Treating Parkinson’s Disease

There are now dozens of different medications used to treat Parkinson’s symptoms, as well as many new approaches in the research pipeline. There have also been innovations in medication delivery. Many people with Parkinson’s disease benefit from a medication called levodopa which helps replenish dopamine in the brain. In addition to forms of levodopa taken by mouth (of which there are many), we now also have options for inhaled levodopa and levodopa delivered continuously to the intestines via a tube placed through the abdomen.

In addition to medication options, therapy is an important component of a Parkinson’s treatment plan. Physical therapy can improve walking, balance, and strength and can help reduce the risk of falls. Occupational therapy can improve manual dexterity and help develop strategies to compensate for tremor. Speech therapy can improve volume and clarity of speech, and improve swallowing. Cognitive therapy can help develop strategies to manage cognitive issues that arise for some people with PD. Psychotherapy can help manage anxiety and depression, which are troublesome for many people with PD.

There is no “one size fits all” treatment recommendation for Parkinson’s disease. We tailor our multidisciplinary approach to best fit the needs of each patient. In general, to be considered for one of the surgical treatments, people should experience symptoms that limit their quality of life despite satisfactory treatment with medications and therapy.

Contrary to many people’s expectations, surgical therapies are not reserved only for patients with very advanced disease. In fact, people benefit most from surgical therapies when they are used earlier in the course of the disease to manage troublesome movement symptoms as they arise, rather than before they result in chronic disability.

If you have bothersome motor symptoms despite medication therapy, you should discuss the possibility of surgical therapy with your Parkinson’s neurologist. If you would like to learn more about surgical options to treat PD, you may also contact us to schedule a consultation at MGH.

There are many different medications to treat Parkinson’s disease symptoms and each has different potential side effects which also vary from person to person. It is best to discuss your particular medications and side effects with your Parkinson’s disease treatment team, as these factors are considered carefully when recommending the best treatment plan for each patient.

Most people treated with deep brain stimulation (DBS) do not experience lasting side effects. However, it is important to understand that side effects or complications do occur for some people.

On average, 1% of people may have a new, lasting neurologic symptom after surgery due to bleeding in the brain or stroke. Infections requiring additional surgery occur in 1-2% of people. Seizures also occur in 1% of people after DBS surgery, but it is unusual to require longstanding anti-seizure medication.

When the stimulator is turned on, some people may experience tingling, cramping, slurred speech, or problems with balance. These side effects can be addressed by changing the settings of the DBS. As part of your DBS consultation, we always have a thorough discussion of potential risks of DBS therapy.

If you are interested in learning more about surgical therapies for Parkinson’s disease, you can call to request a consultation. If you already have a Parkinson’s neurologist, consider discussing with him or her whether referral to our program is appropriate.

We offer a one-day fast-track DBS clinic, during which you will meet with members of our Parkinson’s DBS team from the MGH Neurology, Neurosurgery, and Neuropsychiatry departments. During DBS evaluation, you will learn about the risks, benefits, and process of DBS at MGH.

At the DBS clinic, we discuss in detail what PD symptoms bother you the most and what treatments you have already tried. We provide a personalized assessment of which of your symptoms would be likely to improve with DBS, and which symptoms are likely to remain after DBS. There is ample time to ask any questions you have about DBS or alternative therapies.

For the first approximately 3 months after DBS surgery, you will have follow-up visits every 2-4 weeks in order to determine the most effective settings for your DBS device.

During these visits your DBS neurologist will make adjustments to your stimulator settings while observing your symptoms. You will also discuss changes to your Parkinson’s medications.

While some Parkinson’s symptoms respond quickly to DBS, you should expect that improvements will occur gradually the first few months. Most people are on stable DBS settings within 3 months, though fine tuning may continue after that point. After that, you will generally have follow-up appointments according to your typical schedule, which for most people is every 3-6 months. For people who do not live near Boston, it is also possible to continue to see your own nearby neurologist for Parkinson’s care, and perform DBS check-ups with us on an annual basis.