About Parkinson’s Disease
Medical Treatment
Medications:
Since the first medication to treat PD was introduced in the 1970’s,
research has driven the advancement of a vast medication arsenal now used
to treat Parkinson’s disease. Many different types of medications
are available. What you and your physician decide to use will be unique
for your disease. In fact, you may never encounter another person with
PD utilizing the same medication regimen as yourself. In other words,
there is no “set in stone” protocol for the use of Parkinson’s
medications. You may have to try different strategies before finding a
successful combination to control your symptoms.
Commonly used medications include:
Levodopa/carbidopa (Sinemet, Sinemet CR)
Dopamine agonists (Permax, Requip, Miropex, Apokyn)
COMT Inhibitors (Comtan, Tasmar)
Anti-Cholinergics (Artane, Cogentin)
Amantadine
MAO-B Inhibitors (Eldepryl)
Surgical:
Brain surgery is an option for advanced PWP’s whose symptoms can
no longer be adequately managed with medications. The best surgical candidate
is someone who:
- Responds well to dopaminergic therapy
- Has motor complications (off periods and dyskinesias) that are limiting factors
- Is otherwise healthy and a good surgical risk.
Advanced age is not necessarily a barrier to surgery, but impaired cognition, including forgetfulness, diminished decision-making ability, and language difficulties, along with gradual loss of brain matter (brain atrophy or shrinkage), make the surgery more risky and decreases the likelihood of an optimal outcome.
Depending on the patient, procedure, and skill of the operating team, cognition may be mildly impaired or largely unaffected by the surgery itself. The most commonly reported adverse cognitive effects are reduced decision-making abilities and language impairments.
It is impossible to predict the benefit that any individual patient can expect from surgery. The general rule of thumb is that the maximum benefit is equal to the best response from a dose of levodopa (minus the effect on dyskinesias). Therefore, if a patient’s symptoms are 50% better at the peak of a levodopa dose, the surgery is not likely to improve the patient’s symptoms more than that amount. Importantly though, improvements from surgery are most dramatic during the times the patient is not experiencing the effects of medications (off time). Therefore, surgery may greatly improve the amount of the day during which symptoms are reduced.
Ancillary Therapies:
Physical therapy, speech therapy, and alternative therapies can all have
a role in the treatment of PD. The use of these different interventions
can be useful in optimizing your control of symptoms.
For referrals or more information about the treatment of Parkinson’s
disease, please contact our Information & Referral Center at 1-800-493-2842
