Parkinson’s Disease Treatment – Parkinson’s Disease Health …

In-Depth From A.D.A.M. Treatment

Drugs, physical therapy, and surgical interventions can manage Parkinson's disease. The goals of treatment for Parkinson's disease are to:

Treatment is very individualized for this complicated disease. Patients must work closely with doctors and therapists throughout the course of the disease to customize a program suitable for their particular and changing needs. Patients should never change their medications without consulting their doctor, and they should never stop taking their medications abruptly.

No treatment method has been shown to change the course of the disease. For early disease with little or no impairment, active treatment with medications may not be necessary.

A number of issues must be considered in choosing medication treatment. These include how effective a specific drug group is in treating symptoms, which symptoms are predominant, side effect profile, loss of effectiveness over time, and other considerations.

The American Academy of Neurology recommends the following therapies for the initial treatment of Parkinsons disease:

Levodopa (L-dopa). Levodopa, or L-dopa, has been used for years and is the gold standard for treating Parkinson's disease. L-dopa increases brain levels of dopamine. It is probably the most effective drug for controlling symptoms and is used in nearly all phases of the disease. The standard preparations (Sinemet, Atamet) combine levodopa with carbidopa, a drug that slows the breakdown of levodopa. Levodopa is better at improving motor problems than dopamine agonists but increases the risk of involuntary movements (dyskinesia). Effectiveness tends to decrease after 4 - 5 years of usage.

Dopamine Agonists . Dopamine agonist drugs mimic dopamine to stimulate the dopamine system in the brain. These drugs include pramipexole (Mirapex), ropinirole (Requip), and bromocriptine (Parlodel). The Food and Drug Administration (FDA) pulled the dopamine agonist pergolide (Permax) from the market in 2007 over safety concerns that included potentially fatal heart valve damage. In 2008, a skin patch dopamine agonist, transdermal rotigotine (Neupro), was recalled from the market.

Selegiline (Eldepryl) and Rasagiline (Azilect) . Selegiline is a monoamine oxidase B (MAO-B) inhibitor that may have some mild benefit as an initial therapy. However, unlike levodopa, it does not slow the progression of Parkinson's disease. Rasagiline (Azilect) is another MAO-B inhibitor used for treatment of Parkinsons.

Drug treatments for Parkinson disease do not consistently control symptoms. At certain points during the day, the beneficial effects of drugs wear off, and symptoms can return, including uncontrolled muscular motor function, difficulty walking, and loss of energy. The American Academy of Neurology (AAN) has reviewed evidence for the various drugs used to treat off time" and found that the following drugs have the strongest evidence for controlling off time symptoms:

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