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Treatment

Medication is the primary treatment for symptoms of Parkinson disease. In a few cases, surgery may also be an option. It is very important you, your family and/or caregivers to develop a solid understanding of the treatment options that may be available. Focusing on exercise, stress management, proper nutrition and other available therapies are also part of living well with Parkinson disease.

Q. Do I need a neurologist?

It is highly recommended that anyone facing a diagnosis of Parkinson disease be seen by a neurologist for examination and evaluation. A neurologist is a physician who diagnoses and treats disorders of the nervous system. A medical referral by a family physician or a medical specialist is required for a consultation. The neurologist will report findings to the family physician.

In Southern Alberta, you can access the Movement Disorder Clinic at the Foothills Health Centre in Calgary with a referral from your family physician. In Northern Alberta there is a Movement Disorder Clinic at the Glenrose Rehabilitation Hospital in Edmonton.

Q. What medications are used to treat Parkinson disease?

The medications prescribed to alleviate the symptoms of Parkinson’s disease can be organized into two categories:

  • Medications that temporarily replace, mimic or enhance the depleted neurotransmitter dopamine.
    • Levodopa
    • Dopamine Agonists
    • COMT Inhibitors
    • MAO-B Inhibitors
    • Amantadine
  • Medications that reestablish a balance between the levels of acetylcholine and dopamine.
    • Anticholinergics

When someone has only mild symptoms which do not interfere with their quality of life, they may decide, together with their physician, to postpone drug treatment until symptoms worsen. During that time, they may decide rely on a healthy lifestyle by focusing on exercise, stress management and diet.

Medications can, however, provide relief or a significant decrease in symptoms. Increasing the amount of dopamine can alleviate the symptoms but does not slow the progression of Parkinson disease. As the symptoms worsen, more medication may be needed.

Taking medication on time is a crucial part of treatment. It is very important for the person with Parkinson disease and their family and friends to understand the actions and side effects of medications and what improvement can be reasonably expected.

As Parkinson disease is a very individual condition, medication is prescribed and adapted to individual needs and can help to achieve good symptom control. Response to medication varies from person to person and not every medication will be considered suitable for everyone.

Ask your physician and/or pharmacist for information about medications and possible side effects. If side effects are experienced, they should be reported to the physician as soon as possible.

Q. Are generic medications as effective as brand name medications?

As brand-name drugs get older, they cease to be protected by the patent held by the pharmaceutical company that developed the drug. Once this happens, the drug can be 'copied' and produced more cost-effectively. This copied medication is called the generic version.

The generic medications are, in most cases, identical to the brand-name drug and most people using them are satisfied with them. In some instances, however, people using the generic medication find that it is not as effective as the brand-name drug. One example is Sinemet, where some people with Parkinson disease have found this to be the case.

Many drug insurance plans will only pay for the generic version of a medication and the purchase of the brand-name drug can become a financial burden to the patient.


Q. Are there side effects? If so, how are they managed?

All pharmacological agents (medication, vitamins, and supplements) can cause side effects. Drugs used to treat Parkinson disease are no exception but this does not mean they should not be taken. Side effects for all of the common medications for Parkinson disease may be reversed by lowering the dosage or discontinuing treatment. In addition, there are simple measures to control most of them. The more common side effects include:

Nausea
If you are feeling nauseated in spite of taking medications after food, speak to your doctor or your Parkinson disease nurse. Your doctor may be able to prescribe a medication for you to control the nausea. In some cases the nausea medication may only be needed for the first weeks or months of treatment, after which time the Parkinson disease medication may be tolerated more effectively by your system.

Dizziness
This is often caused by low blood pressure (hypotension). Dizziness most often occurs in the early stages of treatment and during periods of hot weather, but it often responds to simple measures and may wear off over time. However, if your balance is poor and you feel dizzy you may fall and this can lead to a fracture with serious consequences.

Impulsive or Compulsive Behaviour
Drug therapy may contribute to behaviour changes in people with Parkinson disease. Examples include risk-taking, excessive gambling, cleaning, shopping or obsessive interest in sex. When this behaviour is excessive it can damage relationships and cause great financial and personal hardship. It is vital for changes in behaviour to be reported to the family physician or specialist even though this may be embarrassing.

Sleepiness
A few people people find that their anti-Parkinson disease drugs suddenly make them very sleepy. If you sleep well at night but still have excessive daytime sleepiness you should talk to your physician who may recommend adjusting your medication, or adding another medication commonly used to alleviate some of the daytime sleepiness.

Dyskinesia
Dyskinesia refers to the uncontrolled movements, often of the upper body, that are a common side effect of prolonged levodopa use.

Q. Are there medications I should not take while taking Parkinson disease medications?

Yes, there are medications that are strictly contraindicated (must not be taken) with Parkinson medications, including:

  • Neuroleptics (a class of drugs used mainly in the treatment psychiatric conditions) except atypicals (a limited number of medications with properties unlike the standard neuroleptics)
  • All conventional antipsychotic medications such as Haloperidol, Respiridone, and Olanzapine
  • Major tranquilizers (a class of drugs used to treat symptoms such as severe agitation and anxiety)
  • Certain drugs for nausea including prochlorperazine (Compazine) and metoclopramide (Reglan and Maxeran)
  • Demerol (must be used with caution)

Never assume that a medical professional is aware that you are taking Parkinson disease medication and, further, is aware of the contraindications. You must inform all of your doctors about these critical restrictions. This is particularly important in an emergency situation, surgery or hospitalization when you may be seen by a physician who is unfamiliar with your situation.

Q. What about surgery for Parkinson disease?

Deep Brain Stimulation (DBS) is a form of surgical therapy for the treatment of Parkinson disease and essential tremor. It involves placing a metal wire into a specific site in the brain and stimulation of the site with electrical impulses.

DBS has shown to be beneficial for certain select patients by helping the motor symptoms as well as some of the non-motor symptoms of Parkinson disease. Surgery is NOT a standard treatment for everyone with Parkinson disease and is not an alternative to drug therapy. It is considered only when all medical options have been exhausted. In a limited number of cases, surgery can be effective. The best candidates for surgery meet criteria addressing the length of time since diagnosis, the kind of symptoms, reaction to medications, overall physical health, and overall mental health and stability.

For more information go to www.parkinson.org for their booklet on DBS.

Q. What else can help in the management of symptoms?

Exercise
Exercise can maintain flexibility of joints, muscle strength, improve circulation to the heart and lungs and aid digestion. It also has a positive psychological effect, helping to deal with day-to-day stress and giving the person a sense of control over the condition. It does not alter the fact that a person has Parkinson disease but it can help how they feel about it.

Exercise in combination with good drug therapy can help a person to remain active and enhance the quality of life. Stretching exercise, aerobic exercise and strengthening exercises are important. Many people with Parkinson disease find that yoga, Tai Chi or Qui Gong (gentle form of Tai Chi) are helpful along with walking and swimming.

For more information about Exercise and Programs for Parkinson disease in Alberta please refer to our Client Services Exercise page on this website.

Safety, joint protection and balance are important considerations when exercising. Start slowly and consult your physician before starting a new activity.

Physiotherapy
Physiotherapy is a treatment that uses physical means to relieve pain, regain range of movement, restore muscle strength and return patients to the normal activities of daily living. People with Parkinson disease can benefit from an assessment by a physiotherapist as a way of identifying and treating specific areas of the body where weakness or stiffness is a concern. Physical therapists can recommend exercises to address specific concerns.

Massage Therapy
Massage therapy has shown to provide temporary relief from pain and stiffness in addition to enhancing relaxation and stress management.

Nutrition
Nutrition can help to maintain your best level of health if you have Parkinson disease. If you have nutrition-related questions or develop problems such as weight change, poor appetite, difficulty chewing or swallowing, or constipation, consultation with a registered dietician may be helpful.

There is no special diet for people with Parkinson disease. Eat a variety of foods each day from the four food groups as indicated by the Canada Food Guide to obtain all nutrients needed for good health. Some people with Parkinson disease may notice that their medications do not work as well when they take them with protein. In these cases, people may wish to take their medication either an hour before, or an hour after, meals with protein. It is not recommended that people with Parkinson disease remove protein from their diet - rather, they may need to have it at different times in the day.

For general information about nutrition, please go to: www.dialadietitian.org.

Speech Therapy
Many people with Parkinson disease develop speech difficulties. Changes in speech may occur as a result of decreased coordination or reduced movements of the muscles involved in breathing, voice, pronunciation, and prosody (rhythm, intonation, and speaking rate). Often the first change noted in speech is loss of volume resulting in a soft or fading voice. The first indication may be frequent requests by family and friends to repeat what has been said. A Speech-Language Pathologist can evaluate speech problems, provide information and recommend a program.

Q. Are there alternative treatments that can be beneficial?

After the diagnosis of Parkinson disease, sometimes people search for different methods of treating the symptoms. Presently, there is considerable interest in alternative treatments.

When investigating alternative treatments, consider the following:

  • What is the evidence of the effectiveness? The best evidence appears in peer-reviewed scientific journals. Treatments which have not been put through the rigors of scientific evaluation should be approached with caution.
  • What is the cost of the treatment? The cost of some treatments is exorbitant and it is not uncommon for a person, desperate for relief, to pour considerable savings into a treatment that is speculative at best.
  • Can the treatment do harm? The risks associated with any treatment must be clearly explained and completely understood. Of particular concern, is whether or not any supplement or other pills dangerously interact with Parkinson disease medication.
  • What is the source of supplement and how is the potency regulated?

The Parkinson’s Disease Society of the United Kingdom has a publication titled “ Complementary Therapies and Parkinson’s Disease”. You can access it on their website www.parkinsons.org.uk

Use extreme caution when undertaking an alternative treatment. Inform your physician before embarking on any alternative treatment.


Q. Are new treatments being developed?

Researchers around the world are working on finding the cause of Parkinson disease and developing and enhancing treatments. If you are interested in following the latest research findings or in being part of a clinical trial, consider looking at the following websites:

Michael J. Fox Foundation (www.michaeljfox.org)

National Parkinson Foundation (www.parkinson.org)
See "Hot Topics" by Dr. Michael Okun

Northwest Parkinson Foundation (www.nwpf.org)
You can subscribe to weekly Bulletins

PDtrials provides up-to-date information on Parkinson's disease clinical trials currently enrolling participants in the US (www.pdtrials.org)

Parkinson Society Canada (www.parkinson.ca)
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