Neuroprotection in Parkinson's Disease: Are We Getting Close?
Case Study
Angela is a 48-year-old, left-handed sales representative with a large territory to cover. She complains to her doctor that for the past 6 months, she has noticed a gradually worsening tremor in her dominant hand when raising a mug of coffee in the morning. She has also observed a decreasing ability to appreciate fine smells. In recent weeks, she has noticed that her handwriting has become smaller. Occasionally, she has mild aching in her left foot. She tires easily, finding it difficult at times to concentrate when undertaking long stretches of driving. However, she continues to be focused on her work and her sales skills. On examination, she had mild upper left extremity rest tremor, bradykinesia with fine motor tasks (more pronounced on the left side), slight rigidity with activation of the left upper arm, and a mildly slow gait. She was diagnosed with early, mild Parkinson's disease (PD).
Comment
Angela is active in her current employment and enjoys her work. It is important that she be able to continue working and be helped to learn how to deal with her Parkinson's without becoming overwhelmed by the diagnosis.
Given her young age, it is generally thought prudent to delay treatment with levodopa to avoid the development of motor complications. Young patients are particularly prone to levodopa-induced motor complications; therefore, other medications are used as long as they adequately control symptoms.
Given Angela's diagnosis of early PD, a treatment with neuroprotective effects to slow the progression of the underlying disease would be desirable. At this time, no treatment is proven to slow the progression of the underlying disease process. However, MAO-B inhibitors such as selegiline and rasagiline have demonstrated neuroprotective effects in cell and animal models, and several studies suggest that they can slow clinical progression of the disease. Treatment plans for PD should include management of both motor and nonmotor manifestations and should address quality of life issues.
