You and your neurologist have a number of options for medications that treat Parkinson's disease symptoms. Anticholergenics are one of the second-line medications that aid some people with Parkinson's. They address an imbalance between acetylcholine and dopamine in the Parkinsonian brain. A simple analogy illustrates this imbalance.
Imagine you travel to New Orleans, to enjoy some fantastic live jazz. Upon the night of your arrival you go to the French Quarter to one of the renowned jazz clubs. You sit down and start to take it all in. The ensemble at the club that evening is the perfect mix of talent and teamwork between saxophonist, drummer, trumpet player, bassist, and pianist. The trumpet player and saxophonist balance each other perfectly.
After about 30 minutes, you notice something has gone wrong. One of the valves on the saxophone fails, and the experienced musician wisely falls back to take a smaller role within the group. He plays softer, and decides not to take on complicated music runs. Even with the easy music, he frequently fumbles as his instrument fails to behave the way he expects. It is a disappointment to see an accomplished musician sidelined by a minor fault in his instrument.
The trumpet player notices that saxophonist is seriously hobbled by his instruments limitations, but the show must go on. So, he continues to play as he normally would. This messes up the balance of the ensemble. You notice the trumpet even overcompensates for the loss of the saxophone. You wonder if the trumpet player should pull back and lay a little lower to match the diminished saxophonist. Maybe the drummer, bassist and pianist could compensate for the diminished presence of the saxophone, if only the trumpet player would let them.
Let's translate this analogy to Parkinson's disease. Each instrument is a neurotransmitter. The ensemble of neurotransmitters in the brain works together to orchestrate movements, thoughts, memory, and body processes. The saxophone in this analogy represents dopamine; it is compromised with the onset of Parkinson's disease. The trumpet represents acetylcholine, another vital neurotransmitter. A balanced ensemble that includes dopamine and acetylcholine creates fluid movement in the body.
When the onset of Parkinson's disease destroys the majority of dopamine neurons, the brain fails to adjust the levels of acetylcholine. Much like the trumpeter in the analogy, acetylcholine often appears to overcompensate for the loss of dopamine, causing additional trouble and frustration for a person living with Parkinson's disease.
Tuning Down the Acetylcholine Volume
You doctor may be able to restore some balance back into your life by reducing the amount of acetylcholine in your brain—turning down the volume of the trumpet, so to speak. This may help dopamine and other neurotransmitters find a better balance and work together with more harmony.
Anticholergenics are the subclass of drugs that physicians use to turn down the acetylcholine volume. Two popular antichoergenics include Cogentin(benztropine mesylate) and Artane (trihexyphenidyl). This is a strategy physicians tend to use early in Parkinson's disease. It allows them to delay a dopamine replacement strategy until later on in the disease process when more symptoms appear. Anticholergenics seem to be most effective at treating tremors that appear as initial signs of Parkinson's disease, but have limited success with other symptoms.
If you have recently learned about your Parkinson's disease diagnosis, you have a few options including levodopa, a dopamine agonist, or an MAO inhibitor. An anticholergenic may be helpful as well. If you have been living with Parkinson's disease for a while, your doctor may prescribe an anticholergenic. If so, he or she is working to help you achieve better balance between the ensemble that makes up much of who you are.
Souces:
Parkinson's Disease Foundation
Medline Plus
We Move
