Guideline issued for treating sleep, constipation, sexual problems in Parkinson's disease

The guideline is published in the March 16, 2010, issue of Neurology®, the medical journal of the American Academy of Neurology.

"While the main symptom of Parkinson's disease is movement problems, there are many other symptoms to be aware of, including sleep disorders, constipation, and problems with urination and sexual function," said lead guideline author Theresa A. Zesiewicz, MD, with the University of South Florida in Tampa and a Fellow of the American Academy of Neurology. "Without treatment, these symptoms can cause as much pain and discomfort as movement problems and greatly affect daily routines and quality of life."

Sexual problems often affect people with Parkinson's disease. In men with Parkinson's, erectile dysfunction is common. According to the guideline, the drug sildenafil citrate may improve erectile dysfunction. The guideline also found the drug isosmotic macrogol may improve constipation in people with Parkinson's disease.

For problems with excessive daytime sleepiness, the guideline recommends that doctors consider the drug modafinil to help people feel more awake. However, it's important to note that one study showed people taking modafinil had a false sense of alertness. This may pose a safety risk for activities such as driving. The guideline also found the drug methylphenidate may help with fatigue.

The guideline mentions two tests to help identify nonmotor symptoms of Parkinson's disease. One is the NMSQuest rating scale. The other is the Unified Parkinson's Disease Rating Scale (UPDRS). The original UPDRS mainly tests for movement problems. Doctors use the updated version of the UPDRS to test for all Parkinson's symptoms, including those unrelated to movements. People with Parkinson's disease should talk to their doctor about whether these tests may be helpful.

"More research is needed into these symptoms of Parkinson's disease since there are still a lot of unknown answers as to what causes these symptoms and how they can best be treated to improve lives," said Zesiewicz.