What to Know About Managing Parkinson’s Disease > News > Yale Medicine

Managing Parkinson’s disease involves a variety of considerations, including the person’s symptoms, lifestyle, day-to-day challenges, and the extent to which the disease has progressed.

It’s important to note that people with Parkinson’s aren’t always treated with medication right away. Instead, they may be encouraged to stay active. Research shows that exercise can help control symptoms and might even slow the disease’s progression (more on that below). Other beneficial lifestyle changes include following the Mediterranean diet, getting enough sleep, and engaging in intellectually stimulating activities.

When symptoms begin to significantly impact daily life, however, medications are usually prescribed to help increase dopamine levels, which decrease as the disease progresses.

One of the most effective medications is levodopa, which the body converts into dopamine. It comes in several forms, including pills, dissolvable tablets, and liquid. For advanced cases, a surgeon can insert a small tube into the small intestine to deliver levodopa continuously, providing better symptom control.

“While there are other medications, levodopa, which may be given with another drug called carbidopa, has been the primary treatment for people in severe stages of Parkinson’s disease for decades,” says Dr. Patel.

Another group of drugs, called dopamine agonists, mimic dopamine’s effects in the brain but are generally less effective and can cause side effects like nausea and vomiting. MAO-B inhibitors and COMT inhibitors can also enhance the effectiveness of dopamine, though they are typically used alongside other medications.

It’s important to note that the effectiveness of these medications can diminish over time. For instance, levodopa might become less reliable, leading to “off periods” where symptoms, such as tremors and muscle issues, reappear unexpectedly.

For very severe symptoms, such as intense tremors or frequent “off periods,” a surgical option called deep brain stimulation (DBS) may be recommended. This procedure involves implanting small electrodes in specific areas of the brain. Those electrodes are connected to a battery placed under the skin in the chest. The battery sends electrical signals to the electrodes, helping to block problematic brain activity without harming healthy tissue.

“When the disease progresses and the medication effect becomes more variable, DBS can have a clinically meaningful benefit in 90% of cases, often making tremors resolve completely,” Dr. Patel says. “While DBS is not a cure, the results can sometimes be dramatic and life-changing.”