How Parkinson's Disease Is Treated

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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.

Prescriptions

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.

Many of the treatments that are commonly used for Parkinson's disease may also produce side effects. Hallucinations can be as 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. There are prescription medications that can reduce dyskinesias, as well as surgery.

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

Over-the-Counter (OTC) Therapies

Your doctor may recommend OTC therapies for various symptoms of Parkinson's disease. These may include pain relievers, fiber supplements, and thickeners that can help if you have difficulty swallowing.

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 doctor 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.

Be sure to discuss any OTC medications, supplements, or herbal products with your doctor. Some can interact with your prescription medications.

Surgery and Specialist-Driven Procedures

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 (including dyskinesia) 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.

DBS devices include electrodes positioned in either one or both sides of the globus pallidus or the subthalamic nucleus. A generator is implanted in the upper chest region and is programmed to control the correct electrical stimulation. The battery requires replacement every few years.

There are a few other surgical procedures that may also be considered for the management of dyskinesia. Rather than implanting a stimulator, a lesion is created in one of the regions of the brain that are responsible for Parkinson's symptoms. Your treatment team will discuss whether you are a candidate for DBS or lesional surgery.

Repetitive transcranial magnetic stimulation (rTMS) 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.

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.

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

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.

A high protein meal and dairy foods can slow the absorption of the Parkinson's drug levodopa (making is less effective in controlling symptoms), so it is often better to have protein later in the day. If you are avoiding dairy, you may want calcium-fortified alternative milks (such as soy or rice milk), or taking a calcium supplement.

Exercise is important with Parkinson's disease. It can help you maintain your strength, flexibility, and balance. You can enjoy walking, swimming, stretching, and more. One form of exercise that seems especially beneficial in Parkinson's disease is dance. Even if you've never enjoyed it, consider taking dance lessons as it can help, at least in the short term, with balance, mobility, and quality of life.

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.

Taking care of a pet is one lifestyle remedy that can help keep you active and flexible.

Complementary Alternative Medicine (CAM)

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 doctor and ensure your instructor is modifying any exercises as needed for your condition.

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.

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.

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Article Sources

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