Parkinson’s treatment: medication, therapies, self-help

The treatment of Parkinson’s usually involves a combination of medication and other procedures such as physiotherapy. If the symptoms are severe, deep brain stimulation (DBS) surgery can help to alleviate the symptoms of Parkinson’s, such as muscle stiffness (rigor), tremor and slowed movement (bradykinesia). In many cases, however, drugs such as levodopa or dopamine agonists also improve the motor problems.

In this article, we would like to give you an overview of the treatment options available. Find out which therapies are the main focus and what you can do yourself to keep physically and mentally fit with Parkinson’s disease.

What is Parkinson’s disease?

Parkinson’s is a chronic, incurable disease of the nervous system. Parkinson’s is caused by a lack of dopamine, which is triggered by the accelerated death of nerve cells in the black substance (substantia nigra), a region in the midbrain. This dopamine deficiency leads to motor symptoms such as tremors, muscle stiffness, slowed movements and balance disorders. However, it is also accompanied by non-motor symptoms such as sleep disorders, low mood (including depression) and cognitive impairments such as concentration and memory problems. Factors such as age, environmental toxins, but also genes and oxidative stress play a role in the development of the disease.

Drug treatment for Parkinson’s disease

There are various medications that can be used to treat Parkinson’s disease. In many cases, medications are combined with each other. However, they can also be prescribed individually, as monotherapy. The choice of medication and the form in which it is administered depends on the type and intensity of the symptoms and the age of the patient.

Levodopa (L-dopa): precursor substance of dopamine

Levodopa is the most commonly used medication because it is particularly effective. It is a precursor of the neurotransmitter dopamine, which is metabolized to dopamine in the brain. Taking levodopa generally leads to a significant improvement in mobility, reduces muscle stiffness and decreases tremors. Levodopa can be taken in the form of tablets or capsules.

Dopamine agonists: Imitators of dopamine

Dopamine agonists are used in Parkinson’s disease as the sole medication or in combination with levodopa, particularly in the early stages of the disease. Dopamine agonists act directly on the dopamine receptors and mimic the effect of dopamine there. Common dopamine agonists include drugs such as pramipexole, ropinirole, rotigotine and apomorphine. They help to alleviate motor symptoms such as tremors, muscle stiffness and slowed movements. They can also help to reduce levodopa-related complications such as dyskinesia.

MAO-B inhibitors: decelerators of dopamine degradation

MAO-B inhibitors are another important group of drugs in the treatment of Parkinson’s disease. These drugs (such as selegiline and rasagiline) inhibit the enzyme monoamine oxidase-B (MAO-B), which is responsible for the breakdown of dopamine. By inhibiting this enzyme, the breakdown of dopamine is slowed down, leaving more dopamine available in the brain. This helps to improve symptoms such as tremors, stiffness and slowness of movement. MAO-B inhibitors can be used alone in the early stages of the disease or in combination with levodopa to prolong the effect of dopamine and reduce “off” phases.

COMT inhibitors: delaying the breakdown of dopamine

COMT inhibitors (catechol-O-methyltransferase inhibitors) are a class of drugs that inhibit the enzyme catechol-O-methyltransferase. This is also involved in the breakdown of dopamine. COMT inhibitors such as entacapone and tolcapone therefore help to ensure that more dopamine is available in the body and the patient’s symptoms are reduced. These drugs are used particularly in the later stages of the disease to enhance the effect of levodopa.

Anticholinergics: inhibitors of the neurotransmitter acetylcholine

Drugs in this group (such as biperiden) are rarely used for Parkinson’s disease. They reduce the effect of the neurotransmitter acetylcholine in the brain, which compensates for the existing imbalance between dopamine and acetylcholine. This improves the Parkinson’s symptoms of tremor (trembling) and rigor (stiffness of the muscles) in particular.

Amantadine

Amantadine has a complex mode of action in the brain: among other things, it increases the release of dopamine and inhibits its breakdown. These mechanisms of action help to improve the dopamine balance in the brain, which can alleviate Parkinson’s symptoms. Amantadine is often used in combination with other Parkinson’s medications to increase the effectiveness of the therapy and, for example, to prevent involuntary, excessive movements (dyskinesia) that can result from long-term levodopa treatment.

Non-drug treatment: deep brain stimulation

Deep brain stimulation (DBS) is a surgical procedure that is used in the treatment of advanced Parkinson’s disease when medication no longer works sufficiently or causes serious side effects. In a surgical procedure, electrodes are implanted in certain regions of the brain that are involved in controlling movement. These electrodes are connected to a stimulator implanted under the skin in the chest area, which sends electrical impulses to this specific area of the brain to stimulate it. This can lead to a significant improvement in symptoms such as tremor, stiffness and movement disorders.

Accompanying treatments for Parkinson’s disease

In addition to drug therapy, there are a number of other forms of therapy that can make life and everyday life easier for those affected or help to alleviate symptoms. These include the following therapies:

• Occupational therapy: Occupational therapy aims to improve patients’ everyday skills and quality of life. Through targeted exercises and activities, occupational therapy helps to maintain or regain motor skills, improve fine motor skills and optimize movement sequences. Strategies are developed to better manage everyday tasks such as getting dressed, writing or cooking. In addition, aids are introduced and their use trained to promote independence.
• Physiotherapy: Physiotherapy uses special exercises to help strengthen muscles and make them more flexible, improve posture and improve the patient’s balance, for example to reduce the risk of falling. It also helps patients to perform everyday movements, such as getting up or turning in bed, more efficiently and safely.
• Speech therapy: Speech therapy is concerned with getting the speech and swallowing disorders of Parkinson’s patients under control. The aim is for those affected to learn to speak louder and more clearly, for example by strengthening their breathing through special exercises. This can prevent social withdrawal and promote participation in social life. Speech therapy also helps to train swallowing techniques in order to reduce the risk of swallowing food or liquids. This can lead to serious respiratory infections.
• Psychotherapy: In psychotherapy, especially in cognitive behavioral therapy, patients learn to cope better with psychological symptoms such as depression or dementia and thus live better with the disease. For example, they learn to recognize and change negative thought patterns and develop strategies for coping with stress, depression and anxiety.

Parkinson’s self-help: The best tips for a better quality of life

Despite all the advances in medicine, it is good for people with diseases such as Parkinson’s to take measures to improve their own quality of life. This can be done in many different ways, for example through:

• Healthy diet: A balanced diet rich in fruit, vegetables, wholegrain products and healthy fats provides you with essential nutrients that support the brain and promote your physical health. It also has anti-inflammatory effects, which counteracts the inflammatory processes in the brain in Parkinson’s disease. Make sure you get enough fiber (plant fiber) to avoid constipation. Foods that support the formation of dopamine are: Bananas, chicken, fish, eggs, lentils, avocados, nuts (walnuts) and seeds (sunflower seeds).
• Regular exercise: Targeted physical activity will improve your muscle strength, flexibility and endurance, which will help you stay more mobile. This can reduce the risk of falling. Exercise also promotes blood circulation and the release of neurotransmitters such as dopamine. You may notice this in an improvement in motor symptoms, mood and mental performance. Walking, swimming, dancing, tai chi, light yoga or gymnastic exercises contribute significantly to the quality of life with Parkinson’s.
• Social interaction: Social activities not only strengthen emotional well-being, but also promote mental fitness. Interaction with others, be it in the form of friendship meetings or community activities with others, can help prevent isolation and loneliness in Parkinson’s disease. Social activities also provide emotional support and promote a sense of belonging, making it easier to cope with the disease.
• Active stress management: Regular relaxation techniques such as meditation, breathing exercises or Jacobson’s progressive muscle relaxation can help combat anxiety, stress and depression.
• Reduce environmental toxins: Consuming organic foods can help reduce exposure to environmental toxins. Parkinson’s has been linked in part to the intake of certain environmental toxins such as pesticides (crop protection products) and fertilizers used in conventional agriculture. Organic foods do not use such agents, which reduces dietary intake of these potentially harmful chemicals.
• Visit self-help groups: Many sufferers find it helpful to join a self-help group or online community. This helps them to feel less alone with their illness. The exchange and mutual support help to accept the illness and cope with it better.