How is Parkinson’s disease treated?
Treatment is based on the individual patient’s symptoms. A number of medications can target and significantly reduce symptoms. The work by substituting for or increasing dopamine. It is the lack of sufficient dopamine in the brain that causes most PD symptoms.
While medications can initially reduce or improve symptoms, their benefits frequently diminish somewhat, or become less consistent over time. Medications cannot slow or stop the progression of PD.
Medications may include:
Carbidopa-levodopa, the most effective, passes into the brain where it’s converted to dopamine. Side effects may include nausea, lightheadedness, and an eventual reduction in its benefits. Some people have involuntary movements (dyskinesia) when taking higher doses, but dosages can be adjusted to control this.
Inhaled carbidopa-levodopa can help manage symptoms if medications suddenly stop working during the day.
Carbidopa-levodopa infusion is given through a feeding tube that delivers it directly to the small intestine. Infusion is continuous to keep the blood levels of the two drugs constant. Feeding tube placement requires a minor surgery. Side effects include the tube falling out or an infusion site infection.
Dopamine agonists mimic the effects of dopamine, instead of supplying dopamine to the brain. Although not as effective, dopamine agonists last longer and can be used with levodopa to provide more consistent symptom relief. Side effects are similar to those of carbidopa-levodopa. Other side effects can include hallucinations, sleepiness, and compulsive behaviors (hypersexuality, gambling, eating).
Monoamine oxidase B (MAO B) inhibitors help prevent the breakdown of dopamine in the brain by inhibiting the brain enzyme MAO B. This enzyme metabolizes brain dopamine. Side effects can include headaches, nausea, insomnia, or hallucinations if taken with carbidopa-levodopa.
Catechol O-methyltransferase (COMT) inhibitors can prolong the effect of levodopa by blocking an enzyme that breaks down dopamine. Side effects are increased risk of dyskinesia, diarrhea, nausea, or vomiting.
Anticholinergics used to be prescribed to help control tremors. Their side effects include impaired memory, confusion, hallucinations, constipation, dry mouth, and problems with urination.
Amantadine is prescribed for short-term relief of symptoms in mild, early-stage PD. It’s also prescribed in late-stage PD to control dyskinesia. Side effects may include a purple mottling of the skin, ankle swelling, and hallucinations.
Other PD treatments may include:
Surgical procedures can regulate certain regions of the brain to improve symptoms. Deep brain stimulation (DBS) uses implanted electrodes in the brain that are connected to a generator implanted in the chest. It sends electrical pulses to the brain that can reduce symptoms. Benefits of DBS include stabilizing medication fluctuations, reducing or stopping dyskinesia and slowed movement, and reducing tremor and rigidity. Surgical risks include infection, stroke or brain hemorrhage. DBS is used with advanced PD patients who have an inconsistent response to levodopa.
Lifestyle changes can also help alleviate symptoms. Aerobic exercise (walking, dancing, water aerobics, etc.) can increase muscle strength and flexibility, improve balance, and help with depression and anxiety. It may also help avoid falls, which happen very easily to PD patients. Other lifestyle modifications include eating a well-balanced diet high in fiber and low in fat and sugar, maintaining a healthy weight, and limiting alcoholic beverages.
Physical therapy can help with balance, muscle strength and flexibility.
Speech-language or occupational therapists can help with speech problems, or teach techniques to make daily life easier, respectively.
Massage can reduce muscle tension and enhance relaxation.
Tai chi and yoga can improve balance, muscle strength, flexibility, and help prevent falls.