Comprehensive Review from the American Academy of Neurology Provides Important Information for Doctors and Patients
The American Academy of Neurology is issuing new guidelines for diagnosing and treating Parkinson's disease, a degenerative neurological disorder that affects about one million people in the United States and Canada. University of Maryland neurologists played a leading role in the creation of the new guidelines, which provide the most comprehensive review to date of research into Parkinson's disease and give doctors, patients and their families important information on how to improve the quality of life for people with Parkinson's disease.
The new guidelines will be presented on April 3 at the American Academy of Neurology meeting in San Diego, California, and will be published in the April 11 issue of the journal Neurology.
“For many years, there has been considerable confusion about how to diagnose and treat Parkinson’s. These new guidelines focus on the latest evidence-based information and provide a comprehensive review covering a range of issues from early diagnosis and alternative therapies to the emotional aspects of the disease,” says William Weiner, M.D., a senior author of the new guidelines who is professor and chairman of neurology at the University of Maryland School of Medicine, and chief of neurology at the University of Maryland Medical Center where he directs the Parkinson's Disease and Movement Disorders Center.
Dr. Weiner adds, “These guidelines provide physicians with a concise, accurate source of scientific information that they can combine with their own experience to make the best decision for a particular patient’s care. For patients and their families, the guidelines offer a resource they can use to learn more about Parkinson’s disease, enabling them to ask informed questions about their care and make choices about managing their lives.”
The first new guideline is aimed at helping doctors to make a correct diagnosis as early as possible, in order to suggest treatments and lifestyle changes to manage the disease better. It is estimated that up to 10 percent of people with Parkinson’s disease are misdiagnosed, and autopsies reveal that up to 20 percent of people who were diagnosed with Parkinson’s disease should have had a different diagnosis.
Another guideline examines the variety of therapies available to treat motor symptoms of Parkinson’s, such as tremor, stiffness and slowness of movement. The reviewers looked at the evidence for each available drug and deep brain stimulation surgery, and found that a variety of therapies now available could benefit Parkinson’s patients, giving physicians more options to treat motor symptoms. The authors also found evidence that regular exercise as well as physical and speech therapy can be beneficial for Parkinson’s patients, but that nutritional supplements do not make a difference.
“Many people are spending a lot of money hoping to find something that can help them, but there was no evidence available to show that nutritional supplements, including Vitamin E, are useful in slowing the progress of the disease or improving Parkinson’s symptoms,” says Stephen Reich, M.D., a guidelines contributor who is co-director of the Parkinson’s Disease and Movement Disorders Center at the University of Maryland Medical Center and professor of neurology at the University of Maryland School of Medicine. In fact, the reviewers found that while there are good medications to manage Parkinson’s symptoms, there are no medicines at this time, including conventional therapies, which have been shown to actually slow the progression of Parkinson’s disease.
The guidelines also tackle a common misconception about levodopa, one of the most effective Parkinson’s treatments. Some people fear that levodopa may speed the progression of the disease, but the reviewers found that idea to be false.
“After careful review of the best scientific evidence available, our review found levodopa to be a safe and effective treatment to improve movement, and the drug does not increase the progression of the disease,” says Dr. Weiner.
Two other University of Maryland physicians who contributed to the guidelines examined the emotional and cognitive effects of Parkinson’s disease, including depression and dementia.
“The guidelines recommend that Parkinson’s patients be screened and treated for depression, psychosis and dementia,” says Lisa Shulman, M.D., associate professor of neurology at the University of Maryland School of Medicine and co-director of the Parkinson’s Disease and Movement Disorders Center at the University of Maryland Medical Center. “Many people believe that depression and memory loss are just a normal part of Parkinson’s, but there are effective treatments available that can have a tremendous effect on the quality of life for these people and their families.”
“Many Parkinson’s patients may be reluctant to discuss their forgetfulness or hallucinations, so physicians should take a proactive role in identifying and treating these problems,” says Karen Anderson, M.D., a psychiatrist with the Parkinson’s Disease and Movement Disorders Center at the University of Maryland Medical Center and assistant professor of psychiatry and neurology at the University of Maryland School of Medicine.
Most people who have Parkinson’s begin to develop symptoms in their late 50s or early 60s, although it can affect younger people. Researchers don’t know what causes Parkinson’s disease, but it affects the brain’s ability to produce dopamine, the neurotransmitter involved in the communication between the brain cells for motor control. Symptoms include rigidity of the limbs and difficulty initiating movement. Many patients have a tremor in the arms or the legs.
To see the American Academy of Neurology guidelines or summaries designed for patients and their families, go to www.aan.com/pd. For more information on the University of Maryland Parkinson’s Disease and Movement Disorders Center, go to www.umm.edu/parkinsons.
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