Treatment for Parkinson's Disease

Although there is as yet no cure for Parkinson’s Disease (PD), scientists are working hard and fast to look for better treatments to manage its symptoms. There is also a search for treatments that can slow the progression of the disease. Drug therapy to both manage the symptoms of PD, and slow the progression of the disease, remains the ‘Gold Standard’ treatment option for PD. Likewise, the same treatment options are also being offered to patients afflicted with Parkinson's disease even in the Philippines.

Drug Therapies

Levodopa increases the level of dopamine in the brain and thus relieves the movement problems of PD. Levodopa however has side effects. One of Levodopa’s common side effects is nausea so it is usually given with a second drug, carbidopa, that prevents nausea. The combination of Levodopa/Carbidopa effectively treats the symptoms of PD, allowing many people with PD to live relatively normal, active, and productive lives for many years.

Dopamine Agonists are a class of drugs that, like levodopa, increase dopamine activity in the brain. Commonly prescribed dopamine agonists include: bromocriptine (Parlodel), pergolide (Permax), pramiprexole (Mirapex), and ropinirole (Requip). They do not work as well as levodopa for the movement problems of PD but they may be able to slow progression of the disease.

Surgical Treatments

A small percentage of patients with PD do not benefit from drug therapies or suffer from severely disabling dyskinisia as a consequence of drug therapies. When the symptoms become severe surgical procedures may be an option. There are four types of surgical procedures for PD, Pallidotomy, Thalamotomy, Electrical Stimulation (Deep Brain Stimulation) and Neural Implants.

In pallidotomy the globus pallidus, is destroyed. The globus pallidus is targeted because it is a regulatory center for movement circuits of the brain. When the pallidotomy works, it can reduce rigidity and abnormal movements.

In thalamotomy, a small portion of the thalamus, is destroyed. The thalamus relays excitatory information to motor circuits. When the surgery works it can relieve severe tremors.

With Electrical Stimulation (Deep Brain Stimulation) various brain regions involved in motor regulation can be given an electrical stimulus which temporarily blocks activity in that part of the brain. Blocking that activity in turn has beneficial effects on other parts of the brain. Because the blocking is temporary, this procedure is reversible (in contrast to pallidotomoty or thalamotomy). Stimulation to the thalamus controls tremor. Stimulation to the globus pallidus treats balance and rigidity problems, but is generally not used specifically for tremor. The two most common sites for stimulation are the subthalamic nucleus and the globus pallidus.

Neural Implants involve placing tissue that can manufacture dopamine into selected regions of the brain. This treatment option is still very much in the experimental stage.

Physical Therapy

Because PD involves a variety of movement problems a physical therapist can devise a program of exercises that can relieve the patient's pain and maintain the muscle integrity.

Treatment of Non-Motor Behavioral Symptoms

Up to 80% of patients with PD experience depression. Depression in PD can be treated with most of the standard drugs used to treat depression in people without PD such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and venlafaine (Effexor). Triavil and Asendin however should NOT be used by people with PD.
Rarely persons with PD will experience hallucinations. These are usually due to too high a dose of levodopa. These episodes can usually be handled by carefully reducing the levodopa dosage. If that does not help then anti-psychotic drug treatment will usually do the trick.

Sleep problems such as REM Behavior Disorder can be treated with clonazepam. Execessive daytime sleepiness can be treated with modafinil (Provigil).

The management options for PD patients encompass not just the alleviation of the physical signs and symptoms of the disease, but also the improvement of the quality of life and reduction of the potential side effects of whatever treatment modality to be adopted.