Patient information from BMJ

Parkinson's disease: what treatments work?

Last published:Sep 15, 2022

If you or someone close to you has got Parkinson's, you may be worried about what it will mean for the future. But your symptoms may not bother you very much for several years. When they do, there are treatments that can help delay the worst effects.

What treatments are available?

Parkinson's affects how you are able to move. An early sign is often a slight trembling in one hand. Over time you start doing things more and more slowly as your muscles become stiff. You may lose your balance more easily.

Parkinson's happens when your brain stops making enough of a chemical called dopamine. Brain cells need dopamine to send messages around the brain, and to nerves and muscles throughout your body.

There's no cure for Parkinson's, but medicines can help control your symptoms. Exercise, physiotherapy, and other types of therapy can also help you cope with your symptoms. If your Parkinson's is more advanced a type of surgery called deep brain stimulation may be an option.

Medicines

You may have heard of a drug called levodopa that's often used to treat Parkinson's. It can be really helpful for people with Parkinson's, but it can cause unpleasant side effects, which can sometimes be severe.

So doctors don't tend to prescribe it if your symptoms are mild. Once your symptoms become more severe, levodopa is the most effective treatment for Parkinson's.

Other medicines that can help with Parkinson's include: 

• monoamine oxidase-B (MAO-B) inhibitors. These drugs can help you move more easily and reduce stiffness and shaking 

• dopamine agonists. Dopamine agonists work in a similar way to dopamine in the brain, which can help reduce the symptoms of Parkinson's

• amantadine is a medicine that was originally developed to treat flu but was later found to help relieve Parkinson's symptoms

• anticholinergic drugs can help control the physical symptoms of Parkinson's, such as shaking and jerking.

These medicines are sometimes used together, or combined with levodopa and another drug called carbidopa, which helps levodopa to work better.

You take most medicines for Parkinson's as tablets and capsules, although some come as skin patches, injections, and soluble tablets.

All Parkinson's medicines can cause side effects. Your doctor should discuss these with you in detail. Your doctor may also be able to prescribe medicines that help control these side effects.

Levodopa

Most people treated for Parkinson's take levodopa at some point. This treatment can work so well that your symptoms may clear up for a while.

Levodopa is changed into dopamine in your body. This replaces the dopamine in your brain that is lost if you have Parkinson's.

However, levodopa can cause side effects. Nausea, vomiting, and sleep problems are the most common. Also, after taking levodopa for several years it can stop working so well, with your symptoms coming back between doses.

Most people also get more serious side effects after about five years of taking levodopa. The main problem is abnormal movements that you can't control, such as head nodding, jerking, and twitches. These are called dyskinesias. 

Exercise and other types of therapy

Research has found that regular exercise can be helpful for people with any stage of Parkinson's, improving their movements and what they can do physically. Strengthening exercises that use gradually increasing weights seem to be especially helpful.

You may hear this called progressive resistance exercise. Other types of exercise, such as Tai Chi and dance, have also been found to be safe and helpful for people with Parkinson's.

You may also benefit from working with therapists who are trained to treat people with Parkinson's.

• A physiotherapist can advise you about exercises to help you move more easily.

• An occupational therapist can help you to carry on doing things that become harder because of Parkinson's. For example, you may get advice on how to cope around the house or how to continue taking part in leisure activities that you enjoy.

• A speech and language therapist can help if you have problems with your voice, speaking, or swallowing. These problems are more likely in advanced Parkinson's.

Deep brain stimulation

A type of surgery called deep brain stimulation may be an option if you have had Parkinson's for a long time and are no longer helped enough by drug treatments.

It can ease some of your symptoms, especially stiff muscles, shaking, and movements you can't control. But how long the benefits of surgery will last varies from person to person. It may be a year or two, or it could be much longer.

Deep brain stimulation involves having a device fitted in your chest. Wires from the device are fixed into a part of your brain affected by Parkinson's. Electrical pulses from the device stimulate this part of the brain to reduce your symptoms.

You can talk to your doctor about whether surgery would be a good option for you. But it's important to remember that surgery cannot cure Parkinson's. And it won't stop your symptoms progressing. You'll probably need to keep taking drugs for Parkinson's after surgery. 

What to expect in the future

No one can say for sure what will happen to you if you've got Parkinson's. Everyone is different, and the way the condition affects you may be different from the way it affects someone else.

Some people hardly notice their symptoms in the early stages of Parkinson's and lead a full life for many years. But symptoms usually get worse as time goes by and the brain makes less and less dopamine.

Some people also get other problems related to their Parkinson's, such as depression, fatigue, sleep problems, constipation, and reduced mental ability. Be sure to discuss any problems with your doctor, as there may be treatments that can help.

It's important to stay positive if you can. Take regular exercise and carry on doing the things you enjoy. You may also want to join a support group for people with Parkinson's. All these things can help you cope with your condition.

If you're caring for someone with Parkinson's, you may need support, too. If you feel you can't cope or you become depressed, your doctor or another health professional may be able to put you in touch with local support groups and organisations that offer help.