What is the best treatment for Parkinson's?

Parkinson's disease is a long term degenerative disease which influences the central nervous system. Until today, there is no remedy for the condition, yet there are medicines and treatments accessible to address a portion of the signs and improve the life of patients.

Drugs and therapies used in the treatment of Parkinson’s disease:

Increasing dopamine levels        

The symptoms of PD are mainly due to low levels of dopamine in the brain. Dopamine is a chemical messenger or neurotransmitter. Most drugs for the condition aim to either replenish dopamine levels or mimic its action. These are called dopaminergic drugs.

Dopaminergic medications can:

·         reduce rigidity and muscle stiffness

·         improve the speed of movement

·         help with coordination

·         lessen tremor

Levodopa

Levodopa is the most effective medication for PD. Nerve cells in the brain absorb the drug and turn it into dopamine.

The person will take levodopa orally in either tablet or liquid form.

Its side effects include:

·         nausea

·         vomiting

·         fatigue

·         dizziness

Carbidopa-levodopa

This combination drug, which is available under the brand name Sinemet, contains both carbidopa and levodopa.

Carbidopa prevents the destruction of levodopa by enzymes in the digestive tract and reduces some of its side effects, including nausea.

As Parkinson's disease progresses, long-term treatment with levodopa may become less effective.

The doctor may have to change the dosage by amending the size or frequency of the doses. However, the individual will need to continue using the drug because stopping it suddenly can result in withdrawal symptoms.

The side effects of this combination drug may include:

·         mental disturbances, such as confusion, delusions, and hallucinations

·         involuntary movements, such as jerking or twisting

People taking this drug may also have a higher risk of liver, kidney, and cardiovascular problems and be more likely to develop glaucoma.

The long-term use of levodopa, either alone or in combination with carbidopa, increases the risk of:

·         fluctuating motor responses

·         uncontrolled, involuntary movements known as dyskinesia

For this reason, a doctor may prescribe a dopamine agonist instead.

Dopamine agonists

These drugs mimic the effects of dopamine in the brain. The neurons react to them as they would to dopamine.

Dopamine agonists can be a good alternative to levodopa as they have a lower risk of long-term complications.

However, they can have similar side effects to carbidopa-levodopa.

The side effects may include:

·         mental confusion

·         nausea

·         low blood pressure

·         sleepiness

·         muscle cramps

Dopamine agonists may not be suitable for people with a history of cardiovascular disease, depression, or psychosis.

Monoamine oxidase-B inhibitors (MAO-B inhibitors)

MAO-B inhibitors are another alternative to levodopa. Examples include selegiline and rasagiline.

These drugs work by blocking the effects of an enzyme called monoamine oxidase-B (MAO-B), which destroys dopamine in the brain. Blocking MAO-B allows the dopamine to last for longer in this organ.

MAO-B inhibitors have a less significant effect than levodopa, but it is possible to take them together with levodopa or dopamine agonists.

There is a risk that MAO-B inhibitors will have adverse interactions with some depression medications and certain narcotics. They also have some side effects, including:

·         dizziness

·         headache

·         stomach pain

·         vivid dreams

·         fever

·         conjunctivitis

Catechol O-methyltransferase (COMT) inhibitors

This type of medication blocks COMT, an enzyme that breaks down levodopa. By doing this, it can prolong the effect of carbidopa-levodopa therapy.

Anticholinergics

These medications control tremor. Examples include trihexyphenidyl (Artane) and benztropine (Cogentin).

However, some people prefer not to use these drugs because of the side effects, which can include:

·         urine retention, especially in people with an enlarged prostate

·         severe constipation

·         nausea

·         Depression, psychosis, and dementia

Depression is a common problem for people with PD.

The Neurosurgeons recommend amitriptyline for treating depression, stating that there is currently insufficient evidence to support the use of other treatments.

Psychosis can also occur, and this becomes more severe as the disease progresses. Clozapine (Clozaril) can treat psychosis, but doctors should monitor the person carefully as this medication can have severe adverse effects.

Dementia develops over time in many people with PD, especially if they have PD with Lewy bodies.

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