Treatment and Therapies

While there is currently no cure for Parkinson’s there are a range of treatments which can help you manage your symptoms

Available treatments for Parkinson’s disease include a range of prescription medications, surgery and physical and supportive therapies. All treatments aim to control symptoms but none can yet prevent progression of the disease. Most medications have side effects. Which treatment is most suitable for an individual depends on factors such as the age of the person, the symptoms causing most distress and the severity and stage of their disease.

Warning! Parkinson’s NSW has serious concerns about unproven products & therapies (stem cells, chelation therapy, etc). Parkinsons NSW suggests that patients should discuss such treatments with their neurologist. There is also the risk that these untested treatments may actually be harmful, physically as well as financially.

MEDICINE UPDATE

Medicine Update is an online publication produced by National Prescribing Service, designed to be used by consumers who are considering new medicines. It aims to highlight important information about how the medicine is used in therapy, how it compares with other therapies, provides any important safety information and explains the conditions of its listing on the PBS. In the December 2009 issue, Medicine Update considers the benefits of pramipexole (Sifrol), which can be used to treat the symptoms of Parkinson’s disease. Click here to visit Medicine Update

MEDICATIONS

Oral Medication is the First line of treatment for those with Parkinson’s. Parkinson’s medication primarily works on increasing the levels of dopamine in the brain, and optimising the brain’s use of dopamine.

DOPAMINE REPLACEMENT THERAPY

Medications that can replace dopamine, the depleted neurotransmitter in the brain, are the mainstay of treatment. Levodopa, a precursor of dopamine, can be converted to dopamine in the brain. It is administered in combination with carbidopa (as in Sinemet and Kinson) or benserazide (as in Madopar), to maximise the delivery of levodopa to the brain and minimise side effects. These medications are usually effective for many years. However, the response tends to wear off or becomes less predictable with time.

DOPAMINE AGONISTS

Medications such as bromocriptine (Bromocriptine-BC, Bromohexal, Bromolactin, Kripton, Parlodel), pergolide (Permax), cabergoline (Cabaser) and apomorphine (Apomine) stimulate the dopamine receptors in the brain and therefore mimic the action of dopamine. They can be useful at all stages of Parkinson’s disease. In younger onset Parkinson’s disease agonists are sometimes used as initial treatment but in others agonists are prescribed as levodopa sparing agents or introduced once the response to levodopa starts to diminish.

ANTICHOLINERGICS

This group of medications was the first available treatment for Parkinson’s disease before levodopa. They block the effect of acetylcholine, another brain chemical, to re-balance its levels with dopamine. They include benztropine (Cogentin, Benztrop), biperidine (Akineton) and benzhexol (Artane). Some antihistamines such as diphenhydramine (Unisom Sleepgels) also have anticholinergic activity and a useful sedative effect. All these drugs are now rarely used because of the relatively modest benefits that they give compared with their side effect profile.

AMANTADINE (SYMMETREL)

This drug has both anticholinergic and dopamine agonist properties. It can be useful for many patients in controlling drug-induced involuntary movements (diskinesia).

MONAMINE OXIDASE (MAO) TYPE B INHIBITORS

Medications such as selegiline (Elderpryl, Selgene) prevent the breakdown of available dopamine within the brain and therefore prolong the action of levodopa.

CATECHOL-O-METHYL TRANSFERASE (COMT) INHIBITORS

Newer medications such as entacapone (Comtan) and, in some cases, tolcapone (Tasmar), are also used along with levodopa. By blocking an enzyme known as COMT that breaks down levodopa in the intestine and brain, they prolong the action of levodopa and reduce motor fluctuations.

SURGERY

Neurosurgery is increasingly common as a treatment for Parkinson’s disease, especially in relatively young, otherwise healthy people. Surgery is best suited to those who obtain a good response to levodopa but have problems with involuntary movements or have large fluctuations in their response to levodopa. Techniques include:

PHYSICAL AND SUPPORTIVE THERAPIES

People with Parkinson’s disease should remain as active as possible, maintaining daily activities and, if possible, a regular exercise program. Support therapies from physiotherapists, occupational and speech therapists can also help with specific exercises, education and retraining to improve coordination, balance and movement. Overall fitness and good muscle tone can help minimise some of the abnormal movements associated with Parkinson’s disease.

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