Up till this point, in 1998, there was still little public knowledge and publicity about Parkinson’s. I recall that the boxer Muhammad Ali was diagnosed with that, but many people blamed it on his boxing career. And Charlie Sheen who was also diagnosed, had his lifestyle scrutinized. It was awful as it did not answer how my mother had the disease and if there was any hope.
Today, my mother is in Stage Three and Four. She was recently just rediagnosed in the last quarter of 2016. It meant that she had been managing over two decades with the illness and hat in itself is quite a medical feat. But she after accepting the fact that she needed to use the aid of the walking stick, she is now freezing on her walking. What she hates most is people telling her to exercise as it is a daunting task even if she wanted to. The tremors are visible and embarrassing and she for a period of time, she was not able to leave the house as she was not confident that she will be able to walk without falling.
Challenges, aplenty.
Tier 1: Bottom of the Cliff
At this point, the treatment of Parkinson’s is usually pharmacologic. The treatment can be divided into symptomatic and neuroprotective (disease modifying) therapy. At this time of writing, there is no proven neuroprotective or disease-modifying therapy.
Levodopa, coupled with carbidopa, a peripheral decarboxylase inhibitor (PDI), remains the gold standard of symptomatic treatment for Parkinson disease. Carbidopa inhibits the decarboxylation of levodopa to dopamine in the systemic circulation, allowing for greater levodopa distribution into the central nervous system. Levodopa provides the greatest antiparkinsonian benefit for motor signs and symptoms, with the fewest adverse effects in the short term; however, its long-term use is associated with the development of motor fluctuations (“wearing-off”) and dyskinesias. Once fluctuations and dyskinesias become problematic, they are difficult to resolve.
