Parkinson’s disease and Movement Disorders/Parkinsonism

Currently there is no cure but there is lots of promising research into the causes of Parkinson’s, new treatments and finding a cure. The main symptoms of Parkinson’s disease (PD) are also the main symptoms of a range of conditions that together are called “Movement disorders” or “Parkinsonism.”

What is Parkinson’s?

The diagnosis of Parkinson’s is based on the presence of a number of core symptoms and a physical examination. The four common features are tremor, slowness of movement, muscle stiffness and loss of balance. There may be other symptoms affecting movement, such as hesitation when beginning to walk, small hand writing or reduced facial expression.

Non-motor symptoms can also occur such as constipation and vivid dreams. These symptoms have often been present long before the change in movement becomes apparent. Each person with Parkinson’s will experience a different range of symptoms and these will change over time. For some people the condition progresses quickly and in others it does not.

We aim to review patients approximately every six months in the Consultant and Specialist Nurse clinics (as recommended by NICE).

Your Specialist will decide how frequently and how often you need to be reviewed dependent on your symptoms and treatments.

The Nurses can be contacted in-between appointments for advice.

There are many treatments available and it is common for people to take more than one medication. Often multiple doses are needed each day.

The regimens can be complex and the Parkinson’s nurse specialists are able to offer advice and support in managing your individual requirements.

A brief guide to treatment options available for Parkinson’s

• Levodopa is converted into dopamine in the brain. Levodopa is combined with benserazide or carbidopa, this helps the levodopa get into the brain where it’s needed.
• Co-beneldopa (levodopa and benserazide) available as unbranded and Madopar standard release capsules and dispersible tablets and controlled release (CR) capsules.
• Co-careldopa (carbidopa and levodopa) available as unbranded and brand names Caramet CR tablets, Sinemet, Sinemet Plus, Sinemet CR, Half Sinemet CR tablets and Lecado CR tablets.
• Co-careldopa and entacapone available as Stalevo, Sastravi and Stanek tablet, (See also COMT inhibitors).
• Levodopa infusions used continuously with a pump. These are advanced treatments used in later stage Parkinson’s.
• Lecigon (levodopa, carbidopa and entacapone ) intestinal gel delivered through a tube into the small intestine).
• Duodopa (levodopa and carbidopa) intestinal gel delivered through a tube into the small intestine.
• Produodopa (levodopa and carbidopa) infusion via tubing and a small needle inserted into the fat layer under the skin.

COMT inhibitors

COMT inhibitors work by blocking the enzyme that breaks down levodopa. They are taken with your levodopa. It can be used when your levodopa is not lasting long enough (end-of-dose deterioration) or the effects “wear off”.

• Entacapone available unbranded or as Comtess (brand name).
• Co-careldopa and entacapone in one tablet are available as Stalevo, Sastravi and Stanek.
• Opicapone (brand name Ongentys).

Dopamine Agonists

Dopamine Agonists act like dopamine to stimulate your nerve cells.

• Pramipexole as unbranded tablets and Mirapexin (brand name) standard release and prolonged release tablets.
• Ropinirole available as unbranded tablets, Adartrel, Aimpart XL, Eppinix XL Ralnea XL, Raponer XL, Repinex XL Requip, Requip XL, Ropilynz XL, Spiroco XL prolonged release tablets.
• Rotigotine and Neupro (brand name) patches.

Apomorphine

• Apo-go and Dacepton intermittent injection pens and infusion vials used continuously with an infusion pump via tubing and a small needle inserted into the fat layer under the skin. Oral strips dissolved under the tongue.

Monoamine oxidase-B inhibitors (MAO-B inhibitors)

MAOB-inhibitors can help the nerve cells make better use of the dopamine that it does have. They block an enzyme called monoamine oxidase type B which breaks down dopamine in your brain. This helps increase the amount of dopamine in your brain which can help relieve the symptoms of Parkinson’s. They can be taken alone or alongside other Parkinson’s medication.

• Rasagiline available unbranded and Azilect (brand name) once a day tablets.
• Selegiline available unbranded and as Eldepryl and Zelapar (brand names) once a day tablets.
• Safinamide (brand name Xadago).

Glutamate Antagonists

• Amantadine and Symmetrel in capsules and syrup.

Amantadine is not used very often in early Parkinson’s but can be used to help with dyskinesia (involuntary movements) and muscle stiffness. It is prescribed alongside your other medications.

Anticholinergics

These drugs block the action of a chemical messenger acetylcholine, this chemical helps send messages in the brain and around your body and nerves in your muscles.

These drugs can be used in younger patients and for treating tremor.

Available in liquid, syrup and tablets unbranded. Procyclidine unbranded and as Arpicolin, kemadrin. Trihexyphenidyl also known as Benzhexol.

Deep Brain Stimulation

Deep Brain Stimulation (DBS) surgery is an option used in later stage Parkinson’s to treat tremor and dyskinesia. This is not a cure and you will still need to take medication.

The Role of the Parkinson’s Nurse Specialist Team

• A source of help, support and information for you, your carers and health professionals.
• To provide advice over the telephone or by email and to review you either in the clinic or at home.

The Nurse Specialist team will:

• Work with your Consultant, GP and other health professionals to optimise your treatment plan.
• Provide information about medication, help when starting new treatments and advice on long term monitoring.
• Refer you to other health care professionals such as physiotherapists, the speech and swallowing team, community occupational therapists and the community matrons where appropriate.

Contact us

Driving and Parkinson’s disease

When you are diagnosed with Parkinson’s you are legally obliged to inform the Driver and Vehicle Licensing Agency (DVLA) and your insurance.

Useful contact numbers and sources of information