Parkinson’s Treatment: How To Manage This Disease

 

Parkinson’s Treatment. The name usually evokes images of tremoring hands, countless medical appointments, or the doom and gloom fate of disease progression. Despite these negative connotations, there is life after the diagnosis. Medication, surgery, and lifestyle changes are ever-evolving. Parkinson’s treatments manage motor symptoms that interfere with daily tasks. Learn which Parkinson’s treatment option is right for you or your loved one.

Parkinson's Treatment

Parkinson’s Disease Treatment Medications

What is Parkinson’s Disease?

Parkinson’s Disease is a progressive central nervous system disorder that breaks down nerve cells (neurons) in the brain. Neurons produce a chemical neurotransmitter known as dopamine. As cell death occurs from the disease process, dopamine levels fall. A lack of dopamine results in abnormal brain activity. Parkinson’s specifically targets the neurons in the substantia nigra—part of the brain responsible for reward and movement.

The cause of Parkinson’s Disease is unknown. However, scientists have located genetic mutations that make one susceptible to the disease. Professionals have observed a few trends over the years. Males over the age of 60 are more likely to develop the disease. Exposure to environmental toxins, like pesticides, also play a role.

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Symptoms of Parkinson’s Disease

Symptoms of Parkinson’s begin mild and progress at varying rates. There are two categories in which to classify symptoms. Learn about the early signs of Parkinson.

Motor Symptoms of Parkinson’s Disease

The motor symptoms of Parkinson’s Disease pertain to movement.

  • Tremors
  • Rigid Muscles
  • Bradykinesia (slow movements)
  • Impaired Balance and Gait
  • Speech Difficulties
  • Writing Changes
  • Loss of Automatic Movements

Non-motor Symptoms of Parkinson’s Disease

The non-motor symptoms of Parkinson’s Disease are the symptoms that do not affect movement.

  • Depression
  • Dementia
  • Sleep disorders
  • Problems urinating
  • Gastrointestinal Dysmotility (constipation, swallowing difficulties, etc.)
  • Fatigue
  • Sexual Dysfunction
  • Chronic Pain
  • Orthostatic Hypotension (a drop in blood pressure upon standing)
  • Smell Dysfunction
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Parkinson’s Treatment: Medications

There is no cure for Parkinson’s Disease, but medications do control some of the symptoms.

Parkinson’s Treatment: Levodopa

Levodopa is crucial for treating all stages of Parkinson’s Disease. While dopamine alone is not an effective therapy because it does not cross the blood-brain barrier, Levodopa can. The drug is a precursor to dopamine—the brain chemical lacking in Parkinson’s Disease patients. Levodopa acts as it is synthesized in the brain.

Levodopa is given in a variety of ways. Physicians prescribe long and short acting pills, a sublingual form that dissolves in the mouth, or combined options. Effectiveness is enhanced when it is combined with other Parkinson’s Disease treatments, like COMT inhibitors or aromatic L-Amino acid decarboxylase inhibitors. 

Examples of Levodopa: Rytary, Parcopa, Stalevo, Sinemet, Parcopa,Duopa

Side effects include low blood pressure, nausea, vomiting, lightheadedness, confusion, loss of appetite, drowsiness, sudden onset of sleep, and dyskensia if used long term (3 to 5 years).

Parkinson’s Treatment: Dopamine Agonists

The human body contains numerous dopamine receptors. Each receptor is responsible for a specific function. Dopamine agonists treat Parkinson’s Disease as they activate the dopamine receptors in charge of their motor symptoms. The dose depends on the progression of the disease.

Examples of Dopamine Agonists: Apokyn (apomorphine hydrochloride), Parlodel (bromocriptine), Neupro (rotigotine), Mirapex (pramipexole dihydrochloride), Mirapex ER (pramipexole dihydrochloride), Requip (ropinirole).

Side effects include nausea, hallucinations, sudden sleepiness, dyskinesia, dizziness, lightheadedness, and impulse control behaviors.

Parkinson’s Treatment: COMT inhibitors

COMT inhibitors received the name due to the effects on the COMT enzyme. Parkinson’s Disease decreases the body’s dopamine levels through the destruction of dopamine-producing neurons. COMT enzymes are responsible for degrading dopamine and COMT inhibitors are effective because they block the COMT enzyme from further breaking down dopamine.

Combining COMT inhibitors with Levodopa is most effective at treating Parkinson’s Disease. With the aid of medication, the body can produce additional dopamine from the dopamine precursor provided by Levodopa. Dopamine levels are preserved and symptoms reduced as COMT inhibitors slow the breakdown of Levodopa.

Examples of COMT inhibitors are: Comtan (entacapone), Tasmar (tolcapone).

Side effects include vivid dreams, drowsiness, diarrhea, hallucinations, dyskinesias, orange colored urine, and dyskinesia. Tolcapone can cause liver toxicity.

Parkinson’s Treatment: MAO-B inhibitors

Aside from COMT, MAO-B is an enzyme that breaks down dopamine. MAO-B inhibitors reduce symptoms of Parkinson’s Disease by increasing the amount of dopamine available to the brain. On its own, the drug only displays a modest improvement in symptoms. Combining MAO-B inhibitors with other Parkinson’s medications advances treatment.

Examples of MAO-B inhibitors: Eldepryl (selegiline), Carbex (selegiline), Zelapa (selegiline), Azilect (rasagiline), Xadago (safinamide).

The side effects of MAO-B inhibitors are constipation, dry mouth, nausea, insomnia, dizziness, lightheadedness, confusion, agitation, dyskinesia, headaches, orthostatic hypotension, and hallucinations. MAO-B inhibitors are infamous for drug interactions. Patients taking MAO-B inhibitors must avoid serotonin-norepinephrine reuptake inhibitors (SSRIs) and tricyclic antidepressants.

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Parkinson’s Treatment: Anticholinergic Drugs

The bulk of drug treatments for Parkinson’s Disease directly target dopamine, but anticholinergics facilitate an increase in dopamine through another neurotransmitter called acetylcholine. Anticholinergics block acetylcholine receptors. As anticholinergics stop the action of acetylcholine, neuron activity in the basal ganglia is increased. Tremors and dystonia, both involuntary muscle movements, are the main Parkinson’s symptoms that respond to anticholinergics.

Examples of Anticholinergics: Artane (trihexyphenidyl), Cogentin (benztropine mesylate).

Side effects anticholinergics are dry mouth, blurry vision, urinary retention, constipation, confusion, hallucinations, and problems with short-term memory.

Parkinson’s Treatment: Symmetrel (amantadine)

Although typically losing its effectiveness within 3 to 4 months, Symmetrel (amantadine) is an antiviral drug that treats Parkinson’s Disease. The drug’s success rates cannot be attributed to its antiviral properties. Amantadine is multi-purposeful in that it increases dopamine, has an anticholinergic component, and studies confirm “it may be a dopamine and noradrenaline presynaptic reuptake blocker” (Münchau & Bhatia, 2000). Early-stage Parkinson’s patients see benefits in dyskinesia, rigor, and resting tremors. Patients later in the disease process tend to have little change in symptoms, especially when not combined with other therapies.

Side effects of Symmetrel (amantadine) are edema, skin mottling, anxiety, insomnia, blurry vision, confusion, and possible renal failure.

Parkinson’s Treatment: Surgical Interventions

Some patients with Parkinson’s Disease do not respond to treatment using medications. While there is no cure for Parkinson’s Disease, surgical interventions provide moderate symptom relief. However, any procedure carries a set of risks. Surgery is often the final recourse if the medication options fail.

Parkinson’s Treatment: Deep Brain Stimulation Procedures

Deep brain stimulation (DBS) is a Parkinson’s treatment designed to decrease motor symptoms through the surgical placement of electrodes in the brain. Magnetic resonance imaging (MRI), an x-ray machine, measures brain activity and allows for a visual to place the electrodes. A second procedure implants a neurostimulator, which is a pacemaker-like device in the abdomen or collarbone attached to an extension. The neurostimulator controls the electrodes. The targeted brain location receives electrical signals from the device.

DBS is the preferred surgical intervention for Parkinson’s Disease because it does not destroy the targeted areas of the brain. The DBS procedures are reversible and associated with typical post-op risks like bleeding, stroke, or infection. As the disease progresses, DBS procedures can be altered to target new symptom combinations. The targeted brain location depends on the type of deep brain stimulation (DBS) procedure.

Parkinson’s Treatment: Thalamic Stimulation

During thalamic stimulation, electrodes are placed in the thalamus to treat essential tremor and have not been noted to benefit the other symptoms of Parkinson’s Disease. Patients seeking coverage in other symptoms must pursue alternative DBS procedures or adjust medication dosing to work optimally with thalamic stimulation.

Subthalamic Nucleus Stimulation

Subthalamic nucleus stimulation targets the subthalamic nucleus. A study published in the New England Journal of Medicine revealed that in the Parkinson’s patients who underwent subthalamic stimulation, “the percentage of time during the day that patients had good mobility without involuntary movements increased from 27 percent to 74 percent.” Subthalamic nucleus stimulation is known to reduce tremor, rigidity, dyskinesia, bradykinesia, and gait disorders.

Pallidal Stimulation

Pallidal stimulation targets the area of the brain called the globus pallidus. The symptoms that the procedure helps are tremor, rigidity, bradykinesia, dyskinesia, and gait disorders.

Parkinson’s Treatment: Lesioning Procedures

Parkinson's Treatment

Parkinson’s Disease Treatment: Surgery

The concept of surgery is universally understood to correct an underlying medical problem. Yet, it is kind of ironic that lesioning procedures relieve symptoms not by fixing the body, but by inflicting damage on the brain. Lesioning is when lesions (scars) are made on a distinct area of the brain, like the thalamus, to target the cells that control movement.
Parkinson’s patients who undergo lesioning procedures have a marked improvement in tremors, stiffness, and motor impairment from medication side effects.

Patients undergo all lesioning procedures awake, as they must interact with the surgery team to ensure the procedure has not compromised brain activity. It is not painful, however. The scalp is numbed prior to the insertion of the surgical instruments to counteract painful sensations. Lesioning was a common in Parkinson’s treatment in the 1950s and 1960s. The procedures are rarely done today unless deep brain stimulation (DBS) fails.

Thalamotomy

The thalamus is a part of the brain responsible for motor control. Using MRI or CT brain imaging to locate the thalamus, a thalamotomy is a lesioning procedure which entails surgically damaging that area of the brain to treat a severe tremor on one side of the body. The procedure is performed on the side of the brain contralateral to the patient’s symptoms. For example, if a patient has a right-sided tremor, then the left side of the brain is operated on. This reduces the surgical risks (i.e. infection, gait problems, numbness, vision problems, and stroke or hemorrhage).

Pallidotomy

In Parkinson’s Disease, there is excessive activity in the globus pallidus. That increase in activity results in a decrease elsewhere (i.e. other parts of the brain that control movement). A pallidotomy is a lesioning procedure in which a surgeon creates a scar on the globus pallidus to reduce brain activity. Targeting the lobus pallidus relieves the motor symptoms of Parkinson’s Disease such as dystonia, tremors, rigidity, and bradykinesia. Patients undergoing a pallidotomy are at risk for seizures.

Subthalamotomy

The surgical process of a subthalamotomy is similar to other lesioning procedures. A subthalamotomy is the rarest of the three. It destroys the subthalamic nucleus to relieve motor symptoms tremor, rigidity, and bradykinesia.

Parkinson’s Treatment: Lifestyle Changes

Parkinson’s Disease is a serious medical condition. Still, the severity of the disease process does not render patients fully at the mercy of their bodies. If you or a loved one have Parkinson’s Disease, it is imperative you feel in control of your treatment. Incorporating lifestyle changes into your daily routine is an asset to medication and surgical treatment options.

Parkinson’s Treatment: Nutrition

No single diet is recommended for the treatment of Parkinson’s Disease. The golden rule is to fuel the body with a well balanced diet. Strive to consume the standard 5 portions of hydrating fruit and vegetables and plenty of fiber. Drinking 6 to 8 glasses of water per day relieves constipation and treats symptoms of low blood pressure. The added hydration flushes toxins out of the cells.

Limit intake of processed foods with harmful fillers and preservatives. Replace sugary, refined carbohydrates with healthy carbs like whole grains that will not cause drastic blood sugar fluctuations. Stabilizing blood sugars is vital to decreasing inflammation levels in the body.

Studies indicate a diet comprised of primarily plant foods slow disease progression. Animal products are high in saturated fat and raise cholesterol. Fat and protein from plant sources is superior. If not, lean meat and fish are fine in moderation. Overall fat consumption should not exceed 30% of caloric intake. Fats remain in the stomach and require more energy to digest, which is counter productive for a Parkinson’s Disease patient with slow gastric motility and constipation.

Antioxidants

Oxidative stress is a metabolic process caused by an accumulation of free radicals—toxic substances formed from pollution, sunlight, smoke, and all stressors. As toxins accumulate, oxidative stress is correlated with the cell death in Parkinson’s Disease. Consuming foods with antioxidants neutralizes oxidative stress.

Antioxidant Foods: Berries: Blueberries, cranberries, raspberries, blackberries, etc., Pomegranate, Beans, Potatoes, Artichoke, Green leafy vegetables, Dark Chocolate, Legumes: Lentils, edamame; Nuts: Walnuts, hazelnuts, pecans, Flax seeds, Beverages: Green tea, red wine.

Medication-Diet Interactions

Levodopa (Sinemet) is the go-to medication for Parkinson’s treatment, but dietary changes are necessary for it to work to its fullest potential. Since Levodopa is a protein building block, meals high protein hinders the action of the drug. The medication competes with dietary protein for absorption.

MAO-B inhibitors interact with diets high in tyramine. When MAO-B inhibitors are exposed to excess tyramine, high blood pressure and cardiac symptoms are real outcomes. Foods with tyramine include: Red wine, Beer, Aged cheeses, Soy products, Cured meats; Fermented cabbage: sauerkraut, kimchi.

Eating a carbohydrate snack (i.e. bread, toast, or crackers) along with medication is advised to avoid an upset stomach.

Parkinson’s Treatment: Exercise and Physical Therapy

Exercise as Parkinson’s treatment reduces stiffness and improves mobility, balance, posture, and gait. Patients have the greatest success exercising when they are most mobile, which tends to be within the peak of their medications (one hour after). With a doctor’s permission, results are best observed when engaging in a safe exercise plan 4-5 times a week for 30-40 minutes a session.

Parkinson's Treatment

Parkinson’s Disease Treatment: Exercise

Research supports a variety of aerobic and learning-based exercises that test balance, preparatory adjustment, and that promote cardiopulmonary fitness. The three key components to the exercise plan of a Parkinson’s Disease patient is to practice large rhythmical movements, rotate the trunk, and alternate between vibration, rocking, and swinging movements.

Effective Exercises: Dancing, Hiking, Obstacle course, Throwing a ball, Tai Chi, Walking outside or in a mall, Yoga, Marching, Swimming with a change in strokes, Paced walking with various speeds.

Repetitive exercise that does not challenge the motor skills does not provide many advantages for patients. Examples include weight lifting, swimming laps, treadmill at one speed, and stationary biking.

Strengthening Exercises

Strengthening exercise, like weight training, is not totally futile for Parkinson’s Disease. Those exercises do maintain and build muscle mass. Close monitoring by a physical therapist is suggested to guarantee that the exercises are executed correctly. Strengthening exercises worsen the stiffness and rigidity of Parkinson’s patients when done incorrectly. Use light weights and incorporate the strengthening exercises into an aerobic activity. Regardless of the form of exercise, a longer cool-down period is crucial to prevent stiff muscles.

Brain Training Exercises

Patients with Parkinson’s Disease struggle with depression and dementia. Brain training exercises have a proven positive impact on the mind. Completing learning based exercises and physical aerobic exercises simultaneously sustain memory function. The therapeutic aspect lies in the sudden shift between activities.

Recommended Brain Activities:

  • Reading
  • Writing
  • Problem-solving
  • Singing
  • Watching Movies
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Parkinson’s Treatment: Speech Therapy

The goal of speech therapy is to improve the overall communication of patients with Parkinson’s Disease. Speech therapy treats dysarthria (difficulty speaking) and dysphagia (difficulty swallowing)—both of which are debilitating Parkinson’s symptoms.

Dysarthria

Difficulty speaking manifests in multiple ways. Muscles in the larynx, throat, mouth, tongue, and lips weaken. As Parkinson’s progresses, patients find it difficult to pronounce and enunciate words. Their speech may be slurred, mumbled, or breathy from a strained voice. Cognitive impairments cause patients to be unable to follow a fast-paced conversation as they struggle to find words.

Speech therapy is helpful to strengthen the weakened muscles in the mouth. Therapists instruct patients on communication techniques. For example, how to properly emphasize word sounds for a clearer understanding in conversation.

There are several exercises:

  • Voice Aerobics: focuses on breath support, posture, and vocal functions
  • Voice Choral Singing Therapy (VCST): a form of music therapy that minimizes fatigue and increases the respiratory volume
  • Voice Choral Singing Therapy (VCST): a 16 session exercise plan including warm-ups and vocal stretches to improve voice intelligibility, inflection, articulation, and quality

Being unable to communicate is a distressing symptom. Through speech therapy, patients discern their speech restrictions by scanning their environment. After recognizing inhibitions of speech, they can modify communication techniques and receive professional insight as to what postures promote communication.

Dysphagia

Dysphagia, or difficulty swallowing, is a symptom of Parkinson’s Disease. Patients experience choking and coughing while swallowing. This regularly interferes with eating, drinking, and communication.

Speech therapists evaluate swallowing function. They can assist the patient to avoid coughing or choking. The therapies build muscle mass to support the movement of swallowing. In severe cases, a camera called an endoscopy is inserted into the throat to depict the patient’s swallowing technique. The speech therapist knows which techniques to apply with the visual information.

Parkinson’s Treatment: Occupational Therapy

Chronic illness undoubtedly disrupts day-to-day living. The tasks that become burdensome after a Parkinson’s Disease diagnosis is incredibly frustrating. Occupational therapy fosters life skills in people of all ages through the therapeutic use of daily activities. Occupational therapists supply resources to adapt to the challenges of Parkinson’s Disease.

Mobility

Motor symptoms frequently cause a lack of mobility (i.e. walking). Occupational therapy teaches patients how they should walk to prevent falls. Whether from chairs, toilets, or bed, patients also learn to transfer from sitting to standing. Therapists inspect the patient’s home for the need for walking aids like wheelchairs and walkers or accessible accommodations like handles in the bathroom showers.

Eating and Drinking

A variety of Parkinson’s symptoms affect eating and drinking. Impairment in motor skills results in difficulty swallowing and coughing during meals. Additionally, cutting and using a spoon, fork, or knife to eat become awkward movements. Occupational therapy develops new postures to reduce choking and familiarizes patients with equipment so using utensils is easier.

Domestic Skills

Parkinson’s Disease diminishes the capability to complete domestic skills such as household chores, meal preparations, and shopping. Occupational therapy equips patients with jar openers, lever taps, and tools to thrive in their home environments.

Miscellaneous

Occupational therapy is conducive for modifying other tasks too. Therapists guide patients in prioritizing the responsibilities in their lives. Through fatigue management, they can then decide which tasks they cannot do on their own. Patients are assisted with self-care routines, handwriting, and cultivating social relationships.

Scientific advancements have revolutionized the treatment of Parkinson’s Disease. Even more, breakthroughs are expected in the future. Life might change following the diagnosis, but hope for a comfortable, contented life is possible with a dedicated care team.

References

Münchau A, Bhatia KP. Pharmacological treatment of Parkinson’s disease Postgraduate Medical Journal 2000;76:602-610.

Seidl, S. E., Santiago, J. A., Bilyk, H., & Potashkin, J. A. (2014). The emerging role of nutrition in Parkinson’s disease. Frontiers in aging neuroscience6, 36. doi:10.3389/fnagi.2014.00036

The Deep-Brain Stimulation for Parkinson’s Disease Study Group. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med. 2001;345:956–63.

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.