Parkinson's Disease Treatment
(Also Known As: Parkinsons Disease Treatment, Parkinson’s Treatment, Shaking Palsy Treatment, Paralysis Agitans Treatment)
(Reviewed by: Paul Peterson, Licensed Therapist)
What are the treatments available for Parkinson’s disease?
There is currently no specific cure for PD, but a variety of medications alleviates the symptoms.
Treatment with L-DOPA (Levodopa):
Administration of L-DOPA to PD patients alleviates different symptoms including rigidity and akinesia. It is believed that the drug is converted in the brain as dopamine which consequently refurbishes the normal balance between inhibition and excitation within the caudate nucleus and putamen. However, administration of dopamine itself will not bring about the same effects because its chemical structure will prohibit it from entering the blood-brain barrier, albeit the slightly different structure of L-DOPA does pass through.11
Usually, levodopa is administered in combination with carbidopa. Carbidopa’s mode of action delays the conversion of levodopa into dopamine until it reaches the brain. The nerve cells can then use levodopa to make dopamine and replenish the brain's decreasing supply. Even though levodopa alleviates most symptoms of PD, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only slightly reduced and impaired balance and other symptoms may not be improved at all.
Treatment with L-Deprenyl:
The mechanism of this drug inhibits the action of monoamine oxidase, the enzyme responsible for the degradation of dopamine after its secretion. As a result, any dopamine that is released will remain in the basal ganglia for a longer period. Furthermore, this treatment helps decelerate destruction of dopamine-secreting neurons and combination of this drug therapy with L-DOPA will usually yield enhanced results rather than treatment of each alone.12
Treatment with Transplanted fetal Dopamine Cells:
Transplant of dopamine-secreting cells obtained from the brains of aborted fetuses to the caudate nucleus and putamen of the patient has provided successful treatment in some cases. In spite of this, the cells do not persist and proliferate for more than a few months. According to studies and observations, if only the implanted cells are able to persist, this therapy would become a specific treatment in the future. 13
Treatment by destroying Part of the feedback circuitry in the Basal Ganglia:
Because of the abnormal signals coming from the basal ganglia which are transferred to the motor cortex in return, some studies suggested that obliteration of the source or part of the source of these abnormal impulses will help treat the condition. As a result, lesions were made in the ventrolateral and ventroanterior nuclei of the thalamus which consequently blocked the feedback circuit from the basal ganglia to the cortex. This therapy only had variable success and sometimes serious neurological damages arise as a side-effect. However, monkeys with Parkinson’s disease have been treated with great success with this therapy. 14
Anticholinergics may help control tremor and rigidity.
Drugs, such as: bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, therefore causing the neurons to react as they would to dopamine.
An anti-viral drug, amantadine, also reduce PD symptoms.
Rasagiline is used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD.
In some cases, surgery is the appropriate final option if the disease will not respond to medications. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In this procedure, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly. 15
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