Parkinson’s Treatment

Parkinson’s disease is a progressive neurological (brain) disorder that is caused by the breakdown of nerve cells in the part of the brain that controls movement. These nerve cells die or become damaged, losing the ability to produce an important chemical called dopamine. Studies have shown that symptoms of Parkinson’s develop in patients with an 80% or greater loss of dopamine-producing cells.

Parkinson’s usually affects people between the ages of 55 and 75, but it can develop at an earlier age. Nearly 1 million Americans are living with the disease. Early detection and treatment can preserve quality of life and manage symptoms.

While a cure has yet to be found for Parkinson’s, Norton Neuroscience Institute treats Parkinson’s with the most advanced techniques and medications available to help control your symptoms and give you better quality of life.

Parkinson’s disease treatments can be broken into three categories:

• Medicine
• Surgery
• Advanced therapies

Your health care team also may recommend lifestyle changes, especially ongoing aerobic exercise, good sleep hygiene and a healthy diet. In some cases, physical therapy that focuses on balance and stretching is important. A speech-language pathologist may help improve speech issues.

Everyone’s Parkinson’s is different, from the onset of symptoms and severity to how fast the disease progresses and what treatments are most effective for you. Your Norton Neuroscience Institute health care team will create a tailored plan for your care, based on many factors including:

• Your age
• Severity of symptoms
• Other medical conditions

Medication for Parkinson’s Disease

Medications can relieve and control Parkinson’s symptoms while minimizing some negative side effects. These medicines have their own benefits, risks and side effects. Your health care team will help you determine what might work best for you and adjust as needed. Everyone responds differently to various medications.

Medicines your care team may prescribe include:

• Carbidopa-levodopa (Rytary, Sinemet, Duopa, others): Levodopa, the most effective Parkinson’s disease medicine, is a natural chemical that passes into the brain and is converted to dopamine. Levodopa is combined with carbidopa (Lodosyn), which stops levodopa from changing to dopamine outside the brain. This prevents or decreases side effects such as nausea.

After years of taking this drug, the benefit from levodopa may lessen. Also, you may experience involuntary movements known as dyskinesia after taking higher doses of levodopa. Your care team can decrease your dose or adjust the times of your doses to control these effects.

Side effects: Nausea or lightheadedness when you stand (orthostatic hypotension).

• Inhaled carbidopa-levodopa: Inbrija is a brand-name medicine delivering carbidopa-levodopa in an inhaled form. It may be helpful in managing symptoms that arise when medicines taken by mouth suddenly stop working during the day.

• Carbidopa-levodopa infusion (Duopa): This therapy combines carbidopa and levodopa. However, it’s administered through a feeding tube that delivers the medicine in a gel form directly to the small intestine.

Side effects: Placement of the feeding tube requires a small surgical procedure. Risks associated with having the tube include the tube falling out or infections at the infusion site.

• Dopamine agonists (Mirapex ER, Neupro, Apokyn). Unlike levodopa, dopamine agonists don’t change into dopamine. Instead, they mimic dopamine effects in the brain. Dopamine agonists aren’t as effective as levodopa in treating symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.

Side effects: Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa. But they also can include hallucinations, sleepiness and compulsive behaviors such as hypersexuality, gambling and eating. If you’re taking these medicines and you behave in a way that’s out of character for you, talk to your health care team.

• Monoamine oxidase B (MAO B) inhibitors (Zelapar, Azilect, Xadago). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme breaks down brain dopamine. Zelapar (selegiline) given with levodopa may help prevent the beneficial effects of levodopa wearing off.

MAO B drugs are not often used in combination with most antidepressants or certain pain medicines due to potentially serious but rare reactions. Check with your health care team before taking any additional medicines with an MAO B inhibitor.

Side effects: Headaches, nausea or insomnia can occur. When added to carbidopa-levodopa, these medicines increase the risk of hallucinations.

• Catechol O-methyltransferase (COMT) inhibitors (entacapone, Ongentys): This medicine mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.

Side effects: There is an increased risk of involuntary movements called dyskinesia, mainly from an enhanced levodopa effect. Other side effects include diarrhea, nausea or vomiting.

Tolcapone (Tasmar) is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.

• Anticholinergics (Cogentin, trihexyphenidyl): These medicines were used for many years to help control the tremor associated with Parkinson’s disease. Their benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.

• Amantadine (Gocovri): Health care professionals may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson’s disease. It also may be given with carbidopa-levodopa therapy during the later stages of Parkinson’s disease to control involuntary movements called dyskinesia induced by carbidopa-levodopa.

Side effects: Patients taking amantadine can experience changes in skin color, ankle swelling or hallucinations.

• Adenosine receptor antagonists (A2A receptor antagonists) (istradefylline, Nuplazid, pimavanserin): These drugs target areas in the brain that regulate the response to dopamine and allow more dopamine to be released.

Advanced Treatment for Parkinson’s Disease

Not everyone responds well to Parkinson’s medication treatment. In the case of levodopa, the benefits eventually wear off. There are surgical options to treat Parkinson’s.

MRI-guided focused ultrasound (MRgFUS) is a minimally invasive treatment that can help manage Parkinson’s-related tremors. Ultrasound is guided by an MRI to the area in the brain where the tremors start. The ultrasound waves are at a very high temperature and burn areas that are contributing to the tremors. There is no risk of infection with MRgFUS, and results are immediate if the procedure is successful.

Deep-brain stimulation (DBS) involves implanting electrodes in the brain that deliver a mild current to the parts of the brain that cause issues. This procedure is reversible. While DBS will not slow the progression of Parkinson’s, it can reduce or halt involuntary movements, reduce tremor and rigidity, and improve overall movement.

DBS is almost always an option in later stages of Parkinson’s disease when levodopa therapy becomes less effective. It is also effective for people who have tremor that doesn’t seem to respond to the usual medications. You may be a good candidate for DBS if you:

• Have been diagnosed with Parkinson’s for five or more years
• Have severe disabling tremors, involuntary movements or severe motor fluctuations
• Have severe motor disturbances that cannot be controlled with medication

There are risks with any surgery. DBS risks include stroke and hemorrhage. Not everyone is a good candidate for DBS, and not all symptoms respond well to it.

There are new and emerging therapies for Parkinson’s treatment. Though the therapies are not widely available, doctors hope they will prove to be effective and lasting treatment for Parkinson’s. They include:

• Stem cell transplants: These add new dopamine-using neurons into your brain to take over for damaged ones.
• Neuron-repair treatments: These treatments try to repair damaged neurons and encourage new neurons to form.
• Gene therapies and gene-targeted treatments: These treatments target specific mutations that cause Parkinson’s disease. Some also boost the effectiveness of levodopa or other treatments.

Parkinson’s Disease Prevention

While there is no proven way to prevent Parkinson’s, there are some ways to slow the progression of the disease and reduce the severity of symptoms. Research has shown that lifestyle interventions may help prevent progression of Parkinson’s, including:

• Exercise and physical activity- studies show the benefits of aerobic exercise for people with Parkinson’s disease to boosting neuroplasticity and improve symptoms
• Management of environmental triggers- There is some evidence that your environment can contribute to your developing Parkinson’s, including exposure to metals, pesticides and certain drugs through ingestion or pollution
• Overall wellbeing- Managing stress, maintaining healthy sleep, and a nutrient  dense diet can help manage symptoms or slow the progression of Parkinson’s disease

Support for Parkinson’s Patients and Their Families

In addition to administering compassionate medical care with expertise for patients with Parkinson’s disease, we provide extensive support that includes:

• DBS patient navigator
• Cressman Neurological Rehabilitation
• Exercise groups
• Patient support classes

Parkinson’s disease is the second most common neurodegenerative disorder in the United States, behind Alzheimer’s disease. Parkinson’s is a progressive disease, but can be managed with treatment. Usually, by the time a formal diagnosis is made, the disease has progressed to a point where people have difficulty controlling bodily movements. It is important to know whether you are at risk and to talk with your health care provider early and often about Parkinson’s disease.

At Norton Neuroscience Institute, our team of nationally recognized neurologists, neurosurgeons and neuropsychologists provide innovative care tailored to the individual needs of our patients. Together with support services from Norton Neuroscience Institute Resource Centers, patients and families have access to numerous clinical trials, specialized rehabilitation services, educational resources and complementary therapies.

Care That’s Focused on You

It’s part of Norton Neuroscience Institute’s goal to care for the whole person, not just the condition.

• Norton Neuroscience Institute Resource Centers offer ways to improve your access to care, provide valuable information on managing your disease and address your quality of life issues. The Norton Healthcare Foundation funds this important service, so patients don’t need to pay.
• Dedicated patient navigators can help schedule follow-up appointments, coordinate prescription assistance, create customized diet plans and provide guidance on disability benefits, housing, financial and employment concerns and more.
• Patients can access support groups, exercise classes and other educational events to connect with others and learn how to make the most of life while managing a neurological condition. 
• Access an on-demand video library of educational content across a variety of condition-related topics is available.
• We want to help prevent illness. Get help quitting smoking and learn the signs of stroke.
• Communicate with your provider, manage appointments, refill prescriptions and more anytime from a computer or mobile device with a free Norton MyChart account.

A Louisville Leader in Neurological Care

More patients from Louisville and Southern Indiana seek their neurology and neurosurgery care from Norton Neuroscience Institute’s nationally recognized specialists than any other providers in the area.

Your Norton Neuroscience Institute medical provider has the expertise, experience, diagnostic tools and sophisticated treatments to provide care tailored to your needs.

• More than 75 medical, surgical and research specialists are dedicated to providing innovative care to those with brain, spine and nervous system conditions.
• Advanced, minimally invasive neurosurgery equipment can speed your recovery and minimize pain.
• Multidisciplinary clinics provide easy access to care in one convenient appointment for your neurological condition, with specialists in oncology, cardiology, orthopedics and behavioral health.
• Norton Healthcare’s four adult-service hospitals in Louisville are certified by DNV, recognizing excellence and expertise in stroke care.
  • Norton Brownsboro Hospital is recognized as a Comprehensive Stroke Center.
  • Norton Audubon Hospital and Norton Hospital are Primary Stroke Centers.
  • Norton Women’s & Children’s Hospital is an Acute Stroke Ready Hospital.
• Norton Neuroscience Institute is at the forefront of neuroscientific research. As investigators on numerous trials, our physicians contribute to groundbreaking studies and publications in peer-reviewed journals. Also, patients may be eligible to take part in these experimental treatments.
  Learn more about current neuroscience clinical trials and studies.

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• The American Heart Association Get With the Guidelines stroke care program has recognized all four of Norton Healthcare’s adult service-hospitals in Louisville for exceeding national averages in getting patients in the door and administering lifesaving treatment to restore blood flow to the brain.
• Norton Neuroscience Institute’s multiple sclerosis (MS) program has been designated a Center for Comprehensive MS Care by the National Multiple Sclerosis Society.
• The National Association of Epilepsy Centers has recognized Norton Neuroscience Institute as a Level 4 Epilepsy Center, providing the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy.
• Norton Neuroscience Institute Resource Center navigators help educate patients and their families about new diagnoses, available treatments and ways to manage their disease.
• We are listed by Becker’s Hospital Review as one of 100 great neurosurgery and spine programs.