Parkinson’s Disease Treatment Options

Top Ways To Treat Parkinsons Disease

This content was developed in partnership with the Parkinsons Foundation.

Every person living with Parkinsons disease experiences symptoms, disease progression and treatments that are unique to them. There is no single treatment plan that works for everyone.

The most common way to treat and manage PD symptoms include medications, exercise, rehabilitation therapies and surgical procedures. Treatment plans should be tailored to respond to an individuals symptoms and personal circumstances. While there is currently no cure for PD, the goals of treatment are to minimize symptoms and improve overall quality of life.

Important Points About The New Medications

With multiple new medications available for the treatment of PD, there is more hope than ever that Parkinsons symptoms can be successfully managed for many years. A few things to consider:

• For people whose symptoms are difficult to control, these new treatments are welcome additions to what was previously available and many people with PD have been using these new medications with significant benefit.
• On the other hand, many of the newly-approved medications have the same mechanisms of action as older medications so they are not breaking new ground in treating symptoms.
• In addition, for some people, the effect on symptoms may be mild or not substantial.

These caveats may mean that your physician has not suggested a medication change for you. It is also important to note that despite all the new medications, carbidopa/levodopa remains the most potent medication to treat the motor symptoms of PD.

If your doctor does choose to try one of the new options, there may be multiple paths that your doctor can take when contemplating a medication adjustment. Often trial and error is the only way to determine the best medication regimen for you, so you may need to practice some patience as you work together with your doctor to determine what works or doesnt work.

Treating The Motor Symptoms Of Parkinsons Disease

Motor symptoms are those that affect a persons ability to move. PD is characterized by 4 primary motor symptoms:1,2

• Tremor A shaking of the hands, arms, foot or legs, when the limb is at rest. Usually seen only on 1 side of the body.
• Rigidity An abnormal stiffness in a limb or part of the body. May include small jerks or ratchet-like movements.
• Postural instability Impaired balance or difficulty standing or walking.
• Bradykinesia Gradual loss and slowing down of spontaneous movement.

Along with the primary motor symptoms, PD may cause a number of secondary motor symptoms, including:2,3

• Freezing of gait or shuffling gait
• Unwanted accelerations in movement or in speech

Initial therapy for motor symptoms of PD usually includes:4

• Levodopa given along with carbidopa
• Monoamine oxidase-B inhibitors

The combination of levodopa and carbidopa is the most effective treatment available for the management of motor symptoms of PD. However, it can cause a side effect known as dyskinesia, which is abnormal involuntary movements. Plus, carbidopa-levodopa therapy can cause fluctuating symptoms of “on” and “off” episodes. “On” episodes describe when the medicine is working and symptoms are minimal. “Off” episodes are when the medicine has not yet taken effect or is wearing off and symptoms are worsened. Some of these symptoms are caused by the levodopa wearing off during the day.4

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Medications To Keep The Light Switch On Longer

There are three main classes of drugs that we use as adjunctive therapy: dopamine agonists, monoamine oxidase type B selective inhibitors, and catechol-O-methyl transferase inhibitors. All of these act in different ways in order to enhance dopamines effect or allow levodopa to linger longer. They can increase on time typically by one to two hours each day, which can improve quality of life for our patients.

Dopamine agonists essentially pretend to be dopamine. A dopamine agonists chemical structure looks so much like dopamines that the nerve cells think theyve received dopamine and act accordingly, controlling symptoms for longer. We have three dopamine agonists on the market today: pramipexole , ropinirole , and rotigotine transdermal patch .

Next, we have what I call the alphabet soup: MAO-B selective inhibitors and COMT inhibitors. MAO and COMT are both enzymes that break down dopamine, whether its dopamine our brain produces or dopamine that comes from levodopa. MAO-B selective inhibitors and COMT inhibitors do as their names suggest: they inhibit, or block, these enzymes from breaking down dopamine. That way, more dopamine is available and it sticks around for a longer period of time, decreasing off periods. MAO-B selective inhibitors include selegiline , rasagiline , and safinamide . COMT inhibitors include entacapone , tolcapone , and opicapone .

Therapy Services Nutrition And Wellness Plans

An integral part of Parkinsons disease treatment is ensuring that each patient receives all the support services they need to help manage the impact the disease has on their overall health and well-being.

Part of the multidisciplinary care provided at Brigham and Womens Hospital, many patients with Parkinsons disease also benefit from:

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Treatment For Parkinsons Disease

A multidisciplinary team that includes a neurologist and therapists who specialise in movement disorders is recommended for the management of the complex PD symptoms.

The appropriate multidisciplinary team members should be seen from the time the diagnosis of PD is received.

The advancement in the treatment options for PD over the last few decades has meant the progression of disabilities can be slowed and a good quality of life maintained. The following is an overview of current treatments that have good evidence to support their effectiveness.

Treatment Options For Parkinsons

While there is no cure for Parkinsons at this time, there are a number of treatments that can ease symptoms. Parkinsons medications are the mainstay of treatment, but modalities are often used in combination. Physical, occupational and speech therapy can be critical to the treatment plan. Surgical options also have an important role for a subset of patients with Parkinsons disease. Finally, complementary therapies can be used to treat some Parkinsons disease symptoms. Your physician and other healthcare professionals can help you determine the best treatment plan for your symptoms.

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Parkinsons Treatment On The Horizon

Immunotherapy: Researchers at the Columbia University Medical Center and the La Jolla Institute for Allergy and Immunology have found evidence that autoimmunityin which the immune system attacks the bodys own tissuesplays a role in Parkinsons disease. The findings raise the possibility that the death of neurons in Parkinsons could be prevented by therapies that dampen the immune response.

Our findings raise the possibility that an immunotherapy approach could be used to increase the immune systems tolerance for alpha-synuclein, which could help to ameliorate or prevent worsening symptoms in Parkinsons disease patients, says study co-leader Alessandro Sette, Dr. Biol. Sci., professor in the Center for Infectious Disease at La Jolla Institute for Allergy and Immunology in La Jolla, Calif. The study was published in Nature.

The idea that a malfunctioning immune system contributes to Parkinsons dates back almost 100 years, said study co-leader David Sulzer, PhD, professor of neurobiology at CUMC. But until now, no one has been able to connect the dots. Our findings show that two fragments of alpha-synuclein, a protein that accumulates in the brain cells of people with Parkinsons, can activate the T cells involved in autoimmune attacks.

This is the strongest evidence we have so far that a drug could do more than provide symptom relief for Parkinsons disease, says the studys senior author, Professor Tom Foltynie .

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Testimonios De Nuestros Pacientes

Soy Florencia, tengo 44 años y hace como un año y medio más o menos, después de dar muchas vueltas, me diagnosticaron fibromialgia y empecé a hacer las primeras sesiones en Biobarica. Yo tenía dolores en todo el cuerpo, incluso estuve varios días en cama sin poder moverme. Inicialmente hice 20 sesiones y la verdad es que me sentí fantástica y de eso pasó ya un año.

Florencia

Soy Verónica, tengo 35 años y tengo vasculitis livedoide . Ya voy 30 sesiones casi, y en las primeras 10 yo ya vi mejoría. Por ejemplo se me estaba poniendo el dedo necrótico, o sea azul, se estaba muriendo el dedo. Y note en 10 días como el dedo que estaba azul volvió a la normalidad.

Verónica

Mi nombre es Victor, de profesión soy abogado, tengo 65 años de edad, hace 5 años que comencé con el mal de parkinson y bueno he venido aproximadamente unas 20 sesiones a la cámara hiperbárica y realmente me siento mucho más seguro, manejo bien, conduzco, hago un montón de situaciones.

Victor

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How Does This Condition Affect My Body

Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.

Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.

When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.

As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.

What Causes The Condition

Although there are several recognized risk factors for Parkinsons disease, such as exposure to pesticides, for now, the only confirmed causes of Parkinsons disease are genetic. When Parkinsons disease isnt genetic, experts classify it as idiopathic . That means they dont know exactly why it happens.

Many conditions look like Parkinson’s disease but are instead parkinsonism from a specific cause like some psychiatric medications.

Familial Parkinsons disease

Parkinsons disease can have a familial cause, which means you can inherit it from one or both of your parents. However, this only makes up about 10% of all cases.

Experts have linked at least seven different genes to Parkinson’s disease. They’ve linked three of those to early-onset of the condition . Some genetic mutations also cause unique, distinguishing features.

Idiopathic Parkinsons disease

Experts believe idiopathic Parkinsons disease happens because of problems with how your body uses a protein called -synuclein . Proteins are chemical molecules that have a very specific shape. When some proteins dont have the correct shape a problem known as protein misfolding your body cant use them and can’t break them down.

With nowhere to go, the proteins build up in various places or in certain cells . The buildup of these Lewy bodies causes toxic effects and cell damage.

Induced Parkinsonism

The possible causes are:

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Treatments For Speech And Swallowing Difficulties

Speech and swallowing problems for people with PD also respond to exercise or strategies. A speech pathologist specialised in movement disorders such as PD can assess the persons speech and teach strategies to improve it.

Speech can be improved through particular exercises and programs such as the Lee Silverman Voice Therapy, Parkinson Voice Project SPEAK OUT!

Often identifying strategies to improve the communication environment or method can lead to more successful speech. Strategies and communication partner training can become invaluable to family and friends if a person with Parkinsons is experiencing cognitive changes which impact on communication such as word finding difficulties. Communication Devices such as amplifiers can help to increase volume and other devices or apps can be used when an alternative to speech is needed. Speech Pathologists can help guide you through what is available and potential avenues to help fund these aids.

Swallowing difficulties are more common in the later stages of PD and need to be investigated by a speech pathologist. Assessment may involve observing a meal or snack and completing an x-ray study call a videofluoroscopy. Once the reason for the dysphagia is identified the speech pathologist will advise on how to manage the difficulty. This may involve strengthening exercises for muscles involved in swallowing, modification to the diet and adaptive behavioural strategies such as improving head and neck posture.

Home Remedies And Lifestyle

Healthy eating can help ease your symptoms when you have Parkinson’s disease. As you may have constipation due to the condition, eating enough fiber and drinking plenty of fluids will help. You may also feel fuller after eating less food, so planning smaller meals and snacks throughout the day is best.

Omega-3 fatty acids, such as found in seafood and fish oil supplements, are being studied to see if they have any beneficial effects in Parkinson’s disease. A Mediterranean-style diet is one that is rich in omega-3 fatty acids, monounsaturated fats , and a good balance of nutrients. While more research is needed to determine if it offers a specific benefit for PD, the diet is considered a healthy eating plan for everyone.

A high-protein meal and dairy foods can slow the absorption of the Parkinson’s drug levodopa , so it is often better to have protein later in the day.

Exercise is important with Parkinson’s disease. It can help you maintain your strength, flexibility, and balance. One form of exercise that seems especially beneficial in Parkinson’s disease is dance. Consider taking some lessons to help improve your balance, mobility, and quality of life, if even just for the short term.

As Parkinson’s disease progresses, you will need to adopt practices aimed at preventing falls and allowing you to still perform your daily living activities. It is good to work with a physical therapist and occupational therapist to get the coaching and assistive devices that can work best.

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How Is Young Onset Parkinsons Disease Diagnosed

Doctors diagnose young onset Parkinsons disease by reviewing your medical history and conducting a physical examination, including neurological tests.

However, it may take doctors longer to reach the diagnosis because young onset Parkinsons disease is less common than late onset. They may recommend genetic testing.

Learn more about diagnosing Parkinsons disease.

What Will A Cure For Parkinsons Look Like

Parkinsons varies so much from person to person. There are over 40 symptoms of Parkinsons. Tremor. Pain. Hallucinations. Everyones experience is different.

Because of this, there may not be a single cure.

Instead we may need a range of different therapies to meet the needs of the individual and their specific form of the condition.

This mix may include treatments, therapies and strategies that can:

• slow or stop the progression of the condition
• replace or repair lost or damaged brain cells
• control and manage particular symptoms
• diagnose Parkinsons at the earliest possible stage.

And this could involve medical treatments, such as drugs and surgical approaches, as well as lifestyle changes, for example to diet and exercise.

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Dopaminergic Features And Their Treatment

Patients with PD usually present with features indicative of degeneration of nigrostriatal pathways. A useful clinical definition for PD is asymmetric onset of an akinetic rigid syndrome with resting tremor and a good response to levodopa. When applied by neurologists with an interest in movement disorders, this definition has a pathological correlation exceeding 98%. When treatment is considered appropriate, and this is a topic discussed in detail below, a variety of options is available. The use of dopaminergic drugs improves motor function, significantly reduces both the morbidity and mortality of PD, and improves quality of life.

Levodopa remains the drug most commonly used in PD. It is very effective in improving bradykinesia and rigidity, and in practice remains the gold standard against which other drugs are judged. Some studies, predominantly in vitro, have suggested that levodopa may be toxic. However, such data are conflicting, and some laboratory studies have suggested a growth factor-like effect for levodopa. Overall, the pre-clinical evidence for levodopa toxicity is not convincing and there are no data to indicate that any toxic action is of clinical relevance.

Table 1

Percentage of patients remaining on dopamine agonist monotherapy at years 14 and years 15 during treatment trials

What Did It Find

• According to the UPDRS score, there was no difference in the progress of disease between the early-start group and the delayed-start group , .
• The estimated rate of change in progression of the disease, a secondary outcome, was similar in both groups between 4 and 44 weeks .
• Due to needing symptomatic relief, 87 people in the delayed-start group had levodopa before week 40.
• The estimated rate of change in progression was faster between weeks 44 and 80 in the early-start group . This means starting levodopa earlier did not slow disease progression.
• At 80 weeks, a similar proportion of participants were suffering complications, such as involuntary movements, from levodopa treatment .

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What We Know So Far

• Weve uncovered clues to the causes and genetic involvement in Parkinsons.
• Were figuring out the chain of events that leads to the damage and loss of brain cells.
• Were working to advance new treatments and therapies.
• Were exploring repurposing drugs to help manage some of the more distressing symptoms, like hallucinations and falls.
• And we know that, although people with Parkinsons share symptoms, each persons experience of the condition and response to treatment is different.

Now, the science is ready for us to develop the new treatments and cure that people with Parkinsons so desperately need.

Research takes time but if you have Parkinsons, you need better treatments now. Thats why weve launched the Parkinsons Virtual Biotech to speed up the most promising potential treatments. The more we can invest, the sooner well get there.

Natural Treatment For Parkinsons #3 Turmeric And Otherherbs And Spices:

A recent study published in the journal Stem Cell Research & Therapy, foundthat the extracts in turmeric, particularly curcumin and the newly discovered Ar-turmerone,can regenerate a damaged brain and reverse neurological disorders. Researchers said Ar-turmerone is a promising candidate to supportregeneration in neurologic disease. Michigan State University researcherBasir Ahmad also found that a compound in turmeric may help fight Parkinsonsdisease by disrupting the proteins responsible for the disease.

Another study published in the Pharmacognosy Magazine found that tumeric can prevent and evenreverse the toxic effects exerted on the brain from fluoride exposure. Fluorideis a nasty and dangerous heavy metal that destroys brain cells and the intricateworkings of the central nervous system. Fluoride poisoning has also beenimplicated in the development of neurological diseases such as Alzheimers,Parkinsons, ALS and multiple sclerosis. 7

Turmeric is also a very potent anti-inflammatory spice. Because Parkinsons is aninflammation type disease, turmeric will help immensely. A heaped teaspoon ofhigh quality turmeric powder taken 3 times daily in asmoothie will do the trick. Just make sure you combine it with 10-12 blackpeppercorns for enhanced absorption Turmeric is also fat soluble so youll need tocombine it with some coconut oil, red palm oil or fish/krill oil as well.

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