In the United States, nearly a million people live with Parkinson’s disease, the second most common neurodegenerative disease after Alzheimer’s disease.
Every one of them will have unique treatment needs.
“No two people with Parkinson’s disease look alike,” says UNC Health neurosurgeon Vibhor Krishna, MD. “The disease causes a constellation of symptoms, and the key to management is understanding what’s bothering a person the most and what will make the most difference in overall quality of life.”
Parkinson’s disease can cause slowness, stiffness, tremors, imbalance, pain, swallowing difficulties, sleep issues, mood changes, cognitive concerns, constipation and changes with smell. These symptoms are partly related to the loss of brain cells making dopamine, a neurotransmitter that impacts multiple systems of the body. Each of these symptoms may appear at different times and change at different rates over the years.
“At every visit, I always ask which symptoms are most impacting your life at the moment, and then we look at what can be done for those,” says UNC Health movement disorders specialist Daniel Roque, MD. “In several circumstances, we have multiple options to treat specific symptoms, but every decision should be tailored toward enhancing the patient’s quality of life.”
Dr. Krishna and Dr. Roque explain some options for treatment your care team could recommend.
Lifestyle Modifications for Parkinson’s Disease
Treating Parkinson’s starts with the basics: regular exercise, a healthy diet and maintaining strong social connections.
“For management of motor symptoms, exercise will play a big role,” Dr. Krishna says. “It’s critical physically and mentally.”
Exercise, especially cardio, can help slow the progression of symptoms and improve balance, sleep issues and mood changes. Ask your doctor about the best type of exercise for you; if there’s something you already like to do, they can help you identify any modifications you may need.
If you are sedentary, start with low-impact options like walking or swimming; generally, people with active lifestyles can continue with high-intensity exercise. In fact, in recent years, non-contact boxing classes designed for Parkinson’s patients have emerged as a way to improve muscle control, balance and mental sharpness.
It’s also important to eat a balanced, healthy diet. If symptoms or side effects from medications make it difficult to eat, talk to your care team.
“Increasing fiber and hydration to reduce the risk of constipation is particularly crucial,” Dr. Krishna says.
Working with a dietitian or nutritionist is helpful for maintaining a healthy diet, particularly if you have problems chewing or swallowing.
A Parkinson’s diagnosis is difficult to receive, and you may feel compelled to withdraw from social situations out of concern about your symptoms or mobility. However, staying connected can be good for your health. Remember you are the same person you were before but now you may need some accommodations. Don’t be afraid to ask for help so you can enjoy life outside your home.
Supportive Therapies for Parkinson’s Disease
A variety of therapists can help you reduce and cope with the symptoms of Parkinson’s disease.
“When patients have difficulty with gait or balance, physical therapy can help and reduce the risk of falls,” Dr. Krishna says. “Speech therapy can help with communication difficulties.”
An occupational therapist can help you learn how to modify or improve your ability to perform activities of daily living, such as dressing or eating, and identify assistive devices for your home or workplace. These may range from devices that make it easier to hold a pen or toothbrush to a walking aid or handrail for the shower.
Seeing a mental health professional can help you cope with the diagnosis and mood changes that often come with Parkinson’s disease.
Medications That Help Treat Parkinson’s Disease Symptoms
Because Parkinson’s disease affects the brain cells that produce dopamine, many medications aim to increase the amount of dopamine available in the brain. Levodopa is the main medication for the motor symptoms of Parkinson’s disease; it is often administered with carbidopa, which helps allow levodopa to be delivered to the brain and away from other parts of the body (where side effects occur).
Finding the right regimen of dopamine therapy can prove difficult and will require adjustments as the disease progresses. Exact benefits of each kind of medication will be quite different from patient to patient and need to be weighed against the patient’s goals and risk of side effects. Side effects of levodopa include dyskinesia, or involuntary fidgeting, twisting or writhing movements of the neck, arms, legs and trunk, which can increase the risk of falls.
“Medications can also improve one symptom while worsening another,” Dr. Roque says. “It’s a balancing act, and we consider the competing symptomatic challenges we might create, especially as the disease progresses.”
Surgical Options for People with Parkinson’s Disease
The two main surgical options for Parkinson’s disease are deep brain stimulation surgery and focused ultrasound ablation.
“Hearing about surgery can be jarring, especially in early disease, but it’s important to know when it might be an option to improve symptoms,” Dr. Roque says.
Deep brain stimulation can assist patients with the primary goals of improving tremor, slowness, stiffness and dyskinesia. Focused ultrasound ablation is most effective at reducing tremor on one side of the body, but in specific cases can aid dyskinesias on one side as well.
For deep brain stimulation, a neurosurgeon places electrodes in your brain, which are connected via wires to a pacemaker in your chest. The pacemaker sends electrical signals to the electrodes when needed, interfering with the brain’s electrical signals believed to cause Parkinson’s motor symptoms. Surgeons use light sedation and general anesthesia for different parts of this procedure.
For focused ultrasound ablation, a neurosurgeon targets ultrasound beams to very specific parts of the brain to destroy cells involved in producing symptoms. You stay awake during the procedure and wear a helmet-like device that holds the head steady to allow reliable deployment of the ultrasound beams; discomfort and nausea are possible during the procedure, but medication is available to help.
“These surgical options are very effective and can restore significant quality of life by reducing symptoms and the need for medications,” Dr. Krishna says. “Before surgery, a patient might spend four to five hours a day in a suboptimal state, because medications are not as effective or because of fluctuations. After surgery, we can cut that time down by 50 percent or more, sometimes even allowing for a reduction in medication.”
The Importance of the Care Team in Parkinson’s Disease
Drs. Krisha and Roque acknowledge that it can be difficult to navigate a condition with so many varying symptoms that change over time. The best way to do it, they say, is to build a multidisciplinary team of physicians and therapists who can identify the care plan you need at that moment.
“Parkinson’s disease is progressive, so we won’t be able to cure any symptom, but we do have management and quality-of-life improvement,” Dr. Roque says. “We can provide education on what will be helpful for your goals and give you comprehensive education about all of your options.”
Looking for a Parkinson’s Foundation Center of Excellence near you can help you connect to professionals who understand the variety of therapies and emerging options that can support your needs.
“A collaborative team can look holistically at your case so that outcomes will be better,” Dr. Krishna says. “It’s important to find a care team that will be able to guide you to overcome the challenges of the condition.”
If you’re concerned about motor symptoms, talk to your doctor. If you need a doctor, find one near you.