Parkinson's Disease (PD) is a most
formidable opponent. It won't spare even the toughest
of fighters — famous sufferers include Muhammad
Ali and late PM Pierre Elliot Trudeau. Now, new guidelines
from the American Academy of Neurology (AAN) aim to
put medicine's best foot forward in the struggle against
the disease and help make life less arduous for the
over one million PD sufferers in Canada and the US.
"It's possible to improve quality
of life for people with Parkinson's," says Dr William
J Weiner of the University of Maryland School of Medicine
in Baltimore, author of the new guidelines. "These recommendations
will help physicians make an early diagnosis, make the
best use of time-tested and effective therapies to improve
motor function and screen for common comorbid conditions."
The new guidelines, released on
April 3 at the American Academy of Neurology's 58th
Annual Meeting in San Diego, have already earned plaudits
from Canadian neurologists. "These are a step in the
right direction as they provide concise yet comprehensive
guidelines which give clear direction to physicians
managing persons with Parkinson's," says Dr Alan E Goodridge,
a professor and PD researcher at Memorial University.
The AAN has also released a patient version of the guidelines,
which Dr Goodridge finds equally helpful. "They're available
to persons with PD and to their families, allowing them
to make informed decisions about their own care," he
says.
Dr R Allan Purdy, head of neurology
at Dalhousie University, agrees the guidelines are a
huge step forward. "To put it simply, they'll be the
clinical standard followed by most North American neurologists
and beyond."
THE
NUTS & BOLTS
The guidelines lay out all common PD treatments and
rate how strong the evidence is to back their use. For
instance, though some researchers touted vitamin E's
PD fighting power in the euphoria following a promising
2002 study, the new guidelines note the proof just isn't
there to support a diet rich in vitamin E as an effective
therapy. Dr Goodrich likes the approach. "The guidelines
are entirely evidence-based and the strength of the
evidence is documented for each observation and recommendation,"
he says. They also contain a call to screen patients
for depression, psychosis and dementia — common
comorbid conditions that often go untreated in PD sufferers.
For this, Dr Purdy offers unalloyed praise: "Quality
of life is big and I like the screening idea."
DON'T
BE MISGUIDED
ut both Drs Goodridge and Purdy stress that these are
only guidelines. "Ultimately, physicians will need to
use their best judgement in the application of these
guidelines to the needs of an individual patient, and
in some circumstances, deviation from them will be reasonable,"
says Dr Goodridge. "I would use these without question
as a guideline, but managing PD does in general require
a neurologist and in particular a movement disorder
specialist," adds Dr Purdy.
So will the American Academy of
Neurology's new guidelines offer any concrete benefits
to PD sufferers? Dr Goodridge thinks so: " As these
guidelines become more widely recognized and applied,
the quality of life of persons with Parkinson's will
improve. They'll get the most effective treatments more
rapidly and will be less likely to spend their time
and money on unproven or ineffective ones."
The new PD guidelines can be
read in full at www.aan.com/pd
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