Parkinson’s disease is still not curable, but the right treatment can extend the life expectancy of those affected and significantly improve their quality of life. What exactly the treatment looks like depends, among other things, on the age of the patient, the symptoms that occur, the stage of the disease, and the tolerance of medication. However, the goal of Parkinson’s therapy is always to alleviate the patient’s symptoms and maintain his or her independence for as long as possible.
Individualized care essential
To achieve these goals, it is important to start as early as possible with treatment tailored specifically to the patient. This is because individualized care is the only way to adequately address the different symptoms as well as the varying rate of progression of the disease. Parkinson’s therapy is primarily based on taking medication. However, speech therapists as well as physiotherapists and occupational therapists also play an important role. If a patient does not respond to medication, surgery may be considered.
Parkinson’s therapy with medication
Since the cause of Parkinson’s disease is unknown in most cases, only the trigger of the typical Parkinson’s symptoms – a lack of dopamine in the brain – can be treated, thus alleviating the patient’s symptoms. Certain medications can compensate for the dopamine deficiency in the brain – but the death of the dopamine-producing nerve cells cannot be prevented by medication. Different types of drugs can be used to alleviate the patient’s symptoms: While levodopa is a precursor of dopamine, dopamine agonists imitate the effect of the neurotransmitter. There are also drugs that inhibit the breakdown of dopamine in the body (MAO B inhibitors and COMT inhibitors). Which drug is used in each individual case will be decided by the treating physician together with the patient. Criteria for the choice of drug include the age and health status of the affected person.
Treating Parkinson’s disease with levodopa
Levodopa is a precursor substance of dopamine that is used to compensate for the lack of dopamine in the brain. Instead of dopamine, this precursor substance must be used because externally supplied dopamine cannot cross the blood-brain barrier and thus cannot enter the brain. For levodopa, however, this is possible and the substance can thus exert its effect in the brain after conversion into dopamine. However, the active substance is already partially degraded on its way to the brain, which is why levodopa is often combined with other drugs that prevent premature degradation in the body. Levodopa is the most effective therapy for Parkinson’s disease and is well tolerated, especially at the beginning of treatment. By taking it, symptoms usually improve quickly, muscle tension is reduced and movement speed is improved. Since disease-related complications can often be avoided by taking levodopa, patients’ life expectancy usually increases significantly. A disadvantage, however, is that levodopa administration can sometimes lead to treatment complications.
Side effects of levodopa
As a rule, the longer levodopa is taken, the more the duration of effect decreases. Often, the effect wears off again just a few hours after taking the drug. In contrast, side effects often become more severe over time. Sleep disturbances, involuntary movements (dyskinesias) and cardiovascular disorders are particularly common. In addition, confusion may occur. For this reason, levodopa is usually used only in patients older than 70 years.
Therapy with dopamine agonists
Because of the increasing side effects of levodopa, younger patients younger than 70 years are often given other medications at the beginning of treatment. These so-called dopamine agonists mimic the action of dopamine and thus take over the role of the neurotransmitter. Compared to levodopa, dopamine agonists have the advantage that they do not lose their effect over time. However, they are also less effective from the start. Unlike levodopa, the body must be slowly acclimated to dopamine antagonists, so the dose is slowly increased over several months. As a result, it takes longer at the beginning of therapy for the patient to feel an improvement in symptoms.If dopamine agonists are taken, unpleasant side effects such as abdominal pain, nausea and drowsiness occur more frequently. If the heart valves are diseased, certain dopamine agonists should not be prescribed, otherwise connective tissue growth may occur on the heart valves.
Treating Parkinson’s with MAO-B and COMT inhibitors.
While treatment with levodopa and dopamine agonists aims to replace the neurotransmitter dopamine, MAO-B and COMT inhibitors reduce the breakdown of dopamine. They do this by inhibiting the function of dopamine-degrading enzymes. The slower degradation allows dopamine to act longer in the brain, and the concentration of the neurotransmitter is increased. While MAO-B inhibitors ensure that the dopamine-degrading enzyme is inhibited in the body, COMT inhibitors prevent the breakdown of levodopa. That is why COMT inhibitors and levodopa are often taken in combination.
Outpatient video-assisted Parkinson’s disease therapy.
If Parkinson’s disease progresses over time, the medication must be readjusted on an outpatient basis by a neurologist on site or in a specialized clinic. An alternative to this is outpatient video-assisted Parkinson’s therapy, although this is currently still being developed. Its advantage is that it allows close observation of the patient’s motor skills and possible fluctuations during the course of the day can be taken into account when readjusting the medication. In outpatient video-assisted Parkinson’s therapy, a video camera, a loudspeaker and a printer are installed in the Parkinson’s patient’s home. The patient now triggers one or more two-minute video recordings every day. During this time, announcements from a neurologist sound over the loudspeaker, prompting the patient to make certain movements. The recording is then transmitted to the responsible physician, who evaluates it. If a certain number of video recordings are available, the doctor draws up a therapy plan and gradually adjusts the medication. The patient can print out the current medication plan every morning. As a rule, video-assisted Parkinson’s therapy lasts 30 days. At the end, the patient is examined again by a neurologist on site. The entire treatment, including the video recordings, is then given to the doctors at the hospital as well as to the neurologist on site, so that it is available at any time in the future.
ON and OFF phases in Parkinson’s disease
The longer the therapy lasts, the more frequently there may be fluctuations in the effectiveness of the medications and thus motor complications. If the medications work well, the patient is mobile and has little discomfort – this state is called the ON phase. However, if the effect of the medication wears off, symptoms such as tremors, unsteadiness of gait and muscle stiffness occur – this state is called the OFF phase. If there is a frequent alternation of ON and OFF phases, the patient’s quality of life can suffer greatly as a result. In such cases, medication readjustment may be necessary.
