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Dementia with Lewy Body and Parkinson's Disease PatientsPatient, Family, and Clinician Working Together for Better Outcomes$
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J. Eric Ahlskog

Print publication date: 2013

Print ISBN-13: 9780199977567

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199977567.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 19 October 2021

Other Levodopa-Responsive Problems: Anxiety, Insomnia, and Pain

Other Levodopa-Responsive Problems: Anxiety, Insomnia, and Pain

(p.101) 9 Other Levodopa-Responsive Problems: Anxiety, Insomnia, and Pain
Dementia with Lewy Body and Parkinson's Disease Patients

J. Eric Ahlskog

Oxford University Press

Carbidopa/levodopa is well recognized to effectively treat movement (“motor”) problems in DLB and PDD, as well as in typical Parkinson’s disease. However, symptoms responding to levodopa also include anxiety and insomnia. Moreover, pain control may improve with optimized levodopa dosages. The role for carbidopa/levodopa in treating these symptoms cannot be overemphasized; quality of life may markedly improve with optimized dosage. Anxiety is a normal part of the human existence. It is normal to become nervous before a school test or speaking before a large audience. In fact, some of us are especially nervous or anxious as part of our normal makeup. However, newly developing anxiety is a frequent component of DLB, PDD, and Parkinson’s disease. In the context of these disorders, anxiety may occasionally be the most troublesome symptom, even bordering on panic. The good news is that this is often treatable with carbidopa/ levodopa. The usual anxiety everyone experiences, or the excessive anxiety of nervous people, does not respond to levodopa. Certain anxiety is normal, such as during family crises and arguments. If a person has been nervous all of their life, levodopa will not be the solution; such anxiety is not due to brain dopamine deficiency. However, anxiety that develops after, or a little before the onset of DLB, PDD, or Parkinson’s disease is different. If recently, small issues have provoked panic and this is not a lifelong pattern, levodopa therapy may prove helpful. The anxiety experienced by those with DLB or PDD may occasionally reach crisis proportions. Emergency room physicians are familiar with older adults being brought in by concerned family members because “mom is in a panic.” Sometimes a Valium-like drug is prescribed to establish a quick response. Medications from the Valium class are termed benzodiazepines and include such agents as alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), as well as Valium itself (diazepam). Benzodiazepines are very sedating, which is beneficial in the emergency room to relax the nervous person; however, ongoing sedation is not acceptable on a long-term basis. Moreover, these drugs contribute to imbalance (fall risk) and tend to impair thinking.

Keywords:   Prozac class of medications (SSRIs), akathisia (inner restlessness), aripiprazole (Abilify), clozapine (Clozaril), cramp-like contractions, diazepam (Valium), haloperidol (Haldol), lorazepam (Ativan), olanzapine (Zyprexa), pain treatment, in DLB and PDD, peripheral neuropathy, rigidity (stiffness), stiffness (rigidity), ziprasidone (Geodon)

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