Different ways to treat PD

There are several ways to manage Parkinson’s disease (PD). They include non-drug treatments, such as physical therapy, occupational therapy and dietary management; surgery such as a pallidotomy (removal of a part of the brain called the globus pallidus), thalamotomy (removal of part of the thalamus), or deep brain stimulation; and drug, or pharmacological treatment. At present, there is no cure for Parkinson’s disease. Management of Parkinson’s disease relieves symptoms but does not cure it.

Drug therapies for PD
There are many drugs that can be effective for Parkinson’s disease, although effectiveness differs for every patient depending on the stage of the disease, how long the drug has been used, and other factors. Side effects may prevent doctors from recommending the most effective dose, or they may require a new drug to counteract them.

Six categories of drugs are currently used to treat PD:

1. Dopamine replacers
   
   Levodopa, a dopamine replacer, is converted into dopamine by the brain. Dopamine is the neurotransmitter that is in short supply in PD patients. It is the single most effective treatment for the symptoms of PD. It may be started when symptoms begin, or when they become serious enough to interfere with work or daily living.
   
   Levodopa usually remains effective for five years or longer, after which time some patients develop motor fluctuations, including peak-dose "dyskinesias" (abnormal movements such as tics, twisting, jerking of the limbs or restlessness), rapid loss of response after taking medication (known as the "on-off" phenomenon), and unpredictable drug response. Higher doses are sometimes tried, but may lead to an increase in dyskinesias.
   


2. COMT inhibitors
   
   TASMAR® (tolcapone) most likely works by stopping a brain enzyme called COMT from interfering with levodopa/carbidopa. It seems to allow levodopa/carbidopa to become more effective again, thus reducing Parkinson’s disease OFF time and increasing ON time. At this time, however, the exact method of action of TASMAR is not entirely understood.
   


3. Dopamine agonists
   
   When certain cells in the brain are stimulated, dopamine, the substance PD patient’s lack, is produced. Drugs that stimulate these cells are called dopamine agonists, or DAs. DAs may be used before levodopa therapy, or added later.
   


4. Anticholinergic drugs
   
   Anticholinergics keep dopamine levels up. However, the side effects of anticholinergics (dry mouth, constipation, confusion, and blurred vision) are usually severe in older patients or in patients with dementia. In addition, anticholinergics rarely work for very long. They are often prescribed for younger patients who have predominant shaking.
   


5. Drugs with uncertain modes of action
   
   Amantadine is sometimes used as an early therapy before levodopa is begun, or added on to other drugs later. Its anti-parkinsonian effects are mild. Drugs like Amantadine can be effective against the psychosis and hallucinations of late PD.
   


6. MAO B inhibitors
   
   MAO B inhibitors work by blocking the enzymes in the brain that break down dopamine.

Alternative treatments
Currently, the best treatments for PD involve the use of drugs such as levodopa. Alternative therapies include acupuncture, massage, yoga, and other therapies. These can help relieve some symptoms of the disease and loosen tight muscles. Alternative practitioners have also applied herbal and dietary therapies to the treatment of PD.

You’ll want to check with your doctor to find out more about which alternative therapies might be right for you.