New dosing decreases Parkinson's symptoms

Nearly one million Americans will be living with Parkinson's disease next year.

So far, there is no cure, but medication can bring patients some relief from the symptoms.

Now, a neurologist at MedStar Washington Hospital Center in Washington, D.C., is trying something new with an old drug to give patients better quality of life.

Seventy-three-year-old Peter Leesam is dressed up to celebrate. He and his wife, Bunny, took first over dozens of other teams in the DC Senior Brain Games, a Jeopardy-like competition.

Peter's mind is sharp, but just a few months ago, his hands weren't working.

"Putting on my shirt was a problem, tying my shoelace was a problem," Peter recalls.

Two years ago, Peter was diagnosed with Parkinson's disease. Doctors prescribed medication to help control symptoms.

"The most effective one is levodopa," says Mark Lin, MD, a senior neurologist.

Peter started on the conventional dose three times a day. He still would have problems with movement throughout the day. That's when Lin tried something new. He began to prescribe the same amount of levodopa per day but taken more frequently.

Lin says taking levodopa in lower doses, more frequently, can reduce dyskinesia involuntary muscle movements caused by the drug.

Peter sets alarms to mark the medication time. And if he forgets, Bunny will remind him. He says he feels much better now, allowing him to take his wife of 30 years out to a luncheon for brain game winners.

Lin says patient compliance is the biggest challenge. For many patients, it's inconvenient to take the levodopa every three hours, or six times a day. Lin says he now prescribes the more frequent dosing to all of his patients.

He suggests Parkinson's patients have the discussion with their neurologist.

MEDICAL BREAKTHROUGHS

RESEARCH SUMMARY

TOPIC: NEW DOSING LESSENS PARKINSON'S SYMPTOMS

REPORT: MB #4668

BACKGROUND: Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. Although Parkinson's disease can't be cured, medications might significantly improve your symptoms. Because the cause of Parkinson's is unknown, proven ways to prevent the disease also remain a mystery. Some research has shown that regular aerobic exercise might reduce the risk of Parkinson's disease. Some other research has shown that people who drink caffeine — which is found in coffee, tea and cola — get Parkinson's disease less often than those who don't drink it. However, it is still not known whether caffeine actually protects against getting Parkinson's or is related in some other way. Currently there is not enough evidence to suggest drinking caffeinated beverages to protect against Parkinson's. Green tea is also related to a reduced risk of developing Parkinson's disease. (Source: https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055)

TREATMENT: Although there are general guidelines that doctors use to choose a treatment regimen, each person with Parkinson's disease (PD) must be individually evaluated to determine which drug or combination of medications is best for them. For some, a "first choice" drug might be one of the levodopa preparations, and for others, an initial prescription may be given for one of the agonists, an MAO inhibitor or an anticholinergic. The choice of medication treatment depends on many variables including symptoms present, other existing health issues (and the medications being used to treat them) and age. Dosages vary greatly depending on a person's needs and metabolism. (Source: https://www.parkinson.org/Understanding-Parkinsons/Treatment/Prescription-Medications)

NEW RESEARCH: Mark Lin, MD, Senior Neurologist at MedStar Washington Hospital talked about adjusting the dose of levodopa for patients, "In the therapy most doctors will give the patient the medication three times a day. But four to five years almost 40 percent of patients would develop multiple complications. And then doctors will give smaller doses multiple times.

I say 'why not do it in the beginning to see what happens?' I use the same dose as everyone else uses. But I split it from three times to six times, so almost once every three hours."

(Source: Mark Lin, MD)