the hospital frequently to line up for registration and dispensing, and there is no abuse of drugs in Parkinson’s disease, it is recommended to increase the single prescription amount of Parkinson’s treatment drugs with reference to the management of chronic diseases.” Professor Zhang Zhenxin concluded.