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20 August, 2008

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Parkinson's disease - treatment

Parkinson’s disease is a progressive neurological condition. The symptoms include tremor, rigidity, slowness and impaired movement. The disease is currently incurable; however, it can be managed and people with Parkinson’s can live independent and productive lives.

The main method of treatment is medication, which aims to alleviate the symptoms. Many kinds of medications are available.

Medication
Symptoms of Parkinson’s disease result from the progressive degeneration of nerve cells in the middle area of the brain. This causes a deficiency in the availability of dopamine, which is necessary for smooth and controlled movements.

Most Parkinson’s medications fit into one of the following broad categories:

Levodopa – dopamine replacement therapy.
Dopamine agonists – mimic the action of dopamine.
Anticholinergics – block the effect of another brain chemical (a neurotransmitter called acetylcholine) to re-balance its levels with dopamine.
Amantadine – has anticholinergic properties and enhances dopamine transmission.
MAO type B inhibitors – prevents the metabolism of dopamine within the brain.
COMT inhibitors – used along with levodopa. This medication blocks an enzyme known as COMT, to prevent levodopa breaking down in the intestine and to allow more of it to reach the brain.

Talk to your doctor about your treatment
It is important to see a neurologist or a doctor who has experience in assisting people living with Parkinson’s disease. These are the best people to help you decide which treatments to use.

There is no ‘best’ drug treatment for Parkinson’s. Each person has different symptoms, disease progression, lifestyle and physical tolerances. All of these factors will affect the timing, type, dose and combinations of medication. As the disease progresses, your individual medication program will need to be reviewed and altered.

It is very important to take your medication at the recommended time and on time every day, whether you are at home, at work, in hospital or in a nursing home. Medications taken late can severely hamper the movements of people living with Parkinson’s.

How long does the medication last?
Medication will help to elevate symptoms but will not alter the progression of the symptoms over time. Over time, you may experience problems with your medication wearing off and may need to try different drug regimes to get the most benefit.

You will need a neurologist to manage your doses and any necessary adjustments, as side effects can be a problem when on large doses.

Multidisciplinary support can help
Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses. Members of the team assess the person with Parkinson’s and identify any potential difficulties.

There are a number of multidisciplinary teams in Victoria that specialise in Parkinson’s management.

Surgery is an option
Neurosurgery (brain surgery) is an option to treat Parkinson’s symptoms, but it is not suitable for everyone. There are strict criteria and guidelines as to who can be a candidate for surgery, and this is something that only your doctor and you can decide.

The three commonly used forms of surgery are:

Thalamotomy – a lesion (cut) is placed on part of the brain to alleviate some forms of tremor.
Pallidotomy – a lesion is placed on a different part of the brain to alleviate dyskinesias (wriggling movements).
Deep brain stimulation – an electronic deep brain stimulator is placed in the brain to control tremor.

Help for carers
Being a carer can be difficult. A wide range of agencies can provide help and support. These include:

Parkinson’s Victoria Tel. 1800 644 189
Carers Victoria Tel. 1800 242 636
Brain Foundation Victoria Tel. 1800 677 579

Support includes counselling, carer education programs, information on a variety of issues, and support groups.

Where to get help

Your doctor, who can refer you to a neurologist
A neurologist or your local doctor can also arrange a referral to a movement disorders clinic
Kingston Movement Disorder Clinic Tel. (03) 9265 1411
Peter James Movement Disorder Clinic Tel. (03) 9881 1888
Parkinson’s Victoria Tel. 1800 644 189

Things to remember

A neurologist is the best person to see if you have Parkinson’s disease – your GP can arrange this.
It is important to discuss your medication issues with your treating health professionals.
No two people have exactly the same Parkinson’s and no two people will have exactly the same treatment.
Good management is a combination of medication and multidisciplinary support.

Related topics:

You might also be interested in:
Dementia explained.
Nervous system.
Parkinson's disease and constipation.
Parkinson's disease and exercise.
Parkinson's disease and going to hospital.
Parkinson's disease and sexual issues.
Parkinson's disease explained.
Physiotherapy - Q & A.

Want to know more?
Go to More information for support groups, related links and references.

This page has been produced in consultation with, and approved by:

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This page has been produced in consultation with, and approved by:

Parkinson's Victoria Inc

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Last updated: January 2007

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