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Parkinson’s is a complex, highly individualized disease. There’s not yet a cure, but the right treatment can slow the disease’s progression — and help you feel better.
Thanks to treatment advances, patients with Parkinson’s can have near-normal lifespans. “Before we had medications for Parkinson’s, people used to live 10 years and die in a statue-like state. Now people live decades,” notes Laura Buyan Dent, MD, PhD, director of UW Health’s Movement Disorders Program.
And “treatment” might not look like what you expect, especially in the early stage of the disease. “First we try non-medicine treatments like exercise, physical therapy and speech therapy,” she says. “Eventually symptoms will intrude more and more, and then we’ll have to start medicines.”
The most common forms of treatment include the following:
“When to start medicine is highly variable depending on symptoms, the patient’s lifestyle, and what his or her job requirements are,” Dent says. If you’re routinely avoiding certain types of activities because of your Parkinson’s, then it might be time to start medication.
Sometimes we’ll try medications and see how they work, and we’ll stop them, too,” Dent says. “Nothing says you have to stay on medication. Finding the right medication that manages your symptoms while minimizing side effects is key.”
Parkinson’s medications work by increasing dopamine production in the brain. The most commonly prescribed medicines are Levodopa and Sinemet, a combination drug that includes Levodopa.
“Symptoms often respond very well to Levodopa, but the big downside is you can develop dyskinesias, a certain type of involuntary movement,” she says. “When you think about Michael J. Fox’s wiggly movements, that’s not because of his Parkinson’s; it’s a side effect of treatment. Because of those, some people are very afraid of starting Sinemet because they think that’s worse.”
As time goes on, medication may not be enough to control your symptoms. “Sometimes as the disease progresses, certain gait difficulties and gait freezing may not respond to medications,” Dent says. “Then we try physical therapy and help people adapt to the physical changes.”
Deep brain stimulation (DBS)
This treatment involves surgically implanting an electrode deep in the brain. A wire is fastened to the skull, and another wire attaches under a battery pack that is surgically implanted in the chest wall.
“It’s a little like a pacemaker,” Dent explains. “It doesn’t slow down disease progression, but it helps attenuate some of the symptoms. It’s really the first time we’ve had a decent treatment for dyskinesias.”
Not every patient will need or want DBS, but it has become part of the standard care offered by most movement centers.
While the standard treatments can be very effective, Parkinson’s researchers are always looking for better ways to improve patients’ quality of life. Participating in clinical trials give you the opportunity to be among the first to try new, cutting-edge treatments.
“There’s always been a lot of research looking at different neurotransmitter systems that have a complementary role to see if they’ll help,” Dent says. “There’s also a lot of research looking at better ways to deliver dopamine to the brain, and researchers are trying to find a better form of Levodopa. And then there is a lot happening in terms of stem cell research, and some of that looks promising, but it’s in very experimental stages.”
However, Dent cautions patients from trying other experimental treatments, including CBD oil and medical marijuana. “Those are not things we recommend that people with Parkinson’s try,” she says. “We don’t know that they’re safe, and they could be toxic to struggling neurons.”
Because of the variable nature of Parkinson’s, it may take some time and patience to find the right treatment. “There’s no one right way to treat it, and finding someone to help you find what’s best for you is the most important thing,” Dent says.