Sleep attacks PD Treatment

Latest 2023 / 2024

Sleep attacks & PD Treatment

• Overwhelming & Irresistible sleepiness that comes on without

warning. (Sleep attacks should not be equated with the normal sleepiness that occurs with dopaminergic agents)

Medications that cause sleep attacks

• Pramipexole, ropinirole, rotigotine & apomorphine

Bromocriptine side effects & management

• The most common dose-limiting effects are psychological reactions

(Confusion, nightmares, agitation, hallucinations, paranoid delusions). Therefore, if present, dosage needs to be decreased.Nausea can be helped with taking food.Can cause dyskinesia and postural hypotension. Rarely, bromocriptine causes retroperitoneal fibrosis, pulmonary infiltrates a Raynaud-like phenomenon, and erythromelalgia (vasodilation in the feet and sometimes hands, resulting in swelling, redness, warmth, and burning pain)

Use of levodopa/carbidopa in treatment/diagnosis

• Levodopa is the most effective drug for PD. At the beginning of

treatment about 75% of patients experience a 50% reduction in symptom severity. Levodopa is so effective, in fact, that if a diagnosis of PD should be questioned if the patient fails to respond. 1 / 2

Phenytoin (Dilantin)

• Anticonvulsant

Therapeutic levels (10-20 ug/mL), sedation and other CNS effects are mild. At plasma levels of 20+ toxicity can occur. Nystagmus (Continuous back-and-forth movements of the eyes) is relatively common. Other manifestations of excessive dosage include sedation, ataxia (staggering gait), diplopia (double vision) and cognitive impairment.

Gingival Hyperplasia

• Associated with phenytoin. Patient teaching is good oral hygiene,

including dental flossing and gum massage can reduce the risk of developing side effect

Morbilliform & Phenytoin

• Rarely developed rash. Seen with genetic mutation known as Hyman

leukocyte antigen (HLA) - B*1502. Therefore, this medication should not be given to patients with this mutation.

Antiseizure drugs and oral contraceptives

- Decrease the effectiveness of oral contraceptives: Carbamazepine,

eslicarbazepine, lamotrigine, oxcarbazepine, phenytoin, phenobarbital, rufinamide, and topiramate. If it is necessary to prescribe these meds, it is important to advise the patient of the risks and need for backup contraceptive.

Nurul tube defects

• Increase folic acid before conception and throughout pregnancy if

patient is on antiseizure drugs.

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