Papel

Parkinson’s Disease: A Comparison of Contemporary Treatments and Therapies
Joe Moulton, Henry Skidmore
Xanthe Farnworth
November 28, 2012

Table of Contents

Title Page i
Letter of Transmittal ii
Table of Contents iii
List of Tables iv
Abstract v
Introduction1
Surgeries3
Deep Brain Stimulation3
Thalamatomy & Pallidotomy4
Drugs6
Levodopa (L-Dopa)6Dopamine Agonists7
Mao B Inhibitors9
Catechol O-methyltransferase (COMT) Inhibitors 10
Anticholinergics12
Amantadine13
Conclusion15
Bibliography22


List of Tables

Table 14
Table 25
Table 37
Table 49
Table 510
Table 612
Table 713
Table 814




Abstract
With the advent of modern medicine, there hasbeen an increasing variety of surgeries and drugs available to alleviate the symptoms of those suffering from the effects of Parkinson’s disease. Unfortunately, little research has been done to compare the effectiveness and cost of these different procedures, nor to judge their appropriateness for specific groups of people. In order to meet this growing need, we have collaborated in researching themost common treatments currently being prescribed for the victims of Parkinson’s disease. We have divided these treatments into two groups, designated as “surgeries” and “drugs,” based on the nature and invasiveness of each. We have then described the characteristics and mechanisms of each separate treatment and noted the similarities and differences between many of the most common treatments.In our conclusion, we have also made specific recommendations for each individual treatment with given populations in mind. Our analysis of these treatments has primarily focused on effectiveness, seriousness of side effects and risks, and cost of each individual treatment. Because of this, we believe that this information will be of great use to the medical world at large and to the growingpool of Parkinson’s patients as well.

Introduction
Among the debilitating and incurable diseases of our generation, one of the most widely-feared and little-understood is Parkinson’s disease. A degenerative disorder of the central nervous system, Parkinson’s primarily affects the substantia nigra and the corpus striatum. These two areas of the human brain, found to be consistently and heavilydamaged in those demonstrating symptoms of Parkinson’s disease, are strongly involved in the formation and execution of precise voluntary movements. Studies of patients with Parkinson’s disease have found that communication between and the functionality of these two essential areas is specifically disrupted by severe deterioration of dopamine-secreting neurons. Symptoms typically manifest in theform of trembling limbs, delayed voluntary movement, rigid or stiff muscles and cramps, and trouble walking or maintaining muscular action. With time, these can grow to include dementia, anxiety, bowel and erectile dysfunction, and decreased sensitivity to outside stimuli (Heyn, 2010). Though initially limited to affecting movement, this deterioration will typically grow and envelop surroundingareas of the human brain, resulting in severe psychological damage later in life.
Previously known as the “shaking palsy”, Parkinson’s received its name and public attention from Dr. James Parkinson in 1817. In An Essay on the Shaking Palsy, Dr. Parkinson provides the first documentation of the iconic gait, tremor, and stutter exhibited by those with this disease (Parkinson, 2002). Since thesebreakthrough diagnoses in 1817, Parkinson’s preliminary research has cascaded into 200 years of careful study and development, aiding and assisting patients and researchers alike. However, this disease was only observed in humans, and without a viable animal models, progress was slow; it was not until the 1960’s that researchers were able to identify the neurotransmitter and brain location in...