Living Well with Parkinson’s Disease: Understanding Treatment Options

In our first blog entry, we talked about four basic steps that can help patients fight some of the symptoms of Parkinson’s Disease (PD). Eating a well-balanced diet, exercising, and getting plenty of sleep can have a significant impact for some people. For others, more aggressive steps may be needed. Here are four treatments that... Read more »

In our first blog entry, we talked about four basic steps that can help patients fight some of the symptoms of Parkinson’s Disease (PD). Eating a well-balanced diet, exercising, and getting plenty of sleep can have a significant impact for some people. For others, more aggressive steps may be needed. Here are four treatments that may be beneficial. Keep in mind that every case of PD is different so it’s very important to work closely with your Parkinson’s specialist to understand each treatment, its effectiveness, side effects, and appropriateness for you.

  1. Medication. Remember what we said before about good attitude, good nutrition and good sleep. Without tough mindedness and good hydration, nutrition and exercise, the medications alone will not help as much. Medications are sometimes very powerful and can relieve some but not all problems. Each person is different, and when and how much medication is best will vary a lot. Medications mostly work for PD by enhancing the dopamine in the brain. Dopamine makes us feel better and move more normally—it helps send the messages from our brain cells to our muscles. Medicines that contain levodopa help us make more dopamine, and medicines like selegiline, rasagiline, entacapone, and carbidopa help to preserve the effectiveness of levodopa and dopamine. Medicines like pramipexole, ropinirole, rotigotine, and apomorphine all imitate the actions of dopamine. Many other medications can help in other ways. Recent studies suggest that it is best to keep the use of medications down to what is really needed, and to include physical and social activities and a more holistic approach as much as possible. Overuse of higher dosages too early may lead to more problems, and the subsequent need for more medications. To me this is like spicy taco sauce—the more you use, the more you need to get the same kick. The brain’s chemistry does tend to shift with reliance on medications like sleeping pills, sedatives, and pain-killers. So the best approach in my opinion is to use only what is really needed or a little less, and work on keeping healthy as long as possible. However, eventually more medications will be needed. The ultimate goal is what is best for the individual patient in terms of achieving the best quality of life for the longest possible duration. This is why it makes sense to be under the care of a specialist.
  2. Understand medication side effects. There are many possible side effects of the above medications but with expert management, they are usually limited. It is important for the patients and caregivers to understand potential side effects. They include nausea, tightness of some muscles, fidgety swaying movements, confusion, drowsiness, and other problems like inappropriate thrill seeking behaviors. Most of these problems can be significantly improved by adjusting medicines. This blog isn’t long enough to go into all the possibilities, but again, a PD specialist can help sort it all out.
  3. Botox can help with some symptoms. Some muscle stiffness or dystonia can be helped by injections of botulinum toxin (Chemodenervation), which can relax the overactive muscle(s) and restore better function, and these effects usually last for about three months. The same injections near saliva glands in the mouth can also reduce the amount of drooling that some patients have. The underlying problem in most cases of drooling is related to the tendency in PD to keep the mouth open, lower the head, and not swallow very often.
  4. Surgery is an option for some. Some patients cannot be adequately helped by medications or there may be intolerance to medications and therapies, and such patients can be good candidates for Deep Brain Stimulation (DBS) surgery. Tremors that are refractory to therapy are a good example. Such surgery has limitations and complications, but when used wisely in carefully selected patients the results are often excellent. Dementia, hallucinations, or atypical forms of Parkinsonism usually are signs that DBS may not be very helpful.

I want to emphasize again that there’s no “one-size-fits-all” approach for a disease as complicated as Parkinson’s. These treatments work for some people, but not others. That’s why it’s important to be involved in your own health care and to work closely with a PD specialist.

John M. Bertoni, M.D., Ph.D.

Director

Parkinson’s Disease Clinic

To connect with Dr. Bertoni or a member of the Movement Disorders program team call (402) 559-8600 or visit us on the web at  NebraskaMed.com/Neuro/Movement-Disorders.

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