Carbidopa/Ldopa is one of the most commonly used medicines for Parkinson’s disease. Ldopa chemically resembles the amino acids or building blocks that make up protein. Because of this, Ldopa ‘competes’ with protein for absorption through the intestines and into the brain.
As the question suggests, optimal absorption of ldopa is important to avoid fluctuations in motor response. A dissolvable form of carbidopa/ldopa does exist but unfortunately it does not absorb through the mouth and still requires swallowing of medicine into the intestine for absorption. An infusion form of Ldopa gel was developed to deliver Ldopa directly to the intestine. This allows precise changes or titration of the amount delivered by using a pump to match the needs of the patient. This form of the medicine and pump delivery is still being studied in clinical research trials and requires that a feeding tube be placed by a surgical procedure into the stomach and advanced through to the small intestines where Ldopa is absorbed. Researchers are also studying different ways to deliver Ldopa using special techniques such as a patch formation. This mode of delivery is not currently available because Ldopa does not easily absorb through the skin requiring special technology to enhance its absorption.
The following tips can help:
- Treat constipation and bloating
- Be sure to get plenty of water, fiber and exercise to help transit of food through the GI tract
- Separate timing of Ldopa dosing from meals
- Eat the majority of your day’s protein when you are less active such as the endo of day
- Eat plant sources (nuts, beans, soy) over animal sources of protein
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Researchers at the University of Virginia are conducting a research study to investigate a new way of controlling tremor. The research study is designed to investigate the safety and feasibility of ultrasound waves targeted at the thalamus, a brain region important for tremor control. Similar to the thalamotomy of the past, this technique causes a lesion or destruction of brain cells that affect tremor.
Unlike traditional thalamotomy, this technique does not require brain surgery that includes drilling a hole in the skull to gain access to the brain and damage the cells but instead relies on MR guidance of these focused wave forms to precisely reach their target. In some ways it is similar to gamma knife thalamotomy, a technique that is sometimes used to treat tremor through focused gamma waves that when converging on a brain region can damage tissue (gamma knife is a common radiosurgery technique used for treating brain tumors and a condition called trigeminal neuralgia). These new techniques are promising and offer a less invasive approach to tremor control. It is important to note that research is just beginning and this current study is being conducted to investigate safety. If proven safe, larger studies will need to be done to test the benefit. Other considerations for this experimental procedure include
- Lesioning techniques (damaged cells) are not reversible since tissue is destroyed. If the wrong area of brain tissue is damaged it can not be restored.
- Focused ultrasound and gamma knife surgery does not have the same risk and recovery period associated with traditional neurosurgery offering a potential treatment for people in which standard surgery carries too much risk.
- Only unilateral thalamotomy at present is recommended for tremor on one side of the body due to concern of side effects with bilateral thalamotomy such as speech and walking problems.
- Research is for tremor predominant Parkinson’s disease, a condition in which other non-tremor movement symptoms are minimal compared with tremor. Non-tremor symptoms of Parkinson’s such as rigidity and bradykinesia are not treated with thalamotomy.
- There is limited experience about the combined effect of thalamotomy and other surgical techniques such as deep brain stimulation (DBS) if this were to be needed in the future.
- Like gamma knife thalamotomy, cells that are to be destroyed are located with MR imaging. Unlike thalamic DBS where a brain electrode is used to locate this precise area in the operating room by recording and stimulating actual brain cells involved in tremor, there is no ability to record the neuronal activity to further ensure that the area of tissue destruction is accurate for the individual.
Given these issues, researchers at the U of VA have designed a careful sham (placebo) controlled study to help effectively address these concerns. These new techniques show promise and offer hope for additional therapies in the future.