Treatments

Unlike for many other neurodegenerative diseases, there is effective treatment for the symptoms of Parkinsons disease. For most patients, these treatments can provide several years of satisfactory treatment. Unfortunately, no therapy has yet been conclusively shown to slow or reverse the disease. Several candidates have been tested in this regard, and have shown intriguing results. However, these studies will need to be repeated and expanded before these agents can be widely recommended.

Several important factors influence decision-making in treatment of PD. These include:

• Levodopa continues to be the most effective treatment for motor symptoms, and all patients eventually require it.
• Long-term complications of levodopa therapy are a concern, and may influence whether therapy begins with levodopa or a Dopamine Agonists (DAs).
• Non-motor symptoms, especially depression, are increasingly being seen as important targets of therapy.
• Surgical treatment has become a mainstay of late-stage management, although not all patients can afford it or are appropriate candidates.
• Cell transplant therapies are still experimental, and their usefulness is currently lessened by the possibility of unacceptable complications. Additional studies are needed to understand and avoid these complications.
• Non-pharmacological treatments remain an important part of the whole treatment program.

Long-term Complications of Treatment

As PD progresses, it becomes increasingly difficult to adequately control symptoms with medications. The most common problems that arise are motor complications, which include motor fluctuations and dyskinesias.

Motor fluctuations refer to unanticipated loss of effect of a given dose of levodopainstead of a smooth, predictable symptomatic benefit, the patient may lose benefit earlier than usual (termed wearing off) or may suddenly switch from on (symptoms controlled) to off (symptoms return). DyskinesiasDyskinesias are involuntary movements that occur when dopamine levels are too high. Motor complications are discussed in more detail in the section Complications of Treatment.