Treatment Options for Motor and Non-Motor Symptoms of Parkinson's Disease

Abstract

Parkinson's disease (PD) usually presents in older adults and typically has both motor and non-motor dysfunctions. PD is a progressive neurodegenerative disorder resulting from dopaminergic neuronal cell loss in the mid-brain substantia nigra pars compacta region. Outlined here is an integrative medicine and health strategy that highlights five treatment options for people with Parkinson's (PwP): rehabilitate, therapy, restorative, maintenance, and surgery. Rehabilitating begins following the diagnosis and throughout any additional treatment processes, especially vis-à-vis consulting with physical, occupational, and/or speech pathology therapist(s). Therapy uses daily administration of either the dopamine precursor levodopa (with carbidopa) or a dopamine agonist, compounds that preserve residual dopamine, and other specific motor/non-motor-related compounds. Restorative uses strenuous aerobic exercise programs that can be neuroprotective. Maintenance uses complementary and alternative medicine substances that potentially support and protect the brain microenvironment. Finally, surgery, including deep brain stimulation, is pursued when PwP fail to respond positively to other treatment options. There is currently no cure for PD. In conclusion, the best strategy for treating PD is to hope to slow disorder progression and strive to achieve stability with neuroprotection. The ultimate goal of any management program is to improve the quality-of-life for a person with Parkinson's disease.

Keywords: Parkinson’s disease; anti-inflammatory; antioxidants; carbidopa/levodopa; integrative medicine; motor and non-motor symptoms; neurodegenerative disorder; older adults; substantia nigra.

Figure 1

Treatment options for PD. As depicted, this PD-directed integrative and health strategy features five areas where intervention can be used to manage the numerous symptoms of PD. A treatment example from each category is given. Although drawn as a stepwise progression from A–E, this is not suggesting that PwP engage all five treatment options at all or in order of their presentation (Figure 1). Treatment option A (Rehabilitate) is considered a reversible entry and exit point to the treatment wheel described by options B (Therapy), C (Restorative), D (Maintenance), and E (Surgery). Please note that the various treatment options are not isolated silos that can only be accessed after fulfilling the prior treatment option. It is more likely that PwP, with guidance and advice from movement disorder neurologists, would likely use several components found in treatment options A–D that may change as their disorder progresses before possibly moving finally to option E (Surgery). Post-surgery-PD patients, assuming a successful response to surgery and under continual guidance from their medical team, would re-engage the A–D treatment options. Furthermore, aspects of the Therapy, Restorative, and Maintenance treatment options overlap and complement one another to develop an effective PD treatment plan.

Figure 2

Structures of some of the key molecules involved in dopamine synthesis, drug therapy, and PD.

Figure 3

Structures of the CAM maintenance compounds used for PD treatment.