The Shijiazhuang patient, male, 76 years old, takes medication as follows: half a tablet of Madopar, one tablet of Taserda, and half a tablet of Xining in the morning, half a tablet of Madopar, one tablet of Taserta, and one tablet of Medopar at noon. Half a tablet, half a tablet of Xining. The main symptom now is that the right upper limb and hand are shaking more seriously when they are close to taking medicine. The constipation is also more obvious, and my sleep is not good. I can only sleep for two hours after taking diazepam. It is more difficult to fall asleep after waking up. I usually only sleep about 4 hours a day. Two knee joints have been replaced, so the joint stiffness is obvious now.

Question: Now that Xining is out of stock, how should I replace it? How to improve sleep constipation, swollen calves, and stiff knee joints?

Professor Li Weiguo’s answer:

Diazepam is of great help to many patients, but for Parkinson’s patients, this kind of sleep is relatively stable and has obvious effects. Zopiclone is relatively less addictive with long-term use.

There are many reasons for knee replacement. It may be the primary reason. The original knee joint is not good. There are also many cases where the wear and tear of the knee joint increases after getting Parkinson's disease, because the stiffness of Parkinson's disease makes the legs The muscle tension increases, and the joint compression is more obvious after the muscle tension increases. Many Parkinson's diseases are combined with cervical spondylosis and lumbar spondylosis, which are also related to increased muscle tone and impact on the knee joint. Because when Parkinson's disease lasts for a long time, there will be postural disorders, forward bending, and a hunchback. You may not be able to take a step for a long time. A lot of pressure is concentrated on the knee joint, and the wear and tear on the knee joint will be worse than It is much more obvious in normal elderly people.

It has been 5 months since this patient had a knee replacement. Two of his calves are edematous. Of course, there are some side effects of the medicine, but they are also related to the surgery.

At present, after Xining is discontinued, you can use Midobar and Codan to extend the onset time of the drug. This is a plan. You can also use Dalinfu. Of course, there are many domestically produced similar drugs that can also be used, and they can be replaced in a 1:1 ratio. In addition, if Parkinson's disease patients can still exercise, they can go out for more activities during the day to increase the amount of exercise they need for rehabilitation. When you increase the amount of rehabilitation exercise, you will sleep better at night.

What to do about frozen gait or swollen legs? You can use elastic socks to improve the weight-bearing feeling of your lower limbs. Be sure to measure your blood pressure when wearing elastic stockings. Many patients without orthostatic hypotension will have their blood pressure rise after wearing elastic stockings. As a surgeon, I perform brain pacemaker surgery every day. I stand for several hours every day. So now I wear elastic stockings, but I will find that after I wear elastic stockings, my lower limbs do feel relaxed, but my blood pressure goes up. Well, because I don’t have orthostatic hypotension, the main purpose of wearing elastic stockings is to prevent venous thrombosis in the lower limbs, but at the same time my blood pressure rises, so what should I do in this situation?

You can learn from me. I wear it when I need it. When I go to bed and lie down, I take it off. Don’t be afraid of trouble.

As for sleep disorders, you can use drugs to improve them, such as taking some zopiclone. If you sleep better, your exercise ability will be relatively improved the next day.

Correspondingly, if your current medication cannot relieve your symptoms, you can increase the medication appropriately, because for elderly patients, we do not particularly care about increasing the dose of medication. For example, you can increase Madopar a little, to 3/4. If you don't have Xinine, you can increase it. See if your symptoms improve after increasing the amount? In addition, when there are no hallucinations or other problems, you can add a small amount of amantadine.