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Re: Parkinson' disease - multidisciplinary team

Dear Editor

I read with interest the review article by Thanvi and Lo on the long term motor complications of levodopa.[1] The authors describe the role of pulsatile stimulation of the post-synaptic dopamine receptors as a possible mechanism for these complications and describe the various strategies currently in use to prevent them. They however fail to acknowledge the role of a multidisciplinary team in the management and possibly prevention of these motor complications. It is clear that Parkinson's disease is a progressive neurological disorder that results in a number of disabilities which can only be partially treated with the currently available oral medication. It is therefore important to involve the physiotherapist and occupational therapist in the rehabilitation of Parkinson's patients. The medicines management can then be tailored to a "goal oriented approach" to counter the disability rather than relying solely on increasing dosage of levodopa or its adjuncts which will never achieve the desired objective on their own and lead to an increasing incidence of complications. The "goal oriented approach" will also help the patient to better accept his disability and understand the clear limitations in the efficacy of anti-parkinsonian medication. I cannot however site a randomised controlled trial to support the above comments but it would defy logic to believe otherwise.

References

1. Thanvi B R, Lo T C N. Long term motor complications of levodopa: clinical features, mechanisms, and management strategies. Postgrad Med J 2004; 80: 452-458