No cure exists for Parkinson’s disease. However, medications and other treatments can improve symptoms and quality of life. People who don’t respond well to medications or who have advanced Parkinson’s need referral to a neurologist that has special knowledge of how to manage the disease.
Medications
The decision to start medications for Parkinson’s disease is based on how severe the symptoms are. This will take into consideration how much the symptoms affect the person’s life and whether the person wants to use medications.
Levodopa-Carbidopa
The most effective treatment for Parkinson’s disease is Levodopa-Carbidopa. These two medications are combined in a single pill. This combination helps replace the dopamine that a person’s neurons are no longer producing.
Levodopa-Carbidopa is most helpful for bradykinesia. Tremor and rigidity can also improve. However, balance and other problems do not improve.
Drug side effects include:
- Nausea
- Sleepiness
- Blood pressure drop
- Headache
- Confusion and hallucinations
Over 5 to 10 years of taking Levodopa-Carbidopa, other complications can occur. These include uncontrolled, involuntary movements (called “dyskinesias”). Another long-term complication of this medication is the “wearing off” or “on-off” effect when the medication wears off before the next dose.
Other Medications
Other medications used to treat motor symptoms of Parkinson’s disease include:
- Monoamine oxidase B (MAO B) Inhibitors. These medications help raise levels of dopamine in the brain by blocking its breakdown.
- Catechol-O-methyl transferase (COMT) inhibitors. These medicines help prolong and enhance the effect of Levodopa-Carbidopa. These medications are used for people who have "wearing off" periods before their next dose of Levodopa-Carbidopa.
- In 2019, the U.S. Food and Drug Administration approved a new type of enzyme inhibitor, the adenosine A2A antagonist istradefylline. It can improve control of motor symptoms in people with who are taking other Parkinson’s medications. Common side effects are dyskinesias, dizziness, constipation, and hallucinations.
- Dopamine Agonists. These medications work by stimulating the response to dopamine in the brain.
- Anticholinergics. These medications are sometimes used for patients with more advanced Parkinson’s disease, especially with tremor. However, these medications are not for older adults because they cause difficulty with urinating, constipation, confusion, memory problems, and falls.
- Amantadine. This medication is an antiviral drug developed to prevent the flu. It also improves mild motor symptoms in people with Parkinson disease. This is generally not for older adults because of side effects such as confusion and hallucinations.
After 5 years of treatment, half of people with Parkinson’s have their motor symptoms return because medications are no longer as effective, or they have the dyskinesia side effects.
Surgery
A surgery, known as deep brain stimulation (DBS), can help people that don’t benefit from medication or have serious side effects. During the surgery, a surgeon places wires into a part of the brain that helps control movement. The wires are attached to a small device. It is similar to a pacemaker and placed under the skin near the collarbone. The device sends electrical signals to the brain to reduce abnormal movements.
Up to 5 percent of surgical patients have infection, hemorrhage, seizures, or death.
Treatment of Non-Motor Symptoms
Treatment can help with the common non-motor symptoms of Parkinson’s disease, which include:
- Depression, which can respond to medication such as anti-depressants (SSRIs)
- Sleep problems may respond to improved sleep hygiene. Treatment of other causes of sleep problems like pain or frequent urination can also help. Other common associated conditions such as restless leg syndrome can be treated as well.
- Dementia symptoms may improve with medications. Some of these medicines also are approved to treat dementia in Parkinson’s disease.
- Hallucinations can sometimes be treated by decreasing the dose of the Parkinson’s medications. antipsychotics can be used if the symptoms are serious.
Last Updated March 2023