A Critical Reappraisal Of The Worst Drugs In Parkinsons Disease
What are the worst drugs for Parkinsons disease patients? Couldnt a simple list be assembled and disseminated to the Parkinson community? Recently Ed Steinmetz, an experienced neurologist in Ft. Meyers, FL pointed out to me, a list approach published in the Public Citizen Newsletter . The approach was to list every drug associated with a single confirmed or unconfirmed symptom of Parkinsons disease or parkinsonism. Parkinsons disease is defined as a neurodegenerative syndrome , whereas parkinsonism encompasses a wider net of drug induced and other potential causes. In parkinsonism symptoms are similar to Parkinsons disease, but patients do not have Parkinsons disease. Patients and family members confronted with a simple drug list approach may falsely conclude that most medicines are bad for Parkinsons disease, and that any medicine may cause parkinsonism. This concept is in general, incorrect. Although the approach is well-meaning, it is in need of a major revision, as Parkinsons disease and parkinsonism are too complex to summarize by simple lists. In this months column I will try to summarize the key information that patients and family members need to know about the worst pills, for Parkinsons disease and parkinsonism.
A Florida Parkinsons Treatment Blog by Michael S. Okun, M.D.
UF Center for Movement Disorders & Neurorestoration, Gainesville FL
What Is Multiple System Atrophy
MSA is caused by the same abnormal protein as in Parkinson Disease
Patients can have parkinsonism but also tend to have a jerky and mixed tremor
There is another subtype that is characterized by lack of coordination in the arms and walking
One of the major hallmarks of MSA is the dysfunction of the autonomic nervous system. This includes symtpoms such as:
neurogenic orthostatic hypotension – drop in blood pressure beyond what the brain can handle leading to dizziness and sometimes passing out
Can Parkinsons Disease Be Prevented
It is not possible to prevent Parkinsons disease, but some believe that lifelong healthy habits may reduce ones risk of developing the condition. Some medications may also relieve some of its symptoms.
In some PD patients, particularly those who are at the late stage of the disease, surgery may be an option to help improve symptoms.
Some experts also advise doing rpeventive measures such as wearing gloves and other protectvie equipment when applying pesticides as it may help protect you against the disease.
Cold Turkey Vs Tapering
It is always recommended to conduct a gradual taper off of anticonvulsant medications. Since this is a drug that affects various neurotransmitters as well, it is important to gradually taper as opposed to quitting cold turkey. By slowly tapering, you are giving your body and brain some time to gradually adapt as you get used to functioning with less of the drug.
If you quit cold turkey, you may experience more debilitating withdrawal effects for a longer period of time. Quitting cold turkey essentially strips your nervous system of a stimuli that it was used to receiving for a long period of time. In some cases, by not tapering, it is thought that you may shock the nervous system and it may take even longer to readjust to functioning without the drug.
Most sources suggest tapering at a rate of 20% to 25% every 2 weeks. You could taper slower or quicker, but this makes roughly for about a 2 month withdrawal period. Even 25% may be too quickly for you if you have been on the drug for a long period of time at a high dose. Take the time to work with a professional and come up with a custom plan to minimize withdrawal symptoms. To be on the safer side you could even reduce at a rate of 15% every 2 weeks.
Serotonin Reuptake Blocking Antidepressants Fluoxetine Sertraline And Paroxetine
Several other medications have been reported to cause drug-induced parkinsonism and to worsen parkinsonism in people with Parkinson disease, including the serotonin reuptake blocking antidepressants fluoxetine, sertraline, and paroxetine. Two calcium channel blockers available in Europe and South America , which are piperazine derivatives, are thought to cause drug-induced parkinsonism by blocking dopamine receptors. Reports of parkinsonism induced by other drugs, such as lithium and amiodarone, are so rare that only after parkinsonism has developed should the possible drug effect be taken into account. Because lithium is not known to block dopamine receptors, another mechanism is likely. Some animal data implicate an effect of lithium on intercellular signalling via G-protein coupled receptors . One antidepressant, amoxapine, has dopamine receptor-blocking properties and, therefore, may induce parkinsonism. Parkinsonism as a transient side effect of alcohol withdrawal has been reported without later development of Parkinson disease, but it is unknown how common this is .
Factors That Influence Depakote Withdrawal
When coming off of any medication, there are various factors that play a role in determining how long the withdrawal process takes as well as the severity of discontinuation symptoms. These factors include things like: the time span over which you took the drug, the dose that you were on, whether you quit cold turkey or tapered, as well as other personal factors.
Parkinsonism Due To Other Neurological Disorders
The following neurological disorders are known to cause parkinsonian symptoms:
Vascular parkinsonismAlso known as arteriosclerotic parkinsonism, this condition is caused by multiple small .
The onset of symptoms can be sudden or gradual, and often includes mobility problems in your legs. Symptoms may level off for a period of time.
Vascular parkinsonism has the slowest rate of progression of all atypical parkinsonisms. It doesn’t usually cause tremors, either.
Post-traumatic parkinsonismAlso known as post-traumatic encephalopathy or “punch-drunk syndrome,” this condition may be caused by a severe head injury or by frequent head trauma, such as from boxing or football.
Post-traumatic parkinsonism can lead to a type of dementia called chronic traumatic encephalopathy . In March 2016, the National Football League admitted that there might be a link between CTE and head trauma.
Essential tremorThis is a tremor that tends to run in families and become worse over time. It’s usually seen most severely in the hands, especially when the hands are moving.
Normal pressure hydrocephalus This condition is caused by an abnormal increase in fluid in the cavities of the brain.
NPH can sometimes be treated by draining the extra fluid into your abdomen using a shunt.
Environmentally Caused Parkinsonism
The following disorders are caused by outside factors like drugs and infection:
The following substances can cause drug-induced parkinsonism:
What Can Be Done To Treat My Tremors
Your doctor will probably ask you to stop taking the drug thats causing the tremors. This generally happens after talking with your doctor about the potential risks and benefits associated with stopping therapy. Your doctor will also discuss possible alternative treatments with you. Your symptoms may not resolve immediately after stopping the offending medication. Symptoms usually subside in about four months, but in some cases, it may take up to 18 months.
Anyone can develop tremors from taking medication. But some people are more at risk than others. Among those at increased risk are:
- the elderly
- anyone with a history of dementia
When To Seek Medical Care For Parkinson’s Disease
If a person feels they are beginning to experience symptoms of Parkinson’s disease, especially if they are over age 59, they should consult with their doctor.
Because Parkinson’s disease is a progressive disease, people will continue to experience new and disturbing symptoms.
- These symptoms can sometimes be hard to distinguish from side effects of medications, which can be numerous in someone with Parkinson’s disease.
- Thus, any change in a person’s baseline health condition should prompt an evaluation to rule out other medical conditions or medication side effects.
Although the emergency department is not the setting for deciding if someone has Parkinson’s disease, visits may be needed to rule out or treat other emergent medical conditions.
Specific complications associated with Parkinson’s disease may need an emergency department visit. For example:
Tremors Caused By Medications
In addition to drug-induced parkinsonism, which includes rest tremor and is caused by medications that block the dopamine receptor, there are also a wide variety of medications that do not block the dopamine receptor, but can cause other types of tremors, such as postural and action tremors. So if you have these types of tremors, but without the slowness, stiffness and other PD-like symptoms, you could have drug-induced tremor .
Apostural tremoroccurs when a body part is held against gravity. Postural tremors occur for example, when the arms are extended, such as when holding a tray. An action tremoroccurs when a body part is moving. Action tremors occur for example, when the arm is moving toward the mouth to eat.
Drug-induced tremors typically are symmetric or equal on both sides of the body. The medications that can cause tremor include, but are not limited to, lithium, valproic acid, amiodarone, beta-adrenergic agonists, and selective serotonin reuptake inhibitors . Be attentive to whether a tremor starts after any new medication is started. If it does, discuss this with your doctor.
Depakote Withdrawal Symptoms + How Long They Last
Depakote is a compound that is utilized as an anticonvulsant to help prevent seizures in epileptics. It also has mood stabilizing properties and is approved to help treat and prevent mania among individuals with bipolar disorder. In some cases it is prescribed for the treatment of migraine headaches as well. Other off-label uses for Depakote include: impulse control disorders and spasms.
Most people that use it for the intended purposes of treating epilepsy and/or mania in bipolar disorder find that it works quite well. Despite the fact that the drug can be very effective, the way it works is not well understood. Some hypothesize that it may work on voltage-dependent sodium channels and may increase GABA to prevent both seizures and mania. Studies in animals have lead researchers to believe that this may inhibit the reuptake of the neurotransmitter GABA in the brain.
Although many people take this medication for a period of time, some have a difficult time dealing with side effects. Various side effects include: hair loss, nausea, diarrhea, vomiting, indigestion, and vision problems. Additionally it may lead a person to gain weight and cause memory problems. The potentially debilitating side effects are reasons people typically end up withdrawing from this medication.
How Will My Doctor Diagnose My Symptoms
Diagnosis of your drug-induced tremors will start with your doctor asking you about your symptoms and medical history. A complete list of the medications youre taking will be extremely helpful during diagnosis. Telling your doctor how often youre having tremors can help aid in your diagnosis. The speed of your tremors can also help your doctor determine their cause.
Some important features of drug-induced tremors that distinguish them from Parkinsons disease include the following:
- The symptoms are on both the left side and the right side. Parkinsons disease typically affects primarily one side.
- The symptoms stop when you stop the medication. Parkinsons disease is chronic and progressive.
- There is no brain degeneration. Parkinsons disease is caused by degeneration in a specific area of the brain.
Your doctor might want to rule out other potential causes of tremors by performing blood tests to check for abnormal levels of certain chemicals in your blood. Problems with your thyroid can also cause tremors, so your levels of thyroid hormones might be checked.
CT and MRI scans are done by a computer and allow your doctor to see your brain. Using these scans, your doctor can potentially rule out defects in your brain that may be causing tremors.
How I Reversed My Parkinsons Disease Symptoms
Being diagnosed with Parkinsons disease is a life-altering event. Youre presented with all these drugs to take to help ward off the unpleasant symptoms but these drugs cause unwanted side effects.
Its not a no-win situation. You can manage and possibly reverse Parkinsons disease and live a full life.
Its time to find out what you can do to help your body deal with this disease naturally and effectively. Just keep reading.
Any Medication That Blocks Dopamine In The Body Can Cause Parkinsons Symptoms
You may have heard of Parkinsons disease , a movement disorder. Someone with it may have characteristic signs, such as a pill-rolling tremor in the fingers or a hunched forward posture. You may recognize someone with this disease from the faltering, tiny steps they take when they walk or by their rigidly emotionless face.
The cause of Parkinsons disease is mostly unknown. Some people develop Parkinsons-like symptoms after treatment with certain medications. This is called drug-induced parkinsonism or secondary parkinsonism. Certain medications can also worsen symptoms in someone who already has Parkinsons disease.
Any medication that blocks dopamine in the body can cause Parkinsons symptoms. Dopamine is a brain chemical that helps control movement. Common dopamine-blocking drugs are antipsychotics. They are used to treat certain mental illnesses or severe nausea. Less commonly, certain types of calcium channel blockers cause drug-induced parkinsonism. These drugs may be used to treat chest pain and high blood pressure, or irregular heart rate.
Can Surgery Treat Essential Tremor
Surgery should be considered for patients with disabling tremor that is not adequately controlled with drug therapy.
The proven surgical treatments are:
- Chronic thalamic deep brain stimulation .
- Stereotactic thalamotomy.
Patients who cannot undergo surgery include those who have medical conditions other than essential tremor that make them poor surgical candidates and those with a significant loss of thinking ability.
Surgical procedures allow patients to potentially reduce their tremor medicines.
What To Do If Your Senior Has Parkinsons
If you notice Parkinsons-like symptoms in your older adult, the first thing to do is talk with their doctor. The doctor should review their complete medication history and you should let them know about any other symptoms or changes.
Important: Dont make any changes to medications without doctor approval that could cause serious problems.
Effects Of Depakote On Other Drugs
Depakote inhibits certain liver enzymes and can cause the levels of Felbatol , Lamictal , Mysoline , and phenobarbital to increase markedlyin some cases, more than double. If a person taking phenobarbital is also given Depakote, a rapid rise in phenobarbital levels can lead to extreme tiredness, slurred speech, and other signs of intoxication.
Depakote has more complex, variable, and less significant effects on Tegretol , Zarontin , Ativan , and Dilantin . Depakote inhibits epoxide hydrolase, thereby increasing levels of the epoxide metabolite of carbamazepine. It also can inhibit metabolism of Zarontin and Ativan, leading to higher levels of these medications. It can displace Dilantin from protein binding sites and slightly increase the free Dilantin level. In each case, side effects may increase slightly.
Coagulation tests should be carefully checked if patients taking anticoagulants such as Coumadin begin taking Depakote.
The Connection Between Pd And Drug
In addition to potentially causing parkinsonism in the general population, these medications should definitely be avoided in people who have parkinsonism from other causes, such as PD. APDA has created a list of Medications to be Avoided or Used With Caution in Parkinsons Disease. It is important to note that there are anti-psychotics and anti-nausea medications which donotcause parkinsonism and can be used safely by people with PD.
Sometimes, a person without a diagnosis of PD is prescribed a medication which leads to a side effect of drug-induced parkinsonism. The prescribing physician may stop the new medication, but the parkinsonism does not resolve. The patient remains off the medication with continuing symptoms, and eventually is given a diagnosis of PD. In this scenario, that person most likely had dopamine depletion in the brain which had not yet manifested as a clinical symptom. The prescription medication that blocked the dopamine receptor, was the proverbial straw that broke the camels back, inducing the full-fledged symptoms of dopamine depletion and revealing that the person did in fact have PD.
The differences of PD vs drug-induced parkinsonism
There are key differences to note between parkinsonism from PD and parkinsonism as a side effect of medication.
What Helps Parkinsons Disease
There is no official cure for Parkinsons Disease.
As the disease progresses, patients often suffer from cognitive decline. Existing treatments can help ease symptoms, but over time, the drugs themselves can cause debilitating side effects.
Carbidopa is most commonly used for Parkinsons disease. However, there can be a number of negative side effects and problems associated with the administration of carbidopa during treatment of Parkinsons disease. This is thought to be because the administration of carbidopa will deplete the body of vitamin B-6, l-tyrosine, l-tryptophan, 5-hydroxytryptophan , serotonin, and sulfur amino acids.
The properly balanced administration of Mucuna pruriens , and not carbidopa, in conjunction with 5-HTP, l-tyrosine, l-cysteine, and other supportive nutritional supplements can improve symptoms.
A research study, led by Dr. Marty Hinz and printed in the International Journal of Internal Medicine, was done with 254 Parkinsons patients who were newly diagnosed with no previous treatment and those who were diagnosed more than 20 years before and had tried many other medical treatment options. It showed that these supplements were helpful in the treatment of Parkinsons Disease.
How To Test For Parkinson’s Disease
No blood test exists that definitively diagnoses Parkinson’s disease. Currently, a strong presumptive diagnosis of Parkinson’s disease is made by a doctor’s observation of the patient’s symptoms, medical history and neurologic examination, and response to a treatment schedule with the combination medicine generically termed -levodopa .
Definitive diagnosis of Parkinson’s disease can be difficult. As stated above, there is no specific blood test or diagnostic study currently available to make the diagnosis. In fact, a brain tissue sample, though not practical in living patients, is the only way to be relatively sure of the diagnosis. This is usually done at . Studies have shown that a misdiagnosis rate in the past of 25% to 35% was not uncommon. This rate drops to about 8% when a movement disorder specialist physician helps make the diagnosis. Consequently, consultation with a specialist is usually recommended.
People that suspect they may be experiencing symptoms of Parkinson’s disease should consult with their primary care doctor and ultimately may need a referral to a neurologist who specializes in movement disorders.
Possible Imaging Technique Diagnosis
Medications To Avoid That Worse Pd
Some medications can worsen movement symptoms of PD, including slowness, stiffness, tremor and dyskinesia. These drugs, listed below, are used to treat psychiatric problems such as hallucinations, confusion or gastrointestinal problems, such as nausea. The stress of your illness, hospital stay or new medicines can increase your risk of hallucinations while hospitalized. Common anti-hallucination medicines to be avoided are listed by generic or chemical name followed by the trade name.
What Looks Like Parkinsons But Isnt
Dr. Fernandez describes two main Parkinsons mimics:
Essential tremor. Also known as benign essential tremor or familial tremor, this movement disorder causes brief, uncontrollable shaking.
It most often affects your hands, but can also affect your head and neck, larynx and other areas. In rare cases, it affects your lower body as well.
But one clue can help distinguish essential tremor from Parkinsons.
This is not an absolute rule, but if shaking occurs at rest, it often is Parkinsons. And if occurs in action, such as when youre writing or eating, it is essential tremor, Dr. Fernandez says.
About half of those with essential tremor have a family history of the condition.
Unlike Parkinsons, essential tremor is generally not perceived as a progressive disorder, and, if mild, may not require treatment.
Doctors can prescribe medications to reduce shaking, but they are not the same drugs used to treat Parkinsons, he says.
Drug-induced Parkinsons.Along with shaking, this condition may cause many symptoms similar to Parkinsons disease, including stiffness, slow movement, a decrease in facial expression and a change in speech.
As the name suggests, taking certain drugs, most commonly antipsychotics and mood stabilizers, can trigger this condition.How long it takes to develop can vary greatly, depending on which drug youre taking, how long you take it and the dosage.
Your doctor likely will treat drug-induced Parkinsons by adjusting your medication.
What Are The Symptoms Of Essential Tremor
The main symptoms associated with essential tremor include:
- Uncontrollable shaking that occurs for brief periods of time.
- A shaking voice.
- Tremors that worsen during periods of emotional stress.
- Tremors that worsen with purposeful movement.
- Tremors that lessen with rest.
- Balance problems, in rare cases.
What Causes Parkinson’s Disease
The causes of Parkinson disease remain unclear; clinicians and researchers have clear evidence that the nerve cells that produce dopamine in the brain’s region known as the substantia nigra are altered and lost . The challenge that remains is to discover how these neurons are destroyed to cause Parkinson’s disease. Advances in genetics have lead researchers to discover that about 10% of people that develop the disease are due to multiple genetic factors, but these people usually are younger than 50. The majority of researchers suggest that a combination of genetic and environmental factors cause about 90% of cases of Parkinson’s disease, but how these factors interact to alter and destroy brain cells thus producing Parkinson’s disease is not well understood. A few theories and risk factors are listed below that may offer additional information and clues that may help lead to a better understanding of Parkinson’s disease causes.
Tremor at Rest
When Are Drugs Prescribed To Treat Essential Tremor
When essential tremor often prevents with daily activities, long-term drug treatment is needed. Your healthcare provider will determine which treatment is best based on other medical conditions you may have and based on the safety of the drugs. The goal is to minimize the side effects of drugs while having improvement in function.
With the use of medication, patients may see improvement in the ability to control tremor and improvement in functions like drinking from a cup or using food utensils. More specialized motor functions, such as being able to thread a needle, may not improve.
For patients with mild ET, the effects of the condition can be lessened by the patients minimizing exposure to emotional stress and avoiding substances, such as caffeine and nicotine that may increase tremor. In social situations, a person with mild tremor can take a beta blocker drug or drink a small amount of alcohol if such treatments are approved by a doctor.
Drugs most commonly used to treat ET include beta blocking drugs Inderal , Tenormin , Betapace , and Lopressor .
What Surgeries And Therapies Can Treat Parkinson’s Disease
In addition to drug treatment, specific surgical options are available that may be used in patients that have severe symptoms of the disease or when medication is no longer able to give symptomatic relief. Early surgical treatments involved removal or destruction of the thalamus to reduce tremors but had little or no effect on symptoms of bradykinesia or rigidity. Pallidotomy and subthalamotomy, two surgical operations that remove parts of the brain have shown improvements in many of the symptoms of Parkinson’s disease. However, these techniques often do not reduce all of the symptoms which may continue to progress and may have many different complications when the brain tissue is destroyed; in some patients, the outcomes versus the risks of these surgeries is still considered.
Parkinson’s Disease Gene Therapy
Parkinson’s Disease Other Therapies
Some studies claim that eating velvet or fava beans help with symptoms , but these studies were not deemed conclusive. Vitamin E and Q have been claimed by some to be neuroprotective but are not a currently recommended treatment. A high fiber has been recommended to reduce the constipation that usually is seen in many Parkinson’s disease patients. has been suggested to help Parkinson’s disease patients; studies suggest that many Parkinson’s disease patients benefit from exercises that flexibility, leg strength, and cardiovascular conditioning.