Does Azilect slow disease progression?
Azilect is a monoamine oxidase inhibitor (MAOB I) designed to block the breakdown or metabolism of dopamine in the brain. This means more dopamine is available for use by the nerve calls. Laboratory and animal studies showed that this medicine may do more and actually protect nerve cells from degeneration or death- a process called neuroprotection. Delaying dopamine nerve cell death would potentially slow down disease progression.
A study of people with mild Parkinson’s tested this hypothesis. Participants were divided into two groups. One group received Azilect right away, the second group got placebo followed by Azilect after 36 weeks. The idea was that is this medicine was protective then taking it earlier would be better.
The picture to the right is a graph of both groups. The bottom yellow line shows the group that recieved Azilect right away and the purple group got placebo followed by Azilect after 36 weeks.
At 72 weeks you will see that both groups did not have the same measure of movement abilities (lower number means better movement). If Azilect were only treating symptoms it would be expected that both lines would intersect by this time.
This suggested that earlier Azilect has a benefit beyond pure symptom control. It does not prove neuroprotection. Here are some possible reasons for this finding
- Azilect could be protecting nerve cells from further degeneration
- Early use of Azilect can lead to favorable brain chemical or activity changes unrelated to the number of dopamine nerve cells
- People felt better earlier leading to improved mood, increased exercise all of which can affect symptoms
The FDA reviewed this data and announced that there just was not enough evidence to confirm that Azilect delayed disease progression. Bottom line- it is not certain if Azilect slows progression but it does appear to change how people are doing over time and it may be better to start medicines before movement problems are significant. See related article.
Learn more about dopamine medicines and their side effects.
Given that the medications only treat the symptoms, and do not cure the disease, does the disease progress any faster if a person does not take all medications recommended by the doctor? I am not a big fan of taking pills especially given all the possible side effects.
Taking the right medicine, at the right time, in the right amount is the correct answer. Certain principles do apply. Abnormal movement patterns and difficulty with movement (such as stiffness, slowness, and loss of fluid movements) due to PD can lead to changes in a person’s activity level, new habits in how we move, and overtime our movement becomes less and less like the pattern of movement normal to a person prior to PD. It is thought that waiting too long or under-dosing your medicine can worsen your movement and lead to this cascade of events that can further change how you move.
What is not known is if this actually exaggerates the brain changes of PD? Before your doctor’s visit, think about how your movement is changing and whether you are doing things differently due to these changes. Are you not using your hand as much for tasks due to tremor or other problems? Is walking changed? Are you experiencing pain or discomfort?
Just as under-dosing can be a problem so can overdosing so be sure to talk with your doctor about the right medicine timing for you. Learn more about medication and side effects.
What is the one piece of advice you would give to others just diagnosed with Parkinson’s?
There is no doubt about it, getting a diagnosis of Parkinson’s can be life changing. People respond in different ways. Some seek out as much information about the disease as possible or take to the internet to find out about the latest treatment. Some people find comfort in support groups while others keep their diagnosis to themselves. A pledge to exercise more or eat healthier is the focus of many.
Think back to the time when you were diagnosed. What worked for you (or didn’t)? What advice do you wish that you were given? What advice would you give to others? How have your ideas about Parkinson’s changed over time. Share your own experience, advice and wisdom with people just recently diagnosed and with PDCommunity! by responding to this post.
Is Parkinson’s hereditary?
Scientists have discovered abnormal genes associated with Parkinson’s and have identified up to 18 gene loci (potential DNA sites) that may be involved. These abnormal genes increase one’s risk but do not directly cause the disease. It is thought that more than one factor (like environmental toxins) needs to also be present to develop the disease. In most cases genetics testing is not typically performed, because the presence of an abnormal gene does not necessarily determine if one would get PD.
A family history of PD in a first degree relative is seen in about 15% of people with PD. There is a 2x risk of developing PD if you have a family history of PD in a first degree relative. Although increased, this risk is still relatively low.
Check back later this year as more information will be posted by genetics experts in a future edition of the Wellness Center.
I get nausea in the morning. Could this be caused by my medicines?
All dopaminergic medicines can cause nausea. Nausea is worse when you first start a medicine and can increase as you increase dose. Nausea usually gets better but many people find the following tips helpful:
- Take medicine with food (exception may be carbidopa/levodopa- see protein article.)
- Eat smaller more frequent meals throughout the day
- Drink plenty of water or ginger ale with medicines
- Try eating ginger- dried ginger, fresh ginger, candied ginger or ginger candies
- Camomille tea, peppermint and peppermint tea soothes gastric upset
- Ask your doctor about carbidopa (Lodosyn) if you are taking carbidopa/levodopa (Sinemet)
- Always see your doctor for nausea that is severe or does not improve
- Vitamins and supplements can also cause nausea. Switch these to night time dosing
Learn more about medicines and their side effects
How important is it that I take my medicine on time?
When symptoms re-emerge between doses, medical professionals call this “disease fluctuation”. When the medication wears off, the person can experience painful muscle rigidity, very slow movement, falls, worsening gait shuffling or freezing of movement, imbalance, and increased tremor and muscle spasms. A delay in medication can even result in worsening swallowing and speech, and sometimes thinking and mood worsen when the PD medications wear off. Learn more about Medication Timing by Sierra Farris, PAC.