Efficacy of Trihexyphenidyl on Apraxia of Eyelid Opening in Parkinsonism: A Case Report

[Farooqji]

Apraxia of eyelid opening (AEO) is occasionally seen in Parkinson’s disease (PD) or related diseases. However, many clinicians have trouble with the management of AEO by Parkinsonism. The following link mentions a case of apraxia of eyelids opening in PD patient which was successfully treated with the subject medication

cureus.com/articles/238517-...

[Despe]

Trihexyphenidyl (THP) is an oral, centrally acting anticholinergic drug used mainly in the treatment of PD and movement disorders [2]

Anticholinergic??? PwP should increase Choline. I would stay away from any anticholinergics!

[Karmaone in reply to Despe]

PwP have a complicated, and not fully understood, relationship with Acetylcholine. Smoking, from my very limited reading, decreases sensitivity to acetylcholine by causing neurogenesis of nicotinic acetylcholine (ACh) receptors. This is one of the again, not fully understood, reasons that smokers are less likely to suffer from Parkinson's. My consultant, after trying me on Levodopa that didn't work, recommended THP, stating that, his young onset PwP, benefit from it. It has risks, but it allowed me to play guitar and play competitive video games competitively again. There's interplay between Acetylcholine and Dopamine....

[Pezo in reply to Karmaone]

Yeah ...same here, leva dopa sometimes works but not very often... I am not so happy with the risks though I mean have you read those risks?.. it's very heavy drug used for amongst all the things epilepsy but as you point out it does work

[pearlette in reply to Despe]

Hello Despe

Antcholinergic drugs breakdown acetycholine into choline and acetic acid.

This happens within the body naturally by enzymes . The anticholinergic medicines does that a little more actively.

Acetylcholine is one of the most widely disributed and functionally active compounds in the body (every cell needs it)

Choline is a naturally existing substance which is present in many foods.

As a general rule of thumb bad effects of most naturally occuring substances cause side effects only when they are used in "pharmacholgical" doses as opposed to "physiological levels"

Anticholinergic drugs do have longer term side effects on the cognitive function but in the shorter term have effects like urinary retention, constipation, raised eye pressure etc. This is from their effect on involuntary muscle (lining of organs both big and small ones)

But many anticholinergic drugs have been used safely for years ( from abdominal colic in babies , eyedrops, asthma medicines, bladder incon tinence and many neurolical symptoms like dystonia, other spasm producing states.

[LeharLover62]

An anticholinergic was the only drug that helped with hubbys urinary incontinenece, so he would take it from time to time about 8 years ago. Now he has dementia so I regret it, but of course we can’t know for sure the relationship. Just be aware of the risks.

[Karmaone in reply to LeharLover62]

Really sorry to hear that, it's a genuine fear of mine. PwP have a higher risk of cognitive disruption and Alzheimer's. Do you mind saying how old your husband is?

[LeharLover62 in reply to Karmaone]

Just turned 62.

[Despe in reply to LeharLover62]

Hubby's urologist/surgeon who performed HoLEP (mayoclinic.org/tests-proced... prescribed bladder medication that it is NOT anticholinergic, exactly to prevent cognitive decline.

[bassofspades]

I was on Artane a long time ago. Tried it to see if it would further eliminate shakiness but at the time it didnt seem to help. Now, many years later, my symptoms have slightly progressed and I am giving it another try. The problem I am having is shakiness and dystonia in my right ankle and foot, which really seems to bother me when Im driving and operating the accelerator pedal. Tried 1 mg twice a day with a little relief. Now up to 2 mg twice a day and experiencing a bit more relief of that problem. Follow up appointment in a few weeks, I suspect that we will slightly increase once again.

What I know about Acetylcholine is, normally, dopamine and acetylcholine work in tandem to help regulate movements. But in Parkinson’s, there is less dopamine available, which throws off the balance between these two neurotransmitters. It’s thought that trihexyphenidyl and other anticholinergics that reduce acetylcholine signaling work to ease Parkinson’s symptoms by helping to restore this balance. parkinsonsnewstoday.com/par...