From the Research
For behavioral management in a patient with Parkinson's disease and acquired brain injury (ABI), quetiapine is often the preferred sedating medication, as it has a lower risk of worsening Parkinson's motor symptoms compared to other antipsychotics, as supported by the most recent study 1.
Key Considerations
- The patient's condition requires careful management of sedation to avoid exacerbating Parkinson's symptoms or causing excessive sedation, falls, or cognitive decline.
- Non-pharmacological approaches, such as environmental modifications, consistent routines, and caregiver education, should be implemented first.
- Quetiapine's relatively weak dopamine D2 receptor blockade makes it a favorable option for patients with neurological conditions.
Recommended Treatment
- Start with a low dose of quetiapine, typically 12.5-25mg at bedtime, which can be gradually increased as needed to 50-100mg daily, divided into two doses if necessary.
- Use quetiapine for the shortest duration possible to manage acute behavioral disturbances, with regular reassessment every 1-2 weeks.
Alternative Options
- Clozapine (starting at 6.25-12.5mg at bedtime) or low-dose lorazepam (0.5-1mg) may be considered for short-term use, but these carry additional risks, as noted in studies 2 and 3.
- Pimavanserin, a selective serotonin inverse agonist, may be an alternative option, but its use is still emerging, and more research is needed to fully understand its benefits and risks, as discussed in 1.
Monitoring and Follow-up
- Close monitoring is necessary to assess the patient's response to treatment and potential side effects, such as worsening of Parkinson's symptoms, excessive sedation, falls, and cognitive decline.
- Regular follow-up appointments should be scheduled to reassess the patient's condition and adjust the treatment plan as needed.