Parkinson's disease (PD) can progress differently for everyone. In the later stages of the disease, your treatment options often include managing changes in your condition.
Palliative care can help you plan for changes in your movement, lower fall risk, and manage changes in your cognition (the way you think and remember).
Because everyone is different, you may not get clear-cut answers to your questions about your late-stage symptoms or how you'll respond to future treatment.
Learning about your treatment options for late-stage Parkinson's can help you better prepare and know what to expect. Whether your condition progresses fast or more slowly, you can explore ways and strategies to help keep your independence longer.
Talk to your doctor about which treatment options may work best for you, both now and in the future.
Exploring Later-Stage Parkinson's Treatment Options
The best way to treat Parkinson's disease uses a combination of medicines called levodopa (Inbrija) and levodopa plus carbidopa (Duopa, Rytary, Sinemet). These medicines often help control PD symptoms such as slow movements or rigidity.
The medicine works to fill in the dopamine that's missing in your brain. But over time, your medicine may start to work less.
More Treatment Choices for Parkinson's Disease
If you or your doctor thinks it's time to explore other options, you'll have many choices. Ask your doctor about what they recommend for you and why.
Your doctor might suggest changing your medication dose first. You can ask your doctor about:
- Any differences in how you'll take your medicines
- Potential medication side effects
- Other things that may affect your treatment plan
You and your doctor will review your medications and come up with the best treatment plan for your health. You'll review many other PD medicine options, too.
Medication 'On' and 'Off' Times
You might start to notice "on" and "off" times. These "on" times are when your medicine eases your symptoms, but "off" times might not.
One small study showed that "on" and "off" times can sometimes happen more quickly for women. When this first starts to happen, your doctor may raise your medication dose. But eventually, they may suggest adding, changing, or combining treatments.
Treating "off" periods
Apomorphine is a medication that can help during your "off" cycles. This medicine can help when your regular medicines aren't working to control your symptoms.
You can take apomorphine in different ways.
No matter which way you choose to take apomorphine, it starts working within 30 minutes or possibly sooner.
Deep Brain Stimulation For Later-Stage Parkinson's Symptoms
Deep brain stimulation (DBS) treatment can implant a device to deliver electrical impulses into your brain. First used to treat tremors, DBS can also help with some later-stage Parkinson's symptoms.
Although DBS can help many people, this treatment isn't right for everyone. As with any brain procedure, DBS can come with risks.
Your doctor may offer DBS if other medications aren't working anymore and you've had PD for at least four years. But keep in mind that DBS can only help with tremors, stiffness, and slowness.
DBS can't help with your other PD symptoms like sleepiness or mental changes. If you have dementia, your doctor may not suggest this treatment because the surgery can worsen your symptoms.
What to expect from DBS
Your surgeon will place fine wires (electrodes) into the parts of your brain that control movement. This can help calm down any abnormal brain activity that may cause your symptoms.
You'll have a battery pack, similar to a heart pacemaker, placed under your skin on your chest. The device can send signals to the electrodes.
After you've healed from your DBS surgery, your doctor can adjust the device to control your symptoms.
Adaptive deep brain stimulation
Your doctor may also suggest a newer type of DBS called adaptive deep brain stimulation (aDBS). Rather than sending constant, preset signals, aDBS fine-tunes the signals based on your brain's feedback.
You and your doctor can talk about DBS and decide if it's a good option for you to consider.
MRI-Guided Focused Ultrasound to Manage Parkinson's Symptoms
You won't need surgery for MRI-guided focused ultrasound. Your doctor uses an MRI scan to find target areas in your brain. Once found, they can send ultrasound waves to disrupt or destroy overactive brain circuits.
Ultrasound therapy can help improve your tremors and other symptoms, but it isn't for everyone. Studies show that ultrasound therapy can work and is relatively safe.
If your medicines aren't controlling your movement symptoms and DBS isn't an option, ultrasound therapy may help. Ask your doctor if you're a good candidate for focused ultrasound.
Treatment Advances for Later-Stage Parkinson's Disease
Research is ongoing around the world in search of safe and more effective treatments – or even a cure – for Parkinson's disease.
Follow Up With Your Doctor
If you have any changes or worsening symptoms, follow up with your doctor. They may adjust your existing medicines or suggest other medicines for you to try. You can also ask questions if you're curious about DBS or focused ultrasound.
You can also talk with your doctor about clinical trials. They can help you find out if you're a good candidate. You can also find information about clinical trials near you by searching ClinicalTrials.gov. Just type "Parkinson's disease" in the condition/disease search box and see what comes up.
Show Sources
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SOURCES:
American Parkinson Disease Association: "Treatment Options for Parkinson's."
Clinical Parkinsonism & Related Disorders: "Should "on-demand" treatments for Parkinson's disease OFF episodes be used earlier?"
Duke Health: "Phase 3 Study of CVN424 (Parkinson's Disease) – Clinical Trial."
Frontiers in Surgery: "An update on advanced therapies for Parkinson's disease: From gene therapy to neuromodulation."
Frontiers in Neurology: "Efficacy and safety of magnetic resonance-guided focused ultrasound for Parkinson's disease: a systematic review and meta-analysis."
Mass General Brigham: "Clinical Trial Tests Novel Stem-cell Treatment for Parkinson's Disease."
Michael J. Fox Foundation for Parkinson's Research: "Medications for Motor Symptoms," "Drug With Potential to Slow or Stop Parkinson's Moves into Next Phase of Clinical Testing."
NPG Parkinson's Disease: "Progression subtypes in Parkinson's disease identified by a data-driven multi cohort analysis."
Parkinson's Foundation: "Motor Fluctuations and Parkinson's 'Off' Times," "Adenosine A2A Antagonists," "New Continuous Pump Medication for Parkinson's Completes Trials in Europe," "Mainstay Parkinson's Medication Sometimes 'Wears Off' Faster for Women."
Trial Screen: "A Phase 1/2 study of CAP-003 gene therapy in Parkinson's Disease."
Social Studies of Science: "A history of deep brain stimulation: Technological innovation and the role of clinical assessment tools."
University of California San Francisco: "This New Treatment Can Adjust to Parkinson's Symptoms in Real Time."
