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Pathophysiology and Pharmacology

Parkinson’s disease is one of the most common neurological disorders that results in stiffness and shakiness in the muscles with difficulty in walking, coordination and balance (Suppa et al., 2017). The health condition is associated with gradual loss of cells in the substantia nigra region of the brain. This region is associated with the production of dopamine and helps in the coordination of movement and activities of the body (Muthuraman et al., 2018). This paper will discuss the critical aspects of the Parkinson’s disease in association with the provided case study of John (58 years). The patient has been recognized struggle with everyday tasks at work and seems to be confused with poor coordination of movements. This paper will also assert on how the treatment provided to the patient, that is of L-Dopa is one of the most effective ways to mitigate the illness.

Parkinson’s disease is a complex disorder that does not have an immediate cure. The disease is treated in the patient through supplementation of dopamine and management of the exerted symptoms (Suppa et al., 2017). The common symptoms that are associated with the condition include poor coordination and difficulty in completion of everyday tasks. This is being also depicted by John who has been associated with poor coordination at work and completion of his routine tasks. John also feels confused and complains of being “out of sorts”. In Parkinson’s disease, the cells that produce dopamine, a neurotransmitter die and are rendered ineffective. Loss of this neurotransmitter results in poor coordination and affects the movement of the individuals (Chagraoui et al., 2020). Drugs that can enhance the synthesis of dopamine levels in the body and supplement its presence are seen as effective treatments. One such treatment option has been applied for John, that is, administration of L-Dopa. L-Dopa is used in patients who suffer from Parkinson’s is because the drug successfully crosses the blood-brain barrier and enhances the dopamine concentrations in the body of the patient (Haaxma et al., 2015). L-Dopa is a precursor molecule of dopamine and is taken up by the dopaminergic neurons. The dopaminergic neurons in the patient convert the L-Dopa into dopamine and increase the net amount of neurotransmitter present in the body (Zhang et al., 2016).

L-Dopa is used in the treatment of Parkinson’s disease instead of dopamine itself as dopamine is unable to cross the blood-brain barrier. It has also been asserted that L-Dopa is a better treatment and management drug than the other options as it provides better mobility and a higher quality of life in the patients against the other common alternatives like dopamine agnostics and monoamine oxidase type B inhibitors (PD Med Collaborative Group, 2014). Dopamine agnostics are more commonly used for treatment in younger people. The use of dopamine agnostics is also less favourable as the use of these drugs increases the chances of dyskinesias (Zhang et al., 2016). Further, non-motor side effects are more common in the use of dopamine agnostics than L-Dopa for the treatment of the patients (Haaxma et al., 2015). Use of dopamine agnostics and monoamine oxidase type B inhibitors have been found to be effective with immediate effects in terms of delay of onset of motor complications with a margin of three to five years, however, in the long term, L-Dopa is a superior alternative as it is more effective in improving the motor function (Zhang et al., 2016). Dopamine cannot be used directly on the patients as it fails to cross the blood-brain barrier and thus, L-Dopa is used for the treatment. Monoamine oxidase type B inhibitors are also used for treatments. The monoamine oxidase type B functions to break the dopamine in the body and therefore, inhibiting this response prolongs the presence of neurotransmitter in the system. These inhibitors are commonly used in conjunction with the L-Dopa for the treatment of the patient and have been found to be more effective than the antagonists in a combinatorial effect with L-Dopa (Muthuraman et al., 2018). However, in the individual assessments, L-Dopa remains to be the most effective medication for the management of Parkinson’s disease in individuals.

This paper provides a brief discussion on the Parkinson’s disease in association with the case study of Mr. John who has been diagnosed with the condition at the age of 58 years. The disease is associated with poor production of dopamine, a neurotransmitter due to damage in the cells that produce the neurotransmitter. The paper discusses the alternate treatment options against L-Dopa and produces an evidence-based analysis to determine their efficacy and suitability treatment. Based on this analysis, the paper concludes that L-Dopa is the superior treatment for a patient suffering from Parkinson’s disease as it helps in improving the motor response in patients with significant long term results.

References for Mr. John Parkinson’s Disease Case Study

Chagraoui, A., Boulain, M., Juvin, L., Anouar, Y., Barrière, G., & Deurwaerdère, P. D. (2020). L-dopa in parkinson’s disease: Looking at the “false” neurotransmitters and their meaning. International Journal of Molecular Sciences, 21(1), 294. https://www.mdpi.com/1422-0067/21/1/294

Haaxma, C. A., Horstink, M. W., Zijlmans, J. C., Lemmens, W. A., Bloem, B. R., & Borm, G. F. (2015). Risk of disabling response fluctuations and dyskinesias for dopamine agonists versus levodopa in Parkinson’s disease. Journal of Parkinson's disease, 5(4), 847–853. https://doi.org/10.3233/JPD-150532

Muthuraman, M., Koirala, N., Ciolac, D., Pintea, B., Glaser, M., Groppa, S., ... & Groppa, S. (2018). Deep brain stimulation and L-dopa therapy: Concepts of action and clinical applications in Parkinson's disease. Frontiers in Neurology, 9, 711. https://www.frontiersin.org/articles/10.3389/fneur.2018.00711/full

PD Med Collaborative Group. (2014). Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson's disease (PD MED): A large, open-label, pragmatic randomised trial. The Lancet, 384(9949), 1196-1205. https://www.sciencedirect.com/science/article/pii/S0140673614606838

Suppa, A., Bologna, M., Conte, A., Berardelli, A., & Fabbrini, G. (2017). The effect of L-dopa in Parkinson’s disease as revealed by neurophysiological studies of motor and sensory functions. Expert Review of Neurotherapeutics, 17(2), 181-192. https://www.tandfonline.com/doi/abs/10.1080/14737175.2016.1219251

Zhang, J., & Tan, L. C. (2016). Revisiting the medical management of parkinson's disease: levodopa versus dopamine agonist. Current Neuropharmacology, 14(4), 356–363. https://doi.org/10.2174/1570159x14666151208114634

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