Parkinson's Disease
Treatment Overview
No known treatment can stop or reverse the breakdown of nerve cells that causes Parkinson's disease. However, drugs can relieve many symptoms of the disease. Surgery also can be effective in a small number of people to treat symptoms of Parkinson's disease.
Treatment is different for every person, and the type of treatment you will need may change as the disease progresses. Your age, work status, family, and living situation can all affect decisions about when to begin treatment, what types of treatment to use, and when to make changes in treatment. As your medical condition changes, you may need regular adjustments in your treatment to balance quality-of-life issues, side effects of treatment, and treatment costs.
Parkinson's disease causes a wide range of symptoms and complications. This topic covers the overall management of the disease. This topic does not discuss managing specific symptoms.
Initial treatment
If your symptoms are mild, you may not need treatment for Parkinson's disease. Your doctor may wait to prescribe treatment with drugs until your symptoms begin to interfere with your daily activities. Additional treatment methods (such as exercise, physical therapy, and occupational therapy) can be helpful at all stages of Parkinson's disease to help you maintain your strength, mobility, and independence.
If you do need drugs at this point, there are several options. Levodopa is considered the "gold standard" of treatment for Parkinson's disease. But levodopa can have negative effects when used long-term. Because of this, dopamine agonists such as pramipexole and ropinirole often are used first. Other non-dopamine drugs may be used early in the course of the disease. These include amantadine, monoamine oxidase inhibitors (such as selegiline), and anticholinergics (such as trihexyphenidyl). As the disease progresses, levodopa will likely need to be added.
Early in the disease, it might be helpful to take pills with food to help with nausea, which may be caused by some medicines taken for Parkinson's disease. Later in the disease, taking the medicines at least one hour before meals (and at least two hours after meals) may help them work better.
Your doctor, other health professionals, or Parkinson's disease support groups can help you get emotional support and education about the illness. This is important both early and throughout the course of the disease.
Ongoing treatment
As Parkinson's disease progresses, the symptoms usually become more disabling. Most people develop mild to moderate tremor. Movement is often slow and limited due to muscular rigidity and the slowing down and loss of automatic and spontaneous movement (bradykinesia). Treatment in this stage is determined by weighing the severity of the symptoms against the side effects of drugs.
The symptoms of Parkinson's disease change as the disease progresses. Because of this, your doctor will adjust your drugs to deal with the symptoms as they appear. Levodopa is the most commonly used drug for Parkinson's disease. However, it may cause side effects with prolonged use or high dosages. Your doctor may prescribe dopamine agonists such as pramipexole or ropinirole to delay the point at which you need to begin taking levodopa. Studies have suggested that this may delay the onset of levodopa's side effects.2, 3, 4 Your doctor may also prescribe levodopa along with a dopamine agonist.
Apomorphine (Apokyn) is a fast-acting dopamine agonist used to treat occasional episodes of immobility associated with Parkinson's disease. Apomorphine can be injected under the skin when muscles become "stuck" or "frozen" and you are unable to rise from a chair or perform daily activities. Treatment with occasional Apokyn shots may make it possible to decrease the regular amount of other medicines you are taking for Parkinson's disease. This may reduce the risk of side effects, such as twitching and other uncontrolled movements.5 Apokyn can be taken with an antinausea drug to prevent side effects of severe nausea and vomiting.
There are many measures you can take at home to make dealing with the symptoms of Parkinson's disease easier. Simplify your daily activities so that you have the energy for those that are most necessary, and arrange your furniture and other commonly used items so that it is easier for you to move around and get to things in your home. This can help keep you functioning independently.
Getting regular exercise and eating a healthy, balanced diet are important parts of treating Parkinson's disease. Exercise can help you maintain your strength, coordination, and endurance, as well as control your weight and reduce the likelihood that you will become constipated. And although a balanced diet is important, people who take levodopa should talk to their doctor about when to eat protein, because levodopa may not work as well if you take it at the same time that you eat protein.
Depression is common in people with Parkinson's disease. Recognizing and dealing with depression is an important part of home treatment. There are medicines that can help the symptoms of depression in people with Parkinson's disease.
Treatment when the condition gets worse
A person in the advanced stages of Parkinson's disease is significantly limited in movement and activity. Symptoms can change daily, and the side effects of drugs can limit their effectiveness. Your doctor may change your drug in order to deal with the symptoms as they arise.
A speech therapist can suggest breathing and speech exercises that can help you overcome the soft, imprecise speech and monotone voice that develop in advanced Parkinson's disease. Changing how and what you eat can help you overcome problems with eating. For example, sitting upright, taking small bites and sips, and eating moist, soft foods can help you avoid nutrition problems and lessen your chance of choking. Keeping your chin up, swallowing often, and not eating sugary foods can help reduce drooling.
Freezing, or motor blocks, can be dealt with through purposeful movement. Stepping toward a specific target on the ground and making your first step a precise, long, marching-style stride can help you overcome freezing episodes. A physical therapist or occupational therapist may be able to offer some helpful advice to improve your walking and reduce your risk of falling.
Other common symptoms that appear during Parkinson's disease include depression and sexual dysfunction. Talk to your doctor about ways to overcome these problems. There are medicines that can help these symptoms in people with Parkinson's disease.
You or your family members may notice that you begin to have problems with memory, problem solving, learning, and other mental functions. When these problems keep you from doing daily activities, it is called dementia. There are medicines that can help treat dementia in people with Parkinson's disease.
Surgeries such as deep brain stimulation or, less commonly, pallidotomy may be done during this stage of the disease.
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| Author: | Monica Rhodes | Last Updated: December 13, 2006 |
| Medical Review: | E. Gregory Thompson, MD - Internal Medicine Colin Chalk, MD, CM, FRCPC - Neurology | |
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