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Parkinson's Treatments

Parkinson's disease can be treated with medication and even surgery to help relieve symptoms.

Parkinson's treatments may require surgical options. [©Shutterstock, 2010]
©Shutterstock, 2010
Parkinson's treatments may require surgical options.

Parkinson's Treatments

Researchers have not discovered a Parkinson's treatment that completely stops its progression. They have, however, found a number of medical and surgical treatments that help people living with Parkinson's disease (PD) deal with its symptoms and lead relatively normal lives. Most of the drugs target the neurotransmitter dopamine, which is often lacking in PD patients. Surgical treatments, on the other hand, target the malfunctioning structures in the brain that create and exacerbate the symptoms of the disease.

Levodopa

One medication commonly prescribed to patients with Parkinson's disease is levodopa (l-dopa), which is sold under the brand names Levopa, Bendopa, Dopar, Eldopar and Laradopa. According to the Mayo Clinic, levodopa is a naturally occurring amino acid that the body uses to create dopamine, an important neurotransmitter. Patients with PD almost always have lower-than-normal levels of dopamine in their brains, which causes some of the disease's main symptoms -- tremors and loss of balance. However, because dopamine cannot pass into the brain through the bloodstream, giving these patients doses of pure dopamine does not have a positive effect on their symptoms. Levodopa can pass through the blood-brain barrier, however, and once it reaches the brain tissue it is converted into much-needed dopamine by a special enzyme called dopa decarboxylase (DDC). Doctors often prescribe a combination of levodopa and another drug, called carbidopa, which slows the rate at which the body breaks down levodopa. This preparation is sold under the brand names Sinemet and Atamet. The University of Maryland Medical Center reports that while levodopa is better at improving motor control than dopamine itself, it may increase the patient's risk of experiencing involuntary movements, a condition known as dyskinesia.

Other Medications for Parkinson's Disease

Aside from levodopa, which is generally considered to be the gold standard of Parkinson's medications, doctors may also prescribe drugs known as dopamine agonists. These mimic dopamine and bind with its receptors in the brain, producing similar effects to those of levodopa. Available under the drug names ropinirole, pramipexole and bromocriptine, dopamine agonists can be used by themselves or along with levodopa.

Some patients with PD have also found relief from their symptoms in rasagiline and selegiline, which belong to a class of drugs called monoamine-oxidase inhibitors (MAOIs). Both these drugs tend to be used during the initial therapy, and they will not slow the progression of PD, unlike levodopa. Amantadine, an antiviral medication, may also reduce the symptoms of tremor, bradykinesia (slow movement) and fatigue experienced by patients with PD.

Surgical Parkinson's Disease Treatments

For patients with Parkinson's disease who do not experience improvement in their symptoms after treatment with medication, doctors may recommend surgical treatment. However, not all patients are good candidates for surgery, and only about 10 percent of all patients with PD are eligible. Patients should also be aware that many of these surgeries, including deep-brain stimulation, which is the newest and most popular procedure, still carry the risk of injury and death. The National Parkinson Foundation reports that approximately 2 percent of patients experience bleeding in their brains and have strokes after surgery.

Deep-Brain Stimulation

Deep-brain stimulation (DBS) is one of the newest and most exciting surgical therapies for Parkinson's disease. Before DBS was invented, surgeons would attempt to treat PD by destroying or removing certain parts of their patients' brains responsible for causing their most debilitating symptoms (i.e., tremors). During DBS surgery, the surgeon places a small electrode on one of these target areas, which then emits an electrical pulse that inactivates the region. The electrode, which is lodged deep in the patient's brain near the brain stem, is connected to a battery-powered generator placed near the collarbone that sends a steady stream of electricity. Given an average daily use of 16 hours, the typical generator's battery will last for about 5 years. When the battery begins to run low, it can easily be replaced with an outpatient surgical procedure.

The main benefit of DBS is its effect on the classic symptoms of PD; generally, it can control tremors and other physical symptoms about as well as levodopa, but without its side effects. Also, it can deliver a more constant stream of relief to patients who experience on and off periods of relief while taking medication. Some patients who receive DBS may experience a reduced need for their medications, while others may be able to safely stop medical treatment altogether.

Despite these substantial benefits, DBS can only be implemented through open-brain surgery, which carries its own set of serious risks. The most common side effect of the surgery is infection, which occurs in about 4 percent of patients. Some patients may also experience dizziness, nausea, sleepiness or changes in their personalities for up to two weeks after the surgery, depending on the extent of swelling in the brain tissue surrounding the electrode.

Pallidotomy

Pallidotomy was the most popular surgical Parkinson's disease treatment before the advent of DBS in the late 1990s. The procedure targets the pallidum, an area of the brain that affects certain characteristic symptoms of PD. Before making permanent changes to the brain cells, the surgeon uses a small probe to send mild electrical impulses through the target region of the patient's brain. If the probe is in the right spot, there should be an immediate and noticeable improvement in the patient's tremors and rigidity. After making sure the proper area is targeted, the surgeon then burns a hole into the brain tissue, creating a chunk of inoperative cells, known as a lesion. Since the area of malfunctioning tissue is now dead, the patient should experience permanent relief from the symptoms alleviated by the electrical impulse. Although the procedure is invasive and may seem frightening, it is only mildly painful and can be performed while the patient is awake.

Complementary Treatments

Many patients with Parkinson's disease use complementary treatments to manage their symptoms and improve their sense of well-being. Physical therapy can improve patients' strength, balance and coordination, which help them fight the symptoms of PD that affect their gross motor skills. Massage, aerobic exercise and active hobbies can also keep patients healthy, happy and motivated to continue leading productive lives.

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