How Is Parkinson’s Disease Treated?

Parkinson’s disease is a neurodegenerative disorder that primarily impacts motor function, causing tremors, bradykinesia (slow and interrupted movements), and rigidity. It is a progressive condition that 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 is the second most common disorder affecting the brain. It’s more often seen in people over age 65 and is more likely to affect people assigned male at birth.

There is no outright cure for Parkinson’s disease. As such, treatment strategies focus on managing symptoms and easing the pain and burden of this disease. This typically involves some combination of taking medications, physical and occupational therapy, and lifestyle changes. In difficult cases that are resistant to other treatments, another therapy called deep brain stimulation is considered.

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Medications

Parkinson’s disease arises due to the degeneration and death of brain cells (neurons) in the substantia nigra, the region of the brain that regulates body movements. These neurons are responsible for the creation of dopamine, a critical brain chemical that helps nerve cells communicate with each other. Parkinson’s symptoms occur due to the lack of dopamine in the body from neuron degeneration.

Dopaminergic therapy, or the use of medications to restore dopamine levels, is a primary treatment for Parkinson’s disease.

Medication therapies are typically individualized, with adjustments and changes made as needed throughout the course of treatment. Make sure to follow your health provider’s indications. Several types of medications can be used, which will be highlighted next.

Levodopa-Carbidopa

Usually, the first-line medication for Parkinson’s disease are derivations of levodopa and carbidopa (the brand names for this combination are Sinemet or Rytary). These are available in capsule or tablet form. The recommended initial dosage of Sinimet is 75 milligrams (mg) a day, with the amount gradually increasing as needed. 

The most common side effects of this therapy 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 a day
  • Requip (ropinirole): Dosages start at 0.25 mg three times a day
  • Neupro (transdermal rotigotine): Dosage is delivered via a skin patch worn throughout the 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. For instance, 5 mg of Zelapar twice a day is currently the recommended indication. 

Potential side effects of MAO B inhibitors are similar to other therapies and include headache, nausea, confusion, hallucinations, and dyskinesia.

Amantadine

Gocovri (amantadine) is typically considered alongside Sinemet (levodopa-carbidopa), working to relieve symptoms when Sinemet wears off. Gocovri is an extended-release derivation, meaning it lasts longer in your body. It is taken once a 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 hallucination, 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, which is an important part of the central and peripheral nervous system. This neurotransmitter is important for muscle control, cognitive function, and autonomic bodily functions such as breathing, heart rate, sweating, and more.

Drugs like Artane (trihexyphenidyl) and Cogentin (benztropine) are anticholinergic drugs that may be prescribed to treat tremors in younger patients. Typically, this approach is not indicated for older adults with Parkinson’s disease and those with cognitive impairment.

Artane, the most common of these, is initially prescribed at doses of 0.5 to 1 mg twice daily, with this dosage eventually increased to 2 mg. There are many potential side effects of this medication, including dry mouth, blurred vision, constipation, nausea, as well as confusion, and hallucinations.

Deep Brain Stimulation

Deep brain stimulation is a more recent approach, generally reserved for refractory Parkinson’s disease (cases that don’t respond to medications) as well as cases that are very advanced.

Deep brain stimulation is a surgical procedure where electrodes are implanted in the subthalamic nucleus of the brain and connected 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 tremor.

Therapies

Since Parkinson’s disease primarily affects motor function and coordination, physical and occupational therapy may help further ease symptoms. Several physical therapy approaches are considered, including:

  • Aerobic exercise (cardiovascular conditioning): Physical therapists work with patients to develop regular aerobic exercise routines of moderate to high intensity.
  • Resistance training: This involves the use of weights, bands, machines, or medicine balls to target specific muscle groups for muscle building and endurance.
  • Gait training: The physical therapists works to develop a set of specific exercises focused on improvement gait, or walking ability.
  • Task-specific training: Depending on the case, exercises to promote fine coordination or limb function may be incorporated into physical therapy.
  • Balance training: Since ability to maintain balance is often impacted by Parkinson’s disease, you may undergo a set of exercises that manipulate and develop posture.

Advanced Parkinson’s disease can also impact speech ability, causing dysarthia. This is characterized by a breathy, monotone, hoarse, or quiet speaking voice and an inability to articulate words. Speech therapy, which involves a set of exercises that work to restore vocalization and articulation, may be incorporated into a treatment plan.

Lastly, Parkinson’s disease can significantly impact mental health and lead to depression and other issues. This being the case, psychiatric therapy and counseling may also be incorporated into the management of the condition. This may involve cognitive behavioral therapy (CBT) to develop coping strategies, medications, or other therapies to ease the mental and emotional burden.

Lifestyle Changes

Alongside medical treatment and physical therapy, your healthcare provider may recommend a set of lifestyle changes to help manage symptoms. This may include:

  • Diet: Dietary adjustments that may help include incorporating more vitamins, minerals, fiber, and antioxidants. In addition, avoiding processed foods, sugars, and excess carbohydrates has been shown to help with managing Parkinson’s.
  • Physical activity: Promoting physical activity is another way to help with the motor symptoms of the condition. Incorporating interval and strength training, especially with guidance from a physical therapist, should be a cornerstone of lifestyle management.
  • Yoga and stretching: Stretching and yoga help both directly by improving mobility and indirectly by promoting relaxation and managing stress.  
  • Stress management: Figuring out ways to cope with stress is another way of helping with the condition. Along with activities like yoga, incorporating meditation, taking baths, or engaging in other relaxing activities can help reduce stress.
  • Sleep management: Sleep disturbances and insomnia can be features of Parkinson’s disease, so working to improve the quality of your rest can be part of management. This may include ensuring you go to be and wake up at consistent times every day, developing routines to help you go to sleep, managing stress, and ensuring you’re getting exercise.

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; however, overall, this disease leads to disability in most patients within 10 years. While it isn’t, itself, fatal, the symptoms increase the mortality (rate of death) of those with this condition three times compared to those without Parkinson’s.

What makes Parkinson’s disease particularly challenging is that, over time, it affects daily functioning and independent living. Additionally, living with a chronic condition like this can be stigmatizing and emotionally challenging. Alongside medical care and other therapies, there are several other strategies that may help:

  • Family/social assistance: Talk to your family or friends about your condition and be ready to ask for help with essential tasks. Note that 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 a great help. Such groups can be a source of useful information, emotional support, and social connections for those with the condition.
  • Advocacy: Patient advocacy organizations, such as the American Parkinson Disease Association and the National Institute of Neurological Disorders and Stroke (NINDS), among others, can connect you to support groups, provide useful information, and work to promote research of the condition.  

A Quick Review

Easing the severity of symptoms is the primary goal of treating Parkinson’s disease. Primarily, this involves taking medications, alongside physical, occupational, and/or speech therapy, and making lifestyle changes. Deep brain stimulation is a newer treatment approach for refractory or more advanced cases. People living with Parkinson’s may eventually need living assistance and require dedicated management and support.

No one should have to go through a condition like Parkinson’s 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 the potential challenges that arise.

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Sources
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