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A progressive disorder of the nervous system marked by muscle tremors, muscle rigidity, decreased mobility, stooped posture, slow voluntary movements, and a mask-like facial expression.

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Lisuride for levodopa‐induced complications in Parkinson's disease

Background: Long‐term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Pergolide versus bromocriptine for levodopa‐induced complications in Parkinson's disease

Background: Long‐term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Lisuride versus bromocriptine for levodopa‐induced complications in Parkinson's disease

Background: Long‐term levodopa therapy in Parkinson's disease is associated with the development of motor complications including abnormal involuntary movements and a shortening response to each dose (wearing off phenomenon). It is thought that dopamine agonists can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Bromocriptine/levodopa combined versus levodopa alone for early Parkinson's disease

Parkinson's disease is a disabling condition characterised by slowness of movement, trembling (tremors) and stiffness. Currently, the best treatment is levodopa. However, according to the number of levodopa treatment years, new disabling fluctuations of movement occur. To overcome this problem, bromocriptine has been tried in combination with levodopa. This review of relevant published trials found no evidence that early use of combined bromocriptine/levodopa prevents or delays such fluctuations of movement in patients with Parkinson's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Bromocriptine for levodopa‐induced motor complications in Parkinson's disease

Background: Motor Complications are an important issue in the management of patients with Parkinson's disease and dopamine agonists have been introduced to ameliorate this problem.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Bromocriptine versus levodopa in early Parkinson's disease

Parkinson's disease is a disabling disease characterised by slowness of movement, trembling (tremors) and stiffness. Currently, the best treatment for Parkinson's disease is levodopa. However, with the number of levodopa treatment years, new disabling fluctuations of movement occur. To overcome this problem, bromocriptine has been tried as an alternative drug. The review of six trials (850 participants) found that bromocriptine may be helpful in delaying such fluctuations of movement problems in patients with Parkinson's disease who can tolerate the drug.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

There is not enough evidence about the safety and effectiveness of amantadine for people with Parkinson's disease.

Parkinson's disease causes progressive muscle rigidity, tremors and other symptoms. The most common drug used to try and relieve these symptoms is levodopa, but serious physical and psychiatric adverse effects are common. Amantadine is another option, used alone or with levodopa. Amantadine can have serious adverse effects (including psychiatric problems), and people can become resistant to the drug. The review found that there is not enough evidence from trials about the effects of amantadine for people with Parkinson's disease. Adverse effects in trials so far have not been severe, and included skin rash, dry mouth and blurred vision.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Speech and language therapy for speech problems in Parkinson’s disease

Many people with Parkinson's disease suffer from disorders of speech. The most frequently reported speech problems are weak, hoarse, nasal or monotonous voice, imprecise articulation, slow or fast speech, difficulty starting speech, impaired stress or rhythm, stuttering and tremor. People with the condition also tend to give fewer non‐verbal cues such as using facial expression to convey information. These disabilities tend to increase as the disease progresses and can lead to serious problems with communication.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Insufficient data are available on the benefits of the COMT inhibitor tolcapone compared with the dopamine agonists bromocriptine and pergolide in relieving the symptoms of later Parkinson's disease.

As Parkinson's disease progresses the control of the symptoms often requires the addition of other drugs to levodopa. The principle aim of COMT inhibitor therapy is to increase the duration of effect of each levodopa dose and thus reduce the time patients spend in the relatively immobile 'off' phase. However other drugs such as dopamine agonists can also be used at this stage of the disease. This review found that the COMT inhibitor tolcapone as an adjuvant to levodopa treatment had a similar level of benefits as two dopamine agonists, bromocriptine and pergolide. There was no significant difference in efficacy between the adjuvant tolcapone and adjuvant bromocriptine or pergolide in the medium‐term. Tolcapone produced nausea less often than these agonists but there was some evidence of liver function abnormalities with tolcapone. Post‐marketing surveillance identified three cases of fatal hepatic toxicity in patients treated with tolcapone. As a result, tolcapone has been withdrawn from some countries and severe restrictions on its use have been imposed in others.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

The COMT inhibitors entacapone and tolcapone show similar benefits in relieving levodopa‐induced complications in Parkinson's disease but more data on the safety of tolcapone is required.

As Parkinson's disease progresses the control of the symptoms often requires the addition of other drugs to levodopa. The principle aim of COMT inhibitor therapy is to increase the duration of effect of each levodopa dose and thus reduce the time patients spend in the relatively immobile 'off' phase. Tolcapone and entacapone can be used to reduce off time, reduce levodopa dose, and modestly improve motor impairment and disability. This is based on, at best, medium term evidence. However some participants on tolcapone had raised liver enzymes. Post‐marketing surveillance identified three cases of fatal hepatic toxicity in patients treated with tolcapone. As a result, tolcapone has been withdrawn from some countries and severe restrictions on its use have been imposed in others.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Pergolide for levodopa‐induced complications in Parkinson's disease

Background: In later Parkinson's disease, long‐term treatment with levodopa therapy is associated with the development of motor complications which include abnormal involuntary movements (dyskinesia) and a shortening response to each dose (wearing off phenomenon). Dopamine agonists have been used in such patients in the hope that they can reduce the duration of immobile off periods and the need for levodopa therapy whilst maintaining or improving motor impairments and only minimally increasing dopaminergic adverse events.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

There is not enough evidence about the safety and effectiveness of amantadine for people with dyskinesia in Parkinson's disease.

Levodopa is regarded as the most effective treatment for Parkinson's disease but in many patients it causes abnormal involuntary movements known as dyskinesias. It is thought that amantadine may be added to levodopa to reduce dyskinesias in patients with Parkinson's disease without worsening Parkinsonian symptoms. This review found that there is not enough evidence from trials about the effects of amantadine for people with dyskinesia in Parkinson's disease. Adverse effects in trials so far have included confusion, worsening of hallucinations, the re‐emergence of palpitations, nausea, dry mouth, swelling of feet and constipation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa in its treatment.

One trial compared pramipexole with bromocriptine but this was not designed to examine differences between the two treatments as there were too few patients included. However, there was a larger reduction in the time patients spent in the immobile off state with pramipexole therapy compared with bromocriptine by an average of 1.4 hours. No differences occurred in dyskinesia rating scale, dyskinesia as a side effect or Unified Parkinson's Disease Rating Scale (UPDRS) complication score. The UPDRS activities of daily living and motor scores showed similar improvements compared to placebo with both agonists. Levodopa dose reduction was similar with both agonists. Subscales of a quality of life measure, the Functional Status Questionnaire, showed significant improvements compared to placebo with both agonists. The finding that another quality of life scale, the EuroQol, improved significantly compared with placebo with pramipexole but not bromocriptine should be treated with caution. Side effects such as nausea, vomiting, and faintness were similar with each agonist, as was the withdrawal from treatment rate.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Anti‐depressant therapies may be able to help relieve depression in people with Parkinson's disease but more research is needed on safety and effectiveness.

Parkinson's disease can lead to psychiatric as well as physical symptoms, the most common of which is depression. Oral antidepressants, electroconvulsive therapy or behavioural therapy are currently used in the treatment of depression in Parkinson's disease. No trials were found examining the efficacy of electroconvulsive therapy or behavioural therapy. We identified three trials which examined antidepressant drugs. The review found that there is not enough evidence from the trials about the effects of antidepressant drugs for the treatment of depression in people with Parkinson's disease. Adverse effects in trials so far have not been severe, and included visual hallucinations and confusion.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Monoamine oxidase B inhibitors for early Parkinson's disease

Parkinson's disease is a disabling condition of the brain characterized by slowness of movement, shaking, stiffness, and in the later stages, loss of balance. Many of these symptoms are due to the loss of certain nerves in the brain, which results in the lack of a chemical called dopamine. Current treatments for Parkinson's are designed to increase dopamine by using levodopa (Sinemet or Madopar), which is converted in the brain into dopamine, or drugs that mimic dopamine (dopamine agonists). Although useful, these treatments do not slow the progression of the disease and can be associated with side‐effects e.g. after a while levodopa use can cause involuntary movements (dyskinesia), painful leg cramps (dystonia) and a shortened response to each dose (motor fluctuations). Monoamine oxidase B (MAO‐B) inhibitors such as selegiline (Eldepryl or Selgene) boost the levels of dopamine by a different mechanism, which may reduce the risk of these complications and slow disease progression. We reviewed 11 controlled trials with a total of 2514 patients that compared giving MAO‐B inhibitors with not giving them in people with early Parkinson's to see if it was safe and effective. The results show that, although MAO‐B inhibitors do improve symptoms of Parkinson's and delay the need for levodopa by a few months, they are too weak to have a major effect and do not seem to delay the progression of the condition. They may, however, reduce motor fluctuations although more information is needed to be certain of this. Although they can cause some side‐effects, these are generally mild.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Beta‐blockers may be able to help relive tremor for people with Parkinson's disease, but more research is needed on safety and effectiveness.

Tremor is one of the main symptoms of Parkinson's disease, and it can be embarrassing and limit daily activities. The drugs most commonly used for Parkinson's disease tend to be more effective in treating other symptoms of the disease (such as rigidity or slowness of movement). Beta‐blocker drugs are used to relieve tremor from other conditions. However, the review found there is not enough evidence from trials to show whether beta‐blockers are safe and effective for tremor in Parkinson's disease. The blood pressure lowering effect of beta‐blockers may be a problem to people with Parkinson's disease and normal blood pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Speech and language therapy for speech problems in Parkinson's disease

Many people with Parkinson's disease suffer from disorders of speech. The most frequently reported speech problems are weak, hoarse, nasal or monotonous voice, imprecise articulation, slow or fast speech, difficulty starting speech, impaired stress or rhythm, stuttering and tremor. People with the condition also tend to give fewer non‐verbal cues, such as facial expressions and hand gestures. These disabilities tend to increase as the disease progresses and can lead to serious problems with communication.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

The effect of blood pressure lowering drugs in protecting the nerve cells involved in Parkinson's disease

Different agents have been examined for their effects in protecting the nerve cells that die in Parkinson's disease (PD). These agents are often called neuroprotective or disease modifying drugs. They can act by preventing the onset of the disease itself (called primary prevention) or by halting the progression of PD once it has been established (called secondary prevention). One group of drugs which has been looked at in animal studies is anti‐hypertensive agents (blood pressure lowering drugs). This review aimed to look at the effects of blood pressure lowering drugs on both preventing the onset of PD and also on symptoms and the progression of disease in people who already have PD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Cabergoline for levodopa‐induced complications in Parkinson's disease

In the later stages of Parkinson's disease, side effects occur because of the use of levodopa treatment. These consist of involuntary writhing movements (choreoathetosis), painful cramps in the legs (dystonia) and a shortened response to each dose referred to as 'end‐of‐dose deterioration' or the 'wearing‐off effect'. Dopamine agonist drugs act by mimicking levodopa in the brain, but they do not cause these long‐term treatment complications when used as initial therapy. For this reason, dopamine agonists have for some years been added once these problems develop in the hope of improving them. Cabergoline is a new dopamine agonist recently licensed in the UK for the treatment of later Parkinson's disease. In this review, we will examine the trials performed with this drug to see how effective it is and what side effects it causes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

There is inadequate evidence to evaluate the effect of occupational therapy for people with Parkinson's disease.

Parkinson's disease is a progressive disabling neurodegenerative disease. Symptoms can include problems with movement such as being stiff, slow, and shaky, and sometimes non‐motor symptoms such as problems with communication, mood, vision, and problem solving abilities. The role of the occupational therapist is to support individuals with Parkinson's disease and to enable them to maintain their usual level of self‐care, work and leisure activities for as long as possible. The review found inadequate evidence from randomised controlled trials to evaluate the effect of occupational therapy for people with Parkinson's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

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