If you have Parkinson's disease, you have a lot of choices for treatment. There's no cure, but medicine and sometimes surgery can help.
Medicine can often keep your symptoms in check for years. Your doctor may suggest you try one of these drugs:
Levodopa. You may hear your doctor call this L-dopa. It's a drug that doctors prescribe most often for Parkinson's.
When you have Parkinson's, your brain gradually stops making dopamine -- a chemical that helps send signals in your brain. Levodopa may improve your symptoms because it is converted to dopamine in the brain.
To curb nausea and other possible side effects from levodopa, doctors usually suggest you take a drug called carbidopa along with it. It comes as a combination drug containing both medicines. Examples include: Duopa, Rytary and Sinemet.
Rarely, some people can't handle carbidopa and need to take levodopa alone. If that's the case for you, it's important not to take it at the same time as food or vitamins that have vitamin B6, which can affect how well your medicine works.
It is possible for symptoms to return in between doses in something called OFF periods. For these instances, your doctor may prescribe an infusion of levodopa through a tube called duopa, a powder form of levodopa (INBRIJA), which can be inhaled, or the new medication istradefylline (Nourianz).
Most doctors try to delay starting people on levodopa as long as possible because the drug tends to stop working as well after a while. Sometimes, if you've been taking levodopa for several years, the medicine's effects can wear off and you develop movement problems called "motor fluctuations." These problems can happen gradually or suddenly.
Safinamide (Xadago) is an add-on medicine that may be prescribed when those taking levodopa and carbidopa have a breakthrough of Parkinson’s symptoms that were previously under control. Studies show that adding this drug may help individuals experience longer times with reduced or no symptoms. The most common side effects are trouble falling or staying asleep, nausea, falls, and uncontrolled, involuntary movements.
Dopamine agonists. These are drugs that imitate the action of dopamine in your brain. Some examples are pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro). You can take them alone or with L-dopa to treat the motor symptoms of Parkinson's disease.
COMT inhibitors. You take these drugs, such as entacapone (Comtan), opicapone (Ongentys) and tolcapone (Tasmar), along with levodopa. They add to the amount of time you get relief from symptoms by blocking the action of an enzyme that breaks down levodopa. Tolcapone is rarely prescribed by doctors, though, because it can cause liver damage.
Stalevo is a tablet that combines carbidopa/levodopa with entacapone. While carbidopa lessens the side effects of levodopa, entacapone adds to the time levodopa is active in the brain.
MAO-B inhibitors. They also block the action of an enzyme that breaks down dopamine. You can take them alone early in Parkinson's disease or with other drugs as your disease moves to a later stage.
Other medications that doctors prescribe for Parkinson's include amantadine (Gocovri), apomorphine (Apokyn), benztropine (Cogentin), and anticholinergic drugs. All can help control symptoms. Some help release dopamine from nerve cells. Others curb the effects of acetylcholine, a chemical messenger in the brain that can cause a drop in dopamine.
Anticholinergic drugs are often used by younger people whose most severe symptom is a tremor. If you take these drugs when you're older, you're more likely to get side effect such as:
Other Types of Treatment for Parkinson's Disease
Some people with Parkinson's have surgery called deep brain stimulation (DBS). In this procedure, doctors place a wire deep inside a specific spot in the brain, depending on the symptoms that need treatment. DBS can lead to dramatic improvements in many people. Other surgical options include focused ultrasound, pallidotomy, and thalamotomy.
Scientists are also exploring ways to place cells that make dopamine into the brain to help treat people with Parkinson's, instead of taking medicine. Some experts are trying to see if stem cells can be used for this, but research is still in an early stage.
Some treatments focus on the effects of the disorder, rather than the causes. Your doctor might refer you to a physical therapist to improve your balance and your ability to move. A physical therapist may also teach muscle-strengthening exercises to help you speak or swallow.
It's important to keep up a daily exercise program and to stay socially active. You can get information about support groups and exercise classes in your area by checking with the American Parkinson Disease Association.