How is Parkinson's disease treated?

Parkinson's disease is treated with medicines that make the symptoms better, but there’s no cure. There are many different types of medicines, but they work by either mimicking how dopamine works or by replacing dopamine with other chemical messengers. Another treatment option is deep brain stimulation. This works by sending small electrical signals to the brain, which can help reduce some of the symptoms.

Dr. Nader Pouratian, MD

Treatments for Parkinson’s disease include medications, surgery, exercise and social support. In all cases, treatment is focused on symptoms. There are no treatments that can change the natural course of the disease. Medications are not started or administered until symptoms become bothersome. Most medical treatments focus on restoring the dopamine that is lost as a natural part of the disease. The main staple of therapy is carbidopa-levodopa (Sinemet). Modern surgical treatment primarily consists of deep brain stimulation surgery, which acts like a pacemaker for the brain to restore a more normal pattern of brain activity. Exercise and social support are also key cornerstones of therapy and are often the primary treatments early in the disease.

How Parkinson's disease is treated depends on the severity of the person's symptoms. People with Parkinson's disease have a number of effective treatment strategies available to them. The severity of the person's motor symptoms determines the type of medicine used.

People with Parkinson's disease are deficient in dopamine, so pharmacologic treatment, with medications, aims to replace or mimic dopamine so the person can function fairly normally in the beginning of the disease.  It can be thought of like the way diabetes is treated. If a person with diabetes is deficient in insulin, taking insulin allows him or her to function fairly normally and have a regular diet.

The strongest medicine available for Parkinson's is carbidopa-levodopa, also known as Sinemet. Levodopa has been around since the late 1960s. Then there are other medications that are a little less potent but can still be equally effective in helping the motor symptoms. These medicines are called dopamine agonists. A medication called a monoamine oxidase B (MAO-B) inhibitor helps recycle the dopamine that the brain is still making and the levodopa medication by preventing its breakdown.

In addition to the medicine, regardless of how severe or not severe symptoms are, there is always a role for therapy, including physical therapy, occupational therapy and speech therapy. There are also specific programs for people with Parkinson's disease, including the LSVT, or the Lee Silverman Voice Treatments method. An exercise program called Parkinson's Wellness Recovery or PWR is also effective in helping people maintain their fluidity, their balance and their walking in a more natural cadence and pattern.

Depression and anxiety may go along with the Parkinson's disease diagnosis and may be a chronic diagnosis, or part of the disease process itself. Either way it needs to be addressed and managed through support groups, counseling or through pharmacologic therapy with antidepressants and antianxiety medication.

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Parkinson's disease can be managed with medication, but many side effects may develop as the disease progresses.

At present, there is no cure for PD. But medications or surgery can sometimes provide dramatic relief from the symptoms. Medications for PD fall into three categories.

The first category includes drugs that work directly or indirectly to increase the level of dopamine in the brain. The most common drugs for PD are dopamine precursors – substances such as levodopa that cross the blood-brain barrier and are then changed into dopamine. Other drugs mimic dopamine or prevent or slow its breakdown.

The second category of PD drugs affects other neurotransmitters in the body in order to ease some of the symptoms of the disease. For example, anticholinergic drugs interfere with production or uptake of the neurotransmitter acetylcholine. These drugs help to reduce tremors and muscle stiffness, which can result from having more acetylcholine than dopamine.

The third category of drugs prescribed for PD includes medications that help control the non-motor symptoms of the disease -- that is, the symptoms that don't affect movement. For example, people with PD-related depression may be prescribed antidepressants.

Treating PD with surgery was once a common practice. But after the discovery of levodopa, surgery was restricted to only a few cases. Studies in the past few decades have led to great improvements in surgical techniques, and surgery is again being used in people with advanced PD for whom drug therapy is no longer sufficient.

This answer was written based on source information from the National Institute of Neurological Disorders and Stroke.

The mainstay treatment for Parkinson's for the past three decades has been the drug levodopa.

Levodopa is converted into dopamine by nerve cells in the brain, which relieves some stiffness and tremors, which are the most troubling and common symptom of the disease.

Enzymes in the blood tend to break down levodopa before it can get to the brain, so it is typically combined with the drug carbidopa, which will keep levodopa intact until it reaches the brain. Levodopa is effective, but it can cause dry mouth, nausea and vomiting.

Once a person has been diagnosed with Parkinson's disease doctors customize the numerous treatment options to meet his or her needs. People with Parkinson's disease often take a variety of medications at different doses and at different times of day to manage symptoms. None of the current therapeutic approaches reverse the progression of Parkinson's disease, but many good treatments are available to alleviate the symptoms.
Current medications to treat Parkinson's include:

  • Levodopa, which is converted into dopamine in the brain, increasing the levels of this important neurotransmitter.
  • Dopamine agonists, which stimulate the dopamine receptors in the brain.
  • Anticholinergics, which decrease the activity of the neurotransmitter acetylcholine, to improve the balance between acetylcholine and dopamine.
  • MAO-B and COMT inhibitors, which help to make levodopa last longer in the brain; MAO-B inhibitors also directly increase dopamine levels.

In some people, medications do not adequately control the disabling symptoms of Parkinson's disease. These people may be eligible for a neurosurgical procedure called deep brain stimulation.

Dr. Audrey K. Chun, MD
Geriatric Medicine Specialist

There is no cure for Parkinson's disease (PD), but the drug levodopa and other medications and treatments can control symptoms for many years. Because the clinical course of disease progression varies widely from patient to patient, identifying risk factors associated with early death can help patients and families plan, and might help doctors better target treatment strategies.

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