Medical treatments for Parkinson’s disease
Although there is no cure for Parkinson’s disease, symptoms can be reduced with medications and lifestyle measures. Symptoms are usually controlled quite successfully when treatment is well adapted to the course of the disease. Despite the anxiety and discouragement, the disease can cause, taking an active role in managing the disease makes it easier to live with.
It is very important for the patient to stay active and exercise. Regular physical activity increases flexibility, balance, and coordination of the body and helps fight depression. Your doctor can suggest a specific exercise program, but any form of physical activity (walking, swimming, etc.) is beneficial.
Also, since people with PD are more prone to osteoporosis, it is advisable to perform exercises that strengthen the skeleton (lifting weights, walking, jogging, jumping in place, etc.). Similarly, you should regularly take a small “dose” of sunshine to counteract a possible deficiency of vitamin D, a common deficiency in PD. Vitamin D plays an essential role in bone health.
Allow yourself periods of relaxation. Practicing a relaxation technique, such as yoga or tai chi, or using massage therapy is important for stress reduction. For people with PD, stress increases the intensity of tremors.
Prevent falls. As the disease progresses, walking becomes more difficult. It is important to wear good shoes – avoid slippery soles – and practice long strides by elevating the legs. Gait training by a physical therapist is often recommended. To minimize the risk of falls, the patient’s space should be set up appropriately. For example, it is best to remove rugs, install grab bars near the toilet and bathtub, and handrails on stairs. An occupational therapy assessment is often required.
To enhance the beneficial effects of levodopa, the physician may make certain dietary recommendations. For example, it is beneficial to consume most protein at the evening meal and to maintain a carbohydrate/protein ratio of 7:1 (7 g carbohydrate to 1 g protein). The vegetarian diet inherently provides such a carbohydrate/protein balance.
At the Mayo Clinic, they recommend a diet rich in fruits, vegetables, and whole grains because they provide natural antioxidants that protect against oxidative damage. These foods are also a good source of fiber, which promotes better intestinal transit. The consumption of saturated fats (red meat, dairy products, palm oil, coconut oil, etc.) should be reduced.
In the advanced stages of the disease, chewing is difficult, so it is important to take small bites.
To prevent constipation associated with PD, doctors recommend drinking plenty of water per day and eating enough fiber.
The use of a support person (a psychologist, psychotherapist, etc.) is often useful, even necessary, to manage the suffering from a chronic disease. Parkinson’s disease can be particularly difficult to manage because it attacks the biochemistry of the brain – which is often a great source of anxiety. You can also join a support group.
The appropriate time to start medication depends on several factors (age, lifestyle, the severity of symptoms, etc.) and is determined in consultation with the doctor. The prescribed medications are intended to relieve the symptoms of the disease, but cannot stop the progression of the disease. Finding the ideal treatment may take some time; it is recommended that you inform your doctor of any new symptoms that occur during treatment so that adjustments can be made.
Levodopa, or L-dopa, is a precursor to dopamine. In the brain, levodopa is converted to dopamine. It is often prescribed in combination with carbidopa or benserazide to enhance the effect or limit side effects (nausea, vomiting, dizziness on waking). Levodopa is particularly effective in reducing difficulty moving, tremors, and stiffness in the limbs. Because levodopa’s effectiveness declines over time it is often significantly less effective after 5 or 6 years that is why doctors usually wait until symptoms of the disease are severe before they prescribe it.
Dopamine agonists mimic the action of dopamine (bromocriptine, pergolide, pramipexole, and ropinirole are examples). These medications may be prescribed as soon as the diagnosis is made and may be combined with levodopa if the disease is in an advanced stage. These medications have levodopa-like side effects but can also cause compulsive behaviors (compulsive gambling, hypersexuality, compulsive shopping) in 7-13% of cases, according to some studies.
Monoamine oxidase B (MAOI B) inhibitors, such as selegiline and rasagiline, may be prescribed early in the course of the disease. They decrease the breakdown of natural dopamine and that formed from levodopa. In addition, they are thought to prevent the formation of free radicals and neurological toxins, thus protecting healthy cells. This protective effect has not yet been fully demonstrated. This class of drugs sometimes causes side effects, such as tremors and confusion. It has many interactions with other medications and natural health products.
Anticholinergics (benztropine, trihexyphenidyl) help reduce tremors in some people by restoring the balance between dopamine and acetylcholine in the brain. It is usually prescribed to younger patients in whom tremors are the dominant symptom. It is the oldest type of medication available to patients.
Catechol-O-methyltransferase (COMT) inhibitors prolong the effects of carbidopa-levodopa therapy by blocking the enzyme that breaks down levodopa. Tolcapone is prescribed only to people who do not respond to other therapies because it can cause liver damage. Entacapone (Comtan) does not cause this problem.
Amantadine, an antiviral drug originally developed to treat influenza, has shown positive effects in people with PD. Because this drug only slightly reduces symptoms, it is used in patients who are in the early stages of the disease. Its mechanism of action in the brain is not yet well understood. In combination with levodopa, amantadine may help reduce motor problems in advanced stages of the disease.
Levodopa and dopamine agonists can cause daytime drowsiness. Monitoring is necessary because some patients treated with these medications may feel drowsy during activities (e.g., driving).
In addition to medications used to reduce motor dysfunction, an antidepressant is sometimes prescribed. Several factors can lead to depression: living with a chronic degenerative disease, habitual tasks that become increasingly difficult, physiological changes that occur in the brain during the disease, and the side effects of certain medications.
Brain surgery may be considered for patients with advanced disease whose symptoms no longer respond to levodopa.
Deep brain stimulation involves implanting electrodes in specific parts of the brain (thalamus, globus pallidus, and subthalamus). A stimulator then sends electrical pulses to reduce involuntary movements and tremors. However, this procedure does not reduce muscle stiffness, does not correct loss of voluntary movement, and has some potential for serious side effects.
Previously, procedures were done in the parts of the brain responsible for Parkinson’s symptoms: Pallidotomy (globus pallidus), Thalamotomy (thalamus), or Subthalamotomy (subthalamic nucleus). These very delicate brain surgeries are rarely performed nowadays.
Kinesiotherapy and speech therapy
Physiotherapy, which includes daily exercise, gymnastics, balance exercises, etc, and occupational therapy are indicated for functional rehabilitation and home adaptation. Speech therapy is used to treat dysarthria, a language expression disorder due to articulation difficulties.
Several innovative treatments are being studied, such as fetal dopamine cell transplantation and gene therapy, but these are experimental treatments and none of them are commonly practiced.