How is CBD treated?
Unfortunately, CBD almost never responds to levodopa, the drug that is the mainstay of Parkinson’ s disease treatment. However, because there are rare exceptions, and because the diagnosis of CBD may be wrong, it’ s usually worth a try in people with apparent CBD and who have important muscle rigidity or slowing of movement. A typical approach is to start the carbidopa-levodopa 25 / 100 size at one tablet once a day on a full stomach and to increase each week by one tablet per day until reaching three per day( taken as one tablet three times per day). The dosage can be increased at weekly intervals to six tablets per day, then nine, then 12. If that doesn’ t help, then the drug should be quickly tapered and discontinued. The most common side effects of carbidopa-levodopa in people with CBD are nausea and sleepiness, each occurring in about 10 % of patients.
There is no evidence that other antiparkinson drugs— such as the dopamine agonists( pramipexole, ropinirole, rotigotine patch)— help, and, in fact, they can have more side effects than levodopa. An exception may be amantadine, an old antiparkinson drug with a complex chemical mechanism that can sometimes help the gait freezing of CBD. The dosage of that drug should not exceed 200 mg per day because of its possible side effects of confusion, constipation, and urinary retention.
The dystonic muscle spasms that sometimes occur in CBD may respond to muscle relaxant drugs, such as cyclobenzaprine, baclofen, and tizanidine. A medication for seizures called levetiracetam can also help and may be better tolerated than the traditional muscle relaxants. The most common side effect of these drugs is sleepiness. The myoclonus of CBD, in the unlikely event that it is troublesome, may respond to clonazepam or levetiracetam.
A different sort of drug that can be useful for people whose CBD is complicated by dystonia is botulinum toxin. This substance is produced by certain bacteria that can contaminate food. A dilute solution can be injected into overactive muscles. The effect takes one to two weeks to start and lasts two to three months before having to be repeated.
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Unfortunately, deep brain stimulation surgery, which can be so useful in Parkinson’ s, does not help CBD.
Is physical therapy useful?
Formal physical therapy is worth a trial in CBD, especially with the goal of teaching the patient to use gait assistive devices, such as a walker. Certain exercises done in the home by oneself on a regular schedule can keep the joints limber. For anyone with CBD, or any chronic illness, exercise also has a clear psychological benefit: improved sense of well-being.
For people with gait or balance problems, many useful exercises can be performed seated in a chair or lying on a mat. Using a stationary bicycle is usually feasible as long as the person has help in mounting and dismounting safely. The best strategy is to obtain a neurologist’ s order for an evaluation and a treatment plan from a physical therapist or physiatrist( a physician specializing in rehabilitation of chronic conditions). The same advice applies to the utility of occupational therapy in improving the apraxia and dystonia of the hand( s) that is so common in CBD.