How Is Parkinson's Disease Treated?
Medically reviewed by Smita Patel, DO
There is no outright cure for Parkinson's disease. Treatment options typically involve some combination of medications, physical and occupational therapy, and lifestyle changes. Another therapy, called deep brain stimulation, is considered in difficult cases that are resistant to other treatments.
Parkinson's disease is a neurodegenerative disorder that primarily impacts motor function. Symptoms include tremors, bradykinesia (slow and interrupted movements), and rigidity. This disorder is progressive, meaning it worsens over time. Parkinson's disease can have a severe impact on mental health, behavior, cognitive ability, and sleep, which can significantly impact your quality of life.
Parkinson's disease is the second most common disorder affecting the brain. The disorder is most often seen in people older than 65 and men.
kali9 / Getty Images
Related: How Is Epilepsy Treated?
Medications
Dopaminergic therapy, or the use of medications to restore dopamine levels, is a primary treatment for Parkinson's disease. Symptoms arise due to the degeneration and death of brain cells (neurons) in the substantia nigra. This region of the brain regulates body movements.
These neurons are responsible for creating dopamine, a critical brain chemical that helps nerve cells communicate with each other. Symptoms occur due to the lack of dopamine in the body due to neuron degeneration.
Medication therapies are typically individualized, with adjustments and changes made as needed. Follow a healthcare provider's indications. They may recommend several types of medications.
Levodopa-Carbidopa
The first-line medication for Parkinson's disease is usually derivations of levodopa and carbidopa. The brand names for this combination are Sinemet and Rytary. These medications are available in capsule or tablet form.
The recommended initial dosage of Sinimet is 75 milligrams (mg) per day, with the amount gradually increasing as needed. The most common side effects include dyskinesia (sudden, uncontrolled, and erratic movements), headache, and nausea.
Non-Ergot Dopamine Agonists
Three drugs of this class may be indicated:
Mirapex (pramipexole): Dosages start at 0.125 mg, three times per day.
Neupro (transdermal rotigotine): The dosage is delivered via a skin patch worn throughout the day.
Requip (ropinirole): Dosages start at 0.25 mg, three times per day.
Side effects of these medications include nausea, vomiting, low blood pressure (hypotension), sleepiness, confusion, and hallucinations.
Monoamine Oxidase Type B (MAO B) Inhibitors
MAO B inhibitors, such as Zelapar (selegiline), Azilect (rasagiline), and Xadago (safinamide), are typically considered for milder or less-advanced cases. Dosages vary based on type. The Food and Drug Administration (FDA) advises 5 mg of Zelapar, for example, twice per day.
Potential side effects of MAO B inhibitors are similar to other therapies. These side effects include headache, nausea, confusion, hallucinations, and dyskinesia.
Amantadine
Gocovri (amantadine) is typically considered alongside Sinemet. This medication works to relieve symptoms when Sinemet wears off. Gocovri is an extended-release derivation, meaning it lasts longer in your body.
You'll take Gocovri once per day at a dose of 137 mg for the first week, which then increases to 274 mg after that. Possible adverse effects of Gocovri include hallucinations, dizziness, low blood pressure, and swelling in the limbs or arms (peripheral edema), among others.
Anticholinergics
Anticholinergics are medications that inhibit the activity of the neurotransmitter acetylcholine. This chemical messenger is an important part of the central and peripheral nervous system. Acetylcholine is essential for muscle control, cognitive function, and autonomic bodily functions like breathing, heart rate, and sweating.
Drugs like Artane (trihexyphenidyl) and Cogentin (benztropine) are anticholinergics that treat tremors in younger people. Healthcare providers typically do not advise this approach for older adults with Parkinson's disease and those with cognitive impairment.
Artane, the most common of these drugs, is initially prescribed at doses of 0.5–1 mg twice daily, with this dosage eventually increased to 2 mg. There are many potential side effects of this medication, including dry mouth, blurry vision, constipation, nausea, as well as confusion, and hallucinations.
Deep Brain Stimulation
Healthcare providers generally reserve deep brain stimulation for refractory and Parkinson's disease. Refractory cases are those that don't respond to medications.
Deep brain stimulation is a surgical procedure in which electrodes are implanted in the subthalamic nucleus of the brain. A healthcare provider will then connect the electrodes to a small device in the chest. This array is able to transmit directed electricity to areas associated with motor function to treat rigidity, bradykinesia, and tremors.
Therapies
Parkinson's disease primarily affects motor function and coordination. Physical and occupational therapy may help ease symptoms.
A healthcare provider may consider several physical therapy approaches, including:
Aerobic exercise (cardiovascular conditioning): A physical therapist develops regular aerobic exercise routines of moderate to high intensity.
Balance training: The ability to maintain balance is often impacted by Parkinson's disease. You may undergo a set of exercises that manipulate and develop posture.
Gait training: A physical therapist works to develop a set of specific exercises to improve gait (walking ability).
Resistance training: This involves the use of weights, bands, machines, or medicine balls to target specific muscle groups for muscle building and endurance.
Task-specific training: Exercises to promote fine coordination or limb function may be incorporated into physical therapy.
Advanced Parkinson's disease can also impact speech ability, causing dysarthria. This causes a breathy, monotone, hoarse, or quiet speaking voice and an inability to articulate words. People with dysarthria may benefit from speech therapy, which involves a set of exercises that work to restore vocalization and articulation.
Parkinson's disease can significantly impact mental health and lead to depression. Psychiatric therapy and counseling may be helpful. For example, cognitive behavioral therapy (CBT) helps develop coping strategies to ease the mental and emotional burden.
Lifestyle
A healthcare provider may recommend lifestyle changes to help manage symptoms alongside medical treatment and physical therapy. These may include:
Diet: Dietary adjustments that may help include incorporating more vitamins, minerals, fiber, and antioxidants. Avoiding processed foods, sugars, and excess carbs can help manage symptoms.
Physical activity: Promoting physical activity is another way to help with the motor symptoms of the condition. Interval and strength training, especially with guidance from a physical therapist, can be helpful.
Sleep management: Sleep disturbances and insomnia can be features of Parkinson's disease. Working to improve the quality of your rest can be part of management. Try to go to bed and wake up at consistent times every day. Develop routines to help you sleep, try to manage stress, and get daily exercise.
Stress management: Figuring out ways to cope with stress is another way of helping with the disorder. Incorporating meditation, baths, or other relaxing activities can help reduce stress.
Yoga and stretching: These low-intensity exercises help improve mobility, promote relaxation, and manage stress.
Living With and Managing Parkinson's Disease
Parkinson's disease is a difficult diagnosis because it's progressive, and there's no known cure. There are significant individual differences in how fast the disease spreads. Parkinson's disease generally leads to disability in most people within 10 years. The disorder isn't itself fatal. Symptoms increase the mortality (rate of death) three times, however, compared to those without Parkinson's disease.
What makes Parkinson's disease particularly challenging is that, over time, it affects daily functioning and independent living. Living with a chronic condition like this can be stigmatizing and emotionally challenging.
Several other strategies may help, including:
Advocacy: Advocacy organizations, such as the American Parkinson Disease Association and the National Institute of Neurological Disorders and Stroke (NINDS), can connect you to support groups, provide useful information, and work to promote research.
Family and social assistance: Talk to your family or friends about your condition and be ready to ask for help with essential tasks. These people can also provide emotional support and social engagement.
Support groups: Finding support from others with this condition or other chronically disabling issues can also be helpful. Such groups can provide useful information, emotional support, and social connections for those with the condition.
Related: How Is Migraine Treated?
A Quick Review
Easing the severity of symptoms is the primary goal of treating Parkinson's disease. Treatments primarily include medications, therapies, and lifestyle changes. A healthcare provider may advise deep brain stimulation for refractory or more advanced cases. People living with Parkinson's disease may eventually need living assistance and require dedicated management and support.
No one should have to go through a condition like Parkinson's disease alone. Reaching out to loved ones, attending support groups, and finding a mental health therapist or counselor can help you cope with the condition and all potential challenges that may arise.
For more Health.com news, make sure to sign up for our newsletter!
Read the original article on Health.com.
