Treatment Options for Parkinson's Disease

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Parkinson's disease is characterized by a number of physical symptoms that can be well-controlled and managed. The treatment options for Parkinson's disease include several different medications, surgical procedures and physical therapy.

If you have Parkinson's disease, you will most likely benefit from treatment for your tremors and other motor symptoms, and you may also need treatment for some of the non-motor effects of Parkinson's disease, such as sleeping problems, pseudobulbar affect, and trouble swallowing.

Many of the treatments that are commonly used for Parkinson's disease may also produce side effects. If the side effects of your Parkinson's disease treatments are particularly bothersome for you, then you might also benefit from taking prescription medications that are aimed at controlling them.

Medications for Control of Parkinson's Disease Symptoms

The most common symptoms of Parkinson's disease include tremors, stiffness, and balance problems.

One of the main root causes of Parkinson’s disease is a diminished amount of dopamine, an important neurotransmitter, in the brain. Most of the medications used to control symptoms of Parkinson’s disease symptoms are aimed at replacing dopamine or optimizing its action in the brain:

  • Levodopa/carbidopa - Levodopa converts to dopamine in the body. When it reaches the brain, it has a beneficial effect on the symptoms of Parkinson’s disease. Carbidopa keeps levodopa from being broken down to its active form in the body, which reduces the side effects of dopamine on the body, and enhances the effects of dopamine on the brain.
  • Tolcapone and entacapone - These medications work by prolonging the action of levodopa and thus they can be added as prescription therapies for people who are taking levodopa/carbidopa.
  • Dopamine agonists - Medications such as pramipexole and ropinirole directly imitate the effects of dopamine to reduce the symptoms of Parkinson’s disease.
  • Amantadine - This medication increases the amount of dopamine in the body and brain and has been used for treatment of Parkinson’s disease symptoms. It is also helpful in treating  dyskinesia, which is one of the potential side effects of long-term use of levodopa.
  • Selegiline - This medication prevents the breakdown of dopamine, allowing it to function for a longer period of time.
  • Trihexyphenidyl and benztropine (anticholinergics) - These medications work by blocking a chemical messenger called acetylcholine, which is found in the brain and body. These medications are most helpful in treating younger people with Parkinson’s disease, or people whose main symptom is tremor.

Medical Problems Associated With Parkinson's Disease

Some medical problems are common for people with Parkinson's disease. If you have Parkinson's disease, you might also need medical treatment for one of the following conditions in addition to the treatment that you receive for control of the tremors, muscle stiffness, and balance problems of Parkinson’s disease:

  • Depression
  • Insomnia 
  • Restless legs
  • Low blood pressure 
  • Dementia 
  • Pseudobulbar affect
  • Dry skin 
  • Swallowing difficulties
  • Constipation

Non-medical Therapy for Parkinson's Disease 

Many people who have Parkinson’s disease experience a degree of improvement of some of the symptoms with the help of physical, occupational, and speech therapy.

The symptoms of Parkinson’s disease that can be reduced with therapy include:

  • Muscle stiffness and rigidity
  • Balance problems
  • Speech difficulty
  • Swallowing problems

Surgery for Parkinson's Disease

Deep brain stimulation (DBS) using a surgically placed device in the brain has been used to control some of the symptoms of Parkinson's disease when they cannot be controlled by medication alone. This approach is beneficial for some people with Parkinson’s disease, but usually people who have DBS still need to take some prescription medications even after the procedure. There are a number of pros and cons to DBS.

Side Effects of Parkinson's Disease Treatment

There are a few common side effects that are caused by the medications used to treat Parkinson's disease. If your medications are effective in reducing your Parkinson’s disease symptoms, your doctor might be able to decrease your dose or switch to another prescription.

But, even if you experience side effects, you will probably not be able to completely discontinue taking medications for Parkinson’s disease, or else your symptoms will return. This means that you may need to take additional prescription medications to control the side effects that you are experiencing. The most common side effects of Parkinson's medications are:

  • Hallucinations – Hallucinations are false visions or sounds. Many medications used to treat Parkinson’s disease can cause an imbalance of dopamine, resulting in excessive dopamine activity in the brain, which produces hallucinations. Some people who experience hallucinations as a side effect of Parkinson’s medications may need to take antipsychotic medications to reduce the hallucinations.
  • Dyskinesia – Dyskinesias are involuntary movements that often result from long-term use of Parkinson’s disease medications. Dyskinesias may occur as sudden movements, and may also manifest as slow, writhing movements. Dyskinesias can be bothersome, but they also may be physically uncomfortable or painful. There are prescription medications that can reduce dyskinesias, and sometimes DBS is used as way to reduce the need for Parkinson’s medications.
  • Wearing off – Many people who have Parkinson’s disease notice that the symptoms become worse in between medication doses. This experience may be described as ‘wearing off’, ‘off time’ or ‘off syndrome,’ and it is managed by adjusting medication doses and timing, as well as by adding medications that prolong the action of dopamine. Surgery is among the approaches used to manage wearing off.

Is There a Cure for Parkinson's Disease?

Currently, there is no cure for Parkinson's disease. The medications, surgery, and therapeutic interventions are aimed at controlling symptoms. Parkinson's disease is a degenerative condition, which means that it naturally gets worse over time.

If you have been diagnosed with Parkinson's disease, this means that you will very likely need to have a surgical procedure or take medication for the long term. Often, because of the way the disease progresses over time, many individuals who are living with Parkinson's disease need changes in the dose or type of prescriptions and therapy over time.

New Directions in Parkinson’s Disease

Stem cell therapy and gene therapy are two of the new concepts in Parkinson's disease research. Thus far, these approaches have not become accessible to patients, except for possibly in a research setting.

A Word From Verywell

Parkinson's disease is an illness that requires ongoing, long-term attention. If you have been diagnosed with Parkinson’s disease, your speed and dexterity may decline over time, and you need to pay special attention to avoid situations that could put you in danger if you lose your balance.

Most people with Parkinson's disease experience improvement and reasonable control of symptoms with medication, therapy, surgery, or a combination of these approaches. However, usually, people with Parkinson’s disease continue to experience some of the symptoms despite medical or surgical treatment.

For the most part, people who have Parkinson's disease are able to have productive lives and often can continue to work and take part in social activities and hobbies.

Source

Oertel W Schulz JB, Oertel W, et al, Current and experimental treatments of Parkinson disease: A guide for neuroscientists,. J Neurochem. 2016.

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