The Disease is Progressive, the Meds are Not

                
  February 18, 2014

Today I wanted to write about medications for Parkinson's Disease.  I find this a fascinating topic as the most commonly used medication was developed in 1967, and is still the medication most prescribed today.  But, slowly....at a snail's pace actually, science and research are beginning to open new options.

 There are two general approaches to the treatment of Parkinson's Disease  with medication. The first approach attempts to slow the loss of dopamine in the brain and are called, Agonists.  The second approach attempts to improve the symptoms of Parkinson's Disease by other means.

Dopamine agonists are drugs that activate the dopamine receptor. They mimic or copy the function of dopamine in the brain.

Requip, Mirapex, and Neupro are dopamine agonists.

Levodopa (also called L-dopa) is the most commonly prescribed and most effective drug for controlling the symptoms of Parkinson's disease, particularly bradykenesia and rigidity.Levodopa is transported to the nerve cells in the brain that produce dopamine. It is then converted into dopamine for the nerve cells to use as a neurotransmitter. Sinemet is made up of levodopa and another drug called carbidopa. Levodopa enters the brain and is converted to dopamine while carbidopa increases its effectiveness and prevents or lessens many of the side effects of levodopa, such as nausea, vomiting, and occasional heart rhythm disturbances.

Now with all that scientific rigamarole out of the way, I'll tell you about my personal experiences with these medications.

A person very close to me was diagnosed with Parkinson's approximately 9 years ago.  We will call him, Allen.  The Neurologist at the time prescribed the agonist, Mirapex.  Around this time, Mirapex was considered to be a miracle drug in the PD nation.  Without follow-up, Allen continued to take the medication which indeed improved the symptoms he suffered from the most.  The problem was, and a little known fact at the time, this medication would prove to do more harm than good.  The drug induced euphoric feelings and enhanced feelings of obsessive and compulsive behaviours.  As a result, many patients experienced heightened compulsions such as gambling, eating, and even sexual drive.  It was soon realized that this medication alone was responsible for many people losing their homes, going bankrupt, and having marriages and families torn apart.  

When I was first diagnosed and put on Levocarb, I pre-warned the Neurologst that I would, under no circumstances consider taking Mirapex, if it ever came to that down the road.  My Neurologist and Movement Disorder Doctor placated me by suggesting that if it ever had to become an option down the road, just the fact that I am aware of the dangers, and with their constant follow-ups, it may be something that I would have to reconsider.

Currently, I am taking Levocarb.  It has been very successful in aiding the symptoms of tremors, rigidity, and gait.  I do experience stomach upset when it is not taken with food.  The advice is for it to be most effective taken on an empty stomach, and on a low protein enriched diet.  This apparently aids in quick absorption.  Of course, me being me, I take it with a meal or snack...protein or otherwise.

Currently I take 2 tablets 5x per day, which is approximately every four hours.  What I am noticing is what we Parkies call, the wearing off effect.  That is, as it gets closer to the next dosage, you feel symptomatic prior to the next dose.  For example, about 3 1/2 hours into my dose (1/2 hr before next dose), my tremor starts getting a little anxious.  That is the tremor in my hand, and the tremor inside my body.  Inside my body, I call it, "that quiver feeling".  Once I take my dose, all is good in Parkieville for the next 3 1/2 hours.  

This, wearing off effect, can be even more pronounced when in a stressful state, or when one is just out of the usual routine.  That is why it is ever so important to have extra pills on hand at all times.  The Ministry of Health is even looking at the importance of Parkies enduring hospital stays, having their medication readily accessible to take on their own time, not in combination with other meds being distributed by nursing staff.  

The most current treatment for Parkinson's Disease is called, DBS, Deep Brain Stimulation. 

Surgery is required to implant the equipment that produces the electrical stimulation. You are awake during the procedure (your scalp is numbed and you won't feel any pain), because you must work with the surgeon in placing the electrodes where they will have the most benefit. A small hole is drilled in your skull, and tiny wire electrodes are placed in your brain. A small battery-powered device (generator) similar to a pacemaker is implanted in your chest and connected to the electrodes in your brain by a wire. The procedure usually takes 3 to 4 hours, although it may take as long as 8 hours.

When the device is turned on, it sends 100 to 180 electrical pulses per minute to stimulate the specific area of the brain. You can turn the device on and off by holding a magnet against the skin over the device. Newer models can be turned on and off with a small remote control unit. The device can be programmed so that it delivers the correct level of stimulation to provide the greatest relief of symptoms,

The big question now is what does the future hold for research.  Currently researches are looking at a Neupro patch.  It is similar to a nicotine patch in the way it delivers Levadopa.  The idea is to limit or diminish the wearing off effects.

A cure down the road?  Perhaps way, way, down the road.  The first step is for research to locate a Biomarker which would tell scientists the where, why and how of the disease.  But, seeing as this is research required on a working brain, the exhaustive research is quite difficult.

Until there is a cure, if ever, the most that we Parkies can hope for is a medication that controls our symptoms comfortably, and extensively.  There is always hope.  Thanks to Michael J Fox and his foundation, Parkinson's Disease is familiar.  He was young, vibrant....and is now the face of the illness.  Perhaps because of him, Linda Rondstatt, and Mahummad Ali, we Parkies may just experience scientific break through in our lifetime.  Until then, we just try to remain, UnSHAKEable.