Simply because new-onset Parkinson’s Disease presents so differently from patient to patient, the neurologist can’t follow a single uniform approach. The management technique of a single person’s illness should be tailored extremely carefully to their particular presentation. Here are 10 principles that usually guide that technique:
1.Simply because the diagnosis is purely based on the clinical impression and no definitive lab tests, biomarkers or scan outcomes, other feasible causes should be ruled out aggressively (eg. particular drugs for treating psychiatric symptoms as well as 1 for treating esophageal acid reflux can trigger a syndrome that mimics Parkinson’s).
2. There’s usually the possibility that the very first clinical impression might be contradicted by the later development of other symptoms much more suggestive of an additional neurological illness.
three. Occasionally 1 has to wait to create an accurate diagnosis to a point where much more of the so-called “cardinal” symptoms develop.
four. A great response to drugs that improve dopamine (levodopa) or mimic dopamine (dopamine agonists like pramipexole or ropinirole) is supportive of the right diagnosis.
five. A minimum of early on, frequently the NMS (non-motor symptoms) could be much more disabling and disturbing than tremor along with other early motor symptoms. For example EDS(excessive daytime sleepiness) can impair job performance and turn out to be a actual danger (eg. driving) for patients.
6. Patients ought to be urged to engage in a program of normal every day physical exercise instantly. Physical exercise is most likely the single greatest measure at keeping symptom worsening at bay.
7. Patients and family members have to be educated that the conventional image of a severely disabled individual who can barely walk isn’t generally around the corner.
8. Treatment requirements to be tailored to what’s most disturbing to the patient not the physician. Some patients for example are extremely conscious of tremor whilst other people are most upset by daytime sleepiness. The drug therapy for either could be extremely various. Obtaining rid of tremor for example might worsen daytime sleepiness and stimulant drugs for sleepiness can frequently make tremor worse.
9. Drug treatment provides numerous choices nevertheless levodopa, the strongest drug, is generally reserved for patients that respond poorly to other weaker drugs with fewer side effects.
10. In prescribing the so-called “milder” drugs, especially the dopamine agonists pramipexole and ropinirole, patients should be carefully warned about and watched for impulse control disorder/dopamine dysregulation syndrome characterized by compulsive gambling, sex, spending, consuming, drug abuse etc. frequently to fantastic detriment and monetary loss to sufferers.