Nov 3, 2016
Idiopathic Parkinson Disease (PD) is the second most common cause of neurodegenerative disease following Alzheimer's. The risk of PD increases to nearly 1 in 100 in the elderly, and although we have been pharmacologically treating this disorder since the early nineteenth century, we have no cure and no definitely therapy to delay disease progression. In this episode of BrainWaves, Dr. David Coughlin illustrates how some of these therapies have evolved and which classes of medications to choose when managing a patient's symptoms--from tremor to dystonia. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. The content in this episode was vetted and approved by Andres Deik. REFERENCES 1. Elias, W. Jeffrey, et al. "A randomized trial of focused ultrasound thalamotomy for essential tremor." New England Journal of Medicine 375.8 (2016): 730-739. 2. Hoehn, Margaret M., and Melvin D. Yahr. "Parkinsonism: onset, progression, and mortality." Neurology 50.2 (1998): 318-318. Hely, Mariese A., et al. "The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years." Movement Disorders 23.6 (2008): 837-844. 3. McIntyre, Cameron C., et al. "Uncovering the mechanism (s) of action of deep brain stimulation: activation, inhibition, or both." Clinical neurophysiology 115.6 (2004): 1239-1248. 4. Olanow, C. Warren. "Levodopa: effect on cell death and the natural history of Parkinson's disease." Movement Disorders 30.1 (2015): 37-44. 5. Parkinson Study Group. "Levodopa and the progression of Parkinson's disease." N Engl J Med 2004.351 (2004): 2498-2508. 6. Parkinson Study Group. "A randomized controlled trial comparing pramipexole with levodopa in early Parkinson's disease: design and methods of the CALM-PD Study." Clinical neuropharmacology 23.1 (2000): 34-44. 7. PD Med Collaborative Group. "Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson's disease (PD MED): a large, open-label, pragmatic randomised trial." The Lancet 384.9949 (2014): 1196-1205. 8. Weaver, Frances M., et al. "Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial." Jama 301.1 (2009): 63-73.