Parkinson

TREATMENT

People who are only mildly affected by Parkinson's disease may need no treatment at first. As symptoms progress, various treatment approaches are available.

Medication

Medication selection and dosage are tailored to the individual. The doctor considers factors such as severity of symptoms, age and presence of other medical conditions. Every patient responds differently to a medication or dosage level, so this process involves experimentation, persistence, and patience. As the disease progresses, drug dosages may need to be modified. Sometimes drugs are combined. Patients need to receive care from doctors who have extensive experience treating all stages of Parkinson's disease — increasing the effectiveness of treatment at every stage of the disease.

Levodopa, a substance normally found in the body in limited amounts, is usually the first medication prescribed. Taken orally, levodopa can be converted by the body into dopamine the body needs.

Another class of drugs, dopamine agonists, is also useful at reducing symptoms and can be used singly or in conjunction with levodopa. Dopamine agonists were introduced 20 years ago. Agonists are chemical substances capable of combining with part of a cell and initiating a reaction or activity.

In 1998, the first in a new class of Parkinson's disease drugs (COMT inhibitors) was approved by the Food and Drug Administration. The COMT inhibitors prolong effects of levodopa therapy by blocking an enzyme that can break down levodopa.

Surgery

In severely affected patients, surgical treatments such as ablation, deep brain stimulation, and pallidotomy may control some symptoms.

Ablation

This procedure locates, targets, and then ablates (destroys) a clearly defined area of the brain affected by Parkinson's. The object is to destroy tissue that produces abnormal chemical or electrical impulses that produce abnormal movements. This approach is done less frequently, in favor of deep brain stimulation.

Deep Brain Stimulation (DBS)

DBS targets areas in the brain where uncontrolled movements originate. The targeted region is inactivated, not destroyed, by an implanted electrode. The electrode is connected via a wire running beneath the skin to a stimulator and battery pack in the patient's chest.

Mayo Clinic has extensive expertise in determining which patients would benefit from the surgery. Read more about deep brain stimulation.

Palllidotomy

Pallidotomy, (named for the pallidum area of the brain) is a delicate surgical procedure that targets a precise area to control certain symptoms. A fine probe measures abnormal electrical activity. Another probe delivers small electrical shocks. The patient, who is awake during the surgery, describes the effects to pinpoint the area for treatment. The surgeon then burns a tiny hole in the cells. Results are almost immediate.

...