How and When to Start Treatment of Parkinson’s Disease?

how and when to start treatment of parkinson's disease?The treatment of PD is a challenge to give the patient and his family the best possible quality of life. The decision of the medication is specific to each case and depends on:

- Age

- Impaired function (how the disability affects everyday life)

- Effect of the dominant side (eg, involvement of the right arm in a right-handed person)

- Social situation

- Problems associated neurological (memory, for example)

- The patient’s desire to experiment with neuroprotective agents likely but unproven (medications theoretically can reduce the course of evolution of the EP).

A young person, right hand tremor and bradykinesia in the right arm may need early and effective treatment with levodopa, as it depends on a quick recovery to maintain adequate working capacity. Another patient young or middle adult with mild stiffness and minimal bradykinesia may prefer a dopamine agonist or neuroprotective. The tendency not to carry out treatment until there is significant impairment of motor function is not recommended.

Retrospective studies have shown no advantage of this non-treatment compared with levodopa monotherapy. Even there may be some motor complications with levodopa for adaptive changes in the sensitivity of postsynaptic receptors due to a lack of dopaminergic stimulation. In order to avoid the complications of early therapy with levodopa, have tried to use new patterns of treatment with selegiline, amantadine, dopamine agonists, Levodopa presentations of slow, sustained release, and anticholinergics.

credit to: Dr. Jimmy Alfonso Schieman Delgado, Dr. G. Hotton, Dr. K. Ray Chaudhuri

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