How does Dr. Schlesinger's approach to Parkinson's treatment differ for early-stage versus advanced-stage patients

Dr. Schlesinger's approach to treating Parkinson's disease differs significantly between early-stage and advanced-stage patients:

Early-Stage Approach

For early-stage Parkinson's patients, Dr. Schlesinger's approach focuses on:

Symptom relief and prevention of motor symptoms.
Utilizing medications like L-dopa and other dopaminergic treatments to slow disease progression.
Recommending exercise or "pre-hab" with physical and occupational therapists to promote physical activity.
Prescribing medications that can make patients feel close to normal, often with complete symptom relief.

Advanced-Stage Approach

For advanced-stage Parkinson's patients, Dr. Schlesinger's approach shifts to:

Adopting a palliative care model to provide comfort and support.
Focusing on treating nonmotor symptoms, including psychiatric and cognitive disorders, autonomic disturbances, and sleep disorders.
Maintaining independent motor function as long as possible by increasing "on" time without dyskinesias and decreasing motor and nonmotor "off" times.
Utilizing innovative technologies like Focused Ultrasound Treatment for movement disorders, offering a non-invasive alternative to traditional surgical interventions.
Considering advanced therapies such as deep brain stimulation when medications become less effective.
Adjusting medication strategies, such as using COMT-inhibitors like tolcapone for patients where entacapone is no longer effective.
Managing cognitive issues with cholinergic inhibitors while carefully balancing motor function.

Dr. Schlesinger's approach emphasizes personalized treatment strategies that evolve with the disease progression, addressing both motor and non-motor symptoms throughout the course of Parkinson's disease.

Sources:
https://pmc.ncbi.nlm.nih.gov/articles/PMC6723065/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3367535/

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