Parkinson’s disease Health Article

Treatment

There is no known cure for Parkinson's disease. The goal of treatment is to control symptoms.

Medications control symptoms primarily by increasing the levels of dopamine in the brain. The specific type of medication, the dose, the amount of time between doses, or the combination of medications taken may need to be changed from time to time as symptoms change. Many medications can cause severe side effects, so monitoring and follow-up by the health care provider is important.

Types of medication:

• Deprenyl may provide some improvement to mildly affected patients.
• Amantadine or anticholinergic medications may be used to reduce early or mild tremors.
• Levodopa may be used to increase the body's supply of dopamine, which may improve movement and balance.
• Carbidopa reduces the side effects of levodopa and makes levodopa work better.
• Entacapone is used to prevent the breakdown of levodopa.
• Pramipexole and ropinirole are used before or together with levodopa.
• Rasagiline is approved for patients with early Parkinson's disease. It may also be combined with levodopa in patients with more advanced cases of the disease. Rasagiline helps block the breakdown of dopamine.
• Neupro is a new skin patch that contains the drug rotigotine. This medicine helps dopamine receptors in the brain work better. The patch is replaced every 24 hours. Neupro is approved for persons with early stage Parkinson's disease.

Additional medications to help reduce symptoms or control side effects of primary treatment medications include antihistamines, antidepressants, monoamine oxidase inhibitors (MAOIs), and others.

Good general nutrition and health are important. Exercise should continue, with the level of activity adjusted to meet the changing energy levels that may occur. Regular rest periods and avoidance of stress are recommended, because fatigue or stress can make symptoms worse. Physical therapy, speech therapy, and occupational therapy may help promote function and independence.

Railings or banisters placed in commonly used areas of the house may be of great benefit to the person experiencing difficulties with daily living activities. Special eating utensils may also be helpful.

Social workers or other counseling services may help the patient cope with the disorder and with obtaining assistance (such as Meals-on-Wheels) as appropriate.

Experimental or less common treatments may be recommended. For example, surgery to implant stimulators or destroy tremor-causing tissues may reduce symptoms in some people. Transplantation of adrenal gland tissue to the brain has been attempted, with variable results.

Support Groups

Support groups may help a person cope with the changes caused by the disease.

See: Parkinson's disease - support group

Expectations (prognosis)

Untreated, the disorder progresses to total disability, often accompanied by general deterioration of all brain functions, and may lead to an early death.

Treated, the disorder impairs people in varying ways. Most people respond to some extent to medications. The extent of symptom relief, and how long this control of symptoms lasts, is highly variable. The side effects of medications may be severe.

Complications

• Varying degrees of disability
• Difficulty swallowing or eating
• Difficulty performing daily activities
• Injuries from falls
• Side effects of medications

Calling your health care provider

Call your health care provider if symptoms of Parkinson's disease appear, if symptoms get worse, or if new symptoms occur. Also tell the health care provider about any possible side effects of medications, which may include:

• Involuntary movements
• Nausea and vomiting
• Dizziness
• Changes in alertness, behavior or mood
• Severe confusion or disorientation
• Delusional behavior
• Hallucinations
• Loss of mental functions

Also call your health care provider if the condition gets worse and the caregiver is unable to care for the person at home.

References

U.S. Food and Drug Administration. FDA Approves Neupro Patch for Treatment of Early Parkinson's Disease. Rockville, MD: National Press Office; May 9, 2007. Release P07-84.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 713-720.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:1612-1618.