Chapter 59: Parkinson Disease

Patient Care Process for the Management of Parkinson Disease

Collect

• Patient characteristics (e.g., age, race, sex, hand dominance)

• Patient history (past medical, family, social—dietary habits, alcohol and tobacco use)

• Motor and nonmotor symptoms (see Table 59-1 and 59-2)

• Current medications, prior medication use for Parkinson disease and response to prior medications for Parkinson disease (e.g., effectiveness, side effects), prior use of dopamine receptor blockers

• Objective data

  • height, weight

  • Labs (e.g., Scr, LFT)

  • Other diagnostic tests when indicated (e.g., neuroimaging)

Assess

• Past and current use of medications associated with drug-induced parkinsonism (e.g., antipsychotics, metoclopramide, tetrabenazine)

• Difficulties with performing activities of daily living

• Gait difficulties and fall risk

• Motor or nonmotor symptoms that are most troublesome for the patient

• Appropriateness, effectiveness, and side effects of current medications for the motor and nonmotor symptoms of Parkinson disease

• Presence of motor complications (e.g., motor fluctuations, dyskinesias, freezing)

Plan^*

• Tailored lifestyle modifications (e.g., exercise)

• Drug therapy regimen including specific medications for Parkinson disease, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Table 59-3)

• Monitoring parameters including efficacy (e.g., symptom improvement, safety (medication-specific adverse effects; see Table 59-4), and timeframe

• Patient education (e.g., purpose of treatment, lifestyle modification, drug therapy, side effects)

• Self-monitoring of symptoms—where and how to record results

• Referrals to other providers when appropriate (e.g., physician, physical therapy, speech therapy)

Implement^*

• Provide patient education regarding all elements of treatment plan

• Use motivational interviewing and coaching strategies to maximize adherence

• Schedule follow-up

Follow-up: Monitor and Evaluate

• Determine symptom relief goal attainment

• Presence of adverse effects

• Occurrence of motor complications, falls, and development/progression of non-motor symptoms

• Patient adherence to treatment plan using multiple sources of information

Content Update

July 24, 2017

Safinamide (Xadago) for Parkinson Disease "Off" Episodes: Safinamide is a selective, reversible monoamine oxidase type B (MAO-B) inhibitor approved as adjunctive treatment with levodopa/carbidopa (with or without other agents) in patients with Parkinson disease experiencing "off" episodes. Other MAO-B inhibitors (rasagiline, selegiline), COMT inhibitors (entacapone), and amantadine are other options for patients experiencing "off" episodes after optimizing dopaminergic therapy. In clinical trials, safinamide modestly increased the mean daily "on" time without troublesome dyskinesia; it may also improve motor function, clinical status, and health-related quality of life. The initial dose is 50 mg orally once daily, increased to 100 mg once daily after 2 weeks. The most common adverse events are dyskinesia, nausea, insomnia, falls, hypertension, hallucinations, impulse control disorder, and serotonin syndrome. Safinamide has numerous potential drug interactions due to risk of serotonin syndrome. High cost could limit its use clinically.

KEY CONCEPTS

• Awareness and continuous surveillance of ...