New guidelines for diagnosis and treatment of Parkinson disease

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New guidelines developed by the American Academy of Neurology aim to educate physicians on the diagnosis and treatment of Parkinson disease and provide people with Parkinson disease an improved quality of life.

The guidelines, released at the American Academy of Neurology 58th Annual Meeting in San Diego, Calif., April 1 - 8, 2006, and published in the journal Neurology, were developed through a rigorous, comprehensive review of all of the scientific evidence available on Parkinson disease.

“It is possible to improve the quality of life for people with Parkinson disease,” said guideline author and Parkinson expert William J. Weiner, MD, FAAN, of the University of Maryland School of Medicine in Baltimore. “The guidelines provide recommendations for: making the correct diagnosis as early as possible, making the best use of time-tested and effective therapies to improve motor function, and screening for and treating depression, psychosis and dementia--common symptoms of Parkinson disease that often are left untreated.”

Parkinson disease is often misdiagnosed. It is estimated that five to 10 percent of people with Parkinson disease are misdiagnosed. Also, up to 20 percent of people diagnosed with Parkinson disease are found to have a different diagnosis during an autopsy. The new guidelines help doctors correctly diagnose Parkinson disease earlier and more accurately. Then neurologists can suggest treatments and lifestyle changes to better manage and treat the disease.

There are a variety of therapies available to treat the motor symptoms of Parkinson disease. The guidelines present how strong the evidence is for each of these drugs and surgery so that physicians can make the best decisions in treating their individual patients. Surprising news includes the wide variety of treatments that are available to help patients with Parkinson disease. No evidence was available to support that nutritional supplements, including vitamin E, are useful in slowing the progress or improving symptoms of Parkinson disease.

Some people have feared that levodopa, one of the most effective treatments for Parkinson disease, may speed up disease symptoms. The guidelines demonstrate that levodopa is a safe and effective treatment to improve movement and does not speed up disease progression. According to a guideline published by the AAN in 2002, either levodopa or a dopamine agonist drug may be used as a first treatment for Parkinson disease.

Movement difficulties can be improved with regular exercise and physical and speech therapy, according to the guidelines. “It’s important to keep talking with your neurologist about new problems or symptoms or any changes,” Weiner said. “People often aren’t aware that exercise and therapy can help with many of these problems.”

The guidelines recommend that people with Parkinson disease be screened for and treated for depression, psychosis, and dementia, which can affect quality of life and how well they function. “Many people just assume that depression, hallucinations, and memory loss are inevitable side effects of Parkinson disease and don’t even discuss them with their neurologist,” Weiner said. “Effective treatments are available, and treatment can greatly improve the patient’s quality of life.”

Parkinson disease is a progressive movement disorder that affects about one million people in the United States and Canada. In people with Parkinson disease a vital chemical in the brain, dopamine, slowly decreases. Dopamine makes smooth and coordinated muscle movement possible. A loss of dopamine leads to symptoms of Parkinson, such as shaking (tremor), stiffness, shuffling walk, slowness of movements, balance problems, small or cramped handwriting, loss of facial expression, and soft, muffled speech.

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