Managing Parkinsons disease with medications
voiceover so our friend here has recently been diagnosed with parkinson's disease, and we need to figure out what kind of medications we can give him to help manage the symptoms that he's experiencing.Now you might have noticed there that i said manage instead of treat, and you might reasonably be thinking well wouldn't you want to treat his symptoms, in other words, make them completely go away and not just manage them well that would be ideal, but unfortunately we don't currently have any medications that can completely get rid of the symptoms.
Of parkinson's disease.In other words, we don't currently have a way to stop or reverse the disease progression, the loss of dopamine neurons in the brain that is causing his movement symptoms.So instead, we have to manage his symptoms.We'll have to give him some medications that will minimize how much these symptoms crop up and interfere with his daily living, right so the management of parkinson's disease may look quite different for two different people and that's because the disease affects everyone a little bit differently.So we want to make sure that we figure out.
Which movement and nonmovement symptoms are really affecting our patient here.Really interfering with his daytoday tasks so that we can address them properly and not give him any medications that he doesn't need because we don't necessarily want to put everyone on every medication right away if the symptoms aren't really causing too many problems, right because there can actually be short and longterm side effects that we might want to minimize or delay.So let's say that our patient here is really struggling with his bradykinesia, his tremor, and his rigidity.
And he's also finding himself feeling really depressed lately, so we want to manage these symptoms.These are the key symptoms for our guy here.These are the ones that are really decreasing his quality of life, so what kind of medications would help with these movement problems here well let's start off by thinking about what's going on inside of our patient that's causing these problems he's losing dopamine neurons, right and when you lose dopamine neurons you end up with reduced levels of dopamine in the brain.So what can we do.
What can we do to fix this well, we can try giving him dopamine to replace the dopamine that he's lost, right so that seems like a reasonable idea, but there's one sort of caveat there.Dopamine doesn't cross the blood brain barrier.That barrier that keeps unwanted molecules and substances out of our central nervous system.So if we just give our guy here straight up dopamine, the blood brain barrier, it won't let it cross into his brain, so there won't be any increase in dopamine in his brain, which is where we really.
Need to replace it to reduce these movement symptoms.So we need a way around this little conundrum here.So what we can actually do is we can give him a medication that is the precursor to dopamine.So in other words, it will turn into dopamine in the right circumstances.And lucky for us, this precursor is called ldopa.So here it is, here is ldopa.It can cross the blood brain barrier so that's great.We're in business here.So we give our patient here ldopa.Oh, and we also know ldopa as levodopa,.
So you might hear that said as well.And ldopa can cross that pesky blood brain barrier and get converted into dopamine.So therefore, it increases dopamine levels in our guy's brain.And just an additional little note about that, it turns out that if we just give ldopa, these enzymes that we have that hang around outside of the central nervous system, they actually just go ahead and convert our ldopa into dopamine before it even has a chance to get into the brain, so that's kind of a problem, right.
That kind of defeats the purpose of giving ldopa in the first place.So what we'll do about that, is we'll give him another medication called a peripheral decarboxylase inhibitor and we'll do that at the same time as we give ldopa and now this drug, the peripheral decarboxylase inhibitor, it will block those enzymes from turning our ldopa into dopamine before it gets into the brain.So good, now ldopa is getting into his central nervous system and it's turning into dopamine and this is helping with his movement problems.
So ldopa is generally considered our most effective medication for dealing with the movement problems in someone like our patient here with idiopathic parkinson's disease, but there are a few problems that can arise about five to 10 years after someone starts taking ldopa.One thing that can happen is something called wearing off.And wearing off is when a dose of ldopa it stops lasting as long as it used to, so the patient's symptoms become really bothersome again before it's even time to take the next dose of ldopa.
So what can we do about this wearing off well where does that dopamine go it's degraded, right it's being broken down by special enzymes that we have in our brain, so we can try to slow down that degradation of dopamine, that's what we can do.That way it can hang around a bit longer and keep stimulating our dopamine receptors and that can help get out patient here through to their next dose of ldopa without their symptoms coming back to bother them.So we can do this with a few different types of medications.
We can use something called a monoamine oxidase b inhibitor, also known as an maob inhibitor.So maob is an enzyme that hangs around in our brain and it breaks down dopamine, so we don't want that.So we can use an maob inhibitor to stop his breakdown and that allows us to keep higher levels of dopamine in the brain, good, so that's one thing that we can do to prevent this wearing off, and another type of medication we can use is called catecholomethyltransferase inhibitor.Man, that's a mouthful.
But if we break that down, the name actually makes sense.So catechol here stands for catecholamine and dopamine is a type of molecule in the catecholamine group.So is epinephrine and norepinephrine.You might have heard of those as well.So these are all catecholemines and methyltransferase here means that this is an enzyme.Remember that the ace part means that it's an enzyme.This enzyme, what it does, is it transfers a methyl group onto the dopamine and this inactivates the dopamine.So already we know that we're going.
To have to do something about this because we want our dopamine to stick around for a bit longer.So when we give our patient here a comt inhibitor, i'll just go ahead and shorten this to comt, we stop that breakdown, right so we have more dopamine floating around to bind to the receptors, the dopamine receptors, and to reduce movement symptoms.So another problem that we can see with prolonged use of ldopa is too much involuntary movement.Now that's a little unexpected, right that's kind of the opposite of what we would expect.
In someone with parkinson's disease.I mean, parkinson's disease it messes around with out basal ganglia pathways, so that we end up with a reduction in movement, right so why are we getting too much movement here well we can think of ldopa as a pendulum, a pendulum that is trying to swing our patient from reduced movements to being able to move normally, but over time after being on ldopa for several years, the pendulum can kind of over shoot and we end up with too much movement and we call this dyskinesia,.
So that presents an interesting little problem here.Essentially, what we need to think about when we're treating parkison's disease is that well ldopa is our most effective medication, but if we use it for a long time, there's a chance the pendulum will swing the other way so to speak and dyskinetic movements will result.So what do we do well sometimes we might delay starting ldopa for as long as we reasonably can.So in other words, we'll try to manage our patient's symptoms without resorting to ldopa right away.
Or maybe we'll just try to use a little bit of ldopa and use another medication as well, at least until later on in the disease when we really, really need ldopa.Ldopa is kind of like the ace up our sleeve, that we want to hang onto until we want to play it and that way we can maybe delay these longterm side effects from happening.So then the question becomes, other than dopamine, what else could we give our patient here that would help him with his movement problems.
Well we could give him something that acts like dopamine, right something that stimulates his dopamine receptors the same way that dopamine does.So let's do that and these are called dopamine agonists.They play the role of dopamine.Kind of like how a substitute teacher plays the role of the regular teacher and helps teach the class while the regular teacher is away.So when we give him these dopamine agonists, the neurons with dopamine receptors are stimulated just as though dopamine was there doing the job.So you might be wondering,.
Okay well if these dopamine agonists act like dopamine, then why is ldopa the most effective medication shouldn't these agonists be just as effective well while these agonists do act like dopamine, they're not dopamine, right they're not a perfect fit for the receptor.Just like how the substitute teacher just isn't as good a fit for the class as the regular teacher is.So these agonists, they just aren't as effective as the real thing, but they can be really helpful maybe early on when symptoms aren't too bad, when the disease hasn't progressed too far,.
Or maybe when we're using them together with ldopa, so that maybe ldopa can be used a little bit less.So those are the main types of medications that we would normally use to manage the movement symptoms of parkinson's disease, but we also need to manage the other symptoms, right like the depression that our patient is experiencing.So one thing that we might want to do before we try to treat his depression or any other symptom that someone with parkinson's disease might experience, is that we would want to figure out.
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