How Parkinson’s Disease Is Treated

Close up of a senior woman having a doctors appointment

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Parkinson’s disease is a progressive neurological condition that has no cure; however, medication, surgery, and other therapies can help you manage the symptoms of Parkinson’s, often for a significant amount of time.

Treatment for this condition is typically highly individualized. Your healthcare provider will evaluate you and suggest a course of treatment based on factors like:

  • Your age, symptoms, medical history, lifestyle, and current health status
  • The type of Parkinson’s disease you have and the progression of the condition
  • Your preference, responsiveness, and tolerance of procedures, medicines, and therapies

Medication

Drug therapy is the primary form of treatment for Parkinson’s disease. Many people can maintain a good quality of life with medication.

The main aim of drug therapy for Parkinson’s disease is to increase your levels of a neurotransmitter (brain chemical) known as dopamine. Low dopamine levels are a characteristic marker of Parkinson’s disease and are responsible for the motor symptoms of this condition. Therefore, dopamine therapy can help with symptoms such as muscle tremors, muscle stiffness, and bradykinesia (slow movements).

Additionally, your healthcare provider may also prescribe medications to help increase your levels of other neurotransmitters that play a role in Parkinson’s disease and treat other symptoms of the condition, such as behavioral symptoms and nonmotor symptoms.

Medication can help improve symptoms significantly, especially at first. However, it becomes less effective over time and symptoms may reappear as the disease progresses.

Below are some of the types of medications that are used to treat Parkinson’s disease.

Levodopa and Carbidopa

Levodopa, also known as L-dopa, is the cornerstone of treatment for Parkinson’s disease. The neurons (nerve cells) in your brain use levodopa to make dopamine and replenish the brain’s diminishing supply. 

Levodopa can reduce the motor symptoms of Parkinson’s disease; however, it cannot stop the progression of the condition. 

Levodopa is typically combined with another drug, known as carbidopa. Carbidopa makes levodopa more effective and reduces its symptoms, which can include low blood pressure, nausea, vomiting, and restlessness. 

High doses or long-term use of levodopa can cause side effects like hallucinations and dyskinesias, which are involuntary bodily movements such as twisting, fidgeting, or writhing.

As Parkinson’s progresses, levodopa becomes less effective and you may find the effects wearing off before you take your next dose, in which case your healthcare provider may suggest taking lower doses more frequently.

Sinemet and Rytary are two brand-name medications containing levodopa and carbidopa. Inbrija is another brand of levodopa, which your doctor may prescribe for off episodes (when your levodopa-carbidopa medication has worn off).

Dopamine Agonists

This type of medication takes a different route than levodopa; it works by mimicking the effect of dopamine on your brain

Dopamine agonists are not as effective as levodopa in controlling symptoms; however, they work for a longer period of time. Your healthcare provider may try this medication first and then add levodopa, if needed, or combine it with levodopa.

Side effects of dopamine agonists are more common in people above the age of 70 and can include confusion, dizziness, nausea, vomiting, edema (swelling), difficulty sleeping, and an uncontrollable desire to gamble, shop, or have sex. 

Dopamine agonists include Requip (ropinirole), Mirapex (pramipexole), Neupro (rotigotine), and Apokyn (apomorphine).

COMT Inhibitors

These drugs work by blocking the catechol O-methyltransferase (COMT) enzyme, which breaks down dopamine in the brain. They are often prescribed in combination with levodopa as they slow down the rate at which your body gets rid of levodopa. This makes levodopa more effective and reduces the off periods you may face on this medication.

However, by making levodopa more effective, these medications can also increase levodopa’s side effects. Side effects of COMT inhibitors can include dizziness, nausea, diarrhea, abdominal pain, urine discoloration, sleep disturbances, low blood pressure, and hallucinations.

COMT inhibitors include Comtan (entacapone), Ongentys (opicapone), and Tasmar (tolcapone). Tolcapone can cause liver damage and needs close monitoring to prevent liver failure, so it is not prescribed often.

MAO-B Inhibitors

Like COMT inhibitors, these drugs work by blocking the enzyme monoamine oxidase B (MAO-B), which also breaks down dopamine in your brain. These medications cause dopamine to accumulate in the brain, thereby reducing the symptoms of Parkinson’s. 

MAO-B inhibitors include Azilect (rasagiline), Xadago (safinamide), Eldepryl (selegiline), and Zelapar (selegiline). Selegiline can delay the need for levodopa by approximately a year. MAO-B inhibitors can also be prescribed along with levodopa, to make it more effective and lower the chances of it wearing off.

Side effects of MAO-B inhibitors can include insomnia, nausea, and orthostatic hypotension (low blood pressure when you stand up).

If combined with levodopa, MAO-B inhibitors can increase the risk of dyskinesia and hallucinations. They are not safe for people who are on certain antidepressants and narcotic medications.

Anticholinergics

These drugs work by reducing the activity of the neurotransmitter acetylcholine. As a result, they can be particularly helpful with symptoms like tremors and muscle rigidity. 

Anticholinergics include Cogentin (benztropine) and Artane (trihexyphenidyl). Their side effects include dry mouth, blurred vision, constipation, urine retention, hallucinations, confusion, and memory loss. 

Anticholinergics are the oldest form of medication for Parkinson’s disease. However, they are not prescribed often since they can cause considerable side effects. In addition, they are not recommended for people over 70 who have memory impairment or are prone to hallucinations or confusion.

Amantadine

Amantadine can help with the symptoms of Parkinson’s as well as the dyskinesia caused by levodopa. It can be prescribed by itself in the early stages or combined with levodopa or anticholinergics. It is sold under the brand names Symmetrel, Osmolex ER, and Gocovri. 

The side effects of amantadine can include hallucinations, agitations, edema, insomnia, and mottled skin.

Surgery and Invasive Procedures

Surgery was the original method of treatment for Parkinson’s disease before levodopa was discovered. Your healthcare provider may suggest surgical options if medication is no longer effective. 

Some of the surgical options to treat Parkinson’s disease are listed below.

Deep Brain Stimulation (DBS)

DBS involves surgically implanting electrodes into the brain and connecting them to a small electrical device implanted in the chest. Like a cardiac pacemaker, the device painlessly delivers electrical impulses that stimulate the brain and block the abnormal brain activity that causes many of the motor symptoms of Parkinson’s disease.

DBS does not halt the progression of Parkinson’s and cannot help with nonmotor symptoms of the condition.

Nevertheless, DBS is an FDA-approved procedure that is widely used to treat Parkinson’s. However, it is only recommended for patients who do not respond to medication and meet strict criteria.

Pallidotomy and Thalamotomy

Originally, Parkinson’s disease was treated by selectively destroying regions of the brain that contribute to the motor symptoms of this condition. These procedures have been refined considerably over the years and can be an effective treatment; however, DBS is a preferred form of treatment, since these surgical procedures involve permanently destroying brain tissue.

Pallidotomy is the more common type of surgery; it involves selectively destroying the part of the brain known as the globus pallidus. This surgery can help with tremors, muscle stiffness, and dyskinesia. 

Thalamotomy, on the other hand, involves destroying a small part of the thalamus. This surgery can help people who have severe tremors in their hands or arms.

How to Make Your Treatment Most Effective

These are some complementary and supportive treatment strategies that can help ease your symptoms:

  • Speech therapy can address the speech disturbances caused by Parkinson’s disease and help improve speech volume and quality.
  • Physical therapy can help with symptoms such as tremors, muscle rigidity, and gait difficulties.
  • Occupational therapy can make everyday activities easier and help with the cognitive symptoms of Parkinson’s.
  • Massage therapy can help with muscle rigidity.
  • Exercise can help improve your balance, flexibility, and strength.
  • A healthy diet with plenty of fiber can help combat the digestive issues caused by Parkinson’s disease, such as constipation.
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