Treating Parkinson's: Deep Brain Stimulation, Neuro-rehabilitation & Parkinson's Disease Medications

There are a few ways of treating Parkinson's disease; however, currently deep brain stimulation, a form of surgery, and neuron-rehabilitation are less common than Parkinson's disease medications. As with any long-term chronic illness, many patients find that regular exercise and a balanced diet can help their overall health and stress levels over the long term.

Parkinson's Disease Medications

Most Parkinson's disease medications do not actually slow or halt disease progression (the so-called "neuro-protection" effect), but rather work to alleviate the symptoms associated with the disease. There are several types of drugs that are used either singly or in multiple combinations. These include:

  • Levodopa and levodopa combinations. These are used in patients with functional impairment. The drugs are converted into dopamine by brain enzymes. There is no evidence that it slows or worsens the progression of Parkinson's disease, but it does improve the symptoms. Taken on its own, levodopa can have a lot of side effects; thus, levopoda combinations were developed to improve patients' tolerance for the therapy.
  • Carbidopa plus levodopa combinations. Brand names are Sinemet and Madopar; these are often used as the first line of therapy. There are also sustained-release forms of Sinemet and Madopar used as Parkinson's disease medications.
  • MAO-B inhibitors. These drugs are used as treatment for early Parkinson's disease if the patient does not have functional impairment. MAO-B inhibitors delay symptom progression and the need for dopamine combinations. They can also be used in combination with the levodopa combinations, lowering the dose of the combinations needed to control symptoms.
  • Selegiline, Atlapryl and Carbex. These are the brand names of drugs that may increase dopamine brain level and benefit the patient by inhibiting MAO-B, and thus inhibiting the breakdown of dopamine in the brain. There is a new long-acting form of the drug called Azilect that can be taken once a day. Another new drug called Zelpar dissolves in the mouth (helping patients with swallowing difficulties). These drugs may have lots of side effects. There is no evidence that they alter the course of Parkinson's disease or make it worse.
  • Dopamine agonists. These stimulate the corpus striatum cells to make dopamine and are used in patients with functional impairment. Dopamine agonists pose a higher risk of side effects, but are alternatives to taking the drug combinations. Permax, Parlodel, Mirapex, Requip are examples of dopamine agonists. They are moderately effective, especially when used at low dose to smooth out the stimulation of dopamine during Parkinson's disease fluctuations. Because although they have side effects and can eventually "wear out" the dopamine receptors, they may be tested by a challenge dose under observation.
  • Amantadine. Amantadine is an antiviral medication and that be used alone or with dopamine agonists. It can reduce fatigue tremor and motor fluctuations.
  • COMT inhibitors. These prolong the effects of L-dopa and its combinations, but may have a smoother sustained interaction with their long half-life. They may have too much toxicity. Comtan is the most commonly used form as a Parkinson’s disease medication.
  • Anticholinergic medications. Biperiden, Benztropine, Procyclidine and Trihexyphenidyl are used in some patients with Parkinson's disease.
  • Elavil or clonazapine. These are most commonly used for depression.
  • Aricept and Exelon. These are most commonly used for dementia.

Surgery & Deep Brain Simulation for Parkinson's Disease

Surgery is another treatment option for Parkinson's disease. Surgery, which works by putting a lesion in the brain, has not been well accepted in the majority of cases. Producing a lesion in a part of the brain known as the globus pallidus is good only for unilateral Essential Tremor; doing so can benefit extreme muscle tone. Deep brain stimulation is the most commonly used form of surgical treatment. The surgeon places simulators in the central portion of the brain in the globus pallidus and this may benefit not only tremor but also other symptoms and signs of Parkinson's disease. This works by pacing the nervous system with this device and it appears well accepted in most patients.

Neuro-rehabilitation

In addition to drug therapies and surgery, neuro-rehabilitation is another treatment option. Neuro-rehabilitation can improve recovery, helping with voice, memory, motor functioning and other aspects of the disease. The Hoehn and Yahr Scale helps clinicians measure progression. Regular moderate exercise and good nutrition are essential along with fiber and GI motility drugs.

Prognosis for Parkinson's Disease

Parkinson's disease is not fatal, but it is progressive and it does lower life expectancy to some degree; the greater the loss of dopamine, the greater the disease progression. There is no way to predict which course a particular patient's disease will take. Experts agree that treatment and rehabilitation do make for a more productive life, and also feel that patients tend to do better in a home environment rather than in a nursing home.

Further Research

Researchers are studying neuro-protective treatments that may alter the course of the disease, not just temporarily improve the symptoms. CoQ-10, qi gong, neural transplants and gene therapy are all being considered, but are not felt to be ready for clinical use. Thus most treatments that are available today help ease the symptoms, but do not alter the degenerative nature of Parkinson's disease.


Author's Note: Sources: Compiled from information found at www.wikipedia.com; www.parkinson.org; www.mayo.com; www.mccare.com; www.prescribersletter.com; www.bnet.com; www.webmd.com; plus the Discovery edition of Brain magazine 2009.