I think it is important to reply to this to correct some misconceptions.

1)   Anticholinergics BLOCK the ACTION of acetylcholine in the brain, not
the production of acetylcholine.
2)   The beneficial effects of anticholinergics in Parkinson's Disease were
known long before we had any idea of the role of dopamine in Parkinsonism.
3)   Some of the early work on the relationship between acetylcholine and
dopamine effects in the brain suggested that the dopamine receptors
inhibited neurons which released acetylcholine.  Therefore, stimulation of
dopamine receptors made less acetylcholine available to ITS receptors.  In
this respect, therefore, the blocking of acetylcholine receptors by
anticholinergics has similar effects to increasing the stimulation of
dopamine receptors by dopamine, but not the same potency.
4)  The anticholinergic drugs still do have a limited role in the management
of Parkinsonism. For reasons that are not known, they seem to inhibit tremor
better than the dopamine agonists or levodopa in certain individuals.  When
tremor is a dominant problem, and other medications seem insufficient to
control it, anticholinergic drugs are worth trying.
5)  Historically, it is interesting to remember that at one time it was
suggested that very early Parkinsonism could be treated with anticholinergic
drugs alone first, much like the arguments that are now used to promote the
same concept with respect to the dopamine agonists.  One big difference is
that anticholinergic drugs are A LOT CHEAPER - so if they work without
limiting side effects, even to a limited degree, they may be worth using.
6)  As with all medications, their use must be guided by the balance between
the risks and benefits.  They do often produce dry mouth or urinary
retention in males;  they may also cause blurring of vision, or exacerbation
of glaucoma.  They also produce some mental and cognitive side effects (like
all antiParkinsonian drugs when given in higher doses) - so these side
effects need to be anticipated,and if they occur, stop the drug or reduce
the dose.  If the cure is worse than the disease...then stop the cure!!!
However, this is not often the case.
7)  The main limitation of the anticholinergic drugs was their relatively
weak potency in terms of relieving the rigidity and bradykinesia.
8)  What works for one PWP does not necessarily work for all PWPs;  what
fails to work in one PWP is not necessarily useless for all PWPs.

It is not wise, therefore, to unilaterally condemn the use of these drugs
without knowing what the situation is in more detail - what drugs have
already been tried, what are the dominant symptoms, what have been the
limiting side effects or problems...only then should one presume to pass
judgement as to whether the use of anticholinergic drugs is appropriate or
not.

In every sense, therefore, it is important that all PWPs work with their
neurologists in much the same way that an athlete works with his/her coach
to design a program to optimize individual performance.


Jorge A Romero, MD

----- Original Message -----
From: "Brian Collins" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, April 10, 2000 6:32 PM
Subject: Re: PD Med's Question


> On Sun 09 Apr, plmaddux wrote:
> > Hi Folks,
> > After having a tremor for 4 1/2 years I decided to try taking a med
> > prescribed by my doctor. He thought that Artane was the most approiate
drug
> > for my symptoms, that being a left side tremor. I had been taking
Benadryl
> > which was giving me some relief but it was not helping much and I was
> > beginning to have a headache all the time.
>
>
>
> Hello Lanier, Re your 1st paragraph :    You show me a doc. who thinks he
> can select an appropriate treatment based on the patients symptoms, and
> I'll show you a fool !
>
> Artane is an Anticholinergic drug. It blocks the production of
acetylcholine
> (another neurotransmitter) The reasoning (!!) is that if there is less
> acetylcholine , it may make more room fpr Dopamine. I was prescribed
Artane
> immediately upon diagnosis, and I think went up to 10 mg in the first year
> (Well it was 21 years ago). Of course at that time, I thought that they
> knew what they were doing.  I suppose there was a slight reduction in
tremor
> but it was never in control . I made a fuss and was switched to Sinemet,
> which I urge you to do also.
> Regards,
> --
> Brian Collins  <[log in to unmask]>  (60/39/34)
>