The management of Parkinson’s disease

Despite recent medical advances, there is currently no cure for Parkinson’s disease. But support can correct symptoms. The point with the Association France Parkinson.

Currently there is no cure for Parkinson’s disease but, since 1960, new treatments and discoveries succeed. Drugs allow a resumption of activities in 80% of cases. For Professor Pierre Cesaro, neurologist, Chairman of the Scientific Committee of the Association France Parkinson, “new treatments can improve the quality of life of patients and extend their life expectancy of ten years compared to 1970s. Among them, the brain stimulation reproduced stably the best effect of medical treatment. ”

Parkinson's disease

Drug treatments
Fifty years after the discoveries of Arvid Carlsson (Nobel Prize 2000) on dopamine, which gave rise to the standard treatment for Parkinson’s disease, researchers are still trying to better treat the symptoms if they can not cure the disease . We do not know in fact still stop to date, or even slow down the destruction of neurons that produce dopamine.

THE STANDARD TREATMENT: THE LEVO-DOPA

Since 1970, the levo-dopa, which is converted into dopamine in the brain has become the treatment of choice to correct the deficit of dopaminergic neurons. Very effective in the early years, it controls the symptoms generally well. Ultimately, however, it is suspected to be the origin of motor complications such as uncontrolled and involuntary movements (dyskinesias).

DOPAMINE AGONISTS

These substances do not contain dopamine but like him and mimic its action. These are stabilizing drugs with more prolonged effects. They represent an interesting used alone or in combination with other alternative medicines.
OTHER APPROACHES

Other less specific approaches involve the MAOIs (monoamine oxidase inhibitors), COMT inhibitors, active anticholinergic on tremors or benzodiazepines to relieve anxiety.

Earlier treatment for more efficiency?
For the first time, a clinical trial shows that a major change in the evolution of management is possible. His results reinforce the idea that we treat patients earlier for maximum therapeutic benefit.

The results of the ADAGIO study (large-scale clinical study with nearly 1200 patients) were presented on 26 August 2008. They emphasize the dual benefit provided by the anti-Parkinson Azilect ® (rasagiline): effects of modifying the progression of the disease by slowing the progression of Parkinson’s disease and symptomatic benefits.

“Rasagiline is convenient to take, because one dose per day (1 mg) and overall tolerance was excellent” announced Professor Olivier Rascol, Professor of Clinical Pharmacology at the University Hospital of Toulouse. A hope for patients, including one in 20 under 40.

In addition, “Adagio is an important clinical trial that challenges the way we now apprehend the management of Parkinson’s disease. Early treatment with rasagiline monotherapy shows a profit compared to a delayed start of treatment. Moreover, these results support the idea that patients with Parkinson’s disease should be treated as soon as the diagnosis is made to increase the chances of successful treatment “says one. So far, the treatment was implemented only when symptoms become bothersome.

Surgical methods
For fifteen years, it is possible to improve motor symptoms by stimulating chronic deep core of the cerebral cortex, a bit like a pacemaker in heart failure. This surgery, which involves certain risks, n is offered only to patients not responding to conventional medical treatments, provided they have no psychiatric disorder.

If it involves less than 5% of patients, the results are good. “This progress has changed our practice, giving us a second wind for some PD patients, and because we can change the therapeutic drug through the surgery or possibly combining the two,” said Dr. Marie Vidailhet.

however, Side effects can be very important, both cognitive and psychiatric: mood disorders, behavioral changes, apathy …

For a comprehensive care
Improving the quality of life of Parkinson ill pass on the one hand by the acceptance of his illness and secondly by the practice of physical activities compatible with its status: swimming, biking, singing … The physiotherapist involved in the functional rehabilitation usefully advise you about this. The objective is to avoid withdrawal or isolation are factors of depression. If care tailored to each specific problem (urology, speech therapy …) are essential, health professionals also stress the importance a psychological support.