Main Treatment For Parkinson’s Disease

Support For People Living With Parkinsons Disease

While the progression of Parkinsons is usually slow, eventually a persons daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinsons disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.

What Causes This Disease

People with Parkinsons disease have a shortage of a chemical called Dopamine. Dopamine creates synchrony is the deep structures of the brain thereby producing normal movement. This happens because the cells that make dopamine in an area called the substantia nigra are no longer present. We do not know exactly how these changes happen. Many theories include accelerated aging and cell death, a genetic susceptibility, environmental factors, among others. It is probable that the disease is caused by a combination of the above.

The Surgical Option: Deep Brain Stimulation

Some patients with Parkinsons disease may benefit from deep brain stimulation , a surgical therapy that has been FDA approved for over a decade. DBS involves implanting an electrode into a targeted area of the brain, usually the subthalamic nucleus or the globus pallidus interna . The implants can be done on one side or both sides of the brain as needed. The electrodes are stimulated through a connection to a pacemaker-like device located under the skin in the chest. Patients that are considered good candidates for this procedure are those with a robust response to Levodopa, no significant cognitive or psychiatric problems, and no significant problems with balance. The procedure can help patients with medication-resistant tremors. It can also help patients who have significant motor fluctuations in which medication response varies during the day and dyskinesias or extra movements may occur as a side effect of medication.

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What Causes The Condition

Although there are several recognized risk factors for Parkinsons disease, such as exposure to pesticides, for now, the only confirmed causes of Parkinsons disease are genetic. When Parkinsons disease isnt genetic, experts classify it as idiopathic . That means they dont know exactly why it happens.

Many conditions look like Parkinson’s disease but are instead parkinsonism from a specific cause like some psychiatric medications.

Familial Parkinsons disease

Parkinsons disease can have a familial cause, which means you can inherit it from one or both of your parents. However, this only makes up about 10% of all cases.

Experts have linked at least seven different genes to Parkinson’s disease. They’ve linked three of those to early-onset of the condition . Some genetic mutations also cause unique, distinguishing features.

Idiopathic Parkinsons disease

Experts believe idiopathic Parkinsons disease happens because of problems with how your body uses a protein called -synuclein . Proteins are chemical molecules that have a very specific shape. When some proteins dont have the correct shape a problem known as protein misfolding your body cant use them and can’t break them down.

With nowhere to go, the proteins build up in various places or in certain cells . The buildup of these Lewy bodies causes toxic effects and cell damage.

Induced Parkinsonism

The possible causes are:

Physical Occupational And Speech Therapy

Physical, occupational and speech therapists can be important partners in the treatment of Parkinsons disease. Physical therapy can improve your gait and direct you to the right exercise regimen. Occupational therapy can be helpful to maximize your fine motor skills. Speech therapy can be useful to address speech and language barriers that may arise with Parkinsons disease.

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What Will A Cure For Parkinsons Look Like

Parkinsons varies so much from person to person. There are over 40 symptoms of Parkinsons. Tremor. Pain. Hallucinations. Everyones experience is different.

Because of this, there may not be a single cure.

Instead we may need a range of different therapies to meet the needs of the individual and their specific form of the condition.

This mix may include treatments, therapies and strategies that can:

• slow or stop the progression of the condition
• replace or repair lost or damaged brain cells
• control and manage particular symptoms
• diagnose Parkinsons at the earliest possible stage.

And this could involve medical treatments, such as drugs and surgical approaches, as well as lifestyle changes, for example to diet and exercise.

Researchers Are Getting Closer To A Drug That Is Truly A Parkinsons Treatmentone That Can Halt Or Cure The Disease Instead Of Just Fighting Symptoms

As the incidence of Parkinsons growsan estimated 50,000 new cases per yearso do the options being offered by drug manufacturers.

Todays Parkinsons treatment options address the symptoms of tremors, stiffness, and slow movement to improve quality of life. However, they do little to slow the progression of this disease. Fortunately, research is helping us better understand Parkinsons. While early signs of Parkinsons disease can be overlooked, once its diagnosed, treatment options are expanding beyond the current drugs. So one day we may find a Parkinsons treatment that makes the disease less of a life sentence.

If you have Parkinsons disease, there arent any treatments that can slow, reverse, or stop the conditions progression, says Kara J. Wyant, M.D., in a Michigan Health blog on Parkinsons treatment. But, although there is no cure, more than a dozen medications can help patients manage symptoms. Our goals when prescribing medications for Parkinsons disease are twofold: to improve day-to-day functioning and quality of life and to keep people functioning as long as possible.

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What Is A Common Side Effect Of Parkinson Disease Medications

Dyskinesias are uncontrollable body movements that can be forceful and painful. They are a side effect of levodopa, a medication that increases dopamine levels in the body and treats Parkinsons tremors, stiffness, and slowness. The movements may start as small tics but can worsen and lead to serious injury.

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What Is The Outlook For Persons With Parkinsons Disease

Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

The future is hopeful. Some of the research underway includes:

• Using stem cells to produce new neurons, which would produce dopamine.
• Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
• Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

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Learn More About Living Well With Pd

The first step to living well with Parkinsons is to understand the disease and its progression.

• The book Parkinsons Disease: Frequently Asked Questionshighlights the most frequently asked questions the Parkinsons Foundation receives through its Helpline.
• In the video Denise and Bernard Coley, The Coleys discuss Denises PD diagnosis, their experience managing PD together, and their journey to becoming PD research advocates.
• In the My PD Story: Phil Gee, Phil shares how he became involved with the Parkinsons community after receiving his PD diagnosis and what motivates him as a Black man to reach underserved populations.
• In the video: What is Parkinsons Disease? James Beck, PhD, Parkinsons Foundation Chief Scientific Officer, defines Parkinsons, describes movement and non-movement symptoms and explains the importance of exercise for people with Parkinsons.
• The book Managing Parkinsons Mid-Stride: A Treatment Guide to Parkinsons is for people who are having more difficulty managing Parkinsons, and how to treat and cope with fluctuating symptoms.

If you have questions about PD or need help finding a specialist, call the Parkinsons Foundation Helpline at 1-800-4PD-INFO or visit Parkinson.org.

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For help finding a culturally sensitive doctor near you, try the Find a Doctor search tool on BlackDoctor.org.

References

Important Points In Treatment

A variety of agents are useful in the treatment of various stages of Parkinson’s disease. Education and support are essential elements of the treatment at the beginning of Parkinson’s disease. Support includes the participation of the family and often will involve support groups. A program of regular exercise is important for the patient’s physical well-being and helps to promote emotional stability as well.

In addition, a number of other health problems can simulate Parkinson’s disease, and a number of drugs can have parkinsonian side effects. The physician will first evaluate the patient to ensure that drug effects or other diseases are not underlying the development of the tremor. Treatment is individualized to meet the specific needs of each patient. Selection of treatment will vary with the stage of the disease and the age of the patient.

Surgical Treatment

The disability caused by Parkinson’s disease has made it the focus of much research. A number of surgical operations have been tried. These have proven to be of help in only a minority of patients. Some forms of therapy for parkinsonism remain experimental and are controversial. Your physician is your best guide to the opportunities that might be suited to your individual needs.

The most effective treatment for Parkinson’s disease is still drug therapy. In a few patients who fail to respond to drug therapy or who cannot take the most useful drugs, the possibility of surgical treatment may be considered.

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Mechanism Of Action Of Available Drugs

The major classes of drugs currently available for the treatment of idiopathic Parkinson’s disease are shown in Table 1. Many aim to increase dopamine in the brain, by increasing its production or altering its metabolism .

Table 1

Drugs with alter metabolism in boxed red italics

Levodopa

Levodopa is absorbed from the small intestine and transported into the brain where it is converted to dopamine. Levodopa has a short plasma half-life of about one hour. Early in Parkinson’s disease, levodopa has a long duration of action which is independent of plasma concentration, but as the disease progresses, the duration of the effect reduces. The short-duration effect is strongly linked to plasma concentration and lasts, at most, hours.

Slow-release preparations are gradually absorbed, resulting in more sustained plasma concentrations. They have reduced bioavailability higher doses are required to match the benefit of an equivalent strength of a standard preparation. Rapid release preparations are taken in liquid form to enhance passage through the stomach and absorption from the small intestine.

Dopamine agonists

Apomorphine is a potent emetic so patients must be pre-treated with domperidone 20 mg three times daily orally for at least 48 hours before the first injection. Domperidone should be continued for at least a few weeks once regular intermittent treatment has commenced. The dose can then be tapered slowly as tolerance to the emetic effects of apomorphine usually develops.

Pharmacological Treatment Of Parkinsons Disease

There is currently no proven disease-modifying or neuroprotective therapy for PD. A summary of previous neuroprotection trials is given in a recent review article. Current evidence-based treatment for PD is symptomatic and mainly based around dopaminergic replacement or modulation . The evidence base is summarised in recent guidelines from the National Institute for Health and Care Excellence and the International Parkinson and Movement Disorder Society. Levodopa, dopamine agonists and monoamine oxidase B inhibitors are all licensed for use as initial therapy in PD. Anticholinergics are no longer routinely used due to the risk of cognitive decompensation.

Pharmacological therapies currently used for initial and adjunctive treatment of motor symptoms in Parkinsons disease

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What Is Fetal Cell Transplantation

Fetal cell transplantation is a procedure in which fetal cells are implanted into the brains of people with Parkinsons disease to replace the dopamine-producing cells in the substantia nigra. Although promising, this area of research is one of the most controversial. Some studies have found that fetal cell transplantation caused an increase in severe involuntary movements due to too much dopamine in the brain. There are also moral and ethical objections to the use of fetal cell implants. As a result, other methods of treatment are being explored.

Complementary And Alternative Therapies

Some people with Parkinson’s disease find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson’s disease.

However, there’s no clinical evidence they’re effective in controlling the symptoms of Parkinson’s disease.

Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldn’t be used instead of the medicines prescribed by your doctor.

Some types of herbal remedies, such as St John’s wort, can interact unpredictably if taken with some types of medication used to treat Parkinson’s disease.

If you’re considering using an alternative treatment along with your prescribed medicines, check with your care team first.

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Top Ways To Treat Parkinsons Disease

This content was developed in partnership with the Parkinsons Foundation.

Every person living with Parkinsons disease experiences symptoms, disease progression and treatments that are unique to them. There is no single treatment plan that works for everyone.

The most common way to treat and manage PD symptoms include medications, exercise, rehabilitation therapies and surgical procedures. Treatment plans should be tailored to respond to an individuals symptoms and personal circumstances. While there is currently no cure for PD, the goals of treatment are to minimize symptoms and improve overall quality of life.

How Is It Treated And Is There A Cure

For now, Parkinsons disease is not curable, but there are multiple ways to manage its symptoms. The treatments can also vary from person to person, depending on their specific symptoms and how well certain treatments work. Medications are the primary way to treat this condition.

A secondary treatment option is a surgery to implant a device that will deliver a mild electrical current to part of your brain . There are also some experimental options, such as stem cell-based treatments, but their availability often varies, and many aren’t an option for people with Parkinsons disease.

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What Is Postherpetic Neuralgia

Postherpetic neuralgia, also known as PHN, is a painful health condition of recurring or persistent pain that affects your nerves and skin. Usually in the area of the body that has undergone an outbreak of herpes zoster, postherpetic neuralgia is commonly referred to as shingles. Shingles is caused by the

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Exploring Seven Recently Approved Parkinsons Treatments

Remarkably, in the last five years, seven new medications have been approved for the treatment of the motor symptoms of Parkinsons disease , with two approved in 2020. Thats exciting progress! And while it is great to have so many choices, the various options can be confusing so today I will describe these new medications and their uses.

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Controlled Release Madopar And Sinemet

Controlled release preparations have the letters CR or HBS after the drug name.

These let the levodopa enter your body slowly instead of all at once. They can increase the time between doses.

They may be used when the dose of standard levodopa starts to wear off and the person taking it no longer feels the treatment is effective.

Controlled release options can sometimes reduce involuntary movements .

Medication For Parkinsons Disease

Once the doctor diagnoses Parkinsons disease, the next decision is whether a patient should receive medication, which depends on the following:

• The degree of functional impairment

• The degree of cognitive impairment

• Ability to tolerate antiparkinsonian medication

• The advice of the attending doctor

No two patients react the same way to a given drug, therefore, it takes time and patience to find an appropriate medication and dosage to alleviate symptoms.

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What Are The Symptoms

The best-known symptoms of Parkinson’s disease involve loss of muscle control. However, experts now know that muscle control-related issues aren’t the only possible symptoms of Parkinson’s disease.

Motor-related symptoms

Motor symptoms which means movement-related symptoms of Parkinsons disease include the following:

Additional motor symptoms can include:

• Blinking less often than usual. This is also a symptom of reduced control of facial muscles.
• Cramped or small handwriting. Known as micrographia, this happens because of muscle control problems.
• Drooling. Another symptom that happens because of loss of facial muscle control.
• Mask-like facial expression. Known as hypomimia, this means facial expressions change very little or not at all.
• Trouble swallowing . This happens with reduced throat muscle control. It increases the risk of problems like pneumonia or choking.
• Unusually soft speaking voice . This happens because of reduced muscle control in the throat and chest.

Non-motor symptoms

Several symptoms are possible that aren’t connected to movement and muscle control. In years past, experts believed non-motor symptoms were risk factors for this disease when seen before motor symptoms. However, theres a growing amount of evidence that these symptoms can appear in the earliest stages of the disease. That means these symptoms might be warning signs that start years or even decades before motor symptoms.

Non-motor symptoms include:

Stages of Parkinsons disease