.
.
.
.
Regional Services Directorate
.
.
.
Department of Neurology
.
..
.
.. Parkinson’s
Disease:
..
.. Treatment Options
..
Acute Services Division
Information for Patients
What can be done?
As yet there is no cure for Parkinson’s disease. The disease is a slowly progressive
disease i.e. the symptoms worsen as time goes on. There are no treatments that have
been proven to slow the progression of the disease. However, there are treatments
which help the symptoms.
When should treatment be started?
Treatment is started when symptoms become troublesome. If you can manage without
treatment there is no advantage in starting therapy early. Low doses are used first,
and increased gradually over months and years. The reason for delaying treatment
until it is necessary is to gain time and delay the onset of troublesome side effects in
years to come.
Are there side-effects from treatment?
Nausea and light headedness may occur when starting medication, in about 1 / 4 of
patients. Usually this is mild and settles as your body gets used to the medication. If
these side-effects are more severe, an anti-sickness tablet is available from your GP
(Domperidone or Motilium 10mg. up to 3 tablets per day). More detail about possible
side effects is given below.
What treatments are available?
The treatments replace the dopamine which is lacking in the brain. These help the
symptoms particularly the slowness and stiffness.
Dopamine Agonists
Dopamine Agonists are medications used to treat Parkinson’s disease. There are
several different types, Bromocriptine (Parlodel), Cabergoline (Cabaser), Pergolide
(Celance), Pramipexole (Mirapexin) and Ropinirole (Requip). In Parkinson’s there is a
deficiency in a substance called dopamine in the base of the brain. Dopamine
agonists are synthetic compounds which stimulate the brain in a similar way to
dopamine, thus in effect are doing the job that the dopamine normally does.
Page 2
Parkinson’s Disease: Treatment Options
Dopamine Preparations (“Levodopa”)
These contain levodopa, which the body converts to dopamine. The names are
Sinemet and Madopar. The levodopa in these tablets is combined with another
substance which helps concentrate the dopamine in the brain where it is needed.
After being on this type of medication for a number of years, side effects or involuntary
movements that you cannot control called dyskinesias can occur. These side effects
are more common with the Levodopa than the dopamine agonists. For this reason,
the dopamine agonists are often started first, the dose gradually increased to a
maximum level, then the dopamine preparations (“Levodopa”) added when more
treatment is required. However, the choice depends on the severity of your symptoms
and any other health problems or treatments you may have.
COMT Inhibitor
This is called Entacapone. This substance prevents the breakdown of dopamine
therefore boosting the dopamine levels in the brain. It is helpful later, if the patient
feels that levodopa therapy is “wearing off.” Side effects include diarrhoea which
comes on after about 6 weeks. If this occurs you should stop the Entacapone tablets.
Other Treatments

Anticholinergics - e.g. Benzhexol, Orphenadrine. These substances can help
with the symptoms of Parkinson’s disease, but can cause confusion and
memory problems and are now less commonly used.

Selegiline - This is a mild treatment which is not so commonly used now. It
was initially thought to slow the progression of Parkinson’s disease, and later
thought to possibly cause excess mortality, but neither was proven.

Amantadine - A small proportion of patients have benefit from this with a
modest improvement in symptoms, mainly dyskinesia.

Surgical Treatments - These may be of value to patients who have severe
involuntary movements. There are different types of surgical procedure, either
to destroy a small part of the brain which is responsible for the involuntary
movements or implant a stimulator. The potential hazards of a surgical
approach such as stroke due to a blocked blood vessel, or a burst blood
vessel, have to be balanced against the benefits.
Other forms of Therapy
Physiotherapy can be helpful for movements and walking. If speech, swallowing or
choking are problems, speech therapy can help. An occupational therapist can help
by assessing your home circumstances and suggesting alterations which help with
daily activities.