and blogs are the Official Website for the books:  Parkinson's Treatment: 10 Secrets to a Happier Life and 10 Breakthrough Therapies for Parkinson's Disease.

Dr. Okun is the co-founder of the University of Florida Center for Movement Disorders and Neurorestoration, the National Medical Director for the National Parkinson Foundation, as well as the author of several books including Ask the Expert about Parkinson's Disease, Lessons from the Bedside, 10 Breakthrough Therapies for Parkinson's Disease and Parkinson's Treatment: 10 Secrets to a Happier life due out in 2013.  His secrets book was translated into 20 languages so that it can be made available to Parkinson's disease sufferers around the world.  Dr. Okun has been recently been honored at the White House as a Champion of Change for Parkinson's Disease. Dr. Okun has been published in journals such as the New England Journal of Medicine and people travel from around the world to seek his opinion on best treatment approaches for this disease.

When to pull the trigger and start a Parkinson's Disease Medication

When should I start medication(s) for my Parkinson’s disease?  This question continues to crop up in National Parkinson Foundation forums, my blogs, and also on the NPF helplines.  I thought I would include some information on the blog since it is such a common question.

The most important factor in initiating medications for an individual patient is whether Parkinson’s symptoms are affecting quality of life, or alternatively whether symptoms are affecting work performance.   Bothersome Parkinson’s symptoms commonly include motor issues (tremor, stiffness, slowness, walking, and balance problems), and/or non-motor issues (depressionanxiety, sexual dysfunction, other issues).  Most experts agree that there is no benefit to delaying medication therapy if bothersome symptoms appear, and there may be risks in delaying treatment, especially if a treatment delay results in unsteadiness, falls, and fractures.

Over the last 10-20 years the thinking has evolved on when and how to initiate medication therapy for early Parkinson’s disease.  Most experts agree that the medication dosage and the timing of the medication dosage should be carefully monitored in order to maximize the control of potentially responsive Parkinson related symptoms.  The recommendation that patients should be started on dopamine agonists instead of levodopa (Sinemet) has faded over the last decade, especially with the emergence of impulse control disorders and other dopamine agonist associated side effects.

The best advice we can offer Parkinson’s disease patients is to not fear treatment, and to especially not fear dopaminergic therapy.  Sinemet and other Parkinson’s therapies have not been shown to be toxic or to accelerate disease progression.  Dopamimergics never “stop working,” however they may require adjustment over time.  If Parkinson’s disease symptoms are affecting quality of life, the work performance, or if there exists a risk of falling, treatment should be initiated.  Many practitioners will start with a MAO-B drug (selegiline, rasagiline, dissolvable selegiline, other), but Parkinson’s patients should be aware that the symptomatic effects of MAO-B’s are extremely mild.  It is in fact rare to remain on this drug without other Parkinson’s drugs for any significant period of time.  Dopamine agonists (ropinerole, pramipexole, cabergoline, rotigotine, others) and levodopa (Sinemet, Madopar) are both excellent choices for early Parkinson’s disease therapy.  The choice of agent should however, consider the individual’s comprehensive medical picture (age, co-morbidities, types of symptoms, history of neurological/psychiatric issues) as therapy should never be viewed as a “one size fits all.”  Finally, patients should remember that if depression, anxiety and other issues persist following dopaminergic treatment, then antidepressant therapy may also be warranted. 

Other drugs such as amantadine may be used early in Parkinson’s disease therapy, however most practitioners reserve amantadine for treatment ofdyskinesia which may or may not occur later in the disease course.  Patients should keep in mind that exercise is like a drug, and that a daily routine is often a great symptomatic supplement to any medication regimen.  Many practitioners wait to utilize physical therapy, occupational therapy, and speech therapy later in the disease, however these modalities can often be powerful treatments when employed early in the disease.  Finally, all Parkinson’s disease patients should have a general practitioner and a dermatologist involved with their care.  The reason for involving “other doctors” is because with adequate Parkinson’s treatment, they will be far more likely to encounter difficulties with other medical illnesses (heart disease, prostate cancer, breast cancer, melanoma, etc.).  Melanoma occurs more frequently in Parkinson’s disease populations.

Find more information on this topic at the What's Hot in Parkinson's Disease blog at National Parkinson Foundation.