What Would You Do?
Case 1: Early Parkinson Disease
Mr. Stark is a 58-year-old man with early probable Parkinson disease (PD), with symptoms of tremor, balance problems, and bradykinesia. His most troublesome symptoms are balance and tremor, which are worse in his dominant right hand. The symptoms are preventing him from enjoying his hobbies of carpentry and guitar playing. He has tried beta-blocker and anticholinergic agents but is dissatisfied with them because of adverse effects, and he is reluctant to try anticonvulsants or anxiolytics. He asks whether coenzyme Q10 or vibration therapy would help improve his motor functioning.
Case 2: Moderate Parkinson Disease
Ms. Ewing is a 75-year-old woman with moderate PD associated with mild cognitive impairment. She has mobility limitations secondary to freezing and a slow, shuffling gait. She is fearful of walking outside of her home, avoids socializing, and prefers to sit at home watching television. She is on optimal doses of carbidopa and has not benefited from amantadine. Her caregiver daughter recalls that her mother used to greatly enjoy dance and music in her youth. She wonders whether any alternative therapies might improve her mother's mobility.
What Is Known About Parkinson Disease?
PD is a chronic, progressive, degenerative neurologic condition associated with dopamine depletion that manifests as a movement disorder. The disease affects up 1%-2% of the adult population and is more prevalent with older age.
PD can be insidious in onset over many years or rapidly progressive, and is characterized by 4 stages:
Premotor/prodromal;
Onset of cardinal symptoms;
Mid-stage/moderate PD; and
Late-stage/advanced PD.[1]
Manifestations of PD include tremor, usually beginning on one side and spreading to the other; bradykinesia and rigidity; and nonmotor symptoms, such as constipation, anosmia, and sleep disturbance. The disease can progress to affect mobility in all spheres, including walking, writing, chewing, and speaking. Nonmotor problems are increasingly recognized and include depression, anxiety, and cognitive decline.
There is no cure for PD; treatment is symptomatic, addressing function and mobility, including fall prevention. Tremors may be controlled with medications (beta-blockers, anticholinergics, or anticonvulsants); mobility can be improved with carbidopa, amantadine, or catechol-O-methyl-transferase inhibitors. However, some symptoms become treatment-resistant over time. Depression and cognitive impairment should be addressed.
Because of the chronicity and inevitable progression of the disease, patients and caregivers often seek alternative, nonmedical forms of therapy to address symptoms.
Medscape Family Medicine © 2013 WebMD, LLC
Cite this: Complementary and Alternative Approaches to Parkinson Disease Symptoms - Medscape - Nov 05, 2013.
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