People with Parkinson’s disease often experience tremor, stiffness and slowness of movement—hallmark symptoms that may be the most outward signs of the disorder, a degenerative neurological condition that affects about one million people in the United States and Canada. However, physicians now recognize that other Parkinson’s symptoms that do not specifically affect movement are very common, such as sleep dysfunction, constipation and sexual problems. These are often unrecognized and may cause just as much pain and discomfort as the more visible motor symptoms.
These “non-motor” symptoms of Parkinson’s disease are the focus of new treatment guidelines, created by an international team of experts including a University of Maryland neurologist, which will provide doctors, patients and their families with important information on how to improve the quality of life for people with Parkinson’s disease. The guidelines also point out the scarcity of research into some these overlooked effects of the disease. The new guidelines will be published in the March 16, 2010, issue of Neurology®, the medical journal of the American Academy of Neurology (AAN).
“Many people with Parkinson’s disease are reluctant to acknowledge or discuss problems with urination, constipation, sex and sleep. Physicians, patients and family members need to be aware that these non-motor symptoms can have a powerful effect on their daily lives and, just as important, there are treatments available that can help them manage some these symptoms,” says William J. Weiner, M.D., a senior author of the new guidelines. Dr. Weiner is professor and chairman of neurology at the University of Maryland School of Medicine, and chief of neurology at the University of Maryland Medical Center, where he directs the Parkinson’s Disease and Movement Disorders Center.
Dr. Weiner served on an international panel of neurologists that did an extensive review of the best scientific studies to create these guidelines and specific drug recommendations for several non-motor symptoms. For example, for erectile dysfunction, the group suggested doctors consider the drug sildenafil citrate. The researchers concluded that the drug isosmotic macrogol may improve constipation in people with Parkinson’s disease.
For problems with excessive daytime sleepiness, the AAN review suggests modafinil may help patients feel more awake; however, the neurologists cautioned that one study showed people taking the drug may have a false sense of alertness, which may be a concern for activities such as driving.
“This review also points to the urgent need for more research into these under-diagnosed, non-motor symptoms. There are a lot of questions about what causes them as well as the need to find ways to treat them. For example, we found insufficient evidence for treatments for many non-motor symptoms such as urinary incontinence and insomnia, and therefore could not make definitive recommendations,” says Dr. Weiner.
The panel suggested research into a wide variety of non-motor symptoms, including restless leg syndrome, nausea, urinary frequency, sweating, sexual dysfunction (in men and women), obsessive behaviors, decreased motivation and decreased concentration.
“The physicians and staff at the University of Maryland Department of Neurology are internationally renowned for their expertise and forward-thinking research. These new guidelines reaffirm the importance of the studies by our faculty who have been leading investigations into how Parkinson’s disease affects the lives of patients and their families,” says E. Albert Recce, M.D., Ph.D., M.B.A., acting president of the University of Maryland, Baltimore, and dean of the University of Maryland School of Medicine.
Most people who have Parkinson’s begin to develop symptoms in their late 50s or early 60s, although it can affect younger people. Researchers don’t know what causes Parkinson’s disease, which affects the brain’s ability to produce dopamine, the neurotransmitter involved in the communication between the brain cells for motor control. Physical symptoms include rigidity of the limbs and difficulty initiating movement. Many patients have a tremor in the arms or the legs. There can also be emotional and cognitive symptoms, including depression and dementia.
To see the American Academy of Neurology guidelines or summaries designed for patients and their families, go to www.aan.com. For more information on the University of Maryland Parkinson’s Disease and Movement Disorders Center, go to www.umm.edu/parkinsons.
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