Parkinson's disease - Treatment 

Treating Parkinson's disease 

What is good care for Parkinson’s disease?

The Department of Health has developed a National Service Framework (NSF) for long-term neurological conditions. The NSF was developed in consultation with people with long-term neurological conditions to raise standards of treatment, care and support across health and social care services. It allows health and social care professionals to plan and deliver services that are:

  • quicker and easier to use
  • more closely matched to people's needs
  • better co-ordinated so people do not have to see too many professionals who tell them the same information repeatedly
  • planned around the views of people with long-term neurological conditions and their carers
  • able to give people more choice about how and where they get treatment and care
  • better at helping people to live more independently

The National Institute for Health and Clinical Excellence (NICE) has published a clinical guideline for Parkinson’s disease. The guideline provides comprehensive evidence-based information on the benefits and limitations of the various methods of diagnosing, treating and caring for people with Parkinson’s disease. This helps health professionals and patients decide on the most appropriate treatment.

The NICE guideline states that if you have Parkinson’s disease, a healthcare professional, such as a Parkinson’s disease specialist nurse, should provide you with help. They should:

  • regularly check how your medicines are making you feel and make changes to your medication if necessary
  • be a point of contact and support for you and your family or carers, and come to see you at home when appropriate
  • give you reliable information about Parkinson’s disease, its symptoms and treatments, and the wider issues that can affect people with the disease and their family or carers

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Treatment overview hide

You may not need any treatment during the early stages of Parkinson's disease as symptoms are usually mild. However, you could require regular appointments with your specialist so your condition can be monitored.

At the moment, there is no cure for Parkinson's disease. However, numerous treatments are available to help control symptoms and maintain your quality of life. These may be supportive therapies that help you cope with everyday life, or medication to control your symptoms. For some people with a particular pattern of symptoms, surgery may be an option.

You should agree a care plan with your healthcare professionals and your family or carers, and this should be reviewed regularly.

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Supportive therapies show

There are several therapies that can make living with Parkinson's disease easier and can help you deal with your symptoms on a day-to-day basis.

Physiotherapy

A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise. The physiotherapist aims to make moving easier and improve your walking and flexibility. They also try to improve your fitness levels and your ability to manage things for yourself.

Occupational therapy

An occupational therapist can identify areas of difficulty in your everyday life, for example dressing yourself or getting to the local shops. They can help you to work out practical solutions and ensure your home is safe and properly set up for you. This will help you carry on as normal for as long as possible.

Speech and language therapy

About half of people with Parkinson's disease have problems communicating, such as slurred speech or poor body language. If you have communication problems, a speech and language therapist can help you improve your speech and use of language. They may use vocal exercises or equipment to help you make yourself understood.

Diet advice

Some people with Parkinson’s can experience constipation (difficulty passing stools). This can be helped by increasing the amount of fibre in your diet and making sure you are drinking enough fluid. Fibre is found in fruit, vegetables and cereals. In the UK, you should be drinking six to eight glasses (1.2 litres) of fluid every day.

Another common problem is orthostatic or postural hypotension. This is low blood pressure when you change position, particularly after standing up too quickly. If you have orthostatic hypotension, your GP may advise that you increase the amount of salt and fluid in your diet.

Hypotension can also be helped by:

  • avoiding caffeine in the evenings
  • eating frequent, small meals, rather than large ones
  • avoiding alcohol

Around 50% of people with Parkinson’s disease will experience some unintentional weight loss. Your GP may refer you to a dietitian (a healthcare professional trained to give diet advice) if you may benefit from changing your diet.

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Medicines show

Medicines may be used to treat the symptoms of Parkinson’s disease. Not all medicines are useful for everyone, and the short and long-term effects of each are different. Three main types of medication are commonly used. These are levodopa, dopamine agonists and monoamine oxidase-B inhibitors. Most people with Parkinson's disease will eventually need to have levodopa, which may be taken at the same time as other medicines to boost its effects.

Each medicine is prescribed to suit the individual needs of the person taking it. Factors that can influence which medicine is prescribed include:

  • your age
  • the severity of your symptoms
  • how well you respond to treatment
  • whether you experience any side effects

When people do not take their medication on time, or stop taking it completely,  they can become very ill. If you have to go into hospital, tell the hospital staff about your medication. If you have a stomach bug or are vomiting, tell your GP as this may affect the levels of medicine in your body.

Your specialist can explain your medication options and discuss which may be best for you. Regular reviews will be required as the disease progresses and your needs change.

Levodopa

Levodopa is absorbed by the nerve cells in your brain and turned into dopamine. It is usually taken as a tablet or liquid. Levodopa is often combined with other medication, such as benserazide or carbidopa. These drugs stop the levodopa being broken down in the gut before it has a chance to get to the brain. They also reduce the side effects of levodopa, which include nausea, vomiting, tiredness and dizziness.

If you are prescribed levodopa, the initial dose will usually be very small and will be gradually increased until it takes effect. At first, levodopa can cause a dramatic improvement in the symptoms. However, it usually becomes less effective over time. This happens because as more nerve cells in the brain die, there are fewer of them to absorb the medicine. This means that the dose may need to be increased from time to time.

Long-term use of levodopa is linked to certain side effects. These include "on-off" effects, where you can suddenly switch between being able to move (on) and being immobile (off), and muscle problems that cause uncontrollable, jerky muscle movements (dyskinesias).

Duodopa

This is a specialist treatment used for patients with severe on-off swings. A tube is inserted through the abdominal wall into the gut. Levodopa gel is continuously fed through the tube by a mini-pump, which is worn on your belt. Only a few centres in the UK offer this treatment, which needs the support of your primary care trust to finance it.

Dopamine agonists

Dopamine agonists act as a substitute for dopamine in the brain and have a similar effect to levodopa. They are used to treat early Parkinson’s disease as they are less likely to cause muscle problems (dyskinesias) than levodopa. They are often taken as a tablet, but can also be injected into a vein (intravenously). Sometimes, dopamine agonists are taken at the same time as levodopa. This allows lower doses of levodopa to be used.

Possible side effects of dopamine agonists include nausea, vomiting, tiredness and dizziness. Dopamine agonists can cause episodes of confusion or hallucinations, so they need to be used with caution, particularly in elderly patients who are more susceptible.

For some people, dopamine agonists, especially at high doses, have been linked to the development of compulsive behaviours, including pathological gambling, increased libido and hypersexuality. These are very complex disorders. Talk to your healthcare specialist if you think you may be experiencing them. As the person themselves may not realise the problem, it is key that carers and family members note any abnormal behaviour and discuss it with the appropriate professional at the earliest opportunity.

If you are prescribed a course of dopamine agonists, the initial dose will usually be very small to prevent nausea. The dosage is gradually increased over a few weeks. If nausea becomes a problem, your GP may prescribe anti-sickness medication, such as domperidone. You may need blood tests and a chest X-ray before some types of dopamine agonist are prescribed.

Monoamine oxidase-B inhibitors

Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinson's disease. They block the effects of a chemical called monoamine oxidase-B in the brain. This chemical destroys dopamine. By blocking it, MAO-B inhibitors allow dopamine to last longer in the brain.

Both selegiline and rasagiline can improve the symptoms of Parkinson’s disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists.

MAO-B inhibitors can cause a wide range of side effects, including nausea, headache and abdominal pain, though not everyone will experience them.

Catechol-O-methyltransferase inhibitors

Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinson’s disease. They prevent levodopa from being broken down by the enzyme COMT.

Side effects of COMT inhibitors include nausea, vomiting, diarrhoea and abdominal pain. If the COMT inhibitor tolcapone is used, you will need liver tests every two weeks.

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Surgery show

Most people with Parkinson’s disease are treated with medication. However, surgery is sometimes used to treat long term patients.

This surgery is available in specialist centres around the UK. However, it is not suitable for everyone and your specialist will discuss the risks and benefits of this type of treatment with you.

Deep brain stimulation

Deep brain stimulation is a surgical technique sometimes used to treat Parkinson's disease. A pulse generator (similar to a heart pacemaker) is inserted in your chest wall and a fine wire placed under the skin and attached to your brain. A tiny electric current is produced from the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinson's disease.

Although surgery does not cure Parkinson's disease, it can ease the symptoms for some.

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Clinical trials show

Much progress has been made in the treatment of Parkinson’s disease due to clinical trials, in which new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.

If you are asked to take part in a trial, you will be given an information sheet about the trial and asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care.

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Complementary therapies show

Some people with Parkinson’s disease find  complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson’s disease. However, there is no clinical evidence they are effective.

Many people think complementary treatments have no harmful effects. However, they can be harmful, and as such it is a bad idea to use them instead of the medicines prescribed by your doctor. If you decide to use an alternative treatment along with your prescribed medicines, it is important to let your doctor know.

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Page last reviewed: 10/05/2012

Next review due: 10/05/2014

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