Parkinson’s disease Treatment and Management Options

Parkinson’s disease is a common neurological disorder with which many Americans are familiar, if not personally knowledgeable because of family members. The disorder is given substantial visibility by afflicted celebrities, including Muhammad Ali and Michael J. Fox, as well as by its relatively common occurrence and striking symptoms.

Parkinson’s disease is a complex disorder for which current treatments focus largely on symptom management. It remains frustratingly resistant to wholesale control and intervention. That said, ongoing research and clinical work is pushing the bounds of our understanding of and relationship with Parkinson’s disease. Let’s take a look at what we know about the disease and its prevention, management and potential interventions.

What Is Parkinson’s disease?

Parkinson’s is a progressive disorder marked by symptoms that worsen over a period of years or decades. Symptoms typically present after the age of 50, though “young onset” Parkinson’s is also recognised. Symptoms present in several distinct forms:

  • Movement-related issues, such as shaking, rigidity, slowness, and difficulty walking or talking
  • Behavioral problems
  • Cognitive problems, including dementia in later stages of the disease
  • Depression or other psychological issues

Potential Preventive Measures

The research around Parkinson’s prevention is mixed at best. Many studies or areas of inquiry have been contradictory and inconclusive. Hard-and-fast claims that “X prevents or reduces the risk of Parkinson’s” should be taken with a sizable grain of salt.

That said, two of the most promising areas of inquiry involve common stimulants: caffeine and nicotine. Caffeine studies have shown a statistically significant reduction (>30% at >95% confidence) in Parkinson’s incidence among otherwise healthy individuals who consume large amounts of coffee. (It’s not at all clear whether caffeine, another substance, or a combination of substances found in coffee contribute to this effect.)

Somewhat less conclusive studies suggest that tobacco users, and specifically tobacco smokers, develop Parkinson’s at lower rates than non-smokers. However, whatever preventive effect tobacco use may have with regards to Parkinson’s should not be construed to outweigh the myriad well-known adverse effects of smoking.

Drug Management

Depending on the disease stage and symptom progression, various classes of drugs are suitable for managing Parkinson’s symptoms and complications. These include:

  • Sinemet–Levodopa/carbidopa
  • Dopamine Agonists Requip Mirapex Neupro
  • Symmetrel—-increases amount of dopamine available for brain
  • Anticholinergics Artane Cogentin
  • Eldypryl and Azilect MAO-B inhibitors help conserve the amount of dopamine
  • COMT inhibitors—-Tasmar,  Comtan     dopamine is retained

Surgery and Other Interventions

One particularly promising area of Parkinson’s management is deep brain stimulation (DBS), a technique pioneered by Dr. Louis Benabid and others in the 1980s and 1990s, and performed by Dr. John Gorecki, MD. DBS uses a device commonly known as a “brain pacemaker” to stimulate the thalamus, subthalamic nucleus or globus pallidus and control the common motor symptoms of Parkinson’s disease.

Looking Ahead

So far Parkinson’s disease cannot be “cured” like syphilis, tuberculosis or other once-devastating bacterial infections. For the foreseeable future, Parkinson’s treatment will focus on the  management of symptoms. But that should not lead anyone to despair. The progress of research is slow, however, so much more can be offered to patients today compared to 40 years ago or even 10 years ago. For those of us who know someone who suffers from the disease or who worry about developing Parkinson’s, it is an exciting time to be involved in research and treatment, and that elusive breakthrough may yet materialize on the horizon.