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.
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 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
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.
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.
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.
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.
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:
These surgical techniques involve destruction (lesioning) of very small specific areas of the brain associated with symptoms such as tremor and other abnormal movements.
Deep brain stimulation
Rather than surgically destroying areas of the brain such as the globus pallidus, thalamus or subthalamic nucleus, an electrode is implanted in these areas to provide high frequency stimulation which is thought to block their activity, thus mimicking the effects of surgical destruction but with a markedly reduced risk of permanent side effects. More information on DBS can be found on the Medtronic Australia website
Foetal cell / stem cell therapy
Transplantation of healthy dopamine-forming cells into the damaged area of the brain is still controversial and highly experimental. The most recent studies which were performed overseas have failed to show that they provide benefit for the majority of patients. These treatments are not available in Australia.
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.
Physical activity has been shown to have numerous health benefits for all. It helps with weight control and reduces the risk or improves the outcomes of many diseases such as cardiovascular disease, diabetes or depression. People with Parkinson's disease who regularly exercise will enjoy all these benefits as well as specific assistance with their movement disorder. It will help keep muscles stay flexible and in good tone; increase the range of movement and maintain physical strength. All these factors influence balance, posture and the way you move.
Don't let a diagnosis of Parkinson's disease interrupt your daily activities before its time. Continue your regular routines of dressing, eating, showering, etc. to help preserve your mobility and independence for as long as possible. Find out what physical aids or home modifications may assist you and use them. Normal household duties such as gardening, cleaning the car and walking the dog will also help maintain general fitness.
Continue with your current sports and hobbies, such as tennis, bowls, golf or dancing. You may find your performance is gradually affected as your Parkinson's disease progresses, but the enjoyment, physical activity and social aspects of sport are still very worthwhile.
Incorporate other exercise routines such as walking or cycling. Try a class of aqua-aerobics at your local pool or visit the local gym for a workout. Qualified fitness instructors will be able to modify most activities to suit any limitations you may have.
Take it gradually and don't overdo it as fatigue can sometimes exacerbate symptoms such as tremor. If you prefer to exercise at home, Parkinson's NSW has an exercise video available for loan or purchase.
Working with a physiotherapist, occupational therapist or speech therapist will provide you with specific strategies and aids to help you make the most of living Parkinson's disease.
Physiotherapy may help with coordination, balance and movement. Speech therapy may help improve problems with speech and swallowing, while occupational therapy can provide you with aids and techniques to maximise your independence with daily activities.
Parkinson's NSW cannot endorse any complementary treatments/medications as cures for Parkinson's disease, since there is no cure. Many people with Parkinson's disease do use alternative therapies for relief from symptoms, though. If you wish to use complementary treatments, please discuss this with your doctor before doing so.