How can Parkinson’s disease be managed?
Parkinson's disease is managed with a combination of medications, therapies, and lifestyle changes.
Managing Parkinson’s disease involves a variety of considerations, including the person’s symptoms, lifestyle, day-to-day challenges, and the extent to which the disease has progressed.
It’s important to note that people with Parkinson’s aren’t always treated with medication right away; instead, they may be encouraged to stay active. Research shows that exercise can help control symptoms and might even slow the disease's progression (our organization conducts several programs to help in slowing this disease’s progression). Lifestyle changes can also be beneficial, e.g. following a Mediterranean diet, getting enough sleep, and engaging in intellectually stimulating activities.
When symptoms begin to significantly impact daily life, however, medications are usually prescribed to help increase dopamine levels, which decrease as the disease progresses.
One of the most effective medications is levodopa, which the body converts into dopamine. It comes in several forms, including pills, dissolvable tablets, and liquid. For advanced cases, a surgeon can insert a small tube into the small intestine to deliver levodopa continuously, providing better symptom control.
While there are other medications, levodopa, often prescribed with another drug called carbidopa, has been the primary treatment for people in severe stages of Parkinson’s disease for decades.
Another group of drugs, called dopamine agonists, mimic dopamine's effects in the brain but are generally less effective and can cause side effects like nausea and vomiting. MAO-B inhibitors and COMT inhibitors can also enhance the effectiveness of dopamine, though they are typically used alongside other medications.
It's important to note that the effectiveness of these medications can diminish over time. For instance, levodopa might become less reliable, leading to "off periods" where symptoms, such as tremors and muscle issues, reappear unexpectedly.
For very severe symptoms, such as intense tremors or frequent "off periods," a surgical option called deep brain stimulation (DBS) may be recommended. This procedure involves implanting small electrodes in specific areas of the brain. Those electrodes are connected to a battery placed under the skin in the chest. The battery sends electrical signals to the electrodes, helping to block problematic brain activity without harming healthy tissue. When the disease progresses and the medication effect becomes more variable, DBS can have a clinically meaningful benefit in 90% of cases, often making tremors resolve completely. While DBS is not a cure, the results can sometimes be dramatic and life-changing.
Medications
Levodopa: A common medication that increases dopamine levels
Dopamine agonists: Mimic dopamine to reduce symptoms
COMT inhibitors: Prolong the effects of levodopa
Therapies
Physical therapy: Helps with balance, stretching, and movement
Occupational therapy: Helps with daily tasks like dressing and getting around
Speech therapy: Helps with swallowing and speech
Massage therapy: Can help with pain and stiffness
Yoga and tai chi: Can help with flexibility and balance
Lifestyle changes
Exercise: Aerobic exercise can help control symptoms and slow the disease's progression
Diet: A healthy diet, like the Mediterranean diet, can help
Sleep: Getting enough sleep is important
Intellectual stimulation: Engaging in mentally stimulating activities can help
Other treatments Deep brain stimulation, Magnetic resonance imaging (MRI)-guided focused ultrasound therapy, and Support groups.
The best treatment plan depends on the person's symptoms, age, and stage of the disease.
