MAO-B inhibitors

Patients who have bradykinesia usually experience loss of automatic movements such as blinking of eyes, arm swinging when walking and swallowing of saliva. These are movements which occur automatically and the person is not aware of their occurrence. Bradykinesia affects these motor actions (Duvoisin and Sage, pp 28). As a result of all these, there is pooling of saliva in the mouth and this may drool from the mouth. The patient also experiences difficulty in walking and swinging of the arms as he or she walks (Duvoisin and Sage, pp 29).

Patients with bradykinesia cannot do two things at the same time and end up stopping one of the activities. The degree of bradykinesia usually varies in that a patient can walk without difficulty at one time whereas later on he might have a difficulty in doing so. This is known as paradoxical kinesia (Duvoisin and Sage, pp 31). Patients have a problem with the posture and usually stand or walk with a bent back. Other changes in posture include leaning on one side as he or she sits.

There is also loss in the normal voice of the person and sometimes some patients may have a slow speech and experience palilalia (repeating a syllable of a word many times). These are, however, improved following therapy (Duvoisin and Sage, pp 36). Drug Therapy Most of the drugs used in the treatment of Parkinson’s disease enhance the activity of the dopamine nerve cells. These drugs include anticholinergic drugs (such as benztropine, trihexyphenidyl and ethopropazine) and dopaminergic drugs (such as pramipexole, ropinirole, bromocriptine and apomorphine).

The former acts to inhibit the activity of acetylcholine whereas the latter enhances or mimics the activity of dopamine. One of the common dopaminergic drugs is amphetamines whose mode of action is the stimulation of dopamine nerve cells hence release of more dopamine. However, this mode of action is indirect and the drug may sometimes fail to work in cases where there is dopamine deficiency. In Parkinson’s disease, the dopamine nerve cells are affected. Therefore, the effective method that has been used to enhance their functions is the use of L-dopa.

L-dopa is transformed into dopamine in the brain. Levodopa which is a commonly used drug contains the active ingredient L-dopa. Other dopamine receptor agonists have been used and they have the advantage in that they directly act on the dopamine receptors hence no conversion is needed in the brain (Duvoisin and Sage, pp 52). There are also drugs that ensure that the level of dopamine in the blood does not go down. These drugs are known as Catechol-O-methyl transferase (COMT) inhibitors. In normal circumstances, COMT is found in the blood and its main function is to break levodopa.

Therefore, these inhibitors block this process hence ensuring that more of this substance finally gets in the brain and subsequently transformed to dopamine. Examples of COMT inhibitors include entacapone and tolcapone. However, these drugs are ineffective on their own unless when used together with levodopa. Drugs such as selegiline (deprenyl) have also been used in treatment. They are MAO-B inhibitors which stop the breakdown of dopamine (Duvoisin and Sage, pp 53). Other Treatment Psychotherapy (talk therapy) has also been used.

It involves a number of techniques such as cognitive behavioral therapy and involves counseling the person and making them to be positive in life. The patient is told how to handle different situations in order to reduce depression. It helps in reducing the depression (McGrath, Para 9). Electroconvulsive therapy (ECT) has been used in patients with Parkinson’s disease. It involves the passage of small electric current in the brain. This stimulates the patient and is used in the management of depression which is commonly associated with Parkinson’s disease. It also relieves the symptoms associated with this disease (McGrath, Para 10).

Works cited Duvoisin, Roger . C. & Sage, Jacob. Parkinson’s disease: a guide for patient and family. Philadelphia: Lippincott Williams & Wilkins. 2001 McGrath, Michael. Major Depression Treatment Options: Psychotherapy, Antidepressants and Electric Shock Therapy. (Sep 16, 2009). Retrieved on 13th May, 2010 from http://patient- health-education. suite101. com/article. cfm/major_depression_treatment_options National Institute of Neurological Disorders and Stroke. What is Parkinson’s disease? Retrieved on 13th May, 2010 from http://www. ninds. nih. gov/disorders/parkinsons_disease/parkinsons_disease. htm

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