Parkinson's Disease
How is Parkinson's disease treated?
- In most cases, treatment with medication starts from the time a diagnosis of Parkinson's disease is made.
- The therapeutic agents are often changed based on the state of the disease, and it is quite normal for the doses or types of medication used to increase.
- The treating physician, in consultation with the patient, will decide the doses and types of medication according to the state of the disease, based on a medical examination and the patient's current condition.
- To ensure treatment goes well, the treating physician should be told about anything that is troubling the patient.
Treatment with medication
List of the main drugs used in Parkinson's disease
| L-dopa | Also called levodopa, L-dopa is an oral medication that is the gold standard for treating Parkinson's disease. It is converted to dopamine in the brain, supplementing the shortage of dopamine. |
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| Dopamine receptor agonists | A dopamine receptor agonist is a drug that stimulates the receptors that receive dopamine in the brain, thereby creating the same condition as if dopamine had been released. A feature of these drugs is their long-lasting effect. Guidelines in Japan recommend a treatment strategy that starts with a dopamine receptor agonist in cases where the patient is younger than age 70 with no dementia and especially where early amelioration of symptoms is not necessary. In addition to oral formulations there are patches that maintain the effects of the drug for 24 hours. |
| MAO-B Inhibitors | MAO-B inhibitors help prolong the effect of dopamine. |
| COMT Inhibitors | COMT inhibitors help L-dopa reach the brain efficiently. |
| Adenosine receptor antagonists | Adenosine is a neurotransmitter that works in balance with dopamine. In Parkinson's disease, the action of adenosine becomes relatively stronger, since the action of dopamine weakens. This causes an imbalance in the nerves, resulting in the emergence of various symptoms. Adenosine receptor antagonists relieve these symptoms by adjusting the balance between adenosine and dopamine. |
| Anticholinergic drugs | Acetylcholine is another neurotransmitter like dopamine. Dopamine and acetylcholine work in balance with each other in the brain. But, in Parkinson's disease, these two become unbalanced, resulting in an emergence of various symptoms. Anticholinergic drugs maintain the balance between acetylcholine and dopamine. |
| Drugs that enhance the release of dopamine | These drugs encourage the release of dopamine by stimulating the neurons that release dopamine. They also help to recover unused dopamine so that it can be reused. |
| L-dopa enhancers | L-dopa enhancers increase dopamine in the brain by promoting the production of dopamine in the body and by eliminating elements that negate the effect of dopamine. |
| Noradrenaline replenishment drugs | Noradrenaline is another neurotransmitter like dopamine. Since a shortage of noradrenaline makes the symptoms of Parkinson's disease appear more readily, these drugs are used to replenish noradrenaline. |
Points to note during treatment for Parkinson's disease
Side effects seen when starting to take medication
These side effects tend to occur when starting to take medication for Parkinson's disease. Consult your doctor if such symptoms occur.
- Gastrointestinal symptoms
Symptoms such as nausea, loss of appetite, and constipation may develop. It may be possible to alleviate symptoms with medication. - Drowsiness
Some medications may have side effects such as drowsiness or induce immediate sleep. - Dizziness upon standing
Dizziness upon standing may be experienced as a side effect. Standing up slowly when getting up is helpful. If this symptom is intense, it may be possible to use a drug that prevents dizziness upon standing.
Side effects after staying on medication for a long time
Particular side effects may appear after taking medication for Parkinson's disease for a long time. The treating physician should be consulted.
- Hallucinations
With Parkinson's disease, the disease or the medication for it may cause hallucinations. These symptoms may subside by changing the type of medication or reducing the dose*. - Edema
Swelling in the feet and legs may occur. Options for handling this include changing the type of medication*. - Dopamine dysregulation syndrome
Patients may develop symptoms such as impulsive buying, addiction to gambling, and compulsive sexual behavior as side effects to medication. Changing the doses and types of medication may curb these symptoms.
If symptoms such as these appear, it is important to consult the treating physician without feeling embarrassed.
- *Also seen when starting on medication
Symptoms that require caution even when taking medication
- Wearing-off
Wearing-off is a phenomenon in which the effects of L-dopa, the chief treatment for Parkinson's disease, lasts for shorter periods. This creates periods during the day when symptoms improve and periods when symptoms worsen.
Increasing the doses of L-dopa and adjusting the frequency of doses or adding another medication may improve the wearing-off effect. - On-off phenomenon
This is a phenomenon in which the effects of medication suddenly disappear, causing immobility, and then suddenly reappear, causing mobility to return all of a sudden. Adding and/or changing medications may improve the on-off phenomenon. - Dyskinesia
Dyskinesia is a phenomenon in which the medication is overly effective, causing the arms and legs to move involuntarily. Adjusting the doses and types of medication may alleviate dyskinesia.
Other important points
Driving a car is prohibited when taking some medications for Parkinson's disease. Also, when taking certain medications, periodic tests for heart disease should be carried out.
The treating physician and pharmacist will explain these points. Make sure to follow their instructions.
Surgical treatment
In Parkinson's disease, treatment focuses on drug therapy, but surgery is sometimes used when it is difficult to control symptoms with medication and when the necessary doses cannot be taken due to side effects.
Depending on the individual case, some patients require surgery early on.
Surgery cannot completely cure Parkinson's disease, rather, it should be considered as assisting drug therapy.
A few conditions must be met in order to undergo surgery, and you should discuss it carefully with your doctor when deciding whether or not to request a referral to see a brain surgeon.