Treatment and Therapies

Treatment and Therapies

While there is currently no cure for Parkinson’s there is a range of treatments that 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 the 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.

Sinemet® Shortage

Sinemet® (levodopa/carbidopa) is a medication commonly used in the treatment of Parkinson’s disease as well as other neurological disorders. From 23 August 2018, there has been an international supply shortage of various formulations of Sinemet®.

Click here for a position statement providing an accurate, evidence-based guide for general clinicians to appropriately substitute the Sinemet formulation.

NPS Medicinewise

NPS MedicineWise was established in 1998 as the National Prescribing Service (NPS) Limited. Through two decades of continuous national leadership and services provided in the health sector, NPS MedicineWise remains committed to supporting quality use of medicines to improve health decisions and health and economic outcomes in Australia.

The NPS MedicineWise website gives information to help you make the best decisions about your medicines and medical tests. Click here to visit the website.

Medications

Oral Medication is the first line of treatment for people living 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.

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).

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

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.

Deep Brain Stimulation

Deep Brain Stimulation (DBS) surgery for Parkinson’s is the most common type of surgery used to treat Parkinson’s. It may help to reduce some motor symptoms of Parkinson’s, such as stiffness, tremor and slowness of movement.

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.

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.

The facts on medical cannabis for treating Parkinson’s

To date, no large-scale studies or peer reviewed scientific research have established the safety and effectiveness of medical cannabis for treating the symptoms of Parkinson’s.

There have been a small number of randomised controlled trials conducted but these studies were too small to be meaningful and inconsistent in their approach.

Parkinson’s NSW supports appropriate, ethical scientific research into the therapeutic benefits of medical cannabis. However, evidence of its safety and effectiveness is currently lacking.

Therefore, Parkinson’s NSW does not endorse the use of medical cannabis for the treatment of Parkinson’s.

We recommend that you do not rely on the internet, social media or word of mouth for information about medical cannabis.

If you are considering any form of unproven therapy, first talk to your GP and neurologist about the potential benefits, risks and costs involved.

References

Kluger B, Triolo P, Jones W, Jankovic J, The Therapeutic Potential of Cannabinoids for Movement Disorders, Movement Disorders Vol 30 No 3, 2015

Carroll CB, Bain PG, Teare BM, Lui X, Joint C, Wroath BA, Parkin SG, Fox P, Wright D, Hobart J, Zajicek JP, Cannabis for Dyskinesia in Parkinson Disease, Neurology October 2004

Stampanoni Bassi M, Sancesario A, Moreace R, Centonze D, Iezzi E, Cannabinoids in Parkinson’s Disease, Cannabis and Cannabinoid Research Vol 2.1 2017

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.

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