Treatment Options for Parkinson’s Everyone With The Disease Should Know About

Marygrace Taylor
·6 mins read
Photo credit: Jamie Grill - Getty Images
Photo credit: Jamie Grill - Getty Images

From Good Housekeeping

One of the first things most people learn after they or a loved one gets diagnosed with Parkinson’s disease is that treatment options aren’t one-size-fits-all.

While the cause of the long-term neurodegenerative disorder remains unknown, Parkinson’s symptoms are believed to stem from the brain making less of the chemical messenger dopamine. That can lead to movement issues like tremors, stiffness, slowness, and instability—rendering basic activities of everyday living such as walking, talking, and getting dressed much, much harder, according to the National Institute of Neurological Disorders and Stroke (NINDS).

The majority of therapies work by boosting dopamine levels in the brain, which can keep more of those symptoms under control. But finding the best plan can involve some trial and error. “No two Parkinson’s patients are alike. There are a lot of nuances to treatment, and there’s some artistry to it,” says Elana Clar, MD, a neurologist and movement disorder specialist at the North Jersey Brain and Spine Center in Hackensack, NJ.

Fortunately, knowing where to start—or when to take a different direction when your current treatment becomes less effective—doesn’t have to be overwhelming. Here’s a look at some of the most powerful medications and surgeries, plus who they can help the most.

Every Parkinson’s patient is different, and figuring out how to best manage your symptoms can take some trial error. That's why it’s important to work closely with your doctor to figure out what’s the best option for you.

Levodopa

Also called L-dopa, it’s considered the gold standard therapy for Parkinson’s. “Currently there is nothing more potent,” says William G. Ondo, MD, Director of the Movement Disorders at Methodist Neurological Institute in Houston. “Almost everyone with Parkinson’s will go on levodopa at some point.”

A central nervous system agent, levodopa works by helping nerve cells make more dopamine to boost the brain’s diminished supply. According to the NINDS, that, in turn, temporarily eases or minimizes stiffness, tremors and slowness of movement. It’s often taken with caridopa, a drug that works by preventing L-dopa from being broken down before it reaches the brain, according to the U.S. National Library of Medicine. This allows patients to take a lower dose of levodopa, so they experience fewer side effects like nausea and vomiting.

The risks

Levodopa can slow the progression of Parkinson’s, but it won’t stop it completely. As a patient’s symptoms progress, most also have to increase their dosage over time. That can cause them to experience dyskinesia—uncontrolled swaying, twisting or fidgeting, notes Dr. Clar. Taking levodopa for more advanced symptoms also increases the chance of it wearing off—Parkinson’s speak for a worsening of symptoms as one dose wanes before it is time for the next one.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

COMT inhibitors

Levodopa and caridopa alone can sometimes be used to treat earlier-stage symptoms. But as symptoms progress and patients start to experience wearing off, additional therapies, called adjunctive treatments, are often needed to help levodopa doses last longer. “Adjunctive drugs lengthen the life of levodopa," Dr. Clar explains. "So you don’t feel that wearing-off as profoundly.” Enter COMT inhibitors, which work by fighting catechol-O-methyltransferase, an enzyme that, the NINDS notes, causes dopamine to break down.

The risks

Since COMT inhibitors can cause side effects like nausea, diarrhea, and even hallucinations, it’s important to weigh the benefits and risks with your doctor.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

MAO-B inhibitors

Think of MAO-B inhibitors as dopamine protectors: They fight monoamine oxidase B, an enzyme that destroys dopamine, to reduce dopamine breakdown in the brain and encourage more to build up. And both of those things can go a long way towards reducing symptoms.

“MAO-B inhibitors can be used in anyone, but can be an especially good first-line option for patients under 70, since the drugs can have more side effects in elderly patients,” says Dr. Ondo. In fact, starting on the MAO-B inhibitor selegiline can help patients go up to a year longer before needing to start on levodopa at all, says the NINDS.

They’re not just for patients with early symptoms, though. A 2017 review concluded that selegiline and other MAO-B inhibitors like rasagiline can also be given as the disease progresses, as an adjunctive therapy to levodopa to help it work better and reduce off periods.

The risks

MAO-B doesn’t have a reputation for causing major side effects. But for some, it can cause nausea, trouble sleeping, or low blood pressure, says the NINDS.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Dopamine agonists

While levodopa helps the brain produce dopamine, dopamine agonists work by mimicking the job that dopamine does in the brain. They, too, can ease symptoms like stiffness, tremors, and movement slowness. “They aren’t quite as potent as levodopa,” says Dr. Ondo. “But they don’t cause dyskinesia, and they have advantages such as improving mood.” What’s more, research shows that starting off on dopamine agonists alone could help patients hold out longer before starting on levodopa.

The risks

Dopamine agonists have the potential to cause some pretty serious side effects. In addition to nausea and vomiting, they can cause hallucinations and increase impulsivity, says Dr. Ondo. So it’s crucial to carefully weigh the pros and cons with your doctor before starting it.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Deep brain stimulation (DBS)

When medications alone aren’t enough to manage a patient’s motor symptoms, help can come in the form of deep brain stimulation. For the 10% to 20% of patients Dr. Ondo estimates are good candidates, it’s an option worth considering.

DBS is a surgical option that involves implanting electrodes in the brain and connecting them to a small electric device in the chest. The electrodes and the electric device work together to normalize electric signals in the brain to ease movement symptoms such as tremors and stiffness.

The risks

DBS traditionally delivers constant electric stimulation to the brain, which can cause side effects like headache and confusion and increase the risk of seizures and stroke. But there’s hope that emerging technologies such as adaptive DBS—where signals are delivered in a dose-responsive fashion according to what’s happening in the brain in real time—could reduce some of those issues.

“It’s a major surgery, and it doesn’t treat symptoms related to cognition, mood, sleep, or balance,” Dr. Ondo adds.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Experimental options

More advanced Parkinson’s symptoms can’t always be well managed with the current roster of treatments. But there’s hope. “The scope of research is increasing every day,” says Dr. Clar. One research option showing serious promise in clinical trials is the RESTORE-1 Study, a surgical treatment aimed at helping patients’ brains produce more of their own dopamine.

COVID-19 put RESTORE-1 clinical trials on pause for much of 2020. But they’ll likely restart soon, and patients aged 45 to 70 are currently being recruited. “The right candidate is midway through the disease process. They’re on levodopa and are having on-off fluctuations that can’t be optimized with medications, but they’re not ready for deep brain stimulation yet,” says Dr. Clar, who’s involved with the study.

The risks

Right now, not a lot is known about potential side effects of this new surgical treament. But researchers hope to learn more once the trials resume.

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