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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) >