Pharmacological treatment of palliative care patients with Parkinson’s disease

Abstract

Parkinson’s disease is the commonest neurodegenerative condition, which can be eased for a long while, however, it inevitably leads to patients’ death. Dying with Parkinson’s disease can be problematic as the clinical situation may change dynamically and necessitate frequent drug dose changes and the introduction of new, preferably injectable, drugs may be necessary. Current treatment of Parkinson’s disease aims to increase the brain’s dopamine focusing mainly on the motor symptoms. The patients suffer frequently from sudden “on” and “off” fluctuations of muscle rigidity accompanied by extreme pain. Classic dopaminergic treatments wear off and become ineffective. The new drug safinamide has been introduced recently with a promising effect on motor and non-motor symptoms including pain. If unavailable, opioids or cannabinoids to relax muscles are the second-best choice. Also, non-motor symptoms like depression, delirium and psychosis may dominate in dying which necessitates antipsychotic treatment with clozapine or quetiapine even if these drugs may hasten deterioration and result in death.