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Health A-Z

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Harvard Medical School

Treatment

There is no cure for PD. But its symptoms can be treated with several different types of medication.

When symptoms are not overly troublesome, medication may not be necessary. Early treatment may even increase the chance of developing side effects and other complications later.

Treatment usually is started when:

  • Symptoms interfere with:

    • Work

    • Management of household affairs

    • Other activities

  • Difficulty with walking and balance becomes significant

Medications
Medications used to treat PD either:

  • Boost the levels of dopamine in the brain

or

  • Mimic the effects of dopamine

The most commonly used medication for PD is levodopa. Levodopa is converted to dopamine in the brain.

Levodopa usually is prescribed in combination with another drug called carbidopa. The second drug increases the amount of active drug that reaches the brain. It also limits side effects. The two drugs, levodopa and carbidopa, are combined in one pill (Sinemet).

Nearly all patients with PD improve after they start taking levodopa. However, long-term use eventually causes side effects and complications. Doctors often need to adjust the frequency and dose of levodopa so the person can continue taking it.

Several medications can be used either alone or in combination with levodopa to treat symptoms.

For mild symptoms in early PD, amantadine (Symmetrel) helps release stored dopamine in the brain.

Anticholinergic medications also help relieve mild symptoms in early PD. There are several choices, including trihexyphenidyl (Artane, Trihexane, Trihexy), benztropine (Cogentin), biperiden(Akineton), or procyclidine(Kemadrin). Anticholinergic drugs are particularly effective against tremor. But they can cause side effects. These include confusion and hallucinations, especially in elderly patients.

Another treatment option for early PD is a monoamine oxidase-B (MAO-B) inhibitor, such as selegiline (Carbex, Eldepryl) or rasagiline (Azilect). MAO-B inhibitors boost the effectiveness of the dopamine that the brain is still making. They may delay the need for stronger drugs. Eventually, though, people taking an MAO-B inhibitor will need a levodopa-containing drug.

Dopamine agonists mimic the effects of dopamine. Some of the commonly used dopamine agonists are bromocriptine (Parlodel), pramipexole (Mirapex) and ropinirole (Requip)ómay be used alone to delay the need for levodopa. Or they may be used with levodopa to increase its effectiveness. This may reduce the amount of levodopa needed. Older patients can be especially sensitive to these drugs. They can cause confusion, hallucinations and weakness due to low blood pressure.

Drugs called COMT inhibitors also can be used in combination with levodopa. COMT inhibitors, such as entacapone (Comtan) and tolcapone (Tasmar), prolong the action of dopamine in the brain. They also increase the effectiveness of levodopa. When a COMT inhibitor is added, the doctor usually lowers the levodopa dose.

Depression is a fairly common problem among people with PD. Many patients can benefit from treatment with antidepressant medications.

Regular exercise and a balanced diet also may help to improve a patient's overall sense of well-being and body control.

Surgery
Surgery is considered when patients stop responding well enough to medications. Surgical options include:

  • Deep brain stimulation. The electrodes are placed after brain mapping.

  • Precise destruction of targeted areas in the brain. Destroyed areas are responsible for the most troubling symptoms.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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