Treatment

Supportive therapies

There are several therapies that can make living with Parkinson's disease easier and help you deal with your symptoms on a day-to-day basis.

There are efforts underway to try to increase the availability of these supportive therapies for Parkinson's patients on the NHS.

Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment.

Read about:

Assessing your care and support needs

Planning for your future care needs

Physiotherapy

A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise.

The physiotherapist aims to make moving easier, and improve your walking and flexibility. They also try to improve your fitness levels and ability to manage things for yourself.

Read moreabout Physiotherapy .

Occupational therapy

An occupational therapist can identify areas of difficulty in your everyday lifefor example, dressing yourself or getting to the local shops.

They can help you work out practical solutions, and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible.

A speech and language therapist can often helpyou improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology.

Diet advice

For some people with Parkinson's disease, making dietary changes can help improve some symptoms.

These changescan include:

• increasing the amount of fibre in your diet and making sure you're drinking enough fluid to reduce low blood pressure , such as dizziness when you stand up quickly
• making changes to your diet to avoid unintentional weight loss

You may see a dietitian, a healthcare professional trained to give diet advice, if your care team thinks youmay benefit from changing your diet.

Want to know more?

Parkinson's UK: therapies and Parkinson's management

Medication

Medicationcan be used toimprove the main symptoms of Parkinson's disease, such as shaking (tremors) and movement problems.

However, not all the medications available are useful for everyone, and the short- and long-term effects of each are different.

Three main types of medication are commonly used:

• levodopa
• dopamine agonists
• monoamine oxidase-B inhibitors

Your specialist can explain your medication options, including the risks associated with each medication, and discuss which may be best for you. Regular reviews will be required as the condition progresses and your needs change.

Read on to learn about the treatments you may be offered. You can also see a summary of the pros and cons of treatments for Parkinson's disease , where you can compare your options.

Levodopa

Most people with Parkinson's disease eventually need a medication called levodopa.

Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement.

Increasing the levels of dopamine using levodopa usually improves movement problems.

Itis usually taken as a tablet or liquid, and is often combined with other medication, such as benserazide or carbidopa.

These medications stop the levodopa being broken down in the bloodstream before it has a chance to get to the brain.

They also reduce the side effects of levodopa, which include:

• feeling sick (nausea) or vomiting
• tiredness
• dizziness

If you're prescribed levodopa, the initial doseis usually very small and will be gradually increased until it takes effect.

At first, levodopa can cause a dramatic improvement in the symptoms.

However, its effects can be less long-lasting over the following yearsas more nerve cells in the brain are lost, there are fewer of them to absorb the medicine. This means the dose may need to be increased from time to time.

Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and "on-off" effects, where the person rapidly switches between being able to move (on) and being immobile (off).

Dopamine agonists

Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect comparedwith levodopa. They can often be given less frequently than levodopa.

Theyare often taken as a tablet, but are also available as a skin patch (rotigotine).

Sometimes dopamine agonists are taken at the same time as levodopa, as this allows lower doses of levodopa to be used.

Possible side effects of dopamine agonists include:

• nausea or vomiting
• tiredness and sleepiness
• dizziness

Dopamine agonists can also cause hallucinations andincreased confusion, so they need to be used with caution, particularly in elderly patients, who are more susceptible.

For some people, dopamine agonists have been linked to the development of compulsive behaviours,especially at high doses, including addictive gambling and an excessively increased libido.

Talk to your healthcare specialist if you think you may be experiencing these problems.

As the person themselves may not realise the problem, it's key that carers and family members also note any abnormal behaviour and discuss it with an appropriate professional at the earliest opportunity.

If you're prescribed a course of dopamine agonists, the initial dose is usually very small to prevent nausea and other side effects.

The dosage is gradually increased over a few weeks. If nausea becomes a problem, your GP may prescribe anti-sickness medication.

A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep.

This generally happens as the dose is being increased and tends to settle once the dose is stable.

People areusually advised toavoid driving while the dose is being increased in case this complication occurs.

Monoamine oxidase-B inhibitors

Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinson's disease.

They block the effects of an enzyme orbrain substance that breaks downdopamine (monoamine oxidase-B), increasing dopamine levels.

Both selegiline and rasagiline can improve the symptoms of Parkinson's disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists.

MAO-B inhibitors are generally very well tolerated, but can occasionallycause side effects, including:

• nausea
• headache
• abdominal pain
• high blood pressure

Catechol-O-methyltransferase inhibitors

Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinson's disease. They prevent levodopa from being broken down by the enzyme COMT.

Side effects of COMT inhibitors include:

• nausea or vomiting
• diarrhoea
• abdominal pain

Want to know more?

Parkinson's UK: drug treatments

Parkinson's UK: Parkinson's drugs and compulsive behaviours

Non-oral therapies

When Parkinson's symptoms become difficult to control with tablets alone, a number of other treatments can be considered.

Apomorphine

A dopamine agonist called apomorphine can be injected under the skin (subcutaneously) eitherby:

• a single injection, when required
• a continuous infusionusing a small pump carried around on your belt, under your clothing, or in a bag

Duodopa

If you have severe on-off fluctuations, a type of levodopa called duodopa may be used.

This medication comes as a gel that's continuously pumped into your gut through a tube inserted through your abdominal wall.

There's an external pump attached to the end of the tube, which you carry around with you.

About 25 specialist neuroscience centres in the UK offer this treatment.This treatment is only available if you have very severe on-off fluctuations or involuntary movements.

Surgery

Most people with Parkinson's disease are treated with medication, although a type of surgery called deep brain stimulation isused in some cases.

This surgery is also available in specialist neuroscience centres around the UK, but it's not suitable for everyone.

Ifsurgery isbeing considered, your specialist will discuss the possible risks and benefits with you.

Deep brain stimulation

Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall.

This is connected to one or two fine wires placed under the skin, and isinserted precisely into specific areas in your brain.

A tiny electric current is producedby the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinson's disease.

Although surgery doesn't cure Parkinson's disease, it can ease the symptoms for some people.

Want to know more?

NICE: deep brain stimulation for Parkinson's disease

Parkinson's UK: surgery

Treating additional symptoms

As well asthe main symptoms of movement problems, people with Parkinson's disease can experience a wide range of additional symptoms that may need to be treated separately.

These include:

• depression and anxiety this can be treated with self care measures such as exercise, psychological therapy or medication; read more about treating depression and treating anxiety
• problems sleeping (insomnia) this can be improved by making changes to your normal bedtime routine; read more about treating insomnia
• erectile dysfunction this can be treated with medication; read more about treating erectile dysfunction
• excessive sweating (hyperhidrosis) this can be reduced using a prescription antiperspirant,or surgery in severe cases; read more about treating hyperhidrosis
• swallowing difficulties (dysphagia) this can be improved by eating softened food, or by using a feeding tube in more severe cases; read more about treating dysphagia
• excessive drooling this can be improved with swallowing exercises, or surgery or medication in severe cases
• urinary incontinence this can be treated with exercises to strengthen the pelvic floor muscles, medication, or surgery in severe cases; read more about treating urinary incontinence
• dementia this can be treated with cognitive therapies and medication in some cases; read more about treating dementia

Clinical trials

Much progress has been made in the treatment of Parkinson's diseaseas the result ofclinical trials,where new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.

If you are asked if you want to take part in a trial, you will be given an information sheet about the trial.

If you want to take part, you will be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care.

Want to know more?

Parkinson's UK: get involved in research

Complementary and alternative therapies

Some people with Parkinson's disease findcomplementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson's disease.

However, there's no clinical evidence they're effective in controlling the symptoms of Parkinson's disease.

Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldn't be used instead of the medicines prescribed by your doctor.

Some types of herbal remedies, such as St John's wort, can interact unpredictably if taken with some types of medication used to treat Parkinson's disease.

If you're considering using an alternative treatment along with your prescribed medicines, check with your care team first.

Want to know more?

Parkinson's UK: complementary therapies