Parkinson's disease treatment

Our approach

At the Movement Disorders Center, part of the Northwell Health Neuroscience Institute, patients have access to the most advanced treatments for Parkinson’s disease. This begins with a comprehensive evaluation and inpatient consultation. Depending on the suspected cause, Parkinson’s disease is classified as being either primary/idiopathic, meaning there is a genetic or unknown reason for its onset, or secondary, which denotes known causes, such as environmental toxins or a history of head injury. Because there currently is no cure for Parkinson’s disease, treatment is focused on alleviating symptoms through medication, diet changes, some types of surgery and multidisciplinary management. 

Overview

There currently is no cure for Parkinson’s disease. However, medications may help control symptoms. Lifestyle modification and physical therapy can also be beneficial in minimizing symptoms.

For some individuals, a surgical procedure called deep brain stimulation can help reduce or even stop involuntary movements and reduce muscle rigidity. With this form of Parkinson’s disease surgical treatment, continuous electrical stimulation effectively jams or blocks abnormal circuitry of your brain that causes unwanted movements. In many cases, DBS can greatly improve your quality of life. It’s a safe and effective surgical procedure that can minimize some of the disabling symptoms of your disease.

Reasons for treatment

Because there is no cure for Parkinson’s disease, treatment is focused in reducing symptoms that include:

  • Tremors
  • Sluggishness
  • Stiffness
  • Impaired posture, balance or coordination

Risks and side effects

If you’ve been diagnosed with Parkinson’s disease, you may be prescribed medications to manage difficulties with walking, movement and tremor. While effective in reducing symptoms, they can have side effects which include:

  • Carbidopa-levodopa – used to increase production of dopamine in the brain, this medication can cause side effects that include nausea and lightheadedness.
  • Dopamine agonists (pramipexole, ropinirole and rotigotine) – used to mimic dopamine effects in the brain, these medications can produce a variety of side effects, such as hallucinations, sleepiness and compulsive behaviors.
  • MAO-B inhibitors (selegiline, and rasagiline)– these medications help break down brain dopamine by inhibiting enzyme monoamine oxidase B (MAO-B). Side effects include nausea and insomnia.
  • Catechol-O-methyltransferase (COMT) inhibitors (entacapone) – This medication can block an enzyme that breaks down dopamine. Side effects include involuntary movement and diarrhea.
  • Anticholinergics – Used to control tremor, their benefits are offset by side effects that include memory loss, confusion, hallucination constipation, dry mouth and impaired urination.

If medications are not able to control your symptoms, deep brain stimulation may be recommended. While this surgical treatment can lead to a significant improvement of symptoms, such as tremor, rigidity, stiffness, slowed movement and walking difficulties, there is a small chance of developing side effects, such as:

  • Allergic reaction to the implanted neurostimulator device
  • Dizziness
  • Infection
  • Leakage of cerebrospinal fluid
  • Loss of balance, coordination or movement
  • Shock-like sensations
  • Speech difficulties
  • Vision changes
  • Temporary pain or swelling at the implantation site
  • Temporary tingling of the face, arms or legs

In a small percentage of individuals, the device can break or shift. In these cases, the device will need to be removed and replaced. 

Preparing for treatment

Your doctor will discuss the best Parkinson’s disease treatment options for you. If deep brain stimulation is a possibility, you will undergo a complete evaluation before the procedure. This will include an assessment, called the Unified Parkinson’s Disease Rating Scale, to determine the progression of your disease. As well, there may be additional evaluations of your memory and thinking. 

What to expect after treatment

After neurostimulator treatment, you will stay in the hospital for several days. You may be prescribed antibiotics to prevent infection. Post-surgery, you will need to return to your doctor’s office for a follow-up visit. During this visit, the stimulator will be turned on and programmed to provide the specific level of stimulation you require.

 

Most people who have neurostimulator treatment have a significant improvement in symptoms and an improved quality of life. However, you may still require medication to manage symptoms such as seizures.