PD Management Update (27 March 1998)
The March 1998 issue of the journal Neurology includes a separate
50-page Supplement, edited by two leading U.S. PD researchers,
outlining for treatment professionals virtually everything known
today about the management of Parkinson's Disease. This is a
thorough revision of a similar colloquium published in 1994,
bringing in the numerous advances in drugs and treatment strategy
that have appeared since then. Containing very little technical
language, it looks like a most valuable reference for patients and
caregivers, as well as attending professionals. It is organized
in the form of an algorithm or decision tree, with several diagrams
that are easy to grasp, including two large wall charts that may
be used by neurologists to educate their patients in this complex
and often confusing disease. One of those is illustrated below.
I shall include a citation for future reference in this month's
Current Science Reviews, but also here, for any listmembers who
may be able to get hold of a copy:
Olanow C, Koller, W; An algorithm (decision tree) for the
management of Parkinson's disease; Neurology 1998, Vol.50:
(Suppl 3):S1
Parkinson's Disease
__________|___________________
| |
Non-Pharmacologic Pharmacologic
| |
|---Education Neuroprotection
|---Support ?Selegiline
|---Exercise |
|---Nutrition Functional impairment----|
| |
| Continue
| to monitor
___________|_______ |
| | |
Yes No-->-|
?Anticholinergics________|
?Amantadine |
(Deterioration)
______|________
| |
^ Dose-<--Dopamine Agonists Levodopa-->--^ Dose
| |_______________| |
| | |
|------------->--Combined Therapy-<---------|
|
Dopamine Agonist
+ Levodopa
|
+/-
COMT inhibitor
|
(Adverse events)
|
See Motor
Complications
|
Unacceptable control
with medical therapy
|
Consider Surgery
--
J. R. Bruman (818) 789-3694
3527 Cody Road
Sherman Oaks, CA 91403-5013
