The Treatment of Parkinson's Disease
The treatment of Parkinson’s disease is primarily aimed at slowing the progression of the disease and providing the patient with the best possible quality of life. There are various strategies for this, ranging from pharmacological to surgical.
Depending on the stage of the disease that the patient is in, the symptoms that have the most impact on their life, their medical history, among other aspects, the treatment places greater emphasis on one point or another. For this reason, not all people are treated in exactly the same way.
The fact that treatment can be personalized to a certain extent helps to facilitate the person’s day-to-day functioning.
Prescriptions for the treatment of Parkinson’s disease
From The Michael J. Fox Foundation for Research, they warn that finding the right combination of medications for the treatment of motor symptoms is a process that requires time and effort, both on the part of the doctor and the patient.
Additionally, they remind us that at all times, we must pay attention not only to the advances that the drugs can provide but also to the side effects that may occur.
Apart from antiparkinson medication, treatment may include symptomatic medication to control secondary complaints.
Medications that are prescribed in the treatment of Parkinson’s disease (also known as antiparkinson drugs ) aim to either mimic the effect of dopamine or optimize the action of this neurotransmitter in the brain. This is what helps control symptoms.
The basis of treatment is levodopa (a precursor of dopamine) + carbidopa (a decarboxylase inhibitor). However, it’s important to bear in mind that, depending on the case, two or more medications could be prescribed. Then, depending on the age of the patient, the dose will vary. According to the MSD Manual, in older adults, it’s usually reduced.
Levodopa has been shown to be effective in reducing stiffness, improving mobility, and reducing tremor in patients. And according to the source already cited, “The drug enables many people with mild disease to return to a nearly normal level of activity and enables some people who are confined to bed to walk again.”
Other prescription medications may include the following:
- Dopamine agonists: Pramipexole, ropinirole, apomorphine HCl
- Monoamine oxidase inhibitors (MAO inhibitors): Rasagiline, selegiline
- Catechol-O-methyltransferase (COMT) inhibitors: Entacapone, opicapone, tolcapone
- Other anticholinergic drugs, including some antihistamines and tricyclic antidepressants, to enhance the action of levodopa
- Amantadine (Gocovri)
Istradefylline (Nourianz) is a drug that was approved in 2019 by the FDA as a supplement to levodopa + carbidopa. It helps block dopamine signaling.
Therapy on demand
Patients who experience severe symptoms during their periods of inactivity (which are also unpredictable in nature) can resort to on-demand therapies. These can be used as necessary rather than within a specific schedule, and they provide faster relief than oral medications. The most prominent are the following:
- Inbrija (via the inhalation route)
- Kynmobi (via the sublingual route)
Managing the side effects of medications
Hallucinations and involuntary movements (dyskinesias) are some of the side effects that patients may experience after a long period of drug treatment. While they can be distressing, the good news is that they can be treated by adjusting medication doses and making other adjustments.
- The aforementioned Gocavri helps with dyskinesias.
Treatment for associated problems
Patients with Parkinson’s disease often need treatment for other associated health problems, such as depression, anxiety, insomnia, unexplained crying, dementia, and others. Depending on the case, the doctor prescribes certain medications or others.
Over the counter drugs
For the relief of the most common discomforts derived from Parkinson’s disease, some over-the-counter medications can be used. For example, pain relievers (such as ibuprofen, for muscle pain), fiber supplements (for constipation), or vitamin D or calcium supplements (to maintain bone health).
In patients who have trouble swallowing, some liquid-thickening medications may also be necessary (to prevent food or drink from going into the airways instead of the stomach).
To reduce the symptoms in those cases in which medication’s insufficient, some surgical treatments are taken into account:
- Deep brain stimulation
- Focused ultrasound surgery
As a complement to the therapies we’ve mentioned above, treating muscle stiffness, difficulties in maintaining balance, and problems with speaking and swallowing is also necessary. In these cases, patients may resort to disciplines such as physiotherapy, occupational therapy, and speech therapy.
Lifestyle plays an important role in complementing any treatment, be it for Parkinson’s or any other disease. The more effort you place on maintaining good life habits, the more benefits can be obtained from the therapeutic strategy and the better quality of life you’ll gain in the short and long term.
Maintaining proper consumption of water and sources of fiber, as well as sources of omega 3 fatty acids, allows you not only to prevent and alleviate problems with constipation and other discomforts, but also to maintain proper nutrition.
At the same time, complying with an exercise routine (or yoga or tai chi sessions) contributes greatly to well-being because it helps to maintain function, relieve physical discomfort, and release accumulated emotional tension.It might interest you...
- Conoce la enfermedad – Federación Española de Parkinson [Internet]. [cited 2021 Jul 5]. Available from: https://www.esparkinson.es/espacio-parkinson/conocer-la-enfermedad/
- Gonzalez-Usigli H. Enfermedad de Parkinson – Enfermedades cerebrales, medulares y nerviosas [Internet]. Manual MSD versión para público general. 2020 [cited 2021 Jul 5]. Available from: https://www.msdmanuals.com/es/hogar/enfermedades-cerebrales,-medulares-y-nerviosas/trastornos-del-movimiento/enfermedad-de-parkinson
- La enfermedad de Parkinson – Asociación Parkinson Madrid [Internet]. [cited 2021 Jul 5]. Available from: https://www.parkinsonmadrid.org/el-parkinson/el-parkinson-definicion/
- Levodopa y Carbidopa: MedlinePlus medicinas [Internet]. [cited 2021 Jul 5]. Available from: https://medlineplus.gov/spanish/druginfo/meds/a601068-es.html
- Medicamentos utilizados en la enfermedad de Parkinson: guía práctica. Consenso la Asoc Colomb Neurol sobre enfermedades [Internet]. 2019 [cited 2021 Jul 5];35(3):75–9. Available from: https://doi.org/10.22379/24224022253
- Recursos en Español | Parkinson’s Disease [Internet]. The Michael J. Fox Foundation for Parkinson’s researchers. [cited 2021 Jul 5]. Available from: https://www.michaeljfox.org/recursos-en-espanol