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The Parkinsn Current Topics
An Algorithm For The
Management Of Parkinson's Disease
A supplement of the
American Academy of Neurology. Reprinted in Neurology 1994;44:S1-S52.
Editors: William Koller, M.D. Ph.D Dee Silver, M.D. Abraham
Lieberman, M.D.
This is a significant work, in that it includes the medical approach to treating problems that Parkinson's disease sufferers endure. It is comforting to know that as the disease progresses, answers to tomorrows "opportunities" have answers, today.
This document can be more effective and manageable if printed rather than read online. Print the document using the Courier font on your printer. The tables will line up if 12 point type is used.
There are 165 references in this document, of which I reproduced 18. I can look up the references for those interested, on a case by case basis or you can find them in Neurology, December 94 edition, supplement, at your medical library.
The breakouts are not included. The breakouts were just a graphical representation of what the text covered. The two Tables included, provided more information than was in the text.
NONPHARMACOLOGIC INTERVENTION
The optimal approach to the management of early PD includes both pharmacologic and non-pharmacologic treatments. The best results will be achieved by addressing all the patient's needs. A good attitude on the part of the patient, a strong support system, and an experienced treating physician are all essential components for a successful outcome. Attention should not be focused solely on pharmacologic therapy. A team approach and a variety of therapeutic interventions are essential to optimal management (breakout 1).
GROUP SUPPORT. Patients and their families need help adapting to living with a chronic, progressive illness. Support groups offer psychologic and social benefits to both patient and family. Patients with PD benefit greatly from interaction with each other. Initially, individuals often tend to feel they are the only ones with this disease. Both the patient and the patient's family can benefit from participation in support groups. A national organization, the American Parkinson Disease Association (APDA), has chapters in most cities. Many of these groups meet on a monthly basis for discussion among themselves and, often, presentations by various professionals. The clinician should advise patients of the APDA's existence and encourage their participation.
Because some patients with early disease might become discouraged when exposed to patients with more advanced disease, special APDA groups for individuals with young-onset PD have been formed to address their unique needs. Families of patients with PD also can benefit from group support. All family members are affected when a loved one is stricken by this disease, and they can react dysfunctionally if they do not have access to educational and support resources.
EDUCATION. Support groups provide practical information regarding PD. They often address issues such as the need for grab bars in the bathroom, a trapeze over the head of the bed, and velcro closures on clothing, which often are not mentioned by the physician. Patients who know as much as possible about their disease will receive the best treatment. PD newsletters from such national organizations as the United Parkinson's Foundation, the National Parkinson Foundation, and the APDA provide the education that allows patients to become advocates for their own causes. Information regarding available support organizations can be obtained by contacting:
The American Parkinson Disease Association, Inc. 60 Bay Street, Suite 401 Staten Island, NY 10301
(800) 223-2732
National Parkinson Foundation, Inc. 1501 N.W. 9th Avenue, Bob Hope Road Miami, FL 33136-1494
(800) 433-7022
Parkinson's Disease Foundation 650 W, 168th Street New York, NY 10032
(212) 923-4700; (800) 457-6676
United Parkinson's Foundation 833 W. Washington Boulevard Chicago, IL 60607
(312) 733-1893
The book Parkinson's Disease: A Guide for Patient and Family, by R.C. Duvoisin[1] also provides excellent information. The physician should let patients know about these invaluable educational resources.
EXERCISE. Daily exercise is one of the most beneficial things a patient can do for himself, can consist of stretching, walking, swimming or any activity the patient enjoys and will do regularly. More formal cardiovascular programs also are beneficial. Physicians should strongly encourage their patients to exercise. [3]
NUTRITION: Patients with PD are at risk for nutritional disturbances for many reasons. Good nutrition is therefore essential to their overall well-being. Although no specific diet is required, patients should receive sufficient fiber and fluids to prevent constipation and enough calcium to avoid osteoporosis. Patients often will ask about the amount of protein needed in their diet, This is a concern only in individuals who are taking levodopa and experiencing erratic responses. It is not usually an issue in early PD.
PHARMACOLOGIC INTERVENTION
Once the diagnosis of PD has been made, the next decision is whether a patient should receive antiparkinsonian medication (breakout 2).[2-6] Before the evidence of selegiline's possible role as a putative neuroprotective agent emerged, the decision to treat or not to treat PD was based solely on the degree of a patient's functional impairment,[3-6] which in turn depended upon the particular symptoms the patient had (tremor, bradykinesia, gait impairment); whether the symptoms affected the dominant hand, nondominant hand, or both; and whether the patient was or was not working. If a neuroprotective therapy is definitely proven, then it should be started as soon as the diagnosis can he made. Once the degree of functional impairment is established, factors that affect a patient's ability to tolerate antiparkinsonian medication should be ascertained. One of the most important of these factors is whether the patient has cognitive impairment. Although these issues may seem straight forward, the decision to treat or not to treat is not easily reached, Assessing the severity of parkinsonian symptoms, functional impairment, and cognitive impairment is difficult.[6]
