Patches for PD meds?

[Carrollee]

I am taking my dad to a neurologist on Tuesday after 5 years of him deteriorating and nobody working out what it was. I sent his symptoms and history to his surgery and said that I believed he had PD. Long story short a doc agreed and sorted a neurology appointment. My question (one of many) is, why do some with PD have their medication thru a patch. A friend of a friend has one and recommended it. I havnt read about it from any contributors on this site so wondered why and what the advantages/disadvantages are. He hasn't been given any treatment yet, that is supposed to be happening Tuesday. He can barely walk now and is sooo exhausted all the time despite many hours in bed, Is this normal? Any ideas gratefully received. I could then run them by the neuro (movement disorder clinic) on Tuesday. Thank you cc 🤗

[johntPM]

I'm sorry to hear about your dad. I would go open minded into the consultation with the neurologist. It's important to get a firm diagnosis.

Regarding a patch, some drugs can be delivered by a patch (e.g. rotigotine), while others (e.g. levodopa) can't without causing inflammation.

Regarding drugs for PD, the doctor is likely to take into account the severity of existing symptoms and the age of the patient. If these are high or the patient is old, he is more likely to prescribe levodopa/carbidopa, rather than an agonist.

The dose should be titrated. You should know in a couple of days whether a particular dose is going to work. People often find that a low dose gives no obvious benefit, but as the dose increases a threshold is crossed, giving a large reduction of symptoms. If you have good communications with the neurologist, you should be able to go through this optimisation process in a few weeks.

Exercise is important.

John

[Carrollee in reply to johntPM]

Thank you John. What you have said ties up with what I have read and am expecting him to be given sinemet. My dad was so well and so active but now only able to shuffle with the use of a Zimmer frame at home. He is so exhausted he rarely goes out now as feels unsafe. He was such an outdoor man with an allotment and travelled to France every year and walked everywhere. I have always believed he had a "condition" and it was not old age, but all sorts of reasons where given him from age to anaemia to vit d deficiency etc. He doesn't have a tremor but it was his right foot sticking to the floor when he was waking/shuffling that took me to this site three months ago. When I looked at the Parkinson sites all his symptoms were there. Why is it so difficult to diagnose? We have seen docs many times and even saw a doc 6 months ago with all these symptoms but the trail went cold and without a tremor I didn't suspect PD. Thank you for your time and advice. I want things like msa and psp eliminated so will listen and learn tommorrow. I believe this doc is a geriatric neurologist but can't find much more about him. There is a dedicated Parkinson's nurse local to him so that's encouraging. All the best cc 🤗