Parkinson’s Disease Treatment

Board-Certified Neurology Specialists Treating Parkinson’s Disease

Parkinson’s disease causes a daily struggle to interact with the world in the way the person did before they were affected with this chronic, progressive movement disorder. Our multidisciplinary team of board-certified neurologists and neurosurgeons works with a dedicated staff of experts in the fields of speech therapy, occupational therapy, nutrition, and more, to provide our patients with a better quality of life and improved independence. Our knowledgeable team of medical professionals is committed to supporting both the patient and their family throughout treatment.

Contact The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health for further information about our services. We are here to provide you the support you need to manage Parkinson’s disease or other movement disorders.

What Is Parkinson’s Disease?

Parkinson’s disease, sometimes simply called Parkinson’s or PD, is a chronic, degenerative neurological disorder affecting movement. Parkinson’s happens due to the gradual degeneration of nerve cells in the midbrain, which controls body movement. The hallmark sign of Parkinson’s is rhythmic, involuntary tremors. Other common signs are stiffness and slowed movement. Symptoms generally develop slowly over years, but the course of the disease is different from one person to the next. The first signs are usually barely noticeable, such as a feeling of weakness or stiffness in the legs, or a slight trembling of the hand. Usually, a person with Parkinson’s begins to notice symptoms between the ages of 50 and 65.

Parkinson’s disease is a type of parkinsonism, which is a general term used to describe the set of Parkinson’s symptoms that stem from other causes. This is an important distinction, because some of the other causes may have their own specific treatments which do not respond to the medications and surgeries used to treat Parkinson’s disease. Some of the other causes of parkinsonism include use of illicit drugs, stroke, thyroid disorder, brain tumors, and brain inflammations.

Although Parkinson’s disease is incurable, the symptoms are manageable with expert medical intervention.

Risk Factors for Parkinson’s Disease

The cause of Parkinson’s remains unknown, but several factors can contribute to its development, including a family history of the disease. Men are more likely to develop Parkinson’s, and most people develop the disease around age 60 or older, although in 10% of cases it can begin as early as age 40.

Parkinson’s Disease Symptoms

The symptoms of Parkinson’s disease are different for everyone, and some early signs may be mild and go unnoticed. In its early stages, those with Parkinson’s may notice their arms do not swing when they walk, or their speech becomes softer and slurred. Because Parkinson’s is a degenerative disease, symptoms become more pronounced over time.

Signs and symptoms of Parkinson’s include:

  • Tremor and involuntary, rhythmic movements of the limbs, hands, and jaw

  • Muscle rigidity or stiffness

  • Slowed movement

  • Loss of spontaneous and automatic movement

  • Unsteady walk or balance

  • Depression

  • Dementia

  • Changes in speech

  • Difficulty writing, handwriting changes

Parkinson’s disease has stages, from mild, to moderate, to advanced. Some people never reach the advanced stage, however. The mild stage involves the least noticeable symptoms, which do not disrupt daily life, and it lasts about 3 to 7 years. The moderate stage is more severe, and can change the way you speak, cause difficulty swallowing, make you more prone to falling, and you might take small, shuffling steps. Advanced Parkinson’s disease is usually unresponsive to most treatment, and many patients are limited to a bed or wheelchair and need round-the-clock care.

Parkinson’s Disease Diagnosis

Parkinson’s is primarily diagnosed based on the common symptoms displayed, as there is no x-ray or blood test to confirm a diagnosis of the disease. Commonly, Parkinson’s is diagnosed by the presence of two or more of the primary symptoms, and the patient should not display other neurological signs upon examination. The patient should also not have any other possible causes of parkinsonian symptoms, such as using tranquilizer medications, head trauma, or previous stroke.

Parkinson’s Disease Treatment Options

Parkinson’s is incurable, but the symptoms can be managed as the disease progresses. Initially, your doctor may recommend lifestyle changes, such as ongoing aerobic exercise, healthy diet, and advice for avoiding falls.

Medication

  • Carbidopa-levodopa (Sinemet®): Sometimes simply called Levodopa, is the most effective Parkinson’s disease medication and has been since its breakthrough in the late 1960s. It is an effective first-line treatment for Parkinson’s and comes in many formulations, including slow- and extended-release pills, and infusions. It works by introducing a natural chemical to the body which converts into dopamine in the brain. This helps reduce symptoms of stiffness and tremors. The medication does not slow the progression of the disease.

  • Catechol O-methyltransferase (COMT) inhibitors: These pills can boost the effectiveness of carbidopa-levodopa. It helps block the brain’s dopamine breakdown to help reduce some of the tremors and motor symptoms of Parkinson’s.

  • Dopamine agonists: This medication mimics the effect of dopamine in the brain and may be used with carbidopa-levodopa. It can be prescribed in the early stages of Parkinson’s, and it can lengthen the effectiveness of carbidopa-levodopa.

  • MAO B inhibitors: This medication has been shown to have moderate benefits for the disease and is usually used as a standalone therapy in the early stages, and as an add-on with other medications as the disease progresses.

  • Anticholinergics: This drug can effectively help control tremors, but it does not affect other symptoms. This is the oldest medication class to be used to treat Parkinson’s, first introduced in the 1900s.

  • Amantadine: In the early stages of Parkinson’s, amantadine can help control tremors.

  • Cannabis (medical marijuana): There is strong interest in the therapeutic properties of medical marijuana, but several clinical studies have not fully demonstrated the effectiveness of cannabis as a Parkinson’s disease therapy. Benefits can include mood improvement, help with sleep dysfunction, and helping nausea. Some patients have anecdotally stated a marked improvement in tremors. If you decide to try cannabis as a therapy for Parkinson’s, you should inform your doctor, to weigh the risks and benefits.

  • Alternative medicine: Holistic medicine can help Parkinson’s patients suffering from pain, fatigue, or depression. Therapies such as massage, yoga, meditation, and pet therapy are often recommended to Parkinson’s patients. You should tell your doctor about any alternative medicine you wish to try.

Innovative surgical options

Surgery is used for severe or late-stage Parkinson’s. For many patients, medication alone is enough to maintain good symptom relief. Surgery is used only on patients who previously showed improvement taking carbidopa-levodopa. Symptoms previously improved with medication are the same symptoms that have the potential to improve through surgery.

Deep brain stimulation (DBS) is the primary surgical method for treating Parkinson’s. It was first approved in 1997 to treat Parkinson’s tremors, and again in 2002 to treat advanced symptoms. Then, in 2016, deep brain stimulation surgery was approved for use in earlier stages of Parkinson’s. In this procedure, a neurosurgeon implants small electrodes into a specific part of the brain. These electrodes provide electrical impulses to the deep parts of the brain involved in motor function. Your neurosurgeon will be able to pinpoint the exact location in the brain through MRI scans and neurophysiological mapping.

DBS can effectively reduce, control or halt involuntary movements (dyskinesia), tremors, rigidity and improve movement slowing. DBS can also control any fluctuations in response to carbidopa-levodopa to control tremors which don’t improve through adjustments to medication. Like other Parkinson’s treatments, however, DBS does not stop the disease from progressing.

Clinical Trials

Several new Parkinson’s treatment options are in the testing phase. These include new surgical procedures looking into other areas to target in the brain, as well as new medications to slow the progression of Parkinson’s. Embryonic stem cell research is another promising field

Request an appointment online now or call 833-656-3876.