Articles

Disease Progression and Treatment

The symptoms of young-onset patients worsen over time, as do those of older patients, with some notable differences. First, younger patients’ symptoms tend to worsen more slowly. As a result, the disease runs its course over decades rather than years. Also, the time between initial diagnosis and the need for treatment is generally longer.

Another difference is that although young-onset patients are highly responsive to PD medications, they are often very susceptible to side-effects. L-DOPA (one of the components of Sinemet) remains the most potent medication for the treatment of PD symptoms. Some young patients are extremely sensitive to very small doses, and many develop abnormal involuntary movements (dyskinesias) much sooner than older patients. Consequently, use of L-DOPA is generally delayed in young patients until absolutely necessary.

Fortunately, there are alternatives to L-DOPA for milder symptoms that require treatment. Some of these medications – trihexyphenidyl, amantidine, and selegiline – are generally better tolerated by younger patients, and they often produce better symptomatic relief than in older patients.

Once these medications are no longer effective alone, the dopamine agonists pramipexole or ropinirole may be added to further delay the need for L-DOPA. At some point, most patients require L-DOPA treatment. Exact doses are carefully adjusted to allow maximum benefit with minimum side-effects.

Finally, deep brain stimulation (DBS) surgery is generally more effective and better tolerated in younger patients than in older patients. Older patients more commonly suffer from strokes, dementia, or other medical illnesses that disqualify DBS surgery or limit its usefulness. As a result, DBS is used more with younger patients, who often see very significant improvement in their symptoms.


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