Non-pharmacologic Therapy
Parkinson’s disease not only affects the various motor systems of the body; it also affects a patient’s overall functional status.  It is important that Parkinson patients do what they can to minimize the impact of this disease on their daily life.  Exercise is of major importance and can be in any form such as daily stretching, walking, swimming, bicycling, gardening or any other regular physical activity that allows for some physical conditioning.  A daily stretching routine is also beneficial.  In earlier stages of Parkinson’s disease, some patients are able to play golf or tennis.  The important point is that physical inactivity can cause accelerated deterioration of a patient’s functional abilities.

Diet can play an important role.  High protein diets may interfere with Ldopa absorption.  It is best to take L-dopa containing medications on an empty stomach or with low protein meals.  This can help minimize problems with motor fluctuation that occur in some patients.  A high fiber diet with adequate daily fluid intake will help to control constipation.  This is a problem that plagues most Parkinson patients.

Physical therapy for gait and balance rehabilitation can be beneficial in patients who have had significant deterioration of balance, walking abilities, and overall functioning.  Unless patients continue at home what they were taught in therapy, their condition will again deteriorate making therapy pointless.  This therapy must also be combined with some form of regular exercise to be maximally effective.  Swallowing difficulty can also be helped to a degree.  Speech therapy can provide a patient with certain maneuvers, head positioning and techniques to minimize the risk of choking or swallowing food/liquids down into the lungs (aspiration.)

Daytime drowsiness, sleepiness and frequent naps are a problem. Some of this is from the Parkinson’s disease itself, but many of the medications can make this problem worse. Patients are encouraged to drink 1-3 cups of regular coffee daily to help combat this. Coffee also helps with control of constipation. Caffeine tablets can be substituted for patients who will not drink regular coffee.

Support groups provide the patient, family and caregivers with the needed educational and emotional support that is frequently lacking.  These groups are a good source for up-to-date information on Parkinson’s disease and the newest therapies that become available.  Patients, family members, caregivers and interested friends should all become involved in their local Parkinson’s disease support groups. Click here for links to national support groups and more Parkinson’s information.

Surgical Treatment of Parkinson’s disease
Researchers have looked for years for a surgical method that could be used to successfully treat Parkinson’s disease. There are three different surgical approaches to treatment of Parkinson’s disease: 1-pallidotomy/thalamotomy, 2-brain stimulator implantation, 3-neural transplantation.  Surgical treatment is helpful for Parkinson patients that have significant motor fluctuations that are not controlled with medications.  These fluctuations include tremor, excessive freezing, dyskinesias, dystonia, and off time.  The current primary surgical treatment for Parkinson’s disease is deep brain stimulator implantation. It is important to note that with surgical treatment of Parkinson’s disease, the best that a patient will do is only as good as they are on their best on time on Sinemet.  Surgery does not reverse the neurodegenerative process.  Patients with dementia or other significant psychiatric symptoms are not candidates for surgical therapy.

Pallidotomy was the first surgical therapy used for treatment of Parkinson’s disease.  In this procedure, a highly trained neurosurgeon inserts a small needle electrode deep into the brain into the globus pallidus.  The procedure is painless and the patients are fully awake.  Using precision localization techniques, the neurosurgeon creates a small lesion at the tip of the electrode, to intentionally destroy a few brain cells.  The clinical effect of a pallidotomy is to relieve some of the disabling symptoms of Parkinson’s disease. Another similar surgical procedure known as a thalamotomy was also used.  Neither of these procedures is used in the current surgical treatment of Parkinson patients.

State-of-the-art therapy for Parkinson’s disease now involves deep brain stimulator (DBS) implants.  The FDA has approved DBS implantation in patients with intention tremor (essential or familial tremor), Parkinson’s disease and dystonia.  Stimulators are effective for severe motor fluctuations.  A deep brain stimulator is similar to a heart pacemaker, but the electrodes are placed in specific areas of the brain instead of the heart.  Deep brain stimulators offer great advantages over pallidotomies and thalamotomies in that it does not involve brain cell destruction.  The stimulators can be fine tuned as the Parkinson symptoms progress or change.  A stimulator can only regulate one side of the brain; therefore, two stimulators would need to be implanted if a patient was having disabling symptoms on both sides. The Kinetra stimulator unit was approved in late 2003 by the FDA.  This is a single unit that can control 2 sets of electrodes, thereby eliminating the need for placement of the second stimulator.

Lastly, there has been an interest in transplantation of dopamine cells into a Parkinson patient’s brain.  Research in the transplantation of fetal pig cells (dopamine containing nerve cells) has shown some promise in alleviating some of the troublesome clinical symptoms of Parkinson’s disease.  Some research even suggests that Parkinson’s disease may be partially reversed.  Research into this area is ongoing and the final conclusions about this procedure’s effectiveness are still several years off.