Parkinson’s disease treatment

Most people with Parkinson’s take medication to manage symptoms. These medications work to increase the activity of the neurotransmitter dopamine in the brain. Dopamine is a chemical messenger in the brain that controls the coordination of movement. Decreased levels of dopamine cause the symptoms of Parkinson’s disease.

Depending on your symptoms, your doctor may prescribe:

• Levodopa: Increases the level of dopamine available in your brain. Levodopa comes in several forms, including an inhaled powder or an infusion. The infusion method is pumped directly into your intestines or the fatty tissues underneath your skin (subcutaneous).
• Carbidopa-levodopa: Helps to prevent breakdown of levodopa. People who take this combination drug usually need less levodopa.
• Adenosine receptor antagonists (istradefylline): Targets receptors in your brain that control the release of dopamine.
• Amantadine: Used during the early stages of PD to manage mild symptoms. It may also be given in later stages of PD to help control involuntary movements (dyskinesia) that may develop as a side effect of long-term carbidopa-levodopa use.
• Anticholinergics (beztropine, trihexyphenidyl): Helps control resting tremors.
• Catechol O-methyltransferase inhibitors (entacapone, opicapone): Blocks another protein that breaks down dopamine called catechol O-methyltransferase (COMT). These drugs are taken along with levodopa to extend the length of time that levodopa works in your body.
• Dopamine agonists (apomorphine, pramipexole, rotigotine): Mimics the effects of dopamine in your brain to decrease side effects of levodopa. Apomorphine is injected as a rescue medication for quick relief if oral levodopa stops working during the day.
• Monoamine oxidase B inhibitors (selegiline, safinamide, rasagiline): Blocks the action of an enzyme, monoamine oxidase B (MAO B), that breaks down dopamine in your brain.
• Pimavanserin: Treats hallucinations or delusions that may develop due to Parkinson’s disease.

Rehabilitative therapies help people with Parkinson’s stay strong and flexible, reduce pain, and participate in daily activities. Research shows that routine exercise and movement can help to form new connections in your brain that may reduce symptoms of Parkinson’s and slow down disease progression. Depending on your symptoms, your care team may recommend:

• Physical therapy: Targeted, customized exercises help keep you flexible, strong, and coordinated and improve balance to reduce your fall risk.
• Occupational therapy: Involves exercises and activities that help you continue to be able to perform daily tasks (such as self-care and cooking) and do things you enjoy.
• Speech therapy: Speech therapists teach you exercises to help communicate clearly and swallow more effectively.

At Penn Medicine, movement disorder specialists collaborate closely with rehabilitation experts at the Dan Aaron Parkinson’s Rehabilitation Center (DAPRC) to bring you specialized therapies that help you manage life with Parkinson’s disease.

Living with Parkinson’s disease brings many changes to your life. Some people with Parkinson’s find that working with a psychiatrist, neuropsychologist, or spiritual counselor is helpful for managing emotions. These specialists provide emotional support, help you develop coping strategies, and prescribe treatments to manage psychological symptoms such as depression or anxiety.

When medications and other therapies do not control symptoms, your doctor may recommend other surgical or nonsurgical treatment options, such as:

• Deep brain stimulation (DBS): DBS electrically replaces the chemical signals of the neurotransmitter dopamine which are lost as Parkinson’s disease progresses. Neurosurgeons implant a device similar to a pacemaker in your chest wall near the collarbone. This device sends electrical signals through a wire to electrodes placed in specific areas of your brain. DBS can effectively reduce more widespread Parkinson’s symptoms.
• Gamma Knife® stereotactic radiosurgery: This surgery uses highly focused radiation beams to target a specific area in your brain. While not as immediately effective as DBS, Gamma Knife radiosurgery may be an option for people who cannot have DBS.
• MR-guided focused ultrasound: This noninvasive treatment uses highly concentrated mechanical energy waves to create heat to target a specific region of your brain that causes tremors in Parkinson’s disease.