Treatment of Non-motor symptoms

Symptom

Treatment

Salivary Drooling (sialorrhoea)

The use of anticholinergics reduce salivary drooling as a side effect. Hyoscine patches or botulinus injection. For severe cases: parotid irradiation which blocks saliva production.

Sweating (seborrhoea)

Increased or reduced frequency of levodopa dosing or controlled release agents as severe sweats usually occur as levodopa dosage wears off. Hydrocortisone application for excessive facial sweating.

Constipation

Increased intake of fibres in mild cases. Dose reduction of anticholinergic drugs as these appear to slow down bowel motility. Stool softeners, laxatives and enemas in severe cases. Apomorphine use during 'off' periods.

Bladder instability

Possibility of Urinary tract infection and prostatism should be excluded first.

Detrusor hyperactivity: peripherally acting anticholinergics eg. oxybutynin.

Detrusor hypoactivity: intermittent catheterisation.

Postural hypotension (dizziness on standing)

Advised to stand up slowly to minimise rick of falling, and as regards food, exercise and hot weather. Head-up bed tilt and compression stockings. Low dose of fludrocortisone which increases intravascular circulating blood volume.

Severe cases: sympathomimetic agents eg. midodrine.

Sleep disturbance

Dependent on the cause. Short acting sedatives, benzodiazepines, tricyclic antidepressants, reduction in night time levodopa treatment, neuroleptics, dopaminergic medications.

Cognitive impairment

Atypical neuroleptic use, cholinesterase inhibitors and reduction in causative factors eg, withdrawal of inappropriate medication which may be contributing eg anticholinergics and some dopamine agonists.

Depression

Tricyclic antidepressants, SSRI's (selective seratonin reuptake inhibitors), Electroconvulsice therapy.

Anxiety

Benzodiazepines, eg lorazepam and beta-blockers.

Hallucinations and Psychosis

Modifications of the anti Pakinson's disease drug regime and the use of atypical anti-psychotics.