Parkinson disease is a movement disorder characterized by physical slowdown, stiffness, tremor at rest, stopped posture, and gait changes. It typically starts in the 6th decades of life but in small percent of cases can start before 50 years of age. This disease was named after Sir James Parkinson who first described the condition in 1817.
More recently it has been established that Parkinson disease is more than a disease of just the motor nervous system. It also afflicts a large number of other systems of the body. Complaints of GI tract such as nausea, abdominal pain, drooling and constipation are common in many patients. Sweating abnormalities, dandruff on the face, frequent urination, erectile dysfunction and eye droopiness are also reported. Sleep disturbance when it starts can lead to a rapid decline of the physical functioning. Emotional disturbances such as anxiety and depression are common. Dementia is present in many older patients (>80 years of age) of the disease after some years. Many patients report pain in the legs and also are diagnosed with restless leg syndrome.
Our understanding of the central role of dopamine in the nervous system became established in the 1960s when Levodopa became the mainstay of the treatment. Despite the fact numerous other medicines were approved subsequently, but Levodopa remains the gold standard which Neurologist would often prefer to save until later in the course of the disease. Dopamine agonists such as Ropinirole (Requip) and Pramipexole (Mirapex) are the usual first line agents in all patients under 75 years of age. MAO-B inhibitors such as Rasagiline (Azilect) or Selegiline (Eldepryl) can be added to these agents if needed to boost the effect but also offer some potential disease modifying effect. COMT inhibitors like Entacapone (Comtan) can also be used to prolong the effect of Levodopa. Motor fluctuations called on-off phenomenon make treatment of the disease difficult. When the patient is “ON” they have too much movements and when “Off” there is stagnation. Patients can even freeze in one place.
Physical therapy and occupational therapy can be considered in selected patients to improve the quality of life. Even boxing has been recommended in early phases of the disease. “Rock Steady” boxing clubs are now open around the country and provide exercise programs.
Brain stimulation and surgery are more invasive options that can be pursued and may provide significant improvement.
Many patients however, still feel that the traditional medicine leaves areas that are not adequately addressed. Such as Sleep disturbances like Insomnia, trouble falling asleep and staying asleep. REM sleep behavior disorder and periodic leg movements of sleep are common in patients with Parkinson disease. Melatonin and Clonazepam may help a lot of patients with these conditions.
However, there is no perfect medicine to help with sleep onset or sleep maintenance insomnia. Changing the timing of the Levodopa and using hypnotic agents like Zolpidem (Ambien) and Eszopiclone (Lunesta) is a choice. Ambien can often cause visual hallucinations and is not recommended in the elderly. These medicines may also stop working after some years. Benzodiazepines such as Lorazepam (Ativan) are never a great option due to their dependence and tolerance issues.
This is where Medical Marijuana can be of help. No clinical trials currently exist for the use of medical marijuana but empirical evidence in clinical practice is strongly suggestive of benefit outweighing the risk. Starting with THC <10% in a marijuana product and with gradually increasing doses, is recommended. Indica strains for their sedative/ hypnotic effect are the better option and CBN which is a derivative of THC is also increasingly being used for insomnia. These treatment choices are waiting for suitable double blind placebo controlled clinical trials.
Medical marijuana can also be of help with the anxiety commonly seen in Parkinson. It is not clear if medical marijuana can help with On-Off phenomenon, but anecdotal evidence suggests that it is possible.
THC in Marijuana can produce a “high”. It is mandatory that any trial of medical marijuana in an older person is done under careful supervision of a family member, who can monitor the patient carefully and start from the lowest dose of THC of 5mg. Keeping CBD 10 or 20 times the THC dose also provides a safety factor against a mental high.
Medical marijuana is known to help with pain of all nature. It seems logical to try it for Parkinson disease pain such as in the legs after other sinister causes have been ruled out.
Research is demonstrating the significant benefit that cannabis can have on your health and wellbeing. Medical Cannabis Clinics of Florida is the leader when it comes to helping patients find the right cannabis treatment method for their conditions. With cannabis clinics serving the areas of Delray Beach, Boca Raton, Boynton Beach, Kissimmee, Saint Cloud, Davenport, Lake Nona, Orlando, Deerfield Beach, Lantana, Harmony, Poinciana and Celebration, you now have outstanding access to a medical marijuana doctor that truly understands your needs.
