Treatment

• Carbidopa & levodopa are given in combination as...

  Co-careldopa
• Apart from levodopa & carbidopa, what other drugs can be used for PD?

  Dopamine agonists

  Monoamine oxidase-B (MAO-B) inhibitors

  Catechol-O-methyltransferase (COMT) inhibitors
• How do dopamine agonists work?

  Activates dopamine receptors in the body → mimics effect of dopamine
• How do monoamine oxidase-B (MAO-B) inhibitors work?

  Inhibits MAOB → increases extracellular levels of dopamine in striatum → increased dopaminergic activity
• How do catechol-O-methyltransferase (COMT) inhibitors work?

  Inhibits COMT in synaptic cleft → stops breakdown of dopamine into homovanillic acid (HVA) → more dopamine within the synaptic cleft
• What is deep brain stimulation?

  Insertion of electrodes into brain
• What are the targets of deep brain stimulation in PD?

  Subthalamic nucleus -> response similar to levodopa with reduction in dyskinesia

  Globus pallidus -> improves dyskinesia but levodopa is still required for motor symptoms

  Thalamus -> only for tremor
• What are the non-pharmacological treatments of PD?

  Deep brain stimulation

  Physio

  Occupational therapy

  S&L therapy

  Lifestyle modifications
• How is physio used in the management of PD?

  Can work to relieve muscle stiffness & joint pain through movement & exercise

  Aim: Make moving easier & improve walking & flexibility
• How is occupational therapy used in the management of PD?

  Identifies difficult areas in everyday life (e.g. getting dressed)

  Help to work out practical solutions & ensure home is safe and properly set up for you

  Helps to maintain independence for as long as possible
• How is speech & language therapy used in the management of PD?

  Many people with PD have swallowing difficulties & speech problems

  S&L therapy can help improve problems by teaching speaking & swallowing exercises or providing assistive technology
• What diet changes can be done in PD?

  Increase fibre in diet & ensure drinking enough fluid → to reduce constipation

  Increase amount of salt in diet & eat small, frequent meals → avoid hypotension

  Changes to diet to avoid unintentional weight loss