Treating Parkinson's disease: drugs, rehabilitation and surgery

Treatment consists of replacing the missing dopamine and compensating for the imbalance of neurotransmitters.

Unfortunately, Parkinson's disease cannot be cured. But with appropriate treatment, we can suppress the symptoms in the long term.

Any chronic treatment brings side effects and complications in addition to symptom relief. The aim is to achieve a balance between the benefits of treatment and complications, and thus improve the patient's quality of life.

Levodopa

Levodopa is the main drug in the treatment of Parkinson's disease.

Dopamine deficiency cannot be compensated for by direct administration of 'finished' dopamine. It does not cross the blood-brain barrier well and much of it would be consumed on its way through the gastrointestinal tract.

Levodopa is a precursor of dopamine that crosses the blood-brain barrier very well into the brain. It is administered together with carbidopa. Carbidopa is a substance that blocks the devaluation of this molecule.

It also comes in a gel called Duodopa. This gel is injected directly into the patient's small intestine. This form of treatment is used for patients who respond to levodopa treatment but have severe side effects.

Dopamine-like substances

Active dopamine-like substances are used in the treatment of side effects either in monotherapy or in combination with levodopa.

Preparations such as pergolide and bromocriptine are no longer used today because of their serious side effects. Instead, pramipexole or ropinirole are given.

COMT

Drugs that block the breakdown of levodopa into ineffective particles are also used. The abbreviation of their name is COMT. They potentiate and prolong the effect of levodopa, so they are given in combination with it.

The first choice of this group of drugs is entacapone. Its advantage is that it has no side effects in the CNS and can therefore be given even to patients at risk.

A similar drug is tolcapone. It is longer-acting but can be toxic to the liver. High doses are not advisable, especially in high-risk patients.

NMDA

Drugs in the NMDA group are represented by amantadine, which was originally developed for the treatment of influenza. It improves mobility and relieves stiffness (rigidity) but does not have as positive an effect on tremor.

In the form for intravenous administration, it is used to treat akinetic crisis.

MAO-B blockers

Monoamine oxidase (MAO-B) is a major factor in the oxidative stress reactions that damage nerve cells in Parkinson's disease. Blocking it protects neurons from this toxic effect, e.g. with the new drug rasagiline.

Neurosurgical treatment

Neuromodulation methods are used in the treatment of Parkinson's disease, the most commonly used of which is deep brain stimulation.

In this technique, an electrode is inserted deep into the brain, into the relevant brain nucleus. It is left there for a long period of time. It emits low-voltage oscillations.

By stimulating the subthalamic nucleus bilaterally, the patient's chronic medication is reduced. This also reduces the side effects of the medication, such as field dyskinesia, which is involuntary limb movements.

Rehabilitation

Rehabilitation of the patient is an important part of the treatment. It includes proper regimen, exercise and movement education.

For speech and swallowing disorders, a speech therapist is helpful.