The new Parkinson's disease treatment book : partnering with your doctor to get the most from your medications

545 Pages·2015·23.146 MB·English

by  J. Eric Ahlskog

THE NEW PARKINSON’S DISEASE
TREATMENT BOOK
OTHER BOOKS BY THE AUTHOR
The Parkinson's Disease Treatment Book: Partnering with Your Doctor to Get
the Most from Your Medications. New York: Oxford University Press; 2005.
532 pp.
Parkinson's Disease Treatment Guide for Physicians. New York: Oxford
University Press; 2009. 382pp.
Dementia with Lewy Bodies and Parkinson’s Disease Dementia.
New York: Oxford University Press; 2014. 250pp.
The New
Parkinson’s Disease
Treatment Book
♦ ♦ ♦
Partnering with Your Doctor to Get
the Most from Your Medications
SECOND EDITION
J. E A , P D, MD
ric hlskog h
1
3
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© 2005, 2015 by Mayo Foundation for Medical Education and Research
Illustrations © 2005, 2015 by The Mayo Clinic
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Library of Congress Cataloging-in-Publication Data
Ahlskog, J. Eric.
[Parkinson’s disease treatment book]
The new Parkinson’s disease treatment book : partnering with your doctor to get the most
from your medications / J. Eric Ahlskog, Ph.D., M.D. — Second edition.
pages cm
Revision of: Parkinson’s disease treatment book. 2005.
Includes index.
ISBN 978–0–19–023186–6
1. Parkinson’s disease—Treatment—Popular works. I. Title.
RC382.A365 2015
616.8′3306—dc23
2015008118
1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper
♦ ♦ ♦
Contents
Acknowledgments ix
1. Background 1
Part One
Basic Facts about the Brain and Parkinson’s Disease
2. A Primer on the Brain 9
3. Parkinson’s Disease: Changes in the Brain and Beyond 19
Part Two
Parkinson’s Disease: Diagnosis and Prognosis
4. How Do I Know If I Have Parkinson’s Disease? 31
5. Prognosis  55
Part Three
Distinguishing Parkinson’s Disease from Other Disorders
6. Conditions Mistaken for Parkinson’s Disease 65
7. Testing 85
v
vi CONTENTS
Part Four
The Cause and Progression of Parkinson’s Disease
8. Clues to the Cause(s): Genes, Environment 97
9. Are There Drugs or Strategies to Slow Parkinson’s Disease
Progression? 111
Part Five
The Movement Problems of Parkinson’s Disease: Medication
Rationale and Choices
10. Medications for Movement Problems (Gait, Tremor,
Slowness): Background and Rationale 129
11. Starting Medical Treatment of Parkinson’s Disease Movement
Problems 145
Part Six
Beginning Treatment of Parkinson’s Disease: Medication
Guidelines
12. Starting Levodopa Treatment 159
13. Starting Dopamine Agonist Treatment 175
14. Refractory Tremor Syndromes: “Medications Don’t Help My
Tremor!” 189
Part Seven
The Early Years on Medications
15. The First Few Years on Carbidopa/Levodopa Treatment 199
16. The Early Years of Parkinson’s Disease If Started on Other
Drugs 205
Part Eight
Later Medication Inconsistency: Motor Fluctuations
and Dyskinesias
17. Later Developing Movement Problems: Motor Fluctuations and
Dyskinesias Treated with Levodopa Adjustments 213
18. Supplemental Drugs for Motor Fluctuations and Dyskinesias 251
CONTENTS vii
Part Nine
Other Treatment Problems: Not Just a Movement Disorder
19. Subjective Parkinson’s Disease Symptoms Due to Dopamine
Deficiency 263
20. Sleep Problems: Insomnia, Daytime Sleepiness, and Nighttime
Disruptions 275
21. Orthostatic Hypotension and Other Causes of Dizziness: Different
Types and Different Treatments 299
22. Depression 325
23. Thinking, Memory, and Dementia 337
24. Hallucinations, Paranoia, Delusions, and Problematic Compulsive
Behaviors 353
25. Problems with Swallowing, Saliva, and Speaking 369
26. Managing Digestive Problems and Constipation 375
27. Urinary Symptoms 385
28. Sexual Dysfunction, Estrogen, and Menstrual Cycles 397
29. Other Treatment Problems: Swelling, Skin Rashes, and Visual
Symptoms 409
Part Ten
Nutrition, Exercise, Work, and Family
30. Diets, Vitamins, Nutrition, Osteoporosis 425
31. Exercise, Physical Medicine, and Physical Therapy 433
32. Family, Friends, the Workplace, and Caregivers 445
Part Eleven
Surgery and Procedures for Parkinson’s Disease: Present
and Future
33. Deep Brain Stimulation (DBS) and Other Brain Surgery for
Parkinson’s Disease 455
34. Experimental Treatments: Fetal and Stem Cell Implantation,
Neurotrophic Hormone and Gene Therapy, Vaccines and
Immunotherapy 469
viii CONTENTS
Part Twelve
Parkinson’s Disease Information Services
35. Support and Advocacy Groups and the Internet 485
Glossary 489
Index 499
♦ ♦ ♦
Acknowledgments
The practice of medicine starts with medical school and residency, which
provide the basis for the real education on the front lines in the clinic and
hospital. The first edition of this book, published a decade ago, especially
acknowledged the countless patients in my clinic that have taught me so
many invaluable lessons. Now, ten years later, I am even more indebted to
my patients. I have done my best to listen to them and recognize the treat-
ment principles that have surfaced in their care. Medicine is not a job but a
calling; the important responsibility for peoples’ health strongly reinforces
the lessons learned in their care. I have religiously read the appropriate medi-
cal journals and been attentive to new ideas; however, the richest source of
knowledge has been taught to me by the people under my care. To them,
I dedicate this book.
I also am very indebted to mentors along the way of my medical and
scientific career. This includes Professor Mark Rilling at Michigan State
University; Professor Bartley Hoebel at Princeton University; and Professor
Barry Levin at Dartmouth Medical School. Their support along my career
path was crucial and provided me with superb role models.
The medical environment of the Mayo Clinic cannot be overestimated as
an influence on my medical career and the care of my patients. Despite the
busy patient calendars, adequate time has been available for the most complex
of patient problems. I have some very smart and experienced medical col-
leagues whom I can call upon for advice. As I have gotten older, I find myself
ix