Treatment

Once it became known that dopamine was depleted in patients with Parkinson’s
disease, a rationale opened for a potential treatment. Levodopa was
the first drug to be used to treat Parkinson’s disease successfully and is still
the most effective treatment available. Dopamine can pass from the blood
into the brain, and levodopa increases the synthesis of dopamine. The drug
does not cure the disease, but it is used in the attempt to control the symptoms.
Although the effectiveness of levodopa may diminish somewhat after
several years, most patients continue to benefit from its use. It is necessary to
monitor patients closely to maintain proper dose levels as well as to register
the appearance of new symptoms, side effects, and other complications.
A number of other drugs, alone or in combination, are being used or being
tested. Drugs that enhance the action of dopamine are dopaminergic
medications. Such drugs may increase dopamine release or may inhibit the
breakdown of dopamine. Other drugs are known as anticholinergic medications,
and these inhibit the action of acetylcholine.
Surgery has also been used to treat symptoms of Parkinson’s disease, but
results have been somewhat mixed. Surgical techniques include thalamotomy,
a procedure producing a lesions in the thalamus gland for relief of severe
unilateral tremor, and pallidotomy, the removal of part of the globus
palledus region of the brain, which is used to treat severe rigidity and
akinesia. More recently, transplantation of dopamine neurons from human
embryos directly into the brain of a patient with Parkinson’s disease has
been used. More trials are required, but results seem to indicate some improvement
in symptoms, including bradykinesia and rigidity. The use of human
tissue has raised many ethical issues because the tissue is taken from
aborted human fetuses. Attempts to use tissues from cultured cells are in
progress. None of the current treatments involving medication or surgery
have produced a complete reversal of the symptoms of Parkinson’s disease.

Sources for Further Study
Cram, David L. Understanding Parkinson’s Disease: A Self-Help Guide. Omaha,
Nebr.: Addicus Books, 1999. A physician, Cram provides a well-written account
of the symptoms and progression of the disease from his personal
perspective and also discusses present and future treatments.
Jahanshahi, Marian, and C. David Marsden. Parkinson’s Disease: A Self-Help
Guide. New York: Demos Medical Publishing, 2000. This book is an excellent
self-help guide. In addition to chapters on the basic medical facts
about Parkinson’s disease, there are chapters dealing with living and coping
with the disease from the personal and family point of view.
Kondracks, Morton. Saving Milly: Love, Politics, and Parkinson’s Disease. New
York: Public Affairs, 2001. The author provides a moving memoir of his
life with his wife, Milly, and the development and impact of Parkinson’s
disease.
Lanad, Anthony E., and Andres M. Lozano. “Parkinson’s Disease: The First
of Two Parts.” The New England Journal of Medicine 339, no. 15 (1998):
1044-1052. Comprehensive review of Parkinson’s disease includes information
on diagnosis and clinical features, pathology, epidemiology, genetics,
and a list of ninety-three references.
__________. “Parkinson’s Disease: The Second of Two Parts.” The New England
Journal of Medicine 339, no. 16 (1998): 1130-1143. The second part
of a two-part review on Parkinson’s disease. The article covers the pathophysiology
and various types of treatment and includes a list of 199 references.
Weiner, William J., Lisa M. Shulman, and Anthony E. Land. Parkinson’s Disease:
A Complete Guide for Patients and Families. Baltimore: Johns Hopkins
University Press, 2001. This book does an excellent job of giving current
information on the features and management of Parkinson’s disease and
also of providing valuable information on how families and patients can
deal with the practical and emotional aspects.
Donald J. Nash
See also: Alzheimer’s Disease; Brain Structure; Neuropsychology; Stress.