Symptomatic anti-Parkinson disease medications usually provide good control of motor signs of Parkinson disease for 4-6 years. After this, disability often progresses despite best medical management many patients develop long-term motor complications, including fluctuations and dyskinesias. Additional causes of disability in late disease include postural instability (balance difficulty) and dementia. Thus, symptomatic therapy for late disease requires different strategies.
Dopamine agonists (ropinirole, pramipexole) provide moderate symptomatic benefit and delay the development of dyskinesia compared with levodopa. Proactively screen patients receiving oral dopamine agonists for adverse events. A review of the Cochrane and PubMed databases from 1990 to 2008 found that these agents caused a 15% increase in adverse events such as somnolence, sudden-onset sleep, hallucinations, edema, and impulse control disorders (e.g., pathologic gambling, shopping, and Internet use; hypersexuality; and hoarding). The side effects were not told to us during the treatments and it was quite worrying when my mother was telling us about the voices and “electric currents” that were running up and down her leg. only much later the doctor decided to give her risperidone but the simple solution was to decrease her symptomatic medication.
The need for the medical personnel to be well versed with the disorder is vital and it was appalling that was not the case then. When the patient is hit with the news, he will need as much information as possible to ensure that he can recalibrate his life as soon as possible.
At the initial point, the physiotherapist was allocated to my mother. However, at that point, there was not real need for the physiotherapist but because it was the “procedure” she was encouraged to go. Instead, perhaps a lifestyle change was in order. Later in the years, it may be good to then refer her to the physiotherapist for more appropriate exercises at that time.
