Management of motor complications in advanced Parkinson’s disease.
Melamed E, Ziv I, Djaldetti R. (2007) Management of motor complications in advanced Parkinson’s disease. , Mov Disord. 2007 Sep; 22 Suppl. 17:S379-84.
This article is a summary of the progression of motor complications seen in the early and later stages of Parkinson’s disease as well as how best to manage those symptoms. As discussed in the literature, levodopa is the most common treatment for PD, but approximately 2-5 years after the treatment is initiated the patient often experiences reduced efficacy of the drug and develops adverse motor complications (e.g. “dyskinesias and dystonias”). As the disease progresses and the medications lose efficacy, most PWP will begin to experience “wearing off” phenomenon and increases in the daily need for levodopa. The authors discussed various specific motor phenomenons (on/off, wearing off, delayed on, no-on) that can occur when taking levodopa (we refer the reader to the article for more discussion of the specific phenomenon, these can also be found in the DBS-STN glossary).
In the article there was discussion about the underlying mechanisms for the motor complications/fluctuations that the PWP may experience. It is notable that these mechanisms are not fully understood. Researchers are continuously attempting to better understand these processes as well as create better therapies for the PWP to avoid motor complications or reduced responses to the medication. The authors discussed 2 general hypotheses (central and peripheral) to explain these motor fluctuations. The central mechanism hypothesis suggests that due to disease progression there are changes in the brain (reduced receptors, less sensitive receptors, and poor conversion of the drug in the system) that do not allow the medications to work as effectively as they once did. The peripheral mechanism hypothesis purports that the drug itself may cause changes in the stomach, which affects how much of the drug is available for the brain.
Lastly, the authors gave specific guidelines for medical professionals to manage motor fluctuations related to levodopa. The authors also gave suggestions on how best to improve absorption of levodopa that can be done within the patient’s home (e.g. taking the medication before meals, avoid protein filled meals, not to lie down after ingesting the medication, etc.). Furthermore, they discussed other medical techniques that have shown promise, including surgical interventions (e.g., e.g. thalamotomy, pallidotomy, DBS, and stem cells). This article, like many before it, concludes simply that more research needs to be done on these approaches to best understand and treat motor complications from PD.
**We at DBS-STN do not offer any medical advice in regard to how to take your medications. Any changes in one’s medication regimen should be done only under the advice of your physician. Any questions regarding how best to manage your motor complications should be discussed with your physician.