Most neurologists treat people who have Parkinson’s disease with a medication called carbidopa/levodopa or Sinemet, as it is known by its brand name. We also offer several new FDA-approved therapies, surgery and other therapies that can greatly improve the quality of a patient’s life.
Recommendations will depend upon the course of the disease, the patient’s medical history and the neurologist’s estimation of which option is best for this particular patient.
New FDA-approved Parkinson’s therapies
Neurologists typically use these therapies in more advanced Parkinson’s disease or in special circumstances. Both therapies aim to increase “on” time, while reducing “off” time. “On” time refers to periods when Parkinson’s symptoms are adequately controlled. “Off” time refers to periods of the day when the medication is not working well, making symptoms worse.
- Rytary (pronounced rye-TAR-ee) is a long-acting carbidopa/levodopa medication.
- Increases total daily “on” time without troublesome dyskinesias (abnormal involuntary movements) by 1 to 2 hours a day compared to regular carbidopa/levodopa.
- Best used by people with significant “off” times during the day, where regular carbidopa/levodopa and other adjunctive (additional) medications are no longer working.
- Same side effects as regular carbidopa/levodopa.
- Quite expensive.
Duopa intestinal gel pump
The pump provides a continuous infusion of levodopa through a tube into the stomach/intestine.
- Provides about 2 hours a day of extra “on” time.
- May be a reasonable option prior to deep-brain stimulation (DBS).
- Relatively safe surgical procedure.
- Most people have some kind of tube-related side effects in the first 2 weeks of use.
Deep brain stimulation (DBS)
In deep brain stimulation, or DBS, a neurosurgeon places electrodes into the deep brain. The electrodes are connected by a wire to a battery implanted in the chest. Electrical pulses into the brain improve the patient’s movement.
- Improves motor symptoms and “off” times.
- Reduces medication requirements.
- Reduces dyskinesias.
- Only works on symptoms that carbidopa/levodopa are currently improving.
- Does not alter the natural course of the disease. Nothing can do that.
- Does not improve non-motor symptoms (speech, cognition, mood/behavior or autonomic symptoms such as dizziness or weakness); in fact, DBS may worsen non-motor symptoms.
Additional Parkinson’s therapy options
It’s important to know that there are additional or supplemental therapies and services that may greatly improve the patient’s quality of life:
- Physical therapy (PT) and/or occupational therapy (OT) can help with:
- Gait retraining, lower extremity strengthening and balance.
- Get this therapy as soon as you need it. Don’t wait until you fall.
- Occupational therapists can also do:
- Home safety evaluations
- Driving safety evaluations
- LSVT BIG® limb and body movement therapy and LSVT LOUD® speech therapy for Bradykinesia (slowness of movement)
- Make sure that your therapist is an LSVT certified clinician.
- Speech and language therapy
- Helpful for speaking and/or swallowing problems.
- Social work
- Very helpful for additional resources, assistance and emotional support.
- Read Dr. Snider’s first blog, Best medications for Parkinson’s.
- Watch Dr. Snider’s video, Parkinson’s Disease 101 from the 2015 U-M Parkinson’s and You Symposium
- Read more about Parkinson’s disease treatment at the University of Michigan Health System.
- Read more about the Clinical Neurosciences at the University of Michigan Health System
- The following Parkinson’s websites and organizations are good resources for more information:
Jonathan D. Snider, M.D., received his medical degree from the University of Michigan, where he is in the second year of a Movement Disorders Fellowship. Dr. Snider has a strong interest in the treatment of movement disorders and medical education.
The University of Michigan’s multidisciplinary neuroscience team is made up of more than 70 nationally recognized neurologists and neurosurgeons. Leading the way in brain, spine and nervous system care for close to 100 years, patients have access to services that can be found at only a handful of places as well as cutting-edge treatments with the latest research. Neurology and Neurosurgery at the University of Michigan Health System have been recognized by U.S. News & World Report numerous times for excellence in patient care.