GUEST POST: Parkinson’s Disease and Medical Cannabis - What You Should Know

April is Parkinson’s Disease Awareness Month, so it’s the perfect time to shed light on a disease that many know far too little about. More than 10 million people worldwide are living with Parkinson’s Disease, and an average of 60,000 Americans are diagnosed each year. While Parkinson’s Disease is not fatal, the symptoms can have a significant impact on the quality of life for those living with the illness. Many people are turning to medical cannabis to help alleviate and manage some of those symptoms.

What Exactly Is Parkinson's Disease?

Let’s first take a look at Parkinson’s Disease. Parkinson’s is a progressive neurological disorder caused by a lack of dopamine in a part of the brain called the substantia nigra. Dopamine is responsible for the coordination and control of movement, which is why Parkinson’s Disease is defined as  a movement disorder.

While the exact cause of Parkinson’s is unknown, research has identified both genetic and environmental risk factors. The largest risk factor is increasing age. The average age of onset is 60, though about 10 percent of the Parkinson’s population are diagnosed with young-onset Parkinson’s at 50 years of age or younger. Additionally, men are two times more likely to get Parkinson’s than women. Environmental risk factors include head injury and exposure to pesticides.

Interestingly, when considering genetic risk factors, research has identified cases wherein Parkinson’s Disease appears to be caused by a single genetic mutation. Research has also shown that the greatest genetic contributor to Parkinson’s Disease is a mutation in the LRRK2 gene.

It is widely believed that in most Parkinson’s Disease cases, a combination of both genetic and environmental factors contribute to the onset of the condition. While research is continuing every single day, it is virtually impossible to determine a specific cause for an individual’s Parkinson’s Disease. Furthermore, because doctors can’t identify a specific cause, there isn’t any scientific evidence to show any preventative measures one can take.

Living With Parkinson’s Disease

People living with Parkinson’s Disease typically experience a range of symptoms affecting both motor and non-motor functions. It is important to remember that everyone with Parkinson’s does not necessarily experience all of the symptoms associated with the disease. In other words, once you’ve met one person with Parkinson’s Disease, you’ve certainly not met them all.

Common motor symptoms include bradykinesia (slowness of movement), rigidity, postural instability, resting tremor, and trouble with gait and balance. Non-motor symptoms include cognitive impairment, depression, anxiety, trouble sleeping, low blood pressure, constipation, speech and swallowing problems, pain, excessive drooling and loss of smell.

These symptoms can be managed by a number of different treatment options, and treatment recommendations vary from patient to patient. There are medication treatment options, surgical treatment options and other therapies. We’ll address exercise separately but it’s worth mentioning here that while medications and surgery can help manage one’s symptoms, the only scientifically proven method to slow the progression of Parkinson’s Disease is exercise.

Fighting Back With Medication

There are many medications available to help manage both motor and non-motor symptoms of Parkinson’s Disease. Unfortunately, while these options may help ease symptoms and improve quality of life, there is currently no known cure or disease-modifying therapy.

The medications that target motor symptoms primarily address tremor, stiffness, and slowness while medications for non-motor symptoms address depression, sleep disturbances and low blood pressure. Like anything else, medication treatments are very individualized and tailored to each person’s symptoms. A movement disorder specialist will typically start medications when symptoms begin to interfere with daily activities and impact one’s ability to do the things they want or need to do.

When caring for someone with Parkinson’s, there are a few medications that should be at the top of the list from the very start. The gold standard and most widely prescribed medication is called levodopa, or L-Dopa. It is absorbed in the intestine and then converted into dopamine in the brain. Another option, Carbidopa, prevents the breakdown of levodopa before it enters the brain. It also helps with side effects of L-Dopa such as nausea and vomiting. The combination of carbidopa and levodopa is often referred to by the brand name, Sinemet™. Sinemet comes in a controlled release option called Sinemet CR™ and Rytary™ as well. This is a capsule that combines immediate release and extended release in one pill.  People taking carbidopa-levodopa can take it alone or with other Parkinson’s medications. Typically, dosages will increase over time. Long-term use of levodopa can occasionally lead to motor complications (e.g., dyskinesia and/or “off” periods). In addition, there is research available showing that dietary protein can decrease the efficacy of carbidopa-levodopa, so it’s important to take this medication with food other than protein sources.

Dopamine agonists mimic the effect of dopamine in the brain. These include Mirapex™, Requip™, Neupro™, and Apokyn™ and can be used alone or in conjunction with other Parkinson’s drugs like carbidopa-levodopa. When compared to levodopa, long-term use of dopamine agonists may be less likely to lead to motor complications. However, some believe that dopamine agonists are less effective than carbidopa-levodopa. Again, medicating for Parkinson’s is not a “one size fits all” scenario.

For those experiencing more mild effects of Parkinson’s Disease, monoamine oxidase (MAO)-B inhibitors may be a good option. These work by decreasing the normal activity of monoamine oxidase, an enzyme that breaks down dopamine after it completes its activity in the brain. This medication allows the available dopamine to function for a longer period of time.

While non-motor symptoms can have just as significant an impact on quality of life as motor symptoms, they are not as widely recognized as the motor symptoms. Non-motor symptoms are different for every patient and can appear at any time throughout the progression of the disease. These include constipation, low blood pressure, cognitive changes, and mood and sleep disturbances. There are many drug therapies available to manage these non-motor symptoms and while some are specifically approved for those living with Parkinson’s Disease, the majority, while FDA-approved, do not have an indication for use in Parkinson’s. This is simply due to the fact that there haven’t been studies conducted with a large enough sample of individuals suffering from Parkinson’s. The best course of action is to discuss these non-motor symptoms with your doctor to determine together what the best treatment option may be.

What Other Treatments Are Available?

In addition to prescription medication, another treatment option known as Deep Brain Stimulation or DBS is typically available to those living with Parkinson’s. DBS is a surgical treatment option, but it is certainly not for everyone. This treatment is typically done for people who have had Parkinson’s for at least four years and still benefit from medications, but now experience motor complications such as significant “off” periods (when the medication isn’t working well and they symptoms return).

In DBS surgery, electrodes are placed into one or both sides of the brain in the specific areas that control movement. The patient is typically awake for the surgery so that the surgical team can make sure the electrodes are placed correctly. Once the electrodes are positioned, they are connected to a battery-operated device (similar to a pacemaker) called a neurostimulator that is placed below the collarbone. This device delivers electrical pulses through the electrodes to lessen the symptoms. A few weeks after the surgery, the movement disorder specialist will program the neurostimulator specifically for the patient’s symptoms. Those settings often need to be tweaked over time and usually, the patient’s medications need to be adjusted.

DBS typically works best to alleviate symptoms like stiffness, slowness and tremors. It has been shown to exacerbate thinking or memory problems and therefore it is not recommended for people with dementia or cognitive impairment. A general rule is that DBS will help improve those symptoms that respond to medication. If one is a good candidate for DBS (which can only be determined by their neurologist and neurosurgeon), it has been shown to be very beneficial to lessen symptoms and subsequently decrease medication dosages.

While the previously discussed treatment options can help manage the symptoms of Parkinson’s Disease and help improve quality of life, as stated above, the only scientifically proven method to slow the progression of the disease is exercise. We all know that exercise can help everyone feel better and improve overall health. That research is well documented. There is strong evidence that shows that the benefits of exercise in people with Parkinson’s, including continued flexibility and improved balance and motor coordination. So which exercise is best for Parkinson’s? The one that you will stick with. There are some options that have been shown to be particularly effective for people living with Parkinson’s including dancing, boxing, cycling, Tai Chi, swimming and yoga.

The Role of Medical Cannabis

Anecdotal and social media reports by people with Parkinson’s about the reduction in tremors after using cannabis piqued the interest of researchers and got them excited to study the effects of cannabis on Parkinson’s. Some researchers now believe that cannabis might be neuroprotective – saving neurons affected by PD. Cannabis has also been looked at for treating other motor symptoms including bradykinesia and dyskinesia. While there have been some promising preclinical findings, researchers have not yet found any meaningful or conclusive benefits of cannabis for people with Parkinson’s. This is why more studies, especially those with more subjects, are needed.  

Melissa Morante is an owner of ComForCare Home Care and serves as Chief Marketing Officer.

Melissa is an expert in Parkinson’s Disease, working to train the agency’s caregivers on recognizing both motor and non-motor symptoms and how to care for those living with the disease.  She serves on the board of directors for the American Parkinson Disease Association (APDA) South Florida Chapter lending support to those who are living with the disease. Melissa facilitates four support groups for family caregivers and those for whom they care.

As a health and wellness aficionado, Melissa believes that a healthy lifestyle and a diet rich in whole foods and regular exercise are the best medicines. Melissa is a certified group fitness instructor with a specialty in senior fitness. She currently volunteers her time leading exercise classes in independent living facilities throughout the area.

About ComForCare

ComForCare Home Care offers private-duty, non-medical home health care that allows people to age comfortably, safely and happily in place. The company has unique expertise in working with those living with Alzheimer’s Disease, dementia, Parkinson’s Disease and other chronic conditions. Services include grooming, hygiene, meal preparation, light housekeeping, transportation, medication reminder and more.

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