Parkinson's Disease — A Variety of Treatments

While a cure for Parkinson's disease (PD) hasn’t yet been identified, there are several treatments that can help manage the symptoms patients experience, including medications.

We know that patients with PD don’t have enough of a specific neurotransmitter — dopamine — in their brains. Dopamine performs many functions in the brain, including helping to control movement, mood, and even memory.

Levodopa

One of the common medications used to treat PD is a combination of two ingredients: carbidopa and levodopa. Levodopa is a building block for dopamine, and when it’s converted into dopamine in the brain, it can be beneficial in controlling many symptoms of PD.

Patients may respond differently to doses of levodopa, so it’s important to remember that there is no single target dose for every patient. While this medication can be quite helpful in alleviating symptoms of PD, side effects like nausea, vomiting, or lightheadedness may be experienced. Often, starting with a very low dose of medication and slowly increasing the dose, can decrease the risk of side effects.

Dopamine Agonists

Dopamine agonists are medications that act like dopamine in the brain. Pramipexole, ropinirole, and rotigotine are commonly used dopamine agonists. These medications can decrease the tremor, slowness, and rigidity caused by PD. Side effects can occur and may include nausea, leg swelling, or sleepiness.

Other Medications

MAO-B (monoamine oxidase-type B) is an enzyme which breaks down dopamine in the brain. Using medications that inhibit or slow the action of this enzyme can improve the levels and function of dopamine in the brain. While side effects are uncommonly seen, this drug may interact with other medications and even supplements, so it’s important that your doctor is aware of all of the medications you are taking.

Medications called COMT inhibitors (entacapone, opicapone, tolcapone) decrease the breakdown of levodopa in the bloodstream so more of it gets into the brain to be converted into dopamine. Your doctor may recommend this type of medication if the effect of your dose of medication seems to “wear off” early. A newer medication called istradefylline, an adenosine receptor antagonist, improves the activity of dopamine in the brain.

Physical Therapy and Exercise

Movement-based therapy can be helpful for patients with PD. Connecting with a neuro physical therapist is beneficial in all stages of PD. In fact, our clinic recommends “annual check-ups" to maximize one’s mobility and physical activity level.

There are specific types of physical therapy which have been developed for PD patients that improve walking, flexibility, posture, balance, and daily activities. This therapy may expand to include occupational and speech therapy, especially if difficulty with movements associated with dressing or getting in and out of bed is noted, or if your voice is quiet.

Regular physical exercise can also improve many aspects of PD. Options such as yoga, Tai Chi, “Nordic walking” (walking with ski poles), biking, and swimming are great choices.

LSVT-BIG^®

A special type of physical therapy, in association with occupational therapy, has been developed for patients with PD. It’s called “LSVT-BIG^®” and has been used since 2002 to help improve mobility and daily function in people with PD.

This PT/OT combination incorporates various strategies to overcome the slowed, small movements that patients with PD often experience. By retraining areas of the brain by performing large (or seemingly exaggerated) movements, patients can return to a more normal level of function.

While this treatment is offered across the country, at Trinity Health Hauenstein Neuroscience Center in Grand Rapids physical therapists and occupational therapists work closely with physicians to ensure patients have the best outcomes. The PT/OT clinic and the patient examination rooms are next to each other, which facilitates interaction between therapists and doctors.

It is important to know that not every therapist is trained or certified in this specialized option. The physical and occupational therapists at Trinity Health Grand Rapids (who are part of the acclaimed Mary Free Bed rehabilitation program) maintain their high level of training and are all certified in this specialized treatment for patients with PD.

Surgery

Some patients with PD may benefit from surgery. Since 1997, deep brain stimulation (DBS), a procedure which implants electrodes in the brain, has been approved to treat tremor associated with PD. DBS can smooth out the effect of medications in patients. Frustratingly, some of the more difficult symptoms associated with PD, such as freezing of gait, balance problems, and swallowing difficulty, cannot be made better with DBS.

High-intensity focused ultrasound, a newer therapy, can also help ease the tremor due to PD.

Diet

A healthy, well-balanced diet is important for people with PD. Some patients worry that eating protein may interfere with the impact of levodopa. Most patients do not experience this, so please ask your doctor about this issue if you have a concern.

Sleep

Getting enough sleep is also important for PD patients. Poor sleep may transiently worsen the symptoms patients experience, but they should return to their baseline when their sleep improves.

In summary, there are many effective treatment options for every patient with Parkinson’s disease, but not all patients will respond in the same way to each treatment. It is important to work with your doctor to develop a plan that’s best for you — one that will optimize your quality of life for as long as possible.

Learn more about diagnosing Parkinson's disease and movement disorders programs and clinics at Trinity Health Michigan.