Parkinson’s Disease

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Parkinson’s disease (PD) is a common chronic, progressive, neurodegenerative disorder in geriatric  population, characterized by the loss of dopaminergic neurons from the substantia nigra that  subsequently results in the loss of control of voluntary movement over time. 

Clinical presentationMotor symptoms: Tremors, rigidity, akinesia or bradykinesia, postural instability 

Non motor symptoms: drooling, dementia, depression, orthostatic hypotension 

Diagnosis is clinical based on United Kingdom Parkinson’s Disease Society Brain Bank (UKPDSBB)  criteria 

Pharmacological management of motor symptoms  First line:  

D: levodopa+carbidopa (FDC) (PO) 100/25mg 8 hourly (escalate dose based on individual  response) for 4weeks 

Give  adjunctive  treatment  for  motor  symptoms:  MAO-B  or  COMT  inhibitors  in  persistent  motor  symptoms despite adequate tolerable doses of Levodopa+carbidopa FDC treatment. 

S: selegiline (PO) 2.5-5mg 24hourly (maximum dose 10mg/day) 

Pharmacological management of non-motor symptoms 

Drooling: 

S: glycopyrrolate (PO) 0.5-1mg 8hourly for 2weeks 

Orthostatic hypotension: consider Levodopa dose reduction and give 

S: fludrocortisone (PO) 0.1mg 24hourly for 2 weeks 

Depression: Individualize therapy, consider 

S: fluoexetine (PO) 20mg 24hourly (maximum 60mg/day) for 4weeks 

OR   

A: amitriptyline (PO) 50mg 24hourly for 4-12 weeks 

Impulse control disorders: Consider modification of dopaminergic drug dosages. 

Non-pharmacological management 

  • Provide physiotherapy, occupational, speech and language therapies
  • Refer for expert neurosurgical evaluation for  Deep  Brain  Stimulation  (DBS) in patients with advanced Parkinson's disease whose symptoms are not adequately controlled by best medical therapy.