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Treatment options overview

The first "line of defense" against Parkinson's disease is pharmacotherapy. Under the guidance of a General Neurologist or specialised Movement Disorders Neurologist, the Parkinson's disease patient will first seek relief through drug therapies. When those therapies are not effective in controlling Parkinson's disease or produce intolerable side effects, surgical options are often explored.

Pharmacological Treatments
The following information on drug therapy is provided for informational purposes only. Medtronic makes no claims for drug effectiveness.
The appeal of using medication to control movement disorders is based on several factors:

Medications are very helpful for many patients. Many patients improve substantially with proper medication, although the improvement cannot always be maintained over long periods of time.
Drug therapy can be quickly modified. Dosages can be adjusted to try to maximise effectiveness and minimise side effects, and different medications can be used when current treatments lose effectiveness.
Drug therapy is a less invasive approach than surgical treatments.

The medications used in the treatment of Parkinson's disease seek to restore the balance between dopamine-based and acetylcholine-based neurotransmitter systems in the brain.

Medications	Mechanism
levodopa	dopamine replacement
carbidopa	slows metabolic breakdown of levodopa
bromocriptine, pergolide, pramimpexole, ropinerole	dompamine agonists, boots receptors for dopamine
biperiden HCI, trihexyphenidyl HCI, benzotropine, mesylate, procyclidine HCI	anticholinergics, suppress acetylcholine neurotransmitter system
amantadine	antiviral medication
selegiline	MAO-B inhibitor, slows breakdown of dopamine
tolcapone, entacapone	COMT inhibitors

What drug therapies are currently used to treat Parkinson's disease?
The drug levodopa is the standard treatment for Parkinson's disease. However, after five to ten years of taking levodopa, more than 80 percent of patients may experience disabling motor fluctuations due to 1) unpredictable changes in drug effectiveness, called the 'on-off effect' ; 2) sudden and unpredictable changes in movement, called levodopa-induced dyskinesia ; and/or 3) decreasing periods of drug effectiveness, called the 'wearing off effect'. These complications compromise long-term treatment.

Olanow CW. Clinical Crossroads, Conferences with patients and doctors at Boston's Beth Israel Hospital: a 61-year-old man with Parkinson's disease. Journal of the American Medical Association. 1996;275(9)716-722.)

Fahn S. Adverse effects of levodopa. In: Olanow CW, Lieberman AN, ed. The Scientific Basis for the Treatment of Parkinson's Disease. London, England: Parthenon Publishing Group; 1992:89-112.

Are there surgical therapies currently used to treat Parkinson's disease?

Pallidotomy
The surgical destruction of a portion of the globus pallidus is used to treat Parkinson's disease. This surgical approach is irreversible and may have to be repeated if symptoms recur. Pallidotomy may improve the symptoms of rigidity, bradykinesia, tremor, and dyskinesia, but it may also result in serious, permanent side effects, especially when performed on both sides of the brain

Deep Brain Stimulation (Parkinson's Control Therapy)
A surgical treatment developed by Medtronic in collaboration with medical researchers for controlling some of the primary symptoms of advanced, levodopa-responsive Parkinson's disease and reducing the dyskinesias from the antiparkinsonian medication. The therapy uses an implanted medical device to deliver electrical stimulation to block the brain signals that cause the symptoms of Parkinson's disease. It involves implanting a thin, insulated wire (called a lead) with four small electrical contacts (called electrodes) in targeted structures of the brain. The lead is connected by an extension to a neurostimulator. The neurostimulator is generally implanted near the collarbone. The stimulation level can be adjusted as needed to get the best possible symptom control . The therapy is reversible because the system can be turned off or removed without leaving any permanent effects.

More information on Deep Brain Stimulation

Stem Cell Implant
Stem cell implant (or nigral implant) is an experimental technique that involves transplanting foetal tissue into the brain to replace degenerated nerves. Many issues are still unresolved, such as the source of embryonic tissue, the amount of tissue required, the number of brain penetrations needed, and rejection of transplanted tissue.