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Parkinson's disease

Description

An in-depth report on the causes, diagnosis, and treatment of Parkinson's Disease

Highlights

Drug Approval

In 2006, the Food and Drug Administration approved rasagiline (Azilect) for treatment of Parkinson’s disease (PD). Rasagiline is used either alone or in combination with levodopa. It is taken once a day by mouth.

Drug Removal

The FDA pulled the dopamine agonist pergolide (Permax) from the market in March 2007 over safety concerns that included potentially fatal heart valve damage.

Updated Guidelines

In 2006, the American Academy of Neurology (AAN) issued updated practice guidelines for the diagnosis and treatment of PD:

Diagnosis

• Doctors can use smell and drug challenge tests to diagnose PD and rule out other neurological diseases with similar symptoms. Smell tests evaluate a patient’s sense of smell using “scratch and sniff” odors. Drug challenge tests use levodopa or apomorphine to see if a patient improves when taking a PD drug.
• The AAN did not find enough evidence for or against using brain imaging scans, blood tests, or other tests to diagnose PD.
• The AAN recommends that patients with PD get screened for depression.

Drug Treatment

• Levodopa or dopamine agonists are recommended for treatment of initial PD motor symptoms.
• Entacapone (Comtan) and rasagiline (Azilect) can reduce “off time,” the periods during which patients may show more symptoms of PD. The drug also received FDA approval as a single-drug treatment for early PD, and for combination therapy with levodopa for more advanced PD.
• Amitriptyline (Elavil) may be helpful for treating PD-associated depression.
• Clozapine (Clozaril) or quetiapine (Seroquel) may help control PD-associated psychosis.
• Rivastigmine (Exelon) and donepezil (Aricept) may help manage dementia.

Surgery

• Deep brain stimulation (DBS) may help control motor fluctuations and involuntary movements.
• Patients who improved with levodopa drug treatment may benefit more from DBS than those who did not respond to drug therapy. DBS may also work best for patients who have had PD for less than 16 years.

Treatment-Associated Compulsive Behavior

Compulsive behavior such as gambling, shopping, and sexual addiction may occur in patients who receive certain PD treatments.

Osteoporosis Risk

PD may increase the risk for low bone density. Patients with PD should get tested for osteoporosis.

• Review Date: 3/30/2007
• Reviewed By: A.D.A.M. Editorial Team: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy. Previously reviewed by Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital (5/22/2006).

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