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Treatments

Medication

There are multiple classes of Parkinson medications which aim to help control Parkinson’s symptoms including tremor, stiffness, and bradykinesia. The most effective drug is carbidopa-levadopa (Sinemet). Levadopa is ingested, goes through the blood-brain barrier, and replaces dopamine in the brain. Carbidopa is paired with levadopa to reduce nausea caused by the levadopa. Another class of drugs is dopamine agonists. These activate dopamine receptors in the brain to maximize the uptake of a person’s natural dopamine as well as levadopa-made dopamine. Common examples of dopamine agonists are mirapex, requip, neupro patch, and apokyn. Because they stimulate the pleasure center of the brain, one side effect of this class of drugs is pathological addiction, such as gambling, shopping, or hyper-sexuality. Monoamine oxidase inhibitor (MAO-B) Inhibitors is another class of drug that stops the breakdown of dopamine in the brain. These are often taken with carbidopa-levadopa or before levadopa is started to prolong the levels of dopamine naturally existing in the brain. Examples include selegiline and rasagiline (Azilect).

Surgery

Deep Brain Stimulation

Deep Brain Stimulation (DBS) involves inserting a device into the brain. This device, often called a “brain pacemaker,” sends electrical signals to specific parts of the brain. DBS in select brain regions has provided remarkable therapeutic benefits for appropriate people with Parkinson disease. A list of hospitals offering Deep Brain Stimulation can be found here.

Benefits of DBS can include:

  • Reduction or elimination of motor fluctuations and drug induced involuntary movements
  • Potentially improved; mental functioning due to medication reduction
  • Significant elimination of tremor, bradykinesia, and rigidity

Certainly, all surgical procedures carry certain risks. The DBS procedure poses a 1-2% risk of stroke or hemorrhage, which can occur during the procedure. Other very low risks include: infection, wire breakage, and skin erosion over the wire. While not a risk, the battery must be replaced every three to five years, which is performed as an outpatient procedure. There are also rechargeable batteries which can last up to 9 years.

Sources: American Parkinson Disease Association National Young Onset Center, Medtronic.

Physical Medicine

Physical Therapy

Most of us are referred to a physical therapist at one time or another. Whether you are experiencing disability as a result of pain, injury, or illness, physical therapists provide physical therapeutic intervention (as opposed to medical or surgical intervention) with the goal of preventing or minimizing disability.

As we learn more about how beneficial exercise is to people with Parkinson’s disease, physical therapy is becoming an essential part of many treatment plans. A physical therapist can help you develop an exercise routine that is right for you. Physical therapy can also help address certain symptoms of PD such as dystonia, freezing and gait. If possible, it is best to see a physical therapist who has experience treating people with Parkinson’s. Some physical therapists become Board-certified as a Neurologic Specialist (NCS). You can find a physical therapist near you by contacting the American Physical Therapy Association (APTA), the APDA Rehab Resource Center or by asking your physician or movement disorders clinic for a referral.

APDA Publications

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Occupational Therapy

Occupational therapists are similar to physical therapists, but they focus on more specific goals related to functioning. In other words, occupational therapist help us “function” (i.e., accomplish the tasks of daily living) to the best of our ability. For people with Parkinson’s disease, routine tasks such as walking, running, standing up from a chair or moving into and out of bed can become difficult; occupational therapists are trained to evaluate these kinds of difficulties and help the person and/or the environment adapt as needs and abilities change.

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Speech Therapy

Most of us, when we think of Parkinson’s disease, think of symptoms such as tremor and slowness of movement. Perhaps less well known are the speech, swallowing, and communication difficulties many people with PD experience.

Speech, for example, may be less loud or less clear. People with Parkinson’s sometimes do not even realize their speech has changed, but may notice that others are asking them to repeat themselves much more frequently than in the past. Non-verbal communication can be affected as well. Referred to as “facial masking,” people with PD may find that they are less able to move their facial muscles which can compromise their ability to communicate effectively with others. This can be a very frustrating symptom because you may look uninterested, even angry, when you are not.

Swallowing can also become difficult because the muscles that help perform this activity can experience tremor, stiffness, and slowness just as the other parts of the body do. Difficulty swallowing can lead to serious problems such as malnutrition, so attending to it is important (see Good Nutrition booklet).

Speech and Language pathologists (SLPs) are trained to evaluate and treat these very difficulties. An SLP can help by developing a program to help you stretch and strengthen the muscles involved in speech, expression, and/or swallowing or by teaching coping strategies that will make communication or swallowing easier.

Some SLPs have been trained in a technique called Lee Silverman Voice Treatment® (LSVT), a speech and voice therapy that was developed specifically for people with Parkinson’s disease. The LSVT®LOUD program can make a difference in quality of life for people with Parkinson’s. It is an intensive program, one that involves 16 sessions during a one-month period, so it may be helpful to think ahead and schedule this type of therapy when you are able to devote the time and energy necessary to achieve the maximum benefit. To find out more about LSVT or to find an SLP who is trained in the technique, visit the Service Locator on this website or www.lsvtglobal.com.

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Complementary Medicine

Some find that CAM offers helpful information related to proper diet, exercise, and stress or pain management. Others turn to CAM to help them address some of the secondary symptoms of PD such as constipation or fatigue. Some people pursue CAM in an effort to minimize the amount of medication they take and delay the long-term side effects like dyskinesia (involuntary movements) associated with some conventional medications.

If you are considering CAM therapies, consult with your neurologist or primary care physician, or seek the advice of an integrative medicine physician. It is important for all those involved in your treatment to be working together to some extent. If you are thinking of taking any supplements or herbs, inform your physician as some of them can interfere with conventional drug treatments. Avoid practitioners who claim to “cure” Parkinson’s disease, and any who advise abruptly stopping or weaning off prescription medications (unless you have first spoken with your physician).

Accupuncture

Chiropractic

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