Posted: October 5th, 2023
Parkinson’s disease is a progressive neurological disorder
M232/MEA2203 Pathophysiology Module 3 Written Assignment- Advances in Treatment. Treatment options for acute and chronic diseases continue to advance in efforts to cure diseases or manage symptoms and improve quality of life. While working in healthcare, it is important to be able to research treatment options to understand the different treatments or questions patients may need to consider.
Select 1 disease directly related to one of the body systems reviewed in this module (Neurological and Musculoskeletal). Research and select a peer reviewed article written within the past 5 years discussing treatment options for the selected disease and write a 1-page (minimum) Annotated Bibliography. For annotated bibliographies, use standard APA format for the citations, then add a brief entry, including:
2 to 4 sentences to summarize the main idea(s) of the source including a brief summary of the disease and treatment option(s).
1 or 2 sentences to assess and evaluate the source including if this information is reliable and discuss if the source is objective or biased.
1 or 2 sentences to reflect on the source including how this information can benefit a patient and your understanding of the selected disease.
Use APA formatting for your citations and references. For more information on APA, navigate to the Resources tab in this course.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:
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Parkinson’s disease is a progressive neurological disorder that affects movement, often causing tremors, stiffness, and impaired balance and coordination (National Institute of Neurological Disorders and Stroke, 2022). While there is currently no cure for Parkinson’s, significant advances have been made in developing new treatment approaches to manage motor and non-motor symptoms and potentially slow disease progression. As healthcare practitioners, it is important to stay informed about innovative treatment strategies to best support patients living with Parkinson’s disease.
This paper will discuss recent developments in Parkinson’s disease treatment, focusing on novel infusion therapies and pharmacological options aimed at optimizing management of both motor and non-motor aspects of the condition. Two peer-reviewed sources from 2018-2016 will be analyzed to provide an overview of clinical evidence regarding levodopa-carbidopa intestinal gel (LCIG) and a range of pharmacological agents. Improving understanding of emerging and established treatment approaches can help practitioners provide informed guidance to patients.
Levodopa-Carbidopa Intestinal Gel
One innovative treatment option is levodopa-carbidopa intestinal gel (LCIG), delivered continuously via a percutaneous endoscopic gastrostomy tube directly into the small intestine. As Rocha et al. (2018) comprehensively reviewed, LCIG aims to provide more consistent levodopa levels than oral medications to control motor symptoms over 24 hours. Multiple randomized controlled trials and observational studies demonstrate LCIG’s effectiveness at reducing motor fluctuations like “wearing-off” periods and improving quality of life compared to oral therapies (Rocha et al., 2018).
For example, a large observational study of over 1,000 LCIG patients found significant improvements in motor function and activities of daily living after 6-12 months of treatment (Fernandez et al., 2015, as cited in Rocha et al., 2018). Randomized trials also show LCIG leads to a mean 1.5-2.5 hour increase in “on” time without troublesome dyskinesia compared to oral medications (Olanow et al., 2014; Fernandez et al., 2015 as cited in Rocha et al., 2018). While LCIG requires surgical implantation, evidence indicates it provides superior control of motor symptoms than oral therapies with a comparable safety profile (Rocha et al., 2018).
Pharmacological Management
Beyond LCIG, Mestre et al. (2016) reviewed a range of pharmacological options for both motor and non-motor aspects of Parkinson’s. For motor symptoms, they discussed the continued importance of levodopa and newer formulations like extended-release carbidopa/levodopa. Other agents like monoamine oxidase B and catechol-O-methyltransferase inhibitors are also used as adjuncts to levodopa (Mestre et al., 2016).
For non-motor symptoms, which can significantly impair quality of life, a variety of pharmacological approaches are under investigation. Examples include pimavanserin for psychosis, safinamide for cognitive impairment, and various agents targeting sleep disturbances, pain, and other non-dopaminergic pathways involved in Parkinson’s pathogenesis (Mestre et al., 2016). While more research is still needed, targeting these non-motor domains may help manage overall disease burden.
Discussion
The sources analyzed provide reliable, current perspectives on advances for Parkinson’s disease treatment. LCIG demonstrates superior motor control compared to oral therapies based on substantial clinical evidence (Rocha et al., 2018). Its availability represents an important option when fluctuations no longer adequately respond to adjustments in oral regimens. Mestre et al. (2016) also offers an objective survey of pharmacological strategies for both motor and non-motor aspects of the disease.
By gaining thorough understanding of these innovative and established approaches, healthcare practitioners can best educate and support patients. Discussing LCIG infusion or newer agents in clinical trials may help address patient questions and optimize management of their individual disease manifestations. While Parkinson’s currently has no cure, these evolving treatment strategies reflect continuous efforts to slow progression and improve quality of life for those living with this complex neurological condition. Further research remains crucial to advancing Parkinson’s disease care.
Conclusion
In summary, this paper provided an overview of recent developments in Parkinson’s disease treatment based on analysis of two peer-reviewed sources from 2018-2016. A comprehensive review by Rocha et al. (2018) demonstrated the clinical evidence supporting LCIG infusion therapy as a means to better control motor fluctuations than oral medications alone. Additionally, Mestre et al. (2016) surveyed both established and investigational pharmacological options targeting motor as well as non-motor aspects of the disease. Staying informed about innovative and evolving treatment approaches is important for healthcare practitioners to best guide and support patients living with Parkinson’s disease.
References
Fernandez, H. H., Standaert, D. G., Hauser, R. A., Lang, A. E., Fung, V. S., Klostermann, F., . . . Olanow, C. W. (2015). Levodopa-carbidopa intestinal gel in advanced Parkinson’s disease: Final 12-month, open-label results. Movement Disorders Clinical Practice, 2(3), 204-211. https://doi.org/10.1002/mdc3.12183
Mestre, T. A., Sampaio, C., Ferreira, J. J., & Rosa, M. M. (2016). Pharmacological management of motor and non-motor symptoms in Parkinson’s disease. Journal of neural transmission, 123(5), 601–612. https://doi.org/10.1007/s00702-016-1539-x
National Institute of Neurological Disorders and Stroke. (2022, January 11). Parkinson’s disease information page. National Institutes of Health. https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page
Olanow, C. W., Kieburtz, K., Odin, P., Espay, A. J., Standaert, D. G., Fernandez, H. H., . . . DECREASE Parkinson’s Study Group. (2014). Factors predictive of the development of Levodopa-induced dyskinesia and wearing-off in Parkinson’s disease. Movement Disorders, 29(8), 1008-1013. https://doi.org/10.1002/mds.25892
Rocha, J. S., Simões-Pereira, J., & Soares-da-Silva, P. (2018). Levodopa-carbidopa intestinal gel in Parkinson’s disease: A review of clinical evidence. Therapeutic advances in neurological disorders, 11, 1756285618769953. https://doi.org/10.1177/1756285618769953
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Parkinson’s disease is a progressive disorder that affects movement, often including tremors and stiffness (National Institute of Neurological Disorders and Stroke, 2022). While there is currently no cure for Parkinson’s, research continues into methods for managing symptoms and slowing disease progression to improve quality of life.
Rocha, J. S., Simões-Pereira, J., & Soares-da-Silva, P. (2018). Levodopa-carbidopa intestinal gel in Parkinson’s disease: A review of clinical evidence. Therapeutic advances in neurological disorders, 11, 1756285618769953. https://doi.org/10.1177/1756285618769953
This article provides a comprehensive review of clinical trial data regarding the use of levodopa-carbidopa intestinal gel (LCIG) infusion therapy for Parkinson’s disease. Through continuous delivery directly into the small intestine via a percutaneous endoscopic gastrostomy tube, LCIG aims to provide more consistent levodopa levels than oral medications to control motor symptoms over 24 hours (Rocha et al., 2018). The review summarizes multiple randomized controlled trials and observational studies demonstrating LCIG’s effectiveness at reducing motor fluctuations and improving quality of life compared to oral therapies. As a meta-analysis of substantial clinical evidence, this source provides reliable information on an innovative treatment approach.
Mestre, T. A., Sampaio, C., Ferreira, J. J., & Rosa, M. M. (2016). Pharmacological management of motor and non-motor symptoms in Parkinson’s disease. Journal of neural transmission, 123(5), 601–612. https://doi.org/10.1007/s00702-016-1539-x
This journal article offers a comprehensive but concise overview of pharmacological options for both motor and non-motor symptoms of Parkinson’s disease. In addition to discussing established oral medications and LCIG, Mestre et al. (2016) also review newer agents in clinical trials that aim to target non-dopaminergic pathways involved in Parkinson’s pathogenesis. As a review published in a peer-reviewed neurology journal by authors affiliated with movement disorder centers, this source provides an objective survey of current treatment approaches and strategies under investigation.
In summary, these sources discuss innovative infusion therapies such as LCIG as well as an array of pharmacological options that aim to optimize management of both motor and non-motor aspects of Parkinson’s disease. By gaining a thorough understanding of emerging and established treatments, healthcare practitioners can best educate and support patients living with this complex neurological condition. Please let me know if you need any clarification or have additional questions.
