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A combination of medications for motor symptoms and non-motor symptoms play a role in managing Parkinson's disease, along with non-pharmacological treatments.

Parkinson's disease — a neurodegenerative disorder that progressively impacts movement and cognition — doesn't currently have a cure. Treatment for Parkinson's therefore aims to lessen the impact of the disease by providing symptom relief and helping patients live as independently as they can. 

When you hear the word "treatment", medications immediately come to mind. Though pharmacological options indeed play a large part in the management of Parkinson's disease, you may be surprised to learn about the numerous other aspects that are often part of a Parkinson's treatment plan.

Pharmacological treatment options for Parkinson's disease

Though none of the pharmacological treatment options for Parkinson's disease reverse or stop the progression of the processes at work in the brain, or even reduce the rate at which the disease advances, they do provide effective symptom management — especially in the earlier stages of the disease. Two kinds of medications may be prescribed to Parkinson's patients, and those are drugs that target the motor symptoms of the disease, and those that aim to improve your non-motor symptoms. 

Parkinson's disease: Medications that target your motor symptoms

Carbidopa-levodopa is one of the best tolerated and most widely used medications, as well as being very effective. It is a combination of two drugs — levodopa helps because it's converted into dopamine, while carbidopa helps ensure that the levodopa is able to do its job. Brand names under which this combination is prescribed include:

  • Sinemet (Taken orally)
  • Rytary (Long-acting and taken orally)
  • Duopa — administered in gel form via a feeding tube
While levodopa and carbidopa work well together, their efficacy gradually declines over time. It is also important to note that most patients won't notice any benefits immediately after they start taking medications that contain these two drugs, so some patience is required. 

Dopamine agonists such as Rotigotine and Apomorphine behave similarly to naturally produced dopamine, and they're sometimes prescribed instead of or in addition to levodopa. Though dopamine agonists do not work as well as levodopa in most patients, they are less likely to be associated with adverse effects after using them for a long time. They may also come into play at the stage where levodopa is not longer as effective. They are again available orally, but can also be administered by means of injections or even through a patch.

Catechol-O-methyltransferase (COMT) inhibitors, meanwhile, can be prescribed to make levodopa work better. Comtan is the most popular example of this kind of drug, but because it increases the efficacy of lepodopa, side effects can include both involuntary movements and diarrhea. These drugs are, as such, mostly prescribed to patients who did not get on well with dopamine agonists.

MAO-B inhibitors release monoamine oxidase B (MAO-B) enzymes, aiming to reduce the loss of dopamine. Extreme caution should be applied in prescribing MAO-B inhibitors to patients who are taking antidepressants or opioids, as these groups of medications can cause extreme interactions in some cases. Brand names include Azilect and Eldepryl.

Anticholinergic drugs used to be extremely commonly prescribed to Parkinson's patients, as they fight tremors. Because these medications, which include benztropine and trihexyphenidyl, are now less popular because they are quite likely to result in side effects like loss of control over the bladder, memory problems, and even hallucinations. Anticholinergic medications are still an option for patients in the later stages of Parkinson's whose tremors are severe and who no longer benefit from levodopa. 

Amantadine is interesting in that it was originally designed as a flu medications, but has also been found to help patients in the earlier stages of Parkinson's by reducing tremors, rigidity, and to help them regain some voluntary control of their muscles. 

Parkinson's disease: Medications you may be prescribed for your non-motor symptoms

Because depression is among the most frequently seen non-motor symptoms in Parkinson's disease — believed to affect up to half of al patients — antidepressants are often part and parcel of the treatment of Parkinson's. SSRI antidepressants (like Citalopram or Escitalopram) are used most often, but tricyclic antidepressants  (like Nortriptyline or Amitriptyline) are also an option. 

Cholinesterase inhibitors are a class of drugs first used in people suffering from Alzheimer's disease. They may be prescribed to people with Parkinson's disease because dementia isn't uncommon in patients, with studies indicating that around a third are affected and dementia becoming increasingly likely as Parkinson's progresses. Cholinesterase inhibitors may help patients improve their memory and cognitive function. Rivastigmine (Exelon), galantamine (Razadyne), and donepezil (Aricept) are among them. 

Antipsychotic medications may become necessary in those Parkinson's disease patients who suffer from hallucinations or psychosis, although changing the dosage of medications taken for motor symptoms or experimenting with new pharmacological options may be enough. When antipsychotic drugs are prescribed, quetiapine (Seroquel) and pimavanserin (Nuplazid) are common choices.

Parkinson's disease treatment: Non-pharmacological treatment and alternative medicine

Physical and occupational therapy

Parkinson's disease progressively robs patients of the ability to engage in everyday tasks, as their motor skills seem to work against them more and more. Rigidity, slowness, and balance problems that cause a serious risk of falling explain why physical and occupational therapy can play such a beneficial role in your treatment. 

Broadly speaking, a physical therapist can help patients gain strength, reduce balance problems, and make walking more functional. Occupational therapy, meanwhile, helps you change the way in which you go about activities, as well as your environment. Home adaptations that increase your independence and instructions on how to carry out tasks in news ways that now work better for you are both examples of things an occupational therapist can help you with. 

Mind-body disciplines

Yoga and Tai Chi are both ancient disciplines that not only help you increase your physical flexibility, but also have the goal of offering a meditative effect. While research on the benefits of these disciplines is still lacking — a small study found that Tai Chi did help Parkinson's patient achieve better movement as well as better emotional health, but research is still inconclusive — patients can try whether yoga or Tai Chi help for themselves. 

Acupuncture

Acupuncture has been around for a very long time. Now considered a form of "alternative medicine", it used to simply be "medicine" in the history of China and many other Asian countries. You can rely on acupuncture being on the list of treatment options for nearly any chronic medical condition, and you can usually count on there being some research, as well. In the case of Parkinson's, there are both studies to suggest it may help reduce symptoms and those that haven't found an objective benefit. 

Dietary supplements

Patients may come across suggestions to take:

  • Coenzyme Q10 supplements — because Parkinson's sufferers frequently lack sufficient levels of uric acid and coenzyme Q10, both of which are needed for cells to work properly. 
  • Vitamin E supplements, as they are believed to increase brain function. 

It is important to note, however, that there is no convincing evidence that these supplements help people with Parkinson's disease. Though dietary supplements are not considered medications, they can sometimes interact with prescription drugs as well as inducing adverse effects on their own. Any patient considering these or other supplements should run it by their treating doctor first.

What is deep brain stimulation, and how can it help people with Parkinson's?

Deep brain stimulation — or DBS — is a surgery that would have sounded like science fiction in the not too distant past. It involves the insertion of a device that can be controlled by the patient and doctor (through a wire with a pulse stimulator attached), and that sends electrical signals to the part of the brain responsible for movement. DBS can reduce the severity of your tremors, slowness of movement, and rigidity. 

Suitable candidates do not suffer from (untreated) depression or dementia, and while some of the motor medications discussed above continue help them, their efficacy fluctuates, making additional treatment beneficial. Parkinson's patients who are considering deep brain stimulation (and their carers) should discuss the advantages and risks of the surgery with their physician in detail, as it carries potential risks, including stroke and brain hemorrhage.

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