There is no cure for Parkinsons’s disease. However, there is a range of approved treatments available to control the symptoms of the disease.
Supportive therapies can help patients cope with Parkinson’s disease and improve daily life. They include:
- Physiotherapy to relieve muscle stiffness and joint pain.
- Occupational therapy to identify and improve problem areas in everyday life.
- Speech and language therapy to help improve swallowing (dysphagia) and speech problems
- Changes in diet to help with non-motor symptoms, such as constipation and low blood pressure. Furthermore, the efficiency and side effects of certain medications can be affected by diet; identifying this early can help with managing symptoms.
Levodopa is a chemical that is converted into dopamine in the brain to combat the decreasing levels experienced by Parkinson’s patients. It frequently is combined with carbidopa, which prevents levodopa from being converted to dopamine prematurely before it reaches the brain. This treatment is available in several formulations. For example, Duopa (produced by AbbVie) is a gel carbidopa-levodopa formulation that is pumped into the intestines to provide a continuous 16-hour release of levodopa, significantly reducing the “off-time” (when symptoms present, as the treatment wears off between doses) that Parkinson’s patients may experience.
Dopamine agonists act as a substitute for (or mimic) dopamine in the brain. These can be prescribed alone or in combination with other drugs. They include Mirapex (pramipexole), Requip (ropinirole), Neupro (rotigotine), and Apokyn (apomorphine).
Monoamine oxidase-B (MAO-B) inhibitors
MAO-B inhibitors act to block dopamine from being broken down in the brain, increasing its levels. These often are given in combination with levodopa or dopamine agonists, but also can be taken alone. They include Azilect (rasagiline), Zelapar (selegiline), and the recently approved Xadago (safinamide). These therapies generally are intended to extend the “on” time, reducing the time a patient experiences symptoms.
Catechol-O-methyltransferase (COMT) inhibitors
(COMT) inhibitors work to prevent the breakdown of levodopa before it reaches the brain, resulting in more dopamine in the brain and prolonging the effect of levodopa. They may be prescribed initially in place of increasing the levodopa dose. The most common COMT inhibitor is Comtan (entacapone). However, Tasmar (tolcapone) also may be prescribed. Tasmar may cause liver damage, requiring regular blood tests to monitor liver function.
Anticholinergics, or drugs that block the action of acetylcholine, are sometimes used to help control tremors. (Acetylcholine is a neurotransmitter, or chemical messenger that transfers signals between nerve cells). Anticholinergics include Cogentin (benztropine) and Artane (trihexypheidyl).
Glutamate antagonists (amantadine) can be prescribed to reduce early-stage Parkinson’s symptoms, or in combination with carbidopa-levodopa therapy to control dyskinesia (involuntary movements) that can be caused by this therapy.
Medication against non-motor symptoms
Parkinson’s disease also has a range of non-motor symptoms associated with it, for which there are various medications. Many of these medications are not specific for use in Parkinson’s disease, but have been shown to be beneficial to Parkinson’s patients. Drugs specifically targeted to treat non-motor symptoms in Parkinson’s include Northera (droxidopa) to treat orthostatic hypotension (low blood pressure that happens when a person stands up) and Nuplazid (pimavanserin) to treat Parkinson’s disease psychosis.
Surgery is mainly used as a treatment when medication has proved ineffectual. It is used to treat motor symptoms and is normally combined with a continued medication plan.
- Deep brain stimulation is the most common surgery for Parkinson’s and may be offered to advanced Parkinson’s disease patients who are not responding to medication. It involves stimulating areas of the brain with an electrical impulse. It is non-destructive and can improve motor symptoms (such as tremors) and may lead to a reduction in the dosage of medication needed.
- In rare cases, lesioning surgery may be offered. This permanently damages a targeted part of the brain and may reduce symptoms such as tremors and dyskinesia.
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