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Dr. Okun

How can I tell its time to ask for medication changes for PD?

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How can I tell that it’s time to ask for medication changes for my Parkinson’s disease?

 

Parkinson’s disease can prove complex to manage both for patients and for practitioners. Patients may struggle in knowing when to ask for more medications, or alternatively to ask for different medications. Patients should keep a few things in mind when approaching the question as to the “need for medications.” Parkinson’s disease is slowly progressive, and therefore if your symptoms are changing and your medication management is not changing-- it may be reasonable to inquire about different approaches in management. It is important to keep in mind that these changes may include doses, intervals and changes in drug combinations. The key point to remember is that it is critical to clearly articulate your symptoms to your doctor, as changes in medication management should be tailored to changes in symptoms. Finally, there is a myth in Parkinson’s disease management that holding back medications until later in the disease course will somehow preserve relative effectiveness of pharmacological approaches. There is little to no data to support this viewpoint, and holding back medications may hasten complications, and possibly diminish quality of life. Most experts will advise their patients to take the minimal amount of Parkinson’s disease medications to effectively control symptoms and improve quality of life.

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How can I tell that it’s time to ask for medication changes for my Parkinson’s disease?

 

Parkinson’s disease can prove complex to manage both for patients and for practitioners. Patients may struggle in knowing when to ask for more medications, or alternatively to ask for different medications. Patients should keep a few things in mind when approaching the question as to the “need for medications.” Parkinson’s disease is slowly progressive, and therefore if your symptoms are changing and your medication management is not changing-- it may be reasonable to inquire about different approaches in management. It is important to keep in mind that these changes may include doses, intervals and changes in drug combinations. The key point to remember is that it is critical to clearly articulate your symptoms to your doctor, as changes in medication management should be tailored to changes in symptoms. Finally, there is a myth in Parkinson’s disease management that holding back medications until later in the disease course will somehow preserve relative effectiveness of pharmacological approaches. There is little to no data to support this viewpoint, and holding back medications may hasten complications, and possibly diminish quality of life. Most experts will advise their patients to take the minimal amount of Parkinson’s disease medications to effectively control symptoms and improve quality of life.

Thank you, Dr. Okun, for your expert reply. I have been writing on Gold Standard Treatment of PD at Open Forum in a step by step way to make it principially

agreeable why, when and how this yet incurable but treatable condition requires patient-doctor partnership, rather than that based entirely on authority.

gmk

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I agree; there is a lot of art to this specialty!

Order is Essence of All Things (J.A. Commenius, 17th Century thinker).

1. It seems to me, Dr. Okun that the first step in diagnosis of a movement disorder should be determination that the patient does have

one of many 'Parkinson Disorders' PDs. It should be done, preferably, at a primary level of medical care delivery, i.e., in the office

of family physician where the patient will have general assessment, including, Chief Complaint and its duration, History of Present Illness,

Past Medical History, Social history, Family History and Systems Review, Preliminary Diagnosis (Dd. Impression) and pertinent Auxiliary and

Ancillary Investigations done. Then, the patient should be referred either to a physician Board Certified in Neurology, i.e., neurologist, which represents secondary level of medical care delivery or, directly to tertiary medical care delivery, which is Movement Disorders Clinic at a teaching hospital and Department of Neurology, University ... School of Medicine where the patient is seen by Consultant in

Neurology. This is, tertiary level of medical care delivery.

At the secondary and/or tertiary level,it will be determined if the patient has a typical, so called idiopathic Parkinson's Disease or

atypical, incomplete presentation of PD under the diagnosis of parkinsonism, or Parkinson Plus, or Parkinson Syndrome, et al. and how

he/she should be treated. Then, the patient can be returned either to his/her family physician or the neurologist for futher care.

Perhaps, it would be possible to differentiate between Dopamine Deficiency Disorder, treatable with L-DOPA and Dopamine Resistant Disorder,

which has to be treated in a different way.

gmk

Edited by gmk

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