Skip to main content

Rotigotine

One of the drugs that is prescribed for me to help manage my Parkinson's disease is Rotigotine. Since the causes of Parkinson's are not well defined, all currently approved Parkinson's medication, including Rotigotine, are limited to treating the symptoms. Rotigotine is a dopamine agonist. Wikipedia describes an agonist as:

a chemical that binds to a receptor and activates the receptor to produce a biological response.

Rotigotine is supplied as transdermal patches, in other words, sticky patches which you stick to your skin so that the drug may be gradually absorbed. Nicotine patches are another type of transdermal patch that you might be more familiar with.

If I have understood it correctly, the Rotigotine molecules have a similar shape to dopamine which means that, once they enter the blood supply, they can bind to the same receptors as dopamine (i.e. the dopamine receptors). I think their shape also means that our brains recognise the Rotigotine molecules as dopamine so it can use them in the same way so that the Rotigotine is effectively mimicking dopamine.

Rotigotine

Rotigotine molecule structure

Dopamine

Dopamine molecule structure

Comparing the 2D structure of the two molecules you might well say "they don't look alike at all," to which I would reply "good point." The 2D representations aim to show the constituent components in a simplified form. Due to the myriad ways that molecules can fold, it is much more difficult to predict 3D structure based on its chemical formula. I guess that Rotigotine must fold in such a way that at least one of its surfaces is a good enough likeness for dopamine so that it fits the same receptor. Wikipedia shows that, while Rotigotine is a very good match for some of our dopamine receptors, it performs less well for others.

I apply my patches every morning after brushing my teeth. I say 'every morning' but part of the reason that it is on my mind is that I quite often forget, especially at weekends when my day is less structured. I'm lucky that my symptoms are not so advanced that I can still get away with this for a little while and still go about my daily routine. 

These unintended breaks trigger several effects and offer an interesting glimpse into how the medication affects us. The most obvious and predictable is a worsening of the symptoms that Rotigotine is designed to treat. On Saturday, I was trying to help my daughter lace up some boots that she was trying on and I noticed that the dexterity in my right hand was worse than normal. There are good days and bad days with Parkinson's so I didn't think too much about it.

Later that day, I became incredibly tired. Sleep has become a bit of a paradox. Without medication, I feel tired but I can't seem to sleep. With Rotigotine, I can sleep better but its like my mind won't let me. I find endless, pointless things to do before I go to bed and wake up early with a list of things that I need to do, nagging at me. The Rotigotine keeps me switched on far longer than normal and I push sleep away into a corner. After a day without it, that pile of sleep comes crashing back down on me suddenly and I just have to sleep, whatever else I was supposed to be doing.

As I sleep, I have brightly coloured, vivid dreams that start happily enough until I realise that, although I am in the company of friends or family, they can't see me or hear me, as if I am a ghost. Around this stage, part of me realises that I am dreaming and, if I am not alone, I become aware of noises and voices but my body is so weary that I can't properly emerge from sleep. I try to speak but my words are indecipherable slurs.

Having, eventually come round, there follows a period where I actually feel normal. When I tweeted that I felt like myself for the first time in months, I was interested to find that I'm not alone in having that sensation.

It felt like I could finally switch off some of the thoughts that had been nagging at me for months.

This, like many of the entries in this blog, is my attempt to understand some of the science concerning Parkinson's disease. Apologies for any inaccuracies, I'm happy to be corrected if you would like to let me know via Twitter or in the comments section at the bottom of the page.

Comments

  1. Very interesting the trade off between feeling yourself and reducing the symptoms.

    ReplyDelete

Post a Comment

Popular posts from this blog

The Conversation

"How are you doing? Lovely day isn't it?" I had been lost in a storm of competing questions not including the state of weather when I encountered this friend in the corridor. Sunshine apart, this was turning out to be well down the list of my favourite days. "Yes, it's nice isn't it?" I said. Back in the office another friend asked how my appointment had gone. "I've got Parkinson's". "No, you haven't". From an early age we learn to look on the bright side and reassure each other that everything is going to be alright. We are less prepared for the occasions where a situation is not going to improve but we all need to have those conversations at various points in our lives. I had the conversation with my family that evening and I was touched by their love and support. We talked about the pros and cons of letting work know. British law tries to protect the disabled from workplace discrimination for examp...

I Heard it Through the Grapevine

My neurologist is a very nice man. He listens well and is faultlessly polite. It is the sort of job where compassion and good observation are called for and he has both in abundance. I think we get on pretty well. At each appointment he asks me to run through a series of exercises to see how my Parkinson's is progressing. There's "play the piano" - hold your hands level and wiggle your fingers as if playing an imaginary keyboard. The Neurology pianoes were never going survive Andrew Lansley's sweeping NHS reforms as part of David Cameron's government's austerity measures and there is a slight downward trend in the number of organ donations in the UK. In another test he stands behind me and pulls me backwards to see how well I resist. As far as I can tell, he has never made the rabbit ears gesture behind my head or made silly faces. I suppose I don't really know but it doesn't feel like it. This test requires tr...

Black Dog

I used to think that the surest way to kill a conversation was to announce "I work in Computing." Panic would grip my respondent and their eyes would dart around the room like a trapped animal. "Err, I'm just going to get another drink," they might say after hastily draining their glass. They would slope off before latching onto someone (anyone) else. I was wrong. There were occasions where somebody had a problem that they thought I might be able to help with so we would talk for a while at least. In my last blog entry I described how Parkinson's was affecting my concentration and how that was making it difficult to do my job. At the time I was hopeful that I would be able to push through those problems and persevere but it hasn't turned out that way. I've been off sick for some time now as we seek a resolution. I keep busy by doing stuff around the house and garden (you probably would not believe m...