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Parkinson Disease (cont.)

Medications

Your treatment will include medications (called neuroprotective agents) to “protect” the neurons that make dopamine.
- Laboratory tests show that the medication selegiline (Eldepryl) gives a neuroprotective effect for dopamine neurons.
- When you are given selegiline alone in early PD, it is with the hope that the rate of degeneration of dopamine neurons may be slowed.
Symptomatic therapy is begun when you have functional disability. The selection of medication depends in part on the nature and cause of the disability.
- If your disability is due solely to tremor, a medication specific for tremors, such as amantadine (Symadine, Symmetrel), an anticholinergic agent, can be used.
  - This type of medication provides good tremor relief in about 50% of people but does not improve bradykinesia or rigidity.
  - Because tremor may respond to 1 anticholinergic medication and not another, your doctor may try a second anticholinergic if the first is not successful.
  - You will be given these medications starting at a low dose and slowly rising to minimize side effects, which include memory difficulty, confusion, and hallucinations. Side effects involving thinking are relatively common, especially in older people.
- If your disability is due to bradykinesia, rigidity, decreased dexterity, slow speech, or shuffling gait, you have dopamine-responsive symptoms.
  - You will be given a medication, such as levodopa-carbidopa (Sinemet), that will increase the dopamine in your brain.
  - These medications are started at a low dose, slowly escalated, and adjusted to control symptoms.
  - Most people require this kind of treatment for bradykinesia and rigidity within 1-2 years after diagnosis.