After the “honeymoon period”, how do Parkinson’s disease patients deal with movement complications?

Author: Wang Yichun, Peking Union Medical College Hospital

Reviewer: Wang Han, Chief Physician, Peking Union Medical College Hospital

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Parkinson's disease (PD) is a neurodegenerative disease characterized by motor symptoms such as tremor, bradykinesia, muscle rigidity and non-motor symptoms such as constipation, depression, and hyposmia. In the early stages of the disease, with the help of doctors for standardized treatment, the symptoms can usually be stably controlled. This period of time is called the "honeymoon period". The length of the "honeymoon period" varies from person to person, generally lasting 2 to 5 years, and is also related to the specific classification of the disease.

When the "honeymoon period" is over, troubling motor complications of Parkinson's disease will appear, including symptom fluctuations and dyskinesias. Symptom fluctuations refer to the fluctuating response of patients to drugs as the disease progresses and long-term drug treatment; dyskinesias refer to involuntary movements such as chorea, throwing, and dystonia in Parkinson's patients. Some are predictable, such as end-of-dose phenomenon, which is also the most common and earliest motor complication; others are unpredictable and irregular, such as delayed "on" period and "on-off" phenomenon.

Since the mechanism of motor complications has not been thoroughly studied, there are certain challenges in their management. Excessive worry about this is not conducive to treatment. Parkinson's patients should adjust their mentality, actively respond, cooperate with treatment, and do a good job of self-management.

1. Keep a Fluctuation Diary

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Patients should first understand the changes in their symptoms. You can use a diary or smartphone to record them. The focus is on the changes in symptom fluctuations within a day. Pay attention to when you are prone to discomfort, usually at what time, whether it can be improved by taking the next medication, etc. You can also record some videos, such as walking and holding objects in your daily life. Video recording is especially recommended when abnormal movement occurs. Remember to bring your own records to communicate with the doctor during follow-up visits, so that the doctor can adjust the medication according to specific symptoms.

2. Do a good job in daily medication management

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First of all, you should be clear about your daily medication, including the type of medication, medication time, and medication dosage, and do not miss or take it by mistake. It is also not recommended to increase or decrease the dosage at will. Keep in mind that good absorption of levodopa is also a basic element of symptom control. Although the medication time can theoretically be taken one hour after a meal, it is best to take dopamine tablets on an empty stomach (such as one hour before a meal) to minimize the competitive absorption of protein and drugs. Patients with stomach discomfort can eat one or two small cookies before taking levodopa. When taking the medicine, the levodopa preparation can be dissolved in vitamin C solution or carbonated beverages, or it can be chewed or ground into powder and swallowed.

3. Plan regular follow-up visits

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As time goes by, Parkinson's symptoms will continue to change. Therefore, regular follow-up is necessary to detect problems in time and make adjustments. Early patients should visit the doctor at least once a year, and patients in the progressive stage can follow up every 3 to 6 months, or arrange follow-up time according to their own situation. Younger Parkinson's patients are more likely to experience dyskinesia and symptom fluctuations in the early stage, and some are also accompanied by dystonia, which is often limited to the feet or lower limbs, such as involuntary upturned toes and calf cramps. It is recommended that patients follow up with a Parkinson's specialist in the outpatient clinic to clarify the cause (such as gene-related PD) and adjust medications.

The occurrence of sports complications is inevitable, but most can be controlled. In addition to drug treatment, surgical treatment options can also be considered. To this end, patients should build confidence, recognize and understand the disease, do a good job of self-management, and work together with doctors. This is an important way to improve the condition and improve the quality of life.

References:

[1]Melamed E, Ziv I, Djaldetti R. Management of motor complications in advanced Parkinson's disease[J]. Mov Disord. 2007,22(Suppl 17):S379-S384.

[2] Evidence-based medicine guidelines for the treatment of motor symptoms in middle and late stage Parkinson's disease in China[J]. Chinese Journal of Neuroimmunology and Neurology, 2021, 28(5): 347-360.