While Parkinson’s disease (PD) has no known cure, doctors and researchers have learned a great deal about how best to diagnose and manage its symptoms. For instance, physicians for the first time have diagnostic tools such as imaging tests to confirm a PD diagnosis in its earliest possible stages, sometimes even before symptoms appear. Prior to 2011, no such imaging tests were available, so confirming a conclusive PD diagnosis sometimes took years. Now a person with PD can make lifestyle choices to help stall symptoms for as long as possible, even before they are noticeable.

DaTscans are the first diagnostic imaging tool developed specifically to look for neurological issues related to PD symptoms. Dr. Lawrence Severt, Attending Neurologist in Movement Disorders at Beth Israel Medical Center in New York, refers to Parkinson’s as a disease that still “requires a clinical diagnosis, even though new DaTscans can actually measure dopamine levels in the brain. In the right clinical context, somebody with dopamine levels that are asymmetrical—larger on one side of the brain than on the other—then we know more than likely that the person has PD or one of the closely related Parkinson-like diseases.”   

According to Dr. Severt, DaTscans can not only confirm the presence of Parkinson’s, “but also rule out similar-looking diseases that are actually much different [and require different treatments], such as essential tremor, so they have become an invaluable new tool in the fight against PD.” Advancements in treatments and new information about the benefits of alternative therapies are also promising.  

Medications
A vast number of medications are available to treat PD and its symptoms. The most widely used PD drug remains levodopa, but a variety of enzyme-inhibitors that metabolize dopamine in the brain are also available.

Levodopa
For decades, the most effective drug to treat PD has been levodopa, or L-dopa, a natural substance already present in the body. Levodopa (Sinemet, Atamet) is always taken in combination with other medications such as carbidopa to help convert it to dopamine in the brain and to prevent nausea. While levodopa can be very effective at controlling PD symptoms, it tends to lose its potency over time, especially as the progression of PD increases a person’s need for dopamine. A patient’s levodopa dosage will likely need to be adjusted or combined with other drugs during the course of treatment as symptoms change or worsen.

Levodopa has a variety of side effects, some of which may include involuntary muscle movements (dyskinesia) and/or painful leg/foot cramps (dystonia). Side effects can usually be remedied by lowering the dosage. Another common side effect of levodopa is low blood pressure upon standing, which could increase your chances of losing your balance and/or falling. Usually, low blood pressure can be easily remedied by switching to a lower dosage. Among the most concerning side effects of levodopa are psychiatric in nature and may include confusion, rapid changes in emotional states, anxiety, vivid dreams, hallucinations, and/or dementia.       

Dopamine Agonists
Over time, as your body adjusts to drug treatment, you may begin to notice that the positive effects from levodopa that keep PD symptoms at bay begin to wane between doses. Doctors refer to that shortened response time as “end-of-dose deterioration” or the “wearing-off effect.”2 Usually, this is a problem only in advanced stages of the disease, and it can be effectively remedied by adding a dopamine agonist, such as ropinirole (Requip), pramipexole (Mirapex), or bromocriptine (Parlodel) to your drug treatment. These drugs extend levodopa’s effectiveness by “mimicking dopamine.”  Other methods of improving levodopa’s long-term effectiveness include changing the dose, taking multiple small doses, altering the delivery method (substituting between sustained- and immediate-release forms of the drug), or changing the diet, such as avoiding food high in protein until late in the day. According to the American Academy of Neurology, two other drugs are also effective at controlling “off-time” symptoms: entacapone (Comtan), rasagiline (Azilect), and tolcapone (Tasmar).   Finally, an additional dopamine agonist treatment option called a rotigotine transdermal system (Neupro) is again available to Parkinson’s patients. Available as a patch, this treatment delivers a continuous, steady flow of the active substance rotigotine through the patient’s skin.

Other Drugs
In addition to levodopa, your doctor might add an anticholinergic drug to decrease the activity of the neurotransmitter acetylcholine, which helps improve the “balance” between neurotransmitters in your brain. MAO-B inhibitors can also increase dopamine levels.   

Conditions often associated with Parkinson’s disease, such as depression, typically have their own drug treatments. Any physician treating your depression, however, should also be aware of your PD diagnosis, as some drugs used to depression, such as selective serotonin-reuptake inhibitors (SSRIs) including fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), can worsen PD symptoms.         

Surgical Procedures
While surgery will not cure Parkinson’s disease, it could improve symptoms in some individuals in advanced stages of the disease. Deep brain stimulation (DBS) is a surgical procedure that places electric stimulators in the form of a device like a pacemaker inside the brain. When employed, the device reduces abnormal signals in the affected areas of the brain that control movement. Continuous monitoring of the brain and spinal cord during the DBS procedure reduces the risk of injury. In the past, other riskier surgical procedures for PD patients involved destroying damaged brain tissue (pallidotomy/thalamotomy), though DBS has since become the standard surgical option.    

Alternative Therapies
Researchers are constantly seeking new therapies to help with the many symptoms of PD, but they already have solid evidence to suggest multiple ways to minimize both motor and non-motor symptoms.

Among the best methods to reduce or control symptoms is daily exercise, such as in a physical therapy program for PD patients. Joining a PD physical therapy program will help increase strength and endurance; improve flexibility, gait, and balance; and demonstrate how to best prevent falling. Your physical therapist will also help you develop a simple daily exercise plan to follow at home.  

Occupational therapy is also very useful for PD patients, as it teaches them alternate methods to perform everyday tasks like dressing or bathing that may have become more difficult. Successful occupational therapy can help those with PD remain independent.     

Parkinson’s patients may also benefit from speech therapy, which can teach methods and techniques for improving clarity, increasing sound and increasing expression, and even provide examples of alternative swallowing techniques for those have difficulty swallowing.