open access
Pharmacological treatment of palliative care patients with Parkinson’s disease
Affiliations- Faculty of Medicine, University of Rzeszow, Poland, United States
open access
Abstract
Parkinson’s disease is the commonest neurodegenerative condition, which can be eased for a long
while, however, it inevitably leads to patients’ death. Dying with Parkinson’s disease can be problematic
as the clinical situation may change dynamically and necessitate frequent drug dose changes and the
introduction of new, preferably injectable, drugs may be necessary. Current treatment of Parkinson’s
disease aims to increase the brain’s dopamine focusing mainly on the motor symptoms. The patients
suffer frequently from sudden “on” and “off” fluctuations of muscle rigidity accompanied by extreme
pain. Classic dopaminergic treatments wear off and become ineffective. The new drug safinamide has
been introduced recently with a promising effect on motor and non-motor symptoms including pain.
If unavailable, opioids or cannabinoids to relax muscles are the second-best choice. Also, non-motor
symptoms like depression, delirium and psychosis may dominate in dying which necessitates antipsychotic
treatment with clozapine or quetiapine even if these drugs may hasten deterioration and result in death.
Abstract
Parkinson’s disease is the commonest neurodegenerative condition, which can be eased for a long
while, however, it inevitably leads to patients’ death. Dying with Parkinson’s disease can be problematic
as the clinical situation may change dynamically and necessitate frequent drug dose changes and the
introduction of new, preferably injectable, drugs may be necessary. Current treatment of Parkinson’s
disease aims to increase the brain’s dopamine focusing mainly on the motor symptoms. The patients
suffer frequently from sudden “on” and “off” fluctuations of muscle rigidity accompanied by extreme
pain. Classic dopaminergic treatments wear off and become ineffective. The new drug safinamide has
been introduced recently with a promising effect on motor and non-motor symptoms including pain.
If unavailable, opioids or cannabinoids to relax muscles are the second-best choice. Also, non-motor
symptoms like depression, delirium and psychosis may dominate in dying which necessitates antipsychotic
treatment with clozapine or quetiapine even if these drugs may hasten deterioration and result in death.
Keywords
Parkinson’s disease, motor symptoms, muscle rigidity, pain, safinamide, opioids, clozapine, quetiapine, apomorphine
About this articleTitle
Pharmacological treatment of palliative care patients with Parkinson’s disease
Journal
Palliative Medicine in Practice
Issue
Article type
Review paper
Pages
117-122
Published online
2022-03-29
Page views
4547
Article views/downloads
477
DOI
Bibliographic record
Palliat Med Pract 2022;16(2):117-122.
Keywords
Parkinson’s disease
motor symptoms
muscle rigidity
pain
safinamide
opioids
clozapine
quetiapine
apomorphine
Authors
Zbigniew Zylicz
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