Parkinsons treatments are directed to the symptoms that are specific to each individual and are implemented to help improve their quality of life, they are included below.
-The use of a system to manage Parkinson's treatments is also essential.
A coordinating exercise, physical therapies, diet and the various Parkinsons medications, as well as patient and family education are needed.
This ensures that the disease disables the person as little as humanly possible.
Understanding the many treatments that are in use for Parkinsymptoms can go a long way, for both the family and your loved one as well.
- Parkinson's Medications (for treatment of motor symptoms)
Parkinson's symptoms are induced by the lack of dopamine in the brain.
As a result, most Parkinson's medications are directed at either duplicating the action of dopamine or temporarily replenishing it in order to ease tremor symptoms and reduce muscle rigidity . ( See Symptoms page)
One of the most effective and widely used Parkinson's medications for the treatment of Parkinson's symptoms. L-dopa is converted into dopamine by the body and stored in the neurons until needed for movement
-Carbidopa is an L-dopa enhancer. Almost always used in conjunction with L-dopa, it reduces the side effects (nausea and vomiting), by allowing a much lower (80% less ) dose of L-dopa.
Combination forms of Carbidopa / L-dopa:
-Sinemet® (immediate release)
-Sinemet CR® (extended release)
-Parcopa® (oral disintegrating)
When L-dopa is taken, a portion of the medication is rendered useless by an enzyme in the body, called Catechol-O-methyl transerase (COMT)
COMT inhibitors block this COMT enzyme from this conversion, making more L-dopa available in the brain and thus reducing Parkinson's symptoms.
-2 COMT inhibitors currently in use:
-Tasmar® (Tolcapone) and
These COMT inhibitors will only produce the desired result when used in combination with L-dopa.
A combined form of L-dopa, Carbidopa, and Entacapone is also used called: Stalevo® , and is used in people with advanced Parkinson's symptoms.
Although rarely used in Parkinsons treatments in the early stages of Parkinsons, it is also used in combination with L-dopa to treat those with prominent tremor problems and L-dopa induced Dyskinesias .
(Involuntary muscle movements, such as jerking, twisting and fidgeting)
Most beneficial for use in Juvenile Parkinson's treatments, whose prominent symptom is tremor, though side effects limit its use.
-MAO-B Inhibitors: MAO-B is an enzyme found in the brain that breaks down dopamine. MAO-B inhibitors help block this break down, making more dopamine available, thus reducing Parkinson's symptoms.
L -deprenyl, Eldepryl® (Selegiline)
These Parkinson's medications allow slight improvement with early signs of the disease and enhance L-dopa effects on dopamine later in the disease.
-Dopamine Agonists: Unlike L-dopa, which is converted into Dopamine in the brain, Dopamine agonists imitate Dopamine without this conversion.
They are often used in early stages as the lone drug used, and in combined form with L-dopa / Carbidopa in later stages of Parkinsons treatments.
Common Dopamine Agonists include:
-Mirapex® (brand name) -Pramipexole (generic)
A Balanced, Healthy Diet is Important : ( see balanced diet chart )
It's really important for all of us, but even more so for those with Parkinson's disease. It helps keep the bones strong in the event of a fall.
-Adding ample water to the diet helps fight against a common constipation symptom. ( see benefits of water )
Dehydration resulting from the many medications used in Parkins treatments can also contribute to dizziness and balance problems.
Physical Therapy and Exercise :
Both can be extremely important in helping to maintain function as well as improving range of motion. This improvement can then in turn increase mobility and also be very helpful in improving balance.
-In fact, research has shown that regular exercise can have a significant benefit for Parkinsons gait and balance issues. It has also been shown to help improve coordination, grip strength and flexibility, as well as a diminishing of tremors.
It is believed that in some cases, regular exercise may slow or even stop the progression of Parkinson's symptoms altogether.
Although research has not shown an increase in dopamine from exercise, it has shown that those who exercise may use dopamine more efficiently in the brain and that their dopamine signals last longer and are stronger.
-Exercise will help with overall health issues that may also be affected by the disease, and provides a sense of well-being and a positive state of mind. (which works wonders for an often-accompanying depression)
The type of exercise used in Parkinson's treatments varies according to the extent and specific type of disability, but therapists will generally include all components of fitness in the exercises.
-We all could use more exercise, whether or not receiving Parkinson's treatments. But especially for those with Parkinsons, the more frequent and the more intense the exercise, the greater the potential benefit.
The use of the Nintendo Wii gaming system has been found to be of immense benefit to those with Parkinsons, as it can help with all aspects of the disease, as well as anyone in need of motivation to exercise.
-It can actually make exercising enjoyable!
- Progressive physical disability can often be helped with the necessary medical equipment to assist your family member to continue to care for him or herself, and to keep them as independent as possible.
The use of a cane or a multi-wheeled walker can be of significant help, and their use should be encouraged for those in need.
-Physical therapists can be of immense help with the use of various techniques -to rise from a chair, get out of bed, all the simple things we all take for granted.
Also, from simple aids such as elevated toilet seats and shower grab bars, to specialized utensils for dining, and help with eating, even with tremors.
-It is very frustrating for those getting Parkinsons treatments, losing the ability to get around, and doing normal everyday activities. Helping with these simple things can go a long way in successful treatment .
The use of a wheelchair usually only becomes necessary in the later stages.
Therapists specializing in speech problems can also be of great assistance to those with problems swallowing or with difficulties in speaking.
-Support groups: Often ignored by many, support groups can really be a huge help for people receiving Parkinsons treatments and their families.
They help maintain the overall wellness of the individual, by addressing not only physical and mental needs, but spiritual and emotional needs as well.
Parkinsons Surgery Options:
Although surgery can be very effective in some cases, only those symptoms that have improved with the use of L-dopa have a real potential for success.
-Parkinsons surgery is limited to people who no longer respond to other medical treatment for tremor symptoms; have Dyskinesias (involuntary jerking, twisting), or intense fluctuations in motor symptoms.
In the following types of ablation surgery (tissue removal), a tiny portion of the brain is destroyed or removed to help relieve Parkinson's symptoms that involve movement, such as rigidity and tremor.
-In Pallidotomy , a small part of the globus pallidus is destroyed.
A type of brain surgery in which the subthalamus, a tiny area of the brain is destroyed, is known as: Subthalamotomy .
-And Thalamotomy - where a tiny part of the brain known as the thalamus is destroyed. It is generally used in people younger than 65 years old who have normal intellectual function and normal recent memory.
Michael J Fox had a Thalamotomy at the age of 37. In a 1998 people magazine article he talked about shaking his left arm that was so violent, "I could mix a margarita in five seconds."
-The surgery has almost completely eliminated Fox's worse tremors.
In all 3 forms of Parkinson's surgery, brain scans utilizing an MRI or CT scan are done in order to identify the correct location with precision before surgery.
Regardless of what type is performed, the surgeon operates on the side opposite that of the affected side. A hand tremor of the left hand for example, will be treated with an operation on the right side of the brain.
Although the procedure may be used on the other side of the brain as well, an increased risk of cognition or speech problems is involved if the surgery is done on both sides of the brain.
-All 3 are rarely done.
Deep Brain Stimulation (DBS) is another surgical treatment option.
Deep brain stimulation is used in Parkinson's treatments for a wide variety of the neurological symptoms of the disease
- Unlike the 3 procedures above, DBS provides stimulation electrically to certain areas of the brain that control movement, blocking the abnormal signals in targeted areas that cause Parkinson's symptoms.
In deep brain stimulation a battery powered device, called a stimulator , (much like a pacemaker used for the heart), is surgically implanted under the skin, usually in the chest area.
-An MRI or CT scan is used to precisely locate the proper area in the brain from which the symptoms originate. Usually the areas concerned are the
globus pallidus , the subthalamic nucleus , and the thalamus .
Once implanted, impulses are transmitted from the stimulator, through the attached wiring, and into the specific part of the brain.
-The electrical impulses intervene with and block the signals that cause Parkinson's symptoms.
The ultimate goal of Deep brain stimulation is of course to reduce symptoms, (and the need for Parkinson's medications) and many patients do see a marked improvement in both.
-Due to this reduction in symptoms, a corresponding reduction in Parkinson's medications needed, is also seen and contributes to a substantial improvement in the side effects from long-term L-dopa use as well. (mainly Dyskinesias - involuntary movements)
All surgical options need to be specifically targeted to each individual and discussed in depth with their neurologist before treatments.
Stem Cells, undeveloped cells that can eventually grow into nerve cells, are able to survive and also reproduce. Once directed to grow as nerve cells, they can be transformed into dopamine-producing cells.
-These cells could then be transplanted into specific areas of the brain that require dopamine.
This type of Parkinson's surgery offers hope in the future for those with the disease.
It may also be a ray of light for those with Huntington's, Alzheimer's ALS (Lou Gehrigs), and Multiple Sclerosis, as well as for those with spinal cord injuries.
Although Parkinson's treatments of this nature may be years away, and more research is needed, it is believed a cure is definitely within sight.
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