Department of Neurology
Parkinson’s Disease: Treatment Options
Information for Patients
What can be done?
As yet there is no cure for Parkinson’s disease. The disease is a slowly progressive disease i.e. the symptoms worsen as time goes on. There are no treatments that have been proven to slow the progression of the disease. However, there are treatments which help the symptoms.
When should treatment be started?
Treatment is started when symptoms become troublesome. If you can manage without treatment there is no advantage in starting therapy early. Low doses are used first, and increased gradually over months and years. The reason for delaying treatment until it is necessary is to gain time and delay the onset of troublesome side effects in years to come.
Are there side-effects from treatment?
Nausea and light headedness may occur when starting medication, in about 1 / 4 of patients. Usually this is mild and settles as your body gets used to the medication. If these side-effects are more severe, an anti-sickness tablet is available from your GP (Domperidone or Motilium 10mg. up to 3 tablets per day). More detail about possible side effects is given below.
What treatments are available?
The treatments replace the dopamine which is lacking in the brain. These help the symptoms particularly the slowness and stiffness.
Dopamine Agonists
Dopamine Agonists are medications used to treat Parkinson’s disease. There are several different types, Bromocriptine (Parlodel), Cabergoline (Cabaser), Pergolide (Celance), Pramipexole (Mirapexin) and Ropinirole (Requip). In Parkinson’s there is a deficiency in a substance called dopamine in the base of the brain. Dopamine agonists are synthetic compounds which stimulate the brain in a similar way to dopamine, thus in effect are doing the job that the dopamine normally does.
Page 2Parkinson’s Disease: Treatment Options
Dopamine Preparations (“Levodopa”)
These contain levodopa, which the body converts to dopamine. The names are Sinemet and Madopar. The levodopa in these tablets is combined with another substance which helps concentrate the dopamine in the brain where it is needed. After being on this type of medication for a number of years, side effects or involuntary movements that you cannot control called dyskinesias can occur. These side effects are more common with the Levodopa than the dopamine agonists. For this reason, the dopamine agonists are often started first, the dose gradually increased to a maximum level, then the dopamine preparations (“Levodopa”) added when more treatment is required. However, the choice depends on the severity of your symptoms and any other health problems or treatments you may have.
COMT Inhibitor
This is called Entacapone. This substance prevents the breakdown of dopamine therefore boosting the dopamine levels in the brain. It is helpful later, if the patient feels that levodopa therapy is “wearing off.” Side effects include diarrhoea which comes on after about 6 weeks. If this occurs you should stop the Entacapone tablets.
Other Treatments
- Anticholinergics - e.g. Benzhexol, Orphenadrine. These substances can help with the symptoms of Parkinson’s disease, but can cause confusion and memory problems and are now less commonly used.
- Selegiline - This is a mild treatment which is not so commonly used now. It was initially thought to slow the progression of Parkinson’s disease, and later thought to possibly cause excess mortality, but neither was proven.
- Amantadine - A small proportion of patients have benefit from this with a modest improvement in symptoms, mainly dyskinesia.
- Surgical Treatments - These may be of value to patients who have severe involuntary movements. There are different types of surgical procedure, either to destroy a small part of the brain which is responsible for the involuntary movements or implant a stimulator. The potential hazards of a surgical approach such as stroke due to a blocked blood vessel, or a burst blood vessel, have to be balanced against the benefits.
Other forms of Therapy
Physiotherapy can be helpful for movements and walking. If speech, swallowing or choking are problems, speech therapy can help. An occupational therapist can help by assessing your home circumstances and suggesting alterations which help with daily activities.