Treatment options

Control and relieve symptoms

The symptoms of Parkinson's disease are caused by insufficient levels of dopamine in the brain due to the loss of dopamine-producing nerve cells. Therefore Parkinson's disease is treated with drugs that aim to replace or increase the amount of dopamine in the brain. These are known as dopaminergic drugs, and there are several types that work to increase dopamine levels in different ways (see table below). This means that some drugs are better at treating certain symptoms than others.

Levodopa is referred to as the ”gold standard” of therapy for Parkinson's diseaes. Most patients with Parkinson's disease will be prescribed levodopa at some point during their treatment.

The benefits of levodopa usually last for 2-5 years. However, after this period, patients may start to experience gradual changes in the drug's effectiveness, including:

• Wearing off - the effects of each dose begin to wear off more quickly
• Motor fluctuations - the rapid switches between good and poor symptom control (ON-OFF time)
• Dyskinesias - the appearance of uncontrollable movements

Therefore, in the early stages of the disease, patients may be prescribed drugs other than levodopa (for example, a dopamine agonist or an MAO-B inhibitor), thereby saving the benfits of levodopa for later stages and delaying the appearance of these complications. In cases where treatment is started with levodopa, other drugs may be added to minimise the impact of wearing off and fluctuations.

Please note that this document is part of the Parkinson's disease handbook. Please fell free to download the full Parkinson's disease handbook from the right-hand toolbox if you would like to learn more.