In previous posts in this series we looked at the causes and symptoms of Parkinson’s Disease (PD), and discussed the differences between Parkinsonism and Parkinson’s Disease. In this Post, I’d like to take a look at current medical interventions for the disease.
Currently there is no cure for Parkinson’s disease and no standard treatment for the disease. The treatment for each person with Parkinson’s is based on his or her symptoms. Treatments include pharmacologic intervention (medicine) and surgical therapy.
Medications can help the patient manage problems with walking, movement and tremor by increasing the brain’s supply of dopamine. However, dopamine can’t be given directly, as it can’t enter the brain. Some of the medications commonly prescribed for the treatment of PD include:
- Carbidopa-levodopa. Levodopa, the most effective Parkinson’s disease medication, is a natural chemical that passes into the brain and is converted to dopamine. Side effects may include nausea or lightheadedness. To lessen this, Levodopa is often combined with carbidopa, which protects levodopa from premature conversion to dopamine outside the brain, thus preventing or lessening side effects such as nausea. Also, one may experience involuntary movements (dyskinesia) after taking higher doses of levodopa in which case the physician may lessen the dose or adjust the times of the doses to control these effects.
- Dopamine agonists. Unlike levodopa, dopamine agonists don’t change into dopamine. Instead, they mimic dopamine effects in the brain. They aren’t as effective as levodopa in treating symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa. Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa, but also include hallucinations, swelling, sleepiness and compulsive behaviors such as hyper-sexuality, gambling and eating.
- MAO-B inhibitors. These medications help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO-B). This enzyme metabolizes brain dopamine. Side effects may include nausea or headaches. When added to carbidopa-levodopa, these medications increase the risk of hallucinations.
- Catechol O-methyltransferase (COMT) inhibitors. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine. Side effects, including an increased risk of involuntary movements (dyskinesias), mainly result from an enhanced levodopa effect. Other side effects include diarrhea or other enhanced levodopa side effects.
Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson’s disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson’s disease to control involuntary movements induced by carbidopa-levodopa. Side effects may include a purple mottling of the skin, ankle swelling or hallucinations.
A patient may have significant improvement of their symptoms after beginning Parkinson’s disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms usually can continue to be fairly well controlled.
- Deep brain stimulation (DBS). In deep brain stimulation surgeons implant electrodes into a specific part of the patient’s brain. The electrodes are connected to a generator implanted in the chest near the collarbone that sends electrical pulses to the patient’s brain and may reduce Parkinson’s disease symptoms. Deep brain stimulation is most often offered to people with advanced Parkinson’s disease who have unstable medication (levodopa) responses. It can stabilize medication fluctuations, reduce or halt involuntary movements, reduce tremor, reduce rigidity, and improve slowing of movement. DBS is also effective in controlling erratic and fluctuating responses to levodopa or for controlling dyskinesias that don’t improve with medication adjustments. However, DBS isn’t helpful for problems that don’t respond to levodopa therapy apart from tremor. A tremor may be controlled by DBS even if the tremor isn’t very responsive to levodopa. DBS may provide a sustained benefit to Parkinson’s symptoms persisting for years after the procedure. However, DBS doesn’t keep Parkinson’s disease from progressing.
In the next Post in this series, we will be examining some of the more unconventional, non-medical treatments for PD.
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