Parkinson’s Disease Treatment: Understand Your Options

Parkinson's disease is a neurodegenerative movement disorder affecting 1 million people in the United States. While there is not a cure for Parkinson's disease, there are several different treatment options available that can help with symptoms. Different treatments affect symptoms in different ways, and can also cause varying side effects.

The best way to get the right treatment for your Parkinson's symptoms is to see a movement disorder specialist, a doctor that specializes in Parkinson's disease and related conditions. Movement disorder specialists are also up-to-date on the latest treatment options and clinical trial opportunities.

Medications for Parkinson's symptoms

Most Parkinson's medications treat motor symptoms of the disease. These symptoms can include:

Resting tremor
Muscle stiffness
Imbalance while standing or walking
Gait freezing
Bradykinesia (slowness of movement)

Treatment for these symptoms can include:

Carbidopa-levodopa: Levodopa is considered to be the "gold standard" for Parkinson's treatment. It's a natural chemical that passes into the brain, where it's converted to dopamine. Levodopa is combined with carbidopa to prevent levodopa from converting into dopamine early, outside of the brain.

After some time taking dopamine treatments – the amount of time varies from patient to patient – it may begin to be less effective. This means you may experience what are called "off" times during which your treatment isn't working optimally, but before it's time for your next treatment.

Long-term use of levodopa can also cause dyskinesia, involuntary movements that are often mistaken for Parkinson's symptoms themselves.

Duopa/Duodopa: A brand-name medication sometimes prescribed later in the Parkinson's disease course, Duodopa is made up of carbidopa/levodopa and administered through a feeding tube. It can be an option for patients who still respond to levodopa, but experience a lot of "off" time. Duopa is continuously delivered, keeping blood levels of the two drugs constant.

Dopamine agonists: This medication option mimics dopamine in the brain, rather than changing into dopamine like levodopa. Though not as effective as levodopa at treating symptoms, they last longer and can be used with levodopa to reduce off time.

Some of the side effects of dopamine agonists are similar to levodopa, such as nausea, but they are also known to have more serious side effects, such as compulsive behavior including gambling addictions and other high-risk behavior. It's important to watch for any changes in behavior if you or a loved one begin taking dopamine agonists.

MAO B Inhibitors: These medications help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B), which metabolizes brain dopamine. Options include selegiline (Eldepryl, Zelapar), rasagiline (Azilect) and safinamide (Xadago).

Catechol O-methyltransferase (COMT) inhibitors: This medication, primarily entacapone (Comtan), mildly prolongs the effect of levodopa therapy by blocking an enzyme in the brain that breaks down dopamine. Side effects result from increased levodopa, and can include a higher risk of dyskinesia and nausea.

Amantadine. This treatment may be prescribed alone to relieve symptoms in early-stage Parkinson's. It can also be combined with carbidopa-levodopa therapy during the later stages of Parkinson's disease to treat dyskinesia.

Find your Parkinson's trial match

Answer a few questions to find clinical trials in your area that you may qualify for. It only takes a minute to find options personalized for you.

Deep brain stimulation (DBS) for Parkinson's disease

In this surgical procedure for Parkinson's disease, electrodes are implanted into a specific part of the brain. The electrodes are connected to a generator that's implanted in your chest that sends electrical pulses to your brain. DBS is most effective for symptoms that levodopa also treats, particularly motor symptoms, in addition to controlling tremor. The surgery is most often suggested for patients with advanced Parkinson's who have unstable responses to levodopa.

Off Time in Parkinson's Disease

"Off" time in Parkinson's happens when levodopa wears off and Parkinson's motor symptoms return. Periods of "off" time in Parkinson's typically increase as the disease progresses and levodopa becomes less effective.

If you're experiencing more off time with your current treatment, talk to your doctor. There are a few steps you can take together:

Change the dosage or timing of your treatment. Changing the amount of medicine you're taking or when you take it can help you reduce off time.

Adjust the type of carbidopa/levodopa you're taking. Your doctor may recommend extended-release formulas, for example, or a different delivery method of carbidopa/levodopa.

Make changes to your diet. When and what you eat can impact how well your Parkinson's medication works. Your doctor may suggest adjustments to your diet to help maximize when your treatment is working effectively.

Consider a recently-approved treatment for "off" time. An inhaled levodopa powder for off episodes, Inbrija, was recently approved by the FDA after early funding by The Michael J. Fox Foundation.

There are also several treatments in development for off time in Parkinson's disease. Start your search for a clinical trial near you.

Exercise for Parkinson's disease

Research suggests that exercise holds particular benefits for people with Parkinson's. Studies are exploring whether or not specific exercise regimens work best, but in general, the best options are ones you enjoy and will stick with. Before starting a new exercise program, talk with your doctor. You may also consider consulting with a physical therapist who works specifically with people with Parkinson's disease for help getting started.

Depending on where you live, there may also be Parkinson's-specific exercise programs you can get involved in. Dance for Parkinson's and Rock Steady Boxing are two popular options with locations around the United States.

Clinical trials for Parkinson's disease

Clinical trials can offer another treatment option for people living with Parkinson's. Current trials are researching disease-modifying treatments, medications for specific Parkinson's symptoms, and non-medication interventions, such as exercise.

It's a common misconception that clinical trials are only available for people who are newly diagnosed with Parkinson's. In fact, clinical trials need volunteers at many different stages of the disease. For example, some trials may look for volunteers who are already taking levodopa to test new approaches to reducing "off" time.

If you're interested in taking part in a clinical trial, start your search using Antidote's Match tool. You'll answer a few questions about your symptoms and treatment, and then see a list of trials that you may qualify for in your area.

Find Parkinson's trials near you.

Our search tool connects you with clinical trials that you may qualify for, in your area. Answer a few questions to start.

Alternative and complementary treatments for Parkinson's

Complementary treatments are used in addition to your regular medications, while alternative treatments are used instead of medications altogether. For example, some people with Parkinson's use acupuncture to treat symptoms, or use supplements to support nutrition.

It's important to talk with your doctor before adding on any alternative medicine options. For example, supplements are not tested through the Food and Drug Administration (FDA) for safety and effectiveness, and may have side effects or interact with your other medications.

Track your symptoms

Limited time with your doctor is a common frustration for people living with Parkinson's. Tracking your Parkinson's symptoms can help improve the conversation at your appointment and identify any issues with your treatment plan.

In your tracker, take note of your daily symptoms, diet, and exercise, along with any other information you'd like to include, such as your mood and how well you slept. Parkinson's can include a wide range of motor and nonmotor symptoms, and keeping track of your experiences can help your doctor find treatment options and exercise regimens that work best for your individual symptoms.

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