 |
 |
Geogg Sorry not to reply to you in an earlier reply. I have just returned from 10 days and PAN (Parkinson's Action Network) and have a lot of catching up to do. In attempting to share my limited knowledge with you, here are my responses to your questions: Quest. 1. (part 1) Has anyone diagnosed with PD, NEVER taken any prescribed medication . . . Ans: Yes - but my guess is their quality of life after a while is nothing to be desired! Many "newly diagnosed" are only prescribed an agonist (Mirapex, Requip, etc) based on studies that are still ambiguous, and must have to do with the second part of your question. Below are some of the studies' findings: Dopamine receptor agonists in the therapy of Parkinson's disease. Foley P, Gerlach M, Double KL, Riederer P. Clinical Neurochemistry, Clinic for Psychiatry and Psychotherapy, University of Wurzburg, Germany. Forty years after its introduction by Birkmayer and Hornykiewicz (1961), L-DOPA-based therapy of Parkinson's disease remains the central pillar in the management of the disorder. Nevertheless, it is not unproblematic, and dopamine receptor agonists play increasingly important roles in antiparkinsonian therapy. Pharmacological and pharmacokinetic properties of these agents are briefly reviewed and followed by a detailed summary of available literature concerning controlled trials in Parkinson's disease. It is concluded that there is little unequivocal evidence to suggest that any of the major dopamine receptor agonists should be invariably preferred in the therapy of Parkinson's disease; their application must be based on the needs and responses of individual patients. Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15480844 * * * Nippon Rinsho. 2004 Sep;62(9):1716-9. [The therapy of wearing-off] Murata M. Department of Neurology, Musashi Hospital, National Center of Neurology and Psychiatry. Wearing-off, predictable end of dose deterioration, is one of the major problems of long-term levodopa treatment for Parkinson's disease. The mechanisms of wearing-off are (1) loss of striatal dopamine storage, (2) change in the peripheral pharmacokinetics of levodopa and (3) modification of dopamine receptors. The main therapeutic strategy for wearing-off is continuous stimulation of dopamine system. For this purpose, we increase frequency of levodopa doses and use long half-life dopamine agonist(continuous stimulation of dopamine receptors), COMT inhibitor and MAOB inhibitor (prolongation of the half-life of levodopa and dopamine), and zonisamide (long-term increase of dopamine synthesis). Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15462390 Quest. 1 (part 2) . . . and if so, how rapid was their deterioration. Also, were the symptoms as bad, or worse, than the increasingly severe side-effects produced by the medication (whatever this may have been, as used by others?); Symptom progression (deterioriation) is highly individualized, differing greatly from person to person. Medication results can vary due to weight, rate of progression, metabolism, dosage, other medications administered simultaneously, and a thousand other variables. However, it makes sense that to start initial therapy on L-dopa would not be best, as findings definitely show that if one begins on dopamine therapy, the earlier the side effects. Also, the jury is still out on the neuroprotective qualities of agonists alone, but some studies point in that direction. * * * Nippon Rinsho. 2004 Sep;62(9):1701-8. Related Articles, Links [Treatment for patients with early Parkinson's disease] Kikuchi S. Department of Neurology, Hokkaido University Graduate School of Medicine. Ad hoc committee of Japanese Neurological Society made a guideline for the treatment of Parkinson's disease in 2002. Based on the chapter of treatment for early Parkinson's disease, starting drugs were discussed in this article. Three points should be considered in initiating the drug treatment, that is, neuroprotection, motor complications, and side effects. In order to demonstrate neuroprotection of dopamine agonists by using neuroimaging techniques, CALM-PD CIT study (pramipexole) and REAL-PET study (ropinirole) were done. There are, however, many controversies concerning neuroprotection and no definite conclusion was drawn. On the contrary, the inhibitory effects of dopamine agonists on the appearance of motor complications were clearly elucidated by several large-scale studies. For the present, although the side effects were reported more frequently in those treated by dopamine agonists than by levodopa, starting the treatment by dopamine agonists were recommended except in patients with dementia and in elderly patients, for whom levodopa should be used first. Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15462388 Quest. 2. Re. Pallidotomy: Many PWPs who have undergone this operation, and gained relief on the side affected, find soon after that PD symptoms begin to manifest on the opposite side of their bodies (Michael J. Fox is a well-known example.) My question is, if the operation is NOT carried out on PWPs who are affected down one side alone, do the symptoms also spread to their "good" side? Ans: Michael J. Fox did NOT have pallidotomy, but a similar operation known as Thalamotomy. "Thalamotomy is a neurosurgical procedure, first introduced in the 1950s for the treatment of Parkinson's type tremor, that selectively lesions a part of the ventrolateral thalamus. Patients with benign essential tremor and dystonia are also candidates for thalamotomy. This lesion relieves tremor of PD but it does not prevent the progression or alleviate the predominantly more incapacitating symptoms of akinesia, off phenomenon, postural instability or bradykinesia." The pallidotomy and thalamotomy "kill" the cells of the brain that are causing the involuntary movements. The progression of the disease will continue (or not continue) without other interventions. Bilateral involvment with PD symptoms is a reason the disease is considered "progressive." (See here for the staging instruments used in diagnosing PD progression) http://www.neuroland.com/move/stag_park.htm I hope this helps answer your questions somewhat. Peggy ----- Original Message ----- From: MyFirstname Mylastname To: [log in to unmask] Sent: Sunday, February 13, 2005 2:02 PM Subject: Same old questions?! Could anyone enlighten me on the following, please:- 1. Has anyone diagnosed with PD, NEVER taken any prescribed medication . . . and if so, how rapid was their deterioration. Also, were the symptoms as bad, or worse, than the increasingly severe side-effects produced by the medication (whatever this may have been, as used by others?); 2. Re. Pallidotomy: Many PWPs who have undergone this operation, and gained relief on the side affected, find soon after that PD symptoms begin to manifest on the opposite side of their bodies (Michael J. Fox is a well-known example.) My question is, if the operation is NOT carried out on PWPs who are affected down one side alone, do the symptoms also spread to their "good" side? Thanks for your time and any clarification of one or both questions. Best Wishes, Geoff Wade ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn