When should you start medication therapy for Parkinson's disease

Ask yourself:  Are Parkinson’s symptoms are affecting my quality of life, or alternatively are Parkinson's symptoms affecting my work performance  

- Motor issues (tremor, stiffness, slowness, walking, and balance problems)

-Non-motor issues (depression, anxiety, sexual dysfunction, other issues) 

If bothersome symptoms appear, you should be aware that there may be risks in delaying treatment, especially if a treatment delay results in unsteadiness, falls, and fractures

- Medication dosage and the timing of the Parkinson medication dosage should be carefully monitored

-Maximize control of potentially responsive Parkinson related symptoms

-Be aware that the thought of using 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

- Do not fear treatment, and do 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. 

- Many docs will first initiate 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

- 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.” 

- Depression, anxiety and other issues should be treated aggressively and they may persist even after starting dopaminergics

- Always consider adding an exercise regimen and making sure you are getting a good nights sleep

- Amantadine may be used early in Parkinson’s disease therapy, however most save this drug for later in the Parkinson's disease course to address dyskinesia

- Melanoma occurs more frequently in Parkinson’s disease so see a dermatologist yearly

- Consider physical, occupational, and speech therapy, even early in Parkinson's disease