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04.01.2014

Treating fatigue in parkinson's, reasons for ringing in the ears - Review

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CausesAlthough doctors don’t know exactly what causes Parkinson's disease, they think it’s probably due to a combination of genetic and environmental factors.Genetic FactorsSpecific genetic factors appear to play a strong role in early-onset Parkinson's disease, an uncommon form of the disease. If you would like to know more about this topic, view the recording of PDF's online seminar, "Fatigue, Sleep Disorders and Parkinson's," led by Joseph Friedman, M.D. Loss of dopamine in the corpus stratia is the primary defect in Parkinson's disease.Dopamine deficiency is the hallmark feature in PD. A higher incidence of parkinsonism has long been observed in people who live in rural areas, particularly those who drink private well water or are agricultural workers.Risk FactorsAgeThe average age of onset of Parkinson's disease is 55.
Loss of dopamine negatively affects the nerves and muscles controlling movement and coordination, resulting in the major symptoms characteristic of Parkinson's disease.
Herlofson and colleagues included a control group of healthy individuals, which is important because fatigue is a relatively common complaint in the general population. Because Parkinson’s disease symptoms are due to a deficiency of the brain chemical dopamine, the main drug treatments help increase dopamine levels in the brain.
Cigarette smokers appear to have a lower risk for Parkinson's disease, indicating possible protection by nicotine. The few studies on nicotine replacement as a treatment for Parkinson’s have not provided any strong evidence that nicotine therapy provides benefits.Coffee Consumption. In some cases of advanced-stage Parkinson’s disease, surgery may help to control motor problems. Deep brain stimulation is currently the preferred surgical method.New Drug ApprovalIn 2012, the Food and Drug Administration (FDA) approved rotigotine (Neupro) for treatment of early and advanced stage Parkinson’s disease. Parkinson’s disease is part of a group of conditions called motor system disorders, which are associated with the loss of dopamine-producing brain cells.
These problems can occur from the disease process or from side effects of medications used to treat Parkinson’s. Parkinson's disease is a slowly progressive disorder that affects movement, muscle control, and balance. Dementia occurs in about two-thirds of patients with Parkinson’s, especially in those who developed Parkinson’s after age 60. Some of the medications used for Parkinson's may cause vivid dreams as well as waking hallucinations.Sexual DysfunctionAlthough Parkinson's disease and its treatments can cause compulsive sexual behavior, the disease can also cause a loss of sexual desire in both men and women.


For men, erectile dysfunction can be a complication of Parkinson’s.Bowel and Bladder ComplicationsConstipation is a common complication of Parkinson’s disease. Weakness in pelvic floor muscles can also make it difficult to defecate.Patients with Parkinson’s disease frequently experience urinary incontinence, including increased urge and frequency.
Parkinson’s can also cause urinary retention (incomplete emptying of the bladder).Sensory ProblemsDecreased Sense of Smell.
Painful symptoms associated with Parkinson’s disease include muscle numbness, tingling, and aching. If patients' symptoms improve when they take levodopa, they likely have Parkinson's, ruling out other neurological diseases.Tests for Depression and DementiaThe American Academy of Neurology (AAN) recommends the Beck Depression Inventory or the Hamilton Depression Rating Scale to screen for depression in patients with Parkinson's disease. Parkinsonism refers to a group of movement disorders that share similar symptoms with Parkinson’s disease, but also have unique symptoms of their own.
About 15% of parkinsonism cases are due to conditions called Parkinson’s plus syndromes (PPS) or atypical parkinsonism.
Marked by apraxia (inability to perform coordinated movements or use familiar objects), stiffness that is more severe than typical Parkinson’s disease, and twitching or jerking in the hand.Lewy body dementia.
Marked by frequent falls, personality changes, and difficulty focusing the eyes.Patients with PPS often have earlier and more severe dementia than those with Parkinson’s disease.
In addition, they do not usually respond to medications that are used to treat Parkinson’s disease.Other Neurologic Conditions.
Alzheimer’s disease can share similar symptoms with Parkinson’s and the conditions can exist together.Medications.
Several drugs, including antipsychotic and antiseizure medications, can cause Parkinson’s symptoms.TreatmentThere is no cure for Parkinson’s disease, but drugs, physical therapy, and surgical interventions can help control symptoms and improve quality of life.
Levodopa, or L-dopa, has been used for years and is the gold standard for treating Parkinson's disease.
Rasagiline (Azilect) is another MAO-B inhibitor used for treatment of Parkinson’s.Treatments for Off TimeDrug treatments for Parkinson disease do not consistently control symptoms.
These drugs slow the breakdown of dopamine that occurs naturally in the brain and dopamine produced from levodopa.Other dopamine agonists, such as ropinirole (Requip, generic) and pramipexole (Mirapex, generic), and the COMT inhibitor tolcapone (Tasmar) may also be helpful for treating off-time symptoms. Some studies have found that selective serotonin-reuptake inhibitors (SSRIs) -- which include fluoxetine (Prozac, generic), sertraline (Zoloft, generic), and paroxetine (Paxil, generic) -- may worsen symptoms of Parkinson's.


Studies indicate that clozapine (Clozaril, generic) and quetiapine (Seroquel), antipsychotic drugs used to treat schizophrenia, may be the best drugs for treating psychosis in patients with Parkinson's disease.
The cholinesterase inhibitor drugs donepezil (Aricept) and rivastigmine (Exelon) are used to treat Alzheimer’s disease and are sometimes used for Parkinson’s. The benefit from these drugs is often small, and patients and their families may not notice much change.Daytime Sleepiness and Fatigue. Methylphenidate (Ritalin, generic) may be considered for patients who experience fatigue.Erectile Dysfunction. PDE5 inhibitor drugs such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can be helpful for men with Parkinson's disease who suffer from erectile dysfunction. Glycopyrrolate, scopolamine, and injections of botulinum toxin may be used to relieve drooling symptoms.Treating Advanced DiseaseAdvanced Parkinson’s disease poses challenges for both patients and caregivers.
The goal of treatment for advanced Parkinson’s disease should be on providing patients with safety, comfort, and quality of life.Levadopa (L-dopa)Levodopa, also called L-dopa, which is converted to dopamine in the brain, remains the gold standard for treating Parkinson's disease. However, some evidence suggests that it impairs areas of the brain related to other learning functions and social behavior.Sleepiness and sleep attacksLevodopa causes fewer psychiatric side effects than other drugs used for Parkinson's disease, including anticholinergics, selegiline, amantadine, and dopamine agonists.
Orthostatic hypotension can also occur with other Parkinson's drugs.High blood pressure (hypertension) if combined with drugs that increase serotonin levels -- such drugs include many antidepressants. Selegine should be used with caution in patients with certain preexisting heart conditions.Dopamine AgonistsDopamine agonists stimulate dopamine receptors in the substantia nigra, the part of the brain in which Parkinson's is thought to originate. There is debate about the value of dopamine agonists as initial therapy for Parkinson’s disease.
Bromocriptine is the only ergot dopamine agonist approved for Parkinson's treatment in the United States.Apomorphine is a dopamine agonist used as a "rescue" drug in people having on-off effects severe enough to require going off L-dopa for a few days. Because it causes severe nausea and vomiting, it must be taken with an anti-nausea drug.Rotigotine (Neupro) is a once-daily transdermal patch that releases a steady level of the drug through the skin to treat symptoms associated with early- and advanced-stage Parkinson’s.
Still, patients should watch out for symptoms of liver damage, including jaundice (yellowish skin), fatigue, and loss of appetite.



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