Parkinson's Disease Treatment Options

Conditions & Diseases: Brain & Nervous System

Parkinson's Disease

Treatment Options

Unfortunately, there is no cure for Parkinson's Disease, but medications or surgery can provide some relief.

Selection of medicine, drug dosage and modification of regimens is tailored for each patient depending on various factors such as severity of symptoms, age and presence of other medical conditions.

This process involves experimentation, persistence and patience since the efficacy of drugs and symptoms are unpredictable in each case.

Medications:

Medications are categorized into the following three categories:

1. The first category of drugs works directly or indirectly to increase dopamine levels in the brain and are called dopamine precursors. Levodopa is an example of this type. Some drugs mimic dopamine (dopamine agonists) and prevent or slow the break down of dopamine.

Levodopa (L-3,4-dihydroxyphenylalanine) is used by nerve cells to produce and replenish the dwindling supply of dopamine in the brain. Carbidopa is given along with Levodopa to delay the conversion of levodopa to dopamine until it reaches the brain. Side effects of levodopa include nausea, vomiting, low blood pressure, restlessness, drowsiness, hallucinations and psychosis.

Examples of dopamine agonists include Apomorphine, Bromocriptine, Pramipexole and Ropinirole.

2. The second category affects neurotransmitters in the body to ease some symptoms of Parkinson's Disease. These drugs reduce tremors and muscle stiffness. Anticholinergic drugs interfere with production and uptake of neurotransmitter acetylcholine. Examples of acetylcholine anticholinergics include Trihexyphenidyl, Benztropine and Ethopropazine.

3. The third category of medications help control non-motor symptoms of the disease i.e., symptoms not affecting the movement. For example, antidepressants are prescribed for patients suffering from Parkinson's Disease related depression.

Examples of antidepressants include Amytriptyline, Fluoxetine, Benzodiazepines and Fludrocortisone.

In addition to the above, the following drugs may also help alleviate the symptoms of PD:

MAO-B inhibitors: Selegiline (deprenyl) and Rasagiline. These drugs cause dopamine to accumulate in surviving nerve cells and reduce symptoms of PD. “These drugs inhibit the enzyme monoamine oxidase B, or MAO-B, which breaks down dopamine in the brain.”

COMT inhibitors (catechol-O-methyltransferase inhibitors): Entacapone and Tolcapone. Catechol-O-methyltransferase is an enzyme that helps break down dopamine. These drugs inhibit COMT and consequently help in alleviating the symptoms of PD.

Amantadine: This is an antiviral drug used to help reduce symptoms of PD and levodopa induced dyskinesia (8).

Surgery:

There are five types of surgery for Parkinson's Disease:

Thalamotomy: A tiny area in the thalamus, a part of the brain, is destroyed with the help of stereotaxic surgery. This surgery is beneficial when a patient suffers from disabling tremors that interfere in his or her daily activities.
Pallidotomy: Like in Thalamotomy, a tiny area called the internal globus pallidus of the brain, is destroyed using a similar method as the one used above to relieve the patients from severe dyskinesia.
Transplantation: Mid-brain tissues of human foetuses are transplanted in diseased portion of the brain. These foetal cells produce dopamine leading to relieving the patients of PD symptoms.
Deep Brain Stimulation: Instead of destroying part of the brain permanently by stereotaxic surgery a deep brain stimulator is inserted to send rapid electrical impulses to specific areas of the brain to treat symptoms of tremor, rigidity and dyskinesias.
Radio surgery: Radiosurgery is carried out by two main methods namely gamma knife and linear accelerator (linac) (14).

Article by Kona Vishnu, MS
Medical Writer,
OmniMedicalSearch.com

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