Treatment options for Parkinson's Disease, as with other diseases, change over time.  Therapies are researched and some standard therapy may be unproven.  You need to be informed. 

Coping with chronic illness can be overwhelming.  But, by learning as much as you can about your condition, you'll be better able to make informed decisions.  The more information you have, the more in control you'll feel.

Because Parkinson's symptoms vary from individual to individual there's no "one-size-fits-all" treatment.  Care can be complex and you should look to your primary care physician to provide coordination.  In addition to your PCP, you may see specialists such as neurologists, physical therapists, speech therapists and psychiatrists. 

It's important to understand that, at present, there is no cure for Parkinson's disease.  Both medical and surgical interventions offer only symptom relief and do not affect the underlying pathology of the disease.

Non-Drug Therapy
In the early stages of Parkinson's, your doctor may advise you to wait to take medication and, instead, try to manage symptoms with other therapies. 

• Physical therapy can be helpful both in the early stages and later to improve mobility, range of motion, balance and muscle tone.
• Speech therapy can help improve problems with speaking and swallowing.
• Massage therapy can improve quality of life by helping to relieve stress (stress can aggravate symptoms) and may provide some relief from muscle rigidity.

Medications
Levodopa has been the mainstay of therapy for Parkinson's disease for several decades.  Most patients experience a dramatic improvement in symptoms when they start taking it. However, over time (in about four to five years) its effectiveness declines and adverse side effects increase. 

There's no absolute right time to start taking medication.  Your doctor's job will be to balance symptom relief against side effects.  Your doctor may:

• Have you take levodopa only when your symptoms are causing difficulty (this is called rescue medication or rescue levodopa)
• Delay levodopa therapy as much as possible by using alternative drugs
• Start levodopa early at a lower dose, increasing it as needed
• Use levodopa in combination with other medications

Levodopa is a chemical found naturally in plants and animals. Nerve cells use it to make dopamine.  Unlike dopamine itself, levodopa can cross the blood-brain barrier (cells in the walls of the brain's capillaries that screen out certain substances), though only a small amount actually reaches the brain.  That's why levodopa is usually combined with carbidopa.  Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain, enhancing its effectiveness and diminishing side effects.

Problems with levodopa or levodapa-carbidopa therapy may include:

• Wearing-off effect (doses becomes less effective more quickly)
• On-off effect (symptoms appear and disappear suddenly and unpredictably)
• Involuntary movements such as nodding, jerking, abnormal twisting
• Drop in blood pressure when standing
• Sleepiness
• Nausea
• Hallucinations and confusion

Other drugs may be used alone or in combination with levodopa and include:

• Dopamine agonists. Mimics the effects of dopamine in the brain.
• MAO-B inhibitors. Prevents the breakdown of dopamine.
• Catechol-O-Methyltransferase (COMT) inhibitors. Prolongs the effect of carbidopa-levodopa.
• Amantadine. Provides short-term relief of mild, early-stage Parkinson's disease; helps control involuntary movements caused by carbidopa-levodopa in later stages.
• Coenzyme Q10 supplements.  May slow the progression of early-stage Parkinson's in some patients (based on a limited study).
• Anticholinergics. Helps control tremor in the early stages of the disease.

Surgery
Surgery may be considered when medication either fails to control symptoms or causes disabling side effects.  However, as with medication, no currently available surgical treatment has been proven to either slow disease progression or restore the nerve cells affected by Parkinson's.  Postoperative improvement usually lasts several years in most patients, but symptoms may return or other symptoms appear after surgery as the disease progresses.  Procedures include deep brain stimulation (DBS) and ablation surgery.

• Deep brain stimulation (DBS) involves implantation of tiny electrodes within the brain.  The electrode wires are connected to a pacemaker-like unit implanted in the upper chest.  This device delivers controlled pulses of energy through the electrodes to block brain signals that cause symptoms. The pulses are adjustable, so they can be tailored to the individual patient. Electrodes placed in the thalamus reduce tremor; those placed in the globus pallidus or subthalamus are most effective in treating stiffness and dyskinesias. 
  
• Ablation (or lesion) surgery involves destroying cells in the brain to block the pathways of messages that can lead to symptoms. These lesions are not reversible.  Pallidotomy targets the globus pallidus to reduce stiffness and dyskinesias.  Thalamotomy targets the thalamus to reduce tremor.

On the Horizon
The research being done today, both in the laboratory and in clinical research with Parkinson's patients, holds real promise that a cure could be near.  In the meantime, a wide range of approaches to better manage or slow the progress of the disease are now in clinical trials.  Many leading Parkinson's groups and the National Institute of Neurological Disorders and Stroke, are leading a nationwide effort to accelerate the development of new treatments for Parkinson's disease by increasing awareness and participation in clinical research. To learn about the importance of clinical trials and to find trials in your area, contact the information request line for PDTrials at (888) 823-8889 or visit www.PDtrials.org.