4.+Effectiveness+of+L-Dopa

==**LEVEL OF EFFECTIVENESS-- ** ==

At this time L-dopa is the single most effective drug available today for the treatment and reduction of Parkinson’s disease and its symptoms. Studies have shown that with the treatment of L-dopa body rigidity and bradykinesia (slow movement and impaired ability to adjust the body’s position) were improved significantly in approximately 80% of patients. (Macaphee, Stewart. 2007) However improvement of tremor symptoms have shown to be less predictable in treatability. However due to the short half life (90 minutes) of L-dopa treatment needs to be administered two to three times daily. In doing this dosage is incredibly important in order to maintain effective treatment. (Macaphee, Stewart. 2007)

Youtube Video Demonstrating Therapeutic Effects of L-dopa Treament:  @http://youtu.be/sf1N0Zf5IqA

==**PROBLEMS WITH TREATMENT****-- ** ==

Although L-dopa treatment appears to be the management of Parkinson’s disease there are a number of questions about its effectiveness over a period of time. Studies show a decline in L-dopa’s efficacy after years of prolonged use with an appearance of severe motor disturbances. (Furlanut, Benetello, et al. 2002) This is due to a number of coexisting factors. With long term use of L-dopa as a treatment the central nervous system looses the ability to store the converted dopamine within the nigrostratal terminals (pathways in the brain that transmit dopamine from one region to another). This is a result of the progression of the disease. However the main factor influencing the long term efficiency of l-dopa treatment is the decreased level of activation from L-dopa to dopamine over continuous use of treatment. It is important that consistent monitoring of L-dopa treatment be provided and dosage modified in order to further explain and inhibit these long term implications of L-dopa treatment of Parkinson’s patients.

==PAST PROBLEMS **-- ****- ** ==

It seems that besides the therapeutic affect L-dopa has on the central nervous system, it may have negative effects when L-dopa is converted to dopamine within the peripheral nervous system. Because of this, a Dopa decarboxylase inhibitor (DCI) is taken with the administration of L-dopa in order to reduce the side effects on the peripheral nervous system. Administration of a DCI also helps to improve L-dopa availability in the brain reducing the amount of L-dopa administration required.(Macaphee, Stewart, 2007).

===SIDE EFFECTS**--- ** ===

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">Over administration of L-dopa may cause side effects such as ("Parkinson's Disease", 2012; Aviles-Olmos & Martinez-Fernandez, 2010 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">):
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">nausea
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">vomiting
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">hypotension (low blood pressure)
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">Drug induced dyskinesia over long periods of use

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">One of the major side effects of L-dopa treatment is induced dyskinesia associated with different levels of drug administration. Dyskinesia is the onset of involuntary dystonic movements. Any part of the body can be affected however the neck and legs appear to be the areas most prone. These side effects can affect around 40% of patients who have been using L-dopa treatment for five years or more and approx 89% of long term users (10+ years) (Aviles-Olmos & Martinez-Fernandez, 2010) <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">There are three types of L- dopa induced dyskinesia:

//<span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">Off- period dyskinesias //
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px; line-height: 25px;">Appear when L-Dopa levels are low
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px; line-height: 25px;">Associated with painful leg cramps and pressure in the foot

//<span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">Diphasic dyskinesias //
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px; line-height: 25px;">Most uncommon form
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px; line-height: 25px;">Appears when L-dopa concentration reaches a certain critical level
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px; line-height: 25px;">Symptoms include rapid and jerky movements and are short lasting

//<span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">Peak-dose dyskinesias //
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px; line-height: 25px;">Most common form
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px; line-height: 25px;">Appears when L-dopa levels are high
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px; line-height: 25px;">Symptoms include involuntary twitching or spasmodic movement of muscle groups (Aviles-Olmos,Martinez-Fernandez, 2010)

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 17px;">[|Here is an example of L-dopa induced dyskinesis on a lab mouse]