How Parkinson's Disease Is Treated

The treatment options for Parkinson's disease include several different medications, surgical procedures, and physical therapies. What's appropriate for you depends on the symptoms you're experiencing and how severe your disease is. You will most likely benefit from treatments for your tremors and other motor symptoms, but other options for some of the non-motor effects of Parkinson's disease (e.g., sleeping problems, pseudobulbar affect, and trouble swallowing) may also be beneficial for you.

Prescriptions

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

• Sinemet, Duopa, Rytary (levodopa and 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. The addition of carbidopa in these combination drugs keeps levodopa from being broken down to its active form systemically in the body. This enhances the beneficial effects of dopamine on the brain while reducing the side effects of dopamine on the rest of the body.
• Inbrija (levodopa inhalation powder): This medication is a fast acting and short acting levodopa formulation that can be taken during off-periods—when the effects of oral levodopa containing medications wear off.
• Dopamine agonists: Medications such as Mirapex (pramipexole), Requip (ropinirole), and Kynmobi (apomorphine HCl) sublingual film directly imitate the effects of dopamine to reduce the symptoms of Parkinson’s disease.
• Tasmar (tolcapone) and Comtan (entacapone), Ongentys (opicapone): These medications, described as catechol-O-methyltransferase (COMT) inhibitors, prolong the action of levodopa by preventing its breakdown in the bloodstream so that more of the medication will be available to enter the brain. They are used to prevent the off-periods that can occur in between levodopa/carbidopa doses.
• Eldepryl, Zelapar (selegiline) and Azilect (rasagiline), Xadago (safinamide): This group of medications are called Monoamine oxidase (MAO-B) inhibitors. They prevent the breakdown of dopamine in the brain, allowing it to function for a longer period of time. It is used in combination with levodopa/carbidopa.
• Nourianz (istradefylline): This medication is an adenosine receptor antagonist, which means that it blocks adenosine receptors. Experts aren't yet sure why this action helps improve motor symptoms of Parkinson's disease. This medication is taken once per day for people who have off periods.
• Gocovri (amantadine): This medication increases the amount of dopamine in the body and brain and has been used for the 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.
• Anticholinergic drugs: Artane (trihexyphenidyl) and Cogentin (benztropine) are examples of these medications, which work by blocking a chemical messenger called acetylcholine. These medications are most helpful in treating younger people with Parkinson’s disease and those whose main symptom is tremor. They are usually given in addition to other drugs for Parkinson's disease.
• Neuroprotective agents: While not currently used in treatment of Parkinson's disease, medications that could have neuroprotective properties, such as glutamate inhibitors, are being investigated as possible treatments that may help prevent disease progression.

Off Periods

Off periods are common in Parkinson's disease, especially during late stages of the disease. These are periods during which symptoms of Parkinson's disease return, and they typically occur before the next dose of levodopa containing medication is due.

For some people, symptoms of off periods are mild. However, off periods can be severe, with debilitating symptoms.

Medications used to help manage off periods include those that prolong the action of levodopa, as well as dopamine agonists. These treatments are used on a daily basis with a schedule of levodopa containing treatment.

On Demand Therapy

For some people who experience unpredictable off periods with severe symptoms, on-demand therapies can be used for rapid relief. On demand therapies are used as needed, rather than on a schedule.

On demand treatments for Parkinson's disease include Inbrija, which is inhaled, and Kynmobi, which is taken under the tongue. Both of these are rapidly absorbed in the body and work more quickly than oral Parkinson's medications.

Sometimes infusion of levodopa/carbidopa intestinal gel is administered for treating off periods that are resistant to other methods of management.

Management of Medication Side Effects

Many of the treatments that are commonly used for treatment of Parkinson's disease may produce distressing side effects. Hallucinations can be a side effect of Parkinson’s medications and some people may need to take antipsychotic medications to reduce them.

Dyskinesias are involuntary movements that often result from long-term use of Parkinson’s disease medications. Gocavri is approved for treatment of dyskinesia in Parkinson's disease, and surgery is another potential treatment for this side effect.

Treatment for Associated Issues

Medical problems such as depression, insomnia, pseudobulbar affect (unexplained crying), dementia, and others are common in people with Parkinson's disease. As such, you may require treatment to manage them in addition to what's prescribed for your Parkinson's symptoms.

For example, Exelon is approved for treating dementia in Parkinson's disease.

Over-the-Counter (OTC) Therapies

Your healthcare provider may recommend OTC therapies for various symptoms and complications of Parkinson's disease. For example:

• Pain relievers may be used for muscle or nerve pain.
• Fiber supplements may be recommended for constipation.
• People with Parkinson's disease may develop difficulty in swallowing, with food and drink going down the wrong pipe and into the airway, rather than the stomach. Using thickeners for liquids can help prevent this problem.
• Your healthcare provider may recommend vitamin D or calcium supplements to help maintain your bone health, as people with Parkinson's disease are increasingly at risk from falls and fractures.

Surgery and Specialist-Driven Procedures

Surgical options and other procedures may be considered when medications have not been successful.

Deep brain stimulation (DBS) has been used to control some of the symptoms of Parkinson's disease (including dyskinesia) when they cannot be controlled by medication alone. The surgery to implant the devices necessary to receive DBS is the most common one done for Parkinson's.

Electrodes are placed on either or both sides of the globus pallidus or the subthalamic nucleus. A generator is then implanted in the upper chest region and programmed to control the delivery of electrical stimulation. The battery requires replacement every few years.

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 consider, so the decision to proceed with DBS—should you be a candidate—should be made carefully.

Other options that may be considered or that are currently being researched include:

• Lesion surgery: Rather than implanting a stimulator, a lesion is created in one of the regions of the brain that are responsible for Parkinson's symptoms.
• Repetitive transcranial magnetic stimulation (rTMS): This is being studied as a therapy for Parkinson's disease. It is a non-invasive procedure that has been used as an FDA-approved alternative treatment for depression. In the procedure, a coil sends magnetic pulses into the brain. The patient is fully awake and not sedated during the procedure.
• 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.

Movement Therapies

Many people who have Parkinson’s disease experience a degree of improvement in 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

Physical Therapy

There are several physical therapy modalities used for Parkinson's disease. One type is called "training big," in which you make exaggerated movements in walking. Using reciprocal patterns such as swinging your arms when walking is another therapeutic practice.

A physical therapist can also work with you on balance exercises, stretching and flexibility, and strength training routines.

Occupational Therapy

An occupational therapist (OT) aims to help you function well in your daily life so you can enjoy your preferred activities as well as perform the basics of self-care.

If you are living at home, the OT may pay a visit to evaluate your home environment, as well as to observe you in performing activities. Then the OT can coach you on alternate ways to perform tasks as well as aids and environmental adaptations. These can allow you to be as independent as possible while also addressing any safety concerns.

Speech Therapy

Parkinson's disease can lead to speech impairments and difficulty swallowing, both of which can be addressed by speech therapy. Lee Silverman Voice Treatment is one program that may be provided. A speech-language therapist can work with you to assess swallowing problems and communication problems and provide techniques or aids to help.

Home Remedies and Lifestyle

Healthy eating can help ease your symptoms when you have Parkinson's disease. As you may have constipation due to the condition, eating enough fiber and drinking plenty of fluids will help. You may also feel fuller after eating less food, so planning smaller meals and snacks throughout the day is best.

Omega-3 fatty acids, such as found in seafood and fish oil supplements, are being studied to see if they have any beneficial effects in Parkinson's disease. A Mediterranean-style diet is one that is rich in omega-3 fatty acids, monounsaturated fats (as from olive oil), and a good balance of nutrients. While more research is needed to determine if it offers a specific benefit for PD, the diet is considered a healthy eating plan for everyone.

Exercise is important with Parkinson's disease. It can help you maintain your strength, flexibility, and balance. One form of exercise that seems especially beneficial in Parkinson's disease is dance. Consider taking some lessons to help improve your balance, mobility, and quality of life, if even just for the short term.

Tai chi may help improve balance, stability, and walking in people with Parkinson's disease, although the results of studies are mixed. The good news is that it is safe and can be enjoyable. Yoga is also often suggested. Be sure to talk with your healthcare provider and ensure your instructor is modifying any exercises as needed for your condition.

As Parkinson's disease progresses, you will need to adopt practices aimed at preventing falls and allowing you to still perform your daily living activities. It is good to work with a physical therapist and occupational therapist to get the coaching and assistive devices that can work best.

Complementary and Alternative Medicine (CAM)

There isn't strong evidence that massage is beneficial for Parkinson's disease, but it might help reduce muscle tension and can help you relax.

Acupuncture and dietary supplements have not been found to be effective in controlling the symptoms of Parkinson's disease. In particular, research has shown coenzyme Q-10 and creatine had no effects beyond that of placebos. Vitamin E supplements raised concerns that they could be harmful in Parkinson's disease.

Some patients find that medical marijuana or CBD oil helps with symptoms of pain and may help improve sleep, but there is no specific evidence supporting benefits.

A Word From Verywell

Most people with Parkinson's disease experience improvement and reasonable control of symptoms with medication, therapy, surgery, or a combination of these approaches. However, people usually continue to experience some symptoms, which can progress, despite medical or surgical treatment. Parkinson's requires ongoing, long-term attention. But, for the most part, people who have this disease are able to have productive lives and often can continue to work and take part in social activities and hobbies.