Parkinson's disease differs from one patient to another.
What treatments to cure Parkinson's disease?
In Parkinson's disease, there are several types of drug treatments with different mechanisms and modes of administration. Whatever the drug, its effectiveness varies from person to person.
Levodopa or L-Dopa
Levodopa or L-Dopa is the most powerful medicine for improving motor disorders. It only acts on certain motor symptoms (slowness, rigidity, tremor) and little on other motor and non-motor signs. It can remain effective throughout the disease, with however the need to significantly increase the doses over time.
The doses and the frequency of the catches often generate side effects and in particular important dyskinesias.
Dopamine agonists work by mimicking the action of dopamine. In contrast, agonists have a slightly broader action than L-Dopa and may affect some non-motor signs such as depression. They cause less dyskinesias than L-Dopa but they can cause other side effects including changes in behavior that must be reported to the neurologist.
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Modes of administration of drug treatments
There are different modes of treatment administration: the most common is the oral route (capsules or tablets). In recent years, a dopaminergic agonist is proposed in the form of a patch, the drug is then assimilated percutaneously.
There are also drug treatments that can be taken subcutaneously or transcutaneously: this is the case of the dopamine agonist named apomorphine can be injected by pump or via a pen injector.
Dopamine can also be injected via a pump via the intestinal tract (duo dopa pump).
The apomorphine pump
Apomorphine is the oldest and most potent dopaminergic agonist. If its name evokes morphine, it has none of the pharmacological properties and has nothing to do with this other drug. The apomorphine pump is a portable and programmable electric syringe that can deliver apomorphine from morning to night or 24 hours a day in case of engine blockage (OFF period).
The apomorphine pump partially replaces the oral treatment (which is often continued but considerably reduced) or even completely eliminates it.
Like all dopaminergic agonists, apomorphine causes undesirable effects but to a lesser extent than oral agonists.
The apomorphine pen
The apomorphine pen is prescribed in some patients with untimely blockages during the day. It allows the patient to self-inject a dose of apomorphine that will act in minutes and allow the patient to unblock quickly.
There is nevertheless a vigilance to have about the risk of addiction to the pen because it can develop a feeling of pleasure during the injection that pushes the patient to increase the frequency of injections.
The dopamine pump
This pump delivers a gel (product called "Duodopa") containing the drugs (levodopa and carbidopa, an enzyme inhibitor that slows down the conversion of levodopa to dopamine before it enters the brain).
This gel is administered via a probe placed directly into the small intestine in the jejunum (the initial part of the small intestine). This treatment can be tested initially by a fine probe placed by the nose to the intestine to evaluate efficacy and tolerance.
Subsequently, to introduce the probe, a small hole is made in the abdominal wall, in the stomach.
Fluctuations in treatment efficiency
The onset of motor complications marks the end of the first phase of the disease, when the symptoms were perfectly controlled. The treatment remains effective, but discontinuously, resulting in variations in the physical and mental state.
Then alternate phases called "on", where the patient goes well with sometimes involuntary movements, and phases "off", where symptoms reappear. Their intensity, however, varies a lot from person to person. They can be taken care of and managed on a daily basis.
Adaptation of the treatment
The drug treatment is unique and adapted for each patient. It will be adjusted throughout the evolution of the disease.
The dosage of each drug, their form as well as the number of daily doses will be determined individually for each patient according to the signs he will describe to his neurologist. The treatments exist in different dosages (50 mg, 125 mg, 150 mg ...) and different forms (ffast-acting dispersible elm, standard form, and lastly prolonged release form of longer action) each selected by the neurologist. Each dosage and form of the drugs thus have a determined action in time, directly visible on the motor state of the patient.
It is important to interact with your neurologist to find a suitable treatment. Do not hesitate to share any side effects for treatment adaptation
Note that in addition to treatment, rehabilitation allows a real wellness.