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Pharmacological Management of Parkinson’s Disease
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Newman Osafo, Samuel Obeng, David D. Obiri, Oduro K. Yeboah, Leslie B. Essel
The motor symptoms of PD are principally treated by employing the dopamine replacement therapies, and nearly 50 years of using levodopa (LD), that is, the precursor compound of dopamine, it is still the most effective treatment. Nonetheless, even though it is beneficial in modulating motor function, the use of dopamine therapy has major drawbacks. This has made it important to develop various therapeutic methods focusing on nondopaminergic pathways (Lang and Obeso, 2004).
Examine the gait
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Q: What is the treatment? Drugs are the main form of treatment.Dopamine agonists, especially in the early stages of the disease and in young patients (ropinirole, pramipexole and rotigotine).Levodopa is still the main and most effective treatment.Monoamine oxidase B inhibitors (rasagiline and selegiline).Catechol-O-methyl transferase (COMT) inhibitors (entacapone).Apomorphine injection and infusion.Surgery, mainly deep brain stimulation. Patient selection is crucial. Patients should have positive responsiveness to dopamine therapy with no cognitive or psychiatric problems.
Pharmacology of Catecholamines
Published in Sam Kacew, Drug Toxicity and Metabolism in Pediatrics, 1990
An evaluation of dopamine therapy in 24 children (2 d to 18 years, mean age of 39 months), most of whom had congenital heart disease and shock from various medical and surgical causes, revealed different results.136 The dopamine infusion was adjusted to the desired response (a >15% increase in systolic blood pressure) and more than half of the patients responded favorably at a mean dose of 8.3 μg/kg/min in the responders. In this group, blood pressure increased, whereas heart rate did not. More recent studies137,138 reported that relatively small dopamine doses (2 to 5 μg/kg/min) improved blood pressure and myocardial performance in neonates. These conflicting results illustrate the limitations of clinical studies which often include patients with diseases of diverse etiologies.
Acute parkinsonism in patients with systemic lupus erythematosus: a case report and review of the literature
Published in International Journal of Neuroscience, 2022
Chayasak Wantaneeyawong, Nuntana Kasitanon, Kullanit Kumchana, Worawit Louthrenoo
Treatment of parkinsonism associated with SLE varied widely (Table 2). Twenty-three patients received initial treatment with corticosteroids (high dose corticosteroids or IVMP and/or immunosuppressive drugs (cyclophosphamide or IVCY) or immunomodulation therapy (plasma pheresis, plasma exchange, intravenous immunoglobulin or rituximab). Dopamine therapy also was used as initial treatment in combination with the treatments above. CNS symptoms, e.g. seizure, psychosis, cognitive dysfunction, dystonia, headache and abnormal speech improved or disappeared in most of the cases. The outcomes of parkinsonian symptoms were complete resolution in 17 patients, partial response in 7 (one due to poor compliance), and persistent symptoms in 4. There were no significant differences in the treatment outcomes among patients who received dopamine therapy and those who did not in terms of symptom resolution and partial response vs. persistent symptoms (13 in 16 patients vs. 11 in 12 patients, p = .613), or those with symptom resolution vs. partial response or persistent symptoms (9 in 16 vs. 8 in 12, p = .704). Of 24 patients, whose duration of treatment was available, the mean ± SD duration of response to treatment was 0.95 ± 1.21 months.
Interaction of Cannabis Use and Aging: From Molecule to Mind
Published in Journal of Dual Diagnosis, 2020
Hye Bin Yoo, Jennifer DiMuzio, Francesca M. Filbey
Despite the neuroprotective effect of THC or the other cannabinoids in Parkinson’s disease, it is essential to note that most of the previous studies were regarding acute damages that induce Parkinsonian symptoms and target the dopamine system only. A real-life model of Parkinson’s disease takes lifelong accumulated damages and compensations in multiple systems (Dauer & Przedborski, 2003). Furthermore, an important risk to note is that dopamine therapy for Parkinson’s disease increases susceptibility toward development of impulse control disorder, which is a behavioral addiction that relates to pathological gambling or compulsive behaviors reported in Parkinson’s disease patients (Weintraub et al., 2010). Impulse control disorder shares pathophysiological features with substance use disorder, especially in the loss of sensitivity in reward pathways (Brewer & Potenza, 2008). This may occur because of an imbalance in Parkinson’s disease patients’ functions of the ventral striatum, which underlies reward processing, and the dorsal striatum that underlies motor control due to dopamine agonist “flooding” of the reward pathway (Voon, Mehta, & Hallett, 2011). It is reported that chronic use of THC upregulates BDNF in ventral tegmental area and nucleus accumbens, which may result in enhanced reward response (Butovsky et al., 2005). Thus, the application of cannabinoids for treating the human model of Parkinson’s disease shows great promise, although more research is needed.
Pharmacotherapy for the management of the symptoms of Machado-Joseph Disease
Published in Expert Opinion on Pharmacotherapy, 2022
Jessica Blanc Leite Oliveira, Alberto R.M. Martinez, Marcondes Cavalcante França Jr
Although rare, patients with SCA3/MJD presenting with tremor but not the complete parkinsonian phenotype have been described. They frequently respond to dopamine therapy, either levodopa or dopamine agonists. Part of them also experience motor complications from levodopa treatment. Patients can experience improvement with the use of benzodiazepines or trihexyphenidyl as well [29–31].