Nutrition is a vital component of maintaining and preserving good health. It may be an especially important consideration when one has a disease or other health condition that may impose certain dietary requirements or restrictions. At the same time, the standard recommendations for good health still stand – heart healthy eating, weight control, adequate fluid intake, limiting alcohol consumption, and more. With Parkinson’s disease, dietary choices and habits can help alleviate some symptoms. For example, fluid and fiber intake may help with constipation, increasing fluid intake may alleviate orthostatic hypotension, the feeling of dizziness when standing up, and a high protein meal can interfere with levodopa absorption, leading to fluctuations in medication effectiveness. In this second of two episodes with Dr. John Duda, Director of the Parkinson’s Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center and Professor of Neurology at the University of Pennsylvania, a Parkinson’s Foundation Center of Excellence, he tells what he recommends about diet and nutrition for his Parkinson’s patients, including when to look for organically grown produce.
Released: March 9, 2021
John Duda, MD is the Director of the Parkinson's Disease Research, Education and Clinical Center (PADRECC) and Co-Director of the Center for Neurotrauma, Neurodegeneration and Restoration of the Cpl. Michael J. Crescenz VA Medical Center and a Professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania. For the past 19 years, he has worked with his colleagues in Philadelphia to provide state-of-the-art care for thousands of Veterans with PD and related disorders.
His research activities have included basic science investigations into the role of Lewy pathology in the pathophysiology of Parkinson’s disease and related disorders as well as investigations into the mechanisms involved in traumatic brain injury. He has also conducted clinical research in Parkinson’s disease with studies of deep brain stimulation therapy, transcranial magnetic stimulation, the benefits of a plant-based, whole food diet, and the use of olfaction as a biomarker of disease diagnosis and progression. He has received research grants from the Department of Veterans Affairs, NIH, the Michael J. Fox Foundation for Parkinson Research, and the Department of Defense. He has been recognized as a BLR&D Senior Clinical Research Scientist and authored more than 120 scientific publications including articles in JAMA, Science, Neuron, The New England Journal of Medicine and Neurology.
A major thrust of Parkinson’s research today is exploring potential ways to slow the progression of the disease. Exercise may be one way and is recommended. Another possible approach is nutrition, although the evidence is not as solid as for exercise. Nonetheless, there is evidence that good nutrition and dietary practices can have beneficial effects for people with Parkinson’s, including lessening digestive symptoms, as well as preserving quality of life by lowering the risk of heart disease, stroke, diabetes, high blood pressure, and dementia. Improving digestive function may even improve the absorption and actions of medications. Dr. John Duda, Director of the Parkinson’s Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center and Professor of Neurology at the University of Pennsylvania, a Parkinson’s Foundation Center of Excellence, recommends a plant-based, whole foods diet. In this podcast, the first of two with Dr. Duda, he explains what a whole foods diet is, how it differs from a standard American diet, and how people can reliably and comfortably change the way they eat.
Released: February 23, 2021
John Duda, MD is the Director of the Parkinson's Disease Research, Education and Clinical Center (PADRECC) and Co-Director of the Center for Neurotrauma, Neurodegeneration and Restoration of the Cpl. Michael J. Crescenz VA Medical Center and a Professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania. For the past 19 years, he has worked with his colleagues in Philadelphia to provide state-of-the-art care for thousands of Veterans with PD and related disorders.
His research activities have included basic science investigations into the role of Lewy pathology in the pathophysiology of Parkinson’s disease and related disorders as well as investigations into the mechanisms involved in traumatic brain injury. He has also conducted clinical research in Parkinson’s disease with studies of deep brain stimulation therapy, transcranial magnetic stimulation, the benefits of a plant-based, whole food diet, and the use of olfaction as a biomarker of disease diagnosis and progression. He has received research grants from the Department of Veterans Affairs, NIH, the Michael J. Fox Foundation for Parkinson Research, and the Department of Defense. He has been recognized as a BLR&D Senior Clinical Research Scientist and authored more than 120 scientific publications including articles in JAMA, Science, Neuron, The New England Journal of Medicine and Neurology.
Episode 70: The Role of the Microbiome in PD: Part Two
Our bodies contain more than just our own human cells. We normally live in harmony with a vast array of microorganisms occupying specific spaces, or niches, on and within us. These bacteria, fungi, viruses, and protozoa form the human microbiome. The ones in the gut, mainly within the colon (large intestine), normally maintain a health balance and keep “bad” microbes from overpopulating that area of the digestive system. The normal gut organisms, consisting of around 1,000 different species of bacteria as well as other microbes, outnumber all the human cells in our bodies.
The gut microbiome acts locally and systemically, meaning it interacts with other parts of the body. Locally in the gut, the microbiome digests foods, helps to regulate the immune system, and produces vitamins that our bodies need for metabolism, nerve function, and blood clotting but that they cannot produce on their own.
There is mounting evidence that the gut microbiome also interacts with the nervous system, including the brain, in health and disease. Its effects also reach beyond the gut. Evidence points to a role for it in the faulty regulation of the immune system, leading to such diseases as rheumatoid arthritis, multiple sclerosis, diabetes, and allergies.
In this episode, Ai Huey Tan of the University of Malaya in Kuala Lumpur, Malaysia discusses what is known about the role of the gut microbiome as it affects Parkinson’s disease and its treatment and what researchers are continuing to investigate.
Released: December 17, 2019
Dr. Tan Ai Huey is a Senior Lecturer and Consultant Neurologist at the University of Malaya Medical Centre, Malaysia. She completed her specialty training in Neurology at the University of Malaya, Malaysia. Her main areas of research are in Parkinson's Disease and Movement Disorders, with a particular interest in exploring the role of gut infections and neuro-inflammation in Parkinson's Disease, and the characterization of rare/"orphan" diseases. She has numerous peer-reviewed journal publications and book chapters and has been awarded the Best Neuroscience Publication Award (UM Faculty of Medicine), and the International Scholarship Award from the American Academy of Neurology.
Dr. Tan has served as a Council Member of the Malaysian Movement Disorder Council since 2013 and was Co-Author of the National Consensus Guidelines for the treatment of Parkinson's disease. Currently, she is the Honorary Secretary of the Malaysian Society of Neurosciences (MSN), the professional body that represents Malaysian clinicians and scientists in the neurology/neuroscience field. At the international level, she serves on several committees in the International Parkinson’s and Movement Disorder Society (MDS) including the MDS Education Committee, which oversees the planning of movement disorder education programs around the world.
Episode 68: The Role of the Microbiome in PD: Part One
How and why Parkinson’s disease (PD) starts and progresses is still not exactly known, but active research points to genetics and environment, among other factors. The environment is both external and internal – external in terms of what people encounter outside their bodies and internal in terms of what is inside their bodies. Researchers studying a variety of diseases have learned the importance of the microbiome in health and disease. The microbiome consists of all those bacteria, fungi, and viruses that occupy niches on and inside of people, such as on the skin, in the nose and mouth, and in the gut. These organisms can have far reaching effects in the body, distant from their own locations. Some of these interactions can affect the brain.
Ali Keshavarzian, MD, Chief of the Division of Digestive Diseases and Nutrition at Rush University in Chicago has been studying the role of the gut microbiome and its relation to inflammation, such as in inflammatory bowel disease, in addition to more distant sites including in the brain. His research includes the role of the gut microbiome as a contributing factor to the development and progression of PD as well as the potential to manipulate it to help manage the disease. He conducts both basic science research using animal models and clinical research with people with PD.
Released: November 19, 2019
Ali Keshavarzian, MD, FRCP, FACP, MACG, AGAF the Josephine M. Dyrenforth Chair of Gastroenterology, Professor of Medicine and the Graduate College, Director of the Division of Digestive Diseases and Nutrition (1999) and Director of the Institute for Advanced Study of the Gut, Chronobiology and Inflammation (2017) at Rush University Medical Center in Chicago, Illinois has been a practicing gastroenterologist with a specialty in managing patients with inflammatory bowel disease for over 30 years.
As a clinician scientist, he has been studying the impact of environmental factors [stress, alcohol, sleep and circadian disruption] on intestinal barrier function host/microbe interaction that promote intestinal and systemic [gut-derived] inflammation leading to initiation and/or progression of inflammatory disorders including IBD, IBS, food allergy, metabolic syndrome, alcoholic cirrhosis, NASH and Parkinson’s disease. He has contributed to over 350 published articles [h-index of 77] and book chapters. His works have been supported by multiple NIH, DoD, NASA and USDA grants. He was one of the first investigators to report the key role of oxygen free radicals in tissue injury in inflammatory bowel disease and one of the first investigators to begin to focus on the role of intestinal microbiota in health and disease in alcoholism, IBD, cancer, HIV and Parkinson. He is one of the early investigators to examine the effects of circadian and sleep disruption on GI tract and to report the negative impact of sleep and circadian disruption in IBD.
The focus of this webinar will be to address the needs of veteran’s living with Parkinson’s disease (PD). A healthy lifestyle is an important part of living well with Parkinson’s. Physical exercise is well-established as beneficial for symptom control and possibly disease modification, and physicians regularly counsel patients to increase overall fitness. Similarly, diet and overall brain health can be another tool to fight PD. This webinar will explore how exercise, dietary choices, stress management, sleep and social connection can affect your brain health and PD care.
John Eric Duda, MD
Professor of Neurology at the Veteran's Administration Medical Center
Director, Parkinson's Disease Research, Education and Clinical Center of the Michael J. Crescenz VA Medical Center, University of Pennsylvania
Co-Director, Center for Neurotrauma, Neurodegeneration and Restoration of the Michael J. Crescenz VA Medical Center, University of Pennsylvania
James F. Morley, MD, PhD
Assistant Professor of Neurology at the Veteran's Administration Medical Center Staff Neurologist, Philadelphia VA Medical Center
Associate Director, University of Pennsylvania/PADRECC Movement Disorders Fellowship Program. Co-director, Parkinson's Disease Research, Education and Clinical Center, Crescenz VA Medical Center
Podcasts
Episode 93: Benefits of Practicing Tai Chi Chuan Exercises
Many people find that Eastern mind-body practices complement Western medicine well and produce additional benefits. One Eastern system of mind-body integration is tai chi and its martial art practice of tai chi chuan. Using continuous, flowing movements, this moving meditation addresses flexibility through stretching and involves aerobic activity and relaxation as well. Through the practice of tai chi, people can develop better awareness of movement and actions, develop better body alignment, posture, core strength, and breath support and control. Studies have shown physical benefits on balance and slowing the decline in motor control as well as mental health benefits in terms of stress management, possibly cognition, and quality of life for people with Parkinson’s and their care partners. In this episode, Dr. Pei-Fang Tang, professor of physical therapy in the School of Physical Therapy at National Taiwan University, says tai chi is based on ancient Chinese philosophy, part of which is a dynamic balance between yin and yang, which are invoked by the movements in its practice and which bring balance to one’s life.
Released: November 17, 2020
Professor Tang earned her BS degree in physical therapy from National Taiwan University, MS degree in physical therapy from University of North Carolina at Chapel Hill, and PhD degree in Exercise and Movement Science from University of Oregon. Her research interests focus on the influences of aging processes and neurologic disorders, especially stroke and degenerative ones, on the cognitive control, neuromuscular control, and brain mechanisms of motor control and motor learning. She also is interested in studying the efficacy and neural mechanisms of different forms of exercise interventions in the promotion of cognitive and motor functions, as well as neuroplasticity, and in the prevention of dementia and disability in middle-aged and older adults and in people with neurologic disorders. The primary research tools her lab uses are movement analysis, biomechanics, and neuroimaging techniques.
Hi. I’m Reka Janisse, and I live with young-onset Parkinson’s disease (YOPD). My symptoms began at 39, and I was officially diagnosed at 42. I’ve learned that Parkinson’s isn’t just about tremors — it’s an unpredictable mix of over 40 possible symptoms, from bradykinesia (slowness of movement) to dyskinesia (involuntary movement of face, arms or legs) and every day can feel different. Some mornings I’m dancing on TikTok, and others I’m moving in slow motion. The key? I never let two bad days stack up.
I approach Parkinson’s like I do my fitness training: with discipline, curiosity, and a lot of humor. Alongside medication, I lean on what I call “frosting therapy” — the lifestyle habits that make the whole journey more manageable. That means prioritizing exercise and focusing on muscle building as a way to fight back against symptoms.
I’m currently training to compete in my second HYROX, a high-intensity fitness competition, because mobility, strength and resilience are my best long-term strategies. Every PR (personal record) in the gym feels like a personal win over Parkinson’s.
I chose to tackle HYROX Dallas as a Parkinson's Champion, where I could design my own event. Not only will it challenge me physically, but the fundraising will help everyone living with PD. I’m interested in spreading awareness and inspiring others to take on a challenge. It’s you against you and it’s such a fulfilling and rewarding challenge especially if you do it year after year and get to work on improving your time. Considering this is a degenerative disease that is a thrilling goal to achieve!
Nutrition is another cornerstone. I’ve made it a non-negotiable to measure my meals and keep my diet steady, not out of obsession but because I know how much it impacts my energy, my gut health and even dopamine production. Food is fuel — and in my case, it’s therapy, too.
I also stay tuned into innovative approaches — like red light therapy, sauna and cold plunge therapy, and supplements — because supporting my body at the cellular level helps me manage symptoms and maintain quality of life. My main focus is to reduce oxidative stress and inflammation and improve cellular health.
Most importantly, I share this journey publicly on Instagram, Facebook, and TikTok to build awareness, reduce the stigma surrounding Parkinson’s, and bring some laughter into a space that often feels heavy. Humor is my superpower. By mixing honest education with moments of levity, I aim to show that living with Parkinson’s doesn’t mean losing joy.
I mostly rely on social media for my updates and news about Parkinson’s. I love the Parkinson’s Foundation Instagram page! Follow them on Instagram now.
My mission is to inspire and empower others, especially those diagnosed at a younger age, to take ownership of their health. Parkinson’s is part of my story, but it’s not my whole story. With movement, nutrition, community, and a little sass, I’m proving every day that you can live strong, laugh loud, and push back against this disease.
La medicación desempeña un papel fundamental en el tratamiento de la enfermedad de Parkinson (EP), pero es sólo una parte de un plan de cuidados más amplio.
El siguiente artículo se basa en una Charla con Expertos - Expert Briefing de la Parkinson's Foundation donde el Dr. Danny Bega explora cómo encajan los medicamentos en el cuidado integral y holístico del Parkinson. El Dr. Bega tiene una maestría en Ciencias, es profesor adjunto de Neurología, director médico y director del programa de residencia en Neurología del Centro de la Enfermedad de Parkinson y Trastornos del Movimiento de la Northwestern University Feinberg School of Medicine, un Centro de Excelencia de la Parkinson’s Foundation. También es director de los programas de las enfermedades de Huntington y Wilson en Northwestern.
Comprender la conexión entre la dopamina y el Parkinson
El Parkinson es un trastorno progresivo relacionado con la disminución de los niveles de dopamina, una sustancia química cerebral que influye en el movimiento, la memoria y muchos otros procesos vitales del organismo. Otras sustancias químicas del cerebro, como la norepinefrina y la serotonina, también pueden verse afectadas en la enfermedad de Parkinson e influir en los síntomas.
A medida que avanza el Parkinson, el número de células cerebrales que producen dopamina sigue disminuyendo y las células restantes luchan por almacenar y liberarla. Esto provoca lentitud de movimientos, temblores, rigidez y otros síntomas motores. También puede causar diversos síntomas no motores, como estreñimiento, pérdida del olfato y cambios en el pensamiento.
Manejo del Parkinson’s
El Parkinson es una enfermedad compleja. No existe un tratamiento estándar. Sin embargo, los medicamentos —junto con el ejercicio, la atención integral, una dieta nutritiva y prácticas de atención plena— pueden controlar los síntomas del Parkinson y ayudarle a vivir bien.
Establecer una rutina de ejercicio poco después del diagnóstico puede ayudar a ralentizar la progresión de la enfermedad y mejorar el movimiento, la fuerza, el equilibrio y el estado de ánimo. También puede ayudarle a dormir mejor. Mantenerse social e interactuar puede reducir la sensación de soledad.
Su equipo de atención es igualmente importante. Busque profesionales médicos expertos en Parkinson, incluyendo un neurólogo, un terapeuta del habla y el lenguaje, un fisioterapeuta y un terapeuta ocupacional, un trabajador social y otros profesionales de la salud, para que le ayuden a controlar los síntomas de la EP. No deje de acudir a las revisiones periódicas.
El papel de los medicamentos
La mayoría de los medicamentos para el Parkinson mejoran los síntomas aumentando la dopamina en el cerebro o actuando como la dopamina. La levodopa es el fármaco más eficaz para tratar los síntomas del Parkinson. En el transcurso del Parkinson, la mayoría de las personas tomarán levodopa en algún momento.
La ansiedad y la depresión también pueden ser frecuentes en el Parkinson y afectar al bienestar incluso más que los síntomas motores. Tratar estos síntomas mediante una combinación de medicamentos, como un ISRS, un IRSN o la mirtazapina, —un antidepresivo tricíclico—, junto con terapia, control del estrés y mantener la actividad física, puede reducir la discapacidad significativamente.
Las personas recién diagnosticadas de Parkinson a menudo se preguntan cuándo deben empezar a tomar la medicación. Los estudios demuestran que esperar no tiene beneficios. La mayoría de los médicos concuerdan en que debe empezar a tomar la medicación cuando los síntomas se vuelvan molestos.
Dado que no cada persona experimenta la EP de forma única, los tratamientos varían de una persona a otra, al igual que el ritmo de progresión. Sin embargo, conocer los estadios típicos del Parkinson puede ayudarle a anticiparse a los cambios:
En los primeros cinco años después del diagnóstico, es posible que los síntomas no afecten su vida diaria significativamente. Su médico podría recomendarle un ensayo clínico. La participación en la investigación del Parkinson podría darle acceso temprano a nuevos tratamientos, mejorar la atención y sentar las bases para una cura.
En un plazo de uno a diez años, conforme los síntomas empiezan a interferir con las actividades, la mayoría de las personas con Parkinson pueden esperar una respuesta duradera y constante a la medicación.
Entre cinco y 20 años después del diagnóstico, al cerebro le resulta cada vez más difícil conservar dopamina. La respuesta de su cuerpo a la levodopa puede volverse más corta y menos eficaz. Esto puede provocar fluctuaciones motoras: periodos en "on", cuando la medicación funciona bien, y periodos en "off", cuando la medicación deja de hacer efecto y los síntomas reaparecen. Es importante trabajar de cerca con su médico para ajustar el tratamiento y encontrar lo que mejor se adapte a usted.
Después de 10 o más años de vivir con Parkinson, las personas pueden experimentar problemas más importantes. Algunas personas pueden desarrollar importantes problemas de memoria y pensamiento. Problemas de equilibrio, caídas y congelamiento (la incapacidad temporal para moverse) también puede volverse un problema. Su médico puede hablarle de ajustes de la medicación o terapias farmacológicas o mandarlo a ver a un profesional médico adecuado para sus necesidades, que puede ser un neuropsicólogo, un psiquiatra, un terapeuta del habla y el lenguaje o un terapeuta ocupacional.
Tipos de medicamentos utilizados en el Parkinson
Es frecuente que las personas con Parkinson tomen una variedad de medicamentos, en distintas dosis y momentos del día, para manejar los síntomas. Esto puede incluir:
Agonistas de la dopamina: al principio, los fármacos que estimulan la dopamina en el cerebro, como el pramipexol, el ropinirol y la rotigotina, a menudo pueden tratar los síntomas motores del Parkinson. Los agonistas de la dopamina presentan menos riesgo de discinesias, movimientos erráticos involuntarios que suelen comenzar tras unos años de tratamiento con levodopa.
Los efectos secundarios pueden incluir náuseas, mareos, somnolencia, confusión y trastornos del control de los impulsos, como compras compulsivas, juegos de azar, comer en exceso y los impulsos sexuales. Los estudios muestran que un 28% de las personas con Parkinson dejan de tomar agonistas de la dopamina debido a los efectos secundarios, mientras que un 40% necesita añadir otra medicación en un plazo de dos años.
Levodopa: la levodopa, el fármaco más eficaz para los síntomas motores del Parkinson, sustituye a la dopamina en el cerebro. Suele administrarse en combinación con el fármaco carbidopa para reducir las náuseas, un efecto secundario frecuente. Tomar levodopa con las comidas también puede reducir las náuseas, pero las proteínas pueden interferir en la eficacia del fármaco. Alrededor de un 2% de las personas dejan de tomar levodopa debido a los efectos secundarios, mientras que un 15% necesita añadir otra medicación a los dos años.
Las discinesias, también relacionadas con la levodopa, pueden controlarse a menudo mediante un ajuste de la dosis o mediante tratamiento directo, utilizando un medicamento llamado amantadina. Funciona bloqueando el NMDA, una sustancia química que provoca movimientos extras. La amantadina de liberación inmediata también se utiliza a veces sola para los síntomas motores del Parkinson. Existe un mayor riesgo de confusión y alucinaciones con el uso de amantadina en personas de más de 75 años. También puede asociarse a hinchazón de piernas, alteraciones de la piel y otros efectos secundarios.
Anticolinérgicos:Los medicamentos trihexifenidilo y benztropina se utilizan a veces para mejorar el temblor o las distonías (calambres dolorosos y sostenidos). Actúan bloqueando la acetilcolina, una sustancia química del cerebro relacionada con el movimiento. Sin embargo, su uso debe evitarse en personas de 70 años o más debido al riesgo de confusión y alucinaciones. Los anticolinérgicos también pueden asociarse a visión borrosa, sequedad de boca, estreñimiento y retención urinaria.
Algunos de los medicamentos que su médico podría considerar para mejorar los efectos de la levodopa son:
Inhibidores de la MAO-B: los inhibidores de la monoaminooxidasa B rasagilina, selegilina y safinamida ponen más dopamina a disposición del cerebro. Estos medicamentos pueden utilizarse solos o en combinación con la levodopa para aumentar su eficacia. Los inhibidores de la MAO-B suelen tolerarse bien, pero un 70% de las personas que los toman solos para el Parkinson necesitarán añadir otra medicación a los dosaños.
Inhibidores de la COMT: medicamentos como la entacapona y la opicapona aumentan la levodopa disponible en el cerebro al bloquear la enzima catecol-O-metil transferasa.
Antagonista del receptor A2A: la istradefilina, un antagonista de la adenosina A2A, bloquea la adenosina en los receptores A2A del cerebro para reducir el tiempo en "off" de la levodopa.
La levodopa inhaladase utiliza a menudo con la levodopa, según sea necesario, para el tiempo en "off" repentino. La apomorfina inyectable también puede utilizarse a demanda, para el alivio en tiempos en "off". Ambos medicamentos pueden aumentar el riesgo de discinesias.
Es importante trabajar con su médico para encontrar el equilibrio adecuado para usted. Su médico puede aumentar o disminuir su dosis de levodopa con base en sus síntomas. Por ejemplo, el temblor, la rigidez o los problemas de movilidad podrían beneficiarse de un aumento de la levodopa. Sin embargo, las alucinaciones, la confusión y la baja presión arterial podrían mejorar con una disminución de la levodopa.
También existen estrategias y medicamentos para controlar el babeo, el goteo nasal, los problemas de sueño, los problemas intestinales, los cambios en el pensamiento y otros desafíos del Parkinson.
¿Qué pasa si no funciona la levodopa?
Si está tomando levodopa pero no obtiene beneficios, hable con su médico. Estas son algunas preguntas que puede hacer:
¿El síntoma que le molesta no responde bien a la levodopa? ¿Podría estar relacionado con otro problema de salud?
¿Puede haber algo que esté interfiriendo en la absorción de la medicación? Algunas personas experimentan menos beneficios cuando toman levodopa con una comida alta en proteínas.
También es importante discutir si es necesario ajustar la dosis. Por ejemplo, los efectos del Sinemet, una forma de levodopa, sólo duran poco tiempo: a los 90 minutos, la mitad ha desaparecido. Su médico puede ajustar el horario y la dosis de levodopa, utilizar una formulación de acción más prolongada o recomendar tomar la medicación 30 minutos antes o 60 minutos después de comer.
Terapias avanzadas
Si se vuelve difícil controlar las fluctuaciones motoras ajustando la medicación oral, existen otras opciones para mejorar la absorción de la medicación y reducir el tiempo en "off":
La terapia con Duopa suministra carbidopa-levodopa en gel directamente al intestino a través de un tubo colocado quirúrgicamente.
La terapia con foscarbidopa y foslevodopa (Vyalev) utiliza una bomba para administrar de forma constante una forma de levodopa bajo la piel a través de un pequeño tubo llamado cánula. Se utiliza una aguja para colocar la cánula.
La terapia continua con apomorfina (Onapgo) utiliza una bomba para administrar apomorfina de forma continua a través de una fina aguja colocada bajo la piel.
Estos medicamentos requieren ajustes en el estilo de vida, instrucción para su uso y un compromiso con el buen cuidado de la piel para reducir el riesgo de irritación e infecciones.
Otras opciones además de la medicación
En ocasiones, los síntomas de Parkinson más avanzados pueden beneficiarse de otras estrategias de tratamiento, como la estimulación cerebral profunda (ECP, o DBS, por sus siglas en inglés), que consiste en implantar quirúrgicamente un generador de impulsos eléctricos conectado a electrodos colocados en el cerebro para tratar los síntomas motores del Parkinson y algunos síntomas no motores.
La ECP podría ser considerada para alguien que:
vive con la enfermedad de Parkinson clásica
tiene síntomas que responden a la levodopa
experimenta frecuentes fluctuaciones motoras y temblores, a pesar de una dosificación constante de la medicación
tiene discinesias molestas
Tras la ECP, muchas personas pueden reducir su medicación y seguir experimentando una reducción de los síntomas de la EP. La reducción de la dosis de medicamento puede llevar a menos discinesias.
El ultrasonido focalizado, una terapia no invasiva, no requiere una incisión quirúrgica. Durante el procedimiento, se dirigen ondas sonoras de alta frecuencia a una zona específica del cerebro relacionada con el temblor para aliviar el temblor de la enfermedad de Parkinson. A diferencia de la terapia de ECP, que es ajustable y reversible, los cambios por ultrasonido focalizado son permanentes.
Si tiene preguntas acerca de las opciones de tratamiento de la EP, comuníquese con nuestra Línea de Ayuda al 1-800-4PD-INFO (473-4636) opción 3 para español o en Helpline@Parkinson.org.
Aprenda más
Explore nuestros recursos acerca de medicamentos para tratar los síntomas del Parkinson:
Medication plays a key role in managing Parkinson’s disease (PD), but it’s only one part of a broader care plan.
The following article is based on a Parkinson’s Foundation Expert Briefing exploring how medications fit into integrated, holistic Parkinson’s care, hosted by Danny Bega, MD, MSCI, associate professor of neurology, medical director and director of the Parkinson's Disease & Movement Disorders Center neurology residency program at Northwestern University Feinberg School of Medicine, a Parkinson's Foundation Center of Excellence. Dr. Bega is also the director of the Huntington's and Wilson’s diseases programs at Northwestern.
Understanding the Dopamine-Parkinson’s Connection
Parkinson’s is a progressive disorder linked to declining levels of dopamine, a brain chemical that influences movement, memory and many other vital body processes. Other brain chemicals, including norepinephrine and serotonin, can also be impacted in Parkinson's disease and influence symptoms.
As Parkinson’s advances, the number of brain cells making dopamine continues to decrease, and remaining cells struggle to store and release it. This leads to slowness of movement, tremor, rigidity and other motor symptoms. It can also cause various non-motor symptoms, such as constipation, loss of smell and thinking changes.
Managing Parkinson’s
Parkinson’s is a complex disease. There is no standard treatment. However, medications — along with exercise, comprehensive care, a nutritious diet and mindfulness practices — can manage Parkinson’s symptoms and help you live well.
Establishing a regular exercise routine soon after diagnosis may help slow disease progression and can improve movement, strength, balance and mood. It can also help you sleep better. Staying social and engaged can reduce feelings of loneliness.
Your care team is equally important. Look for healthcare professionals with expertise in Parkinson’s, including a neurologist, speech-language pathologist, physical and occupational therapist, social worker and other healthcare professionals, to help manage your PD symptoms. Be sure to attend regular checkups.
The Role of Medication
Most Parkinson’s medications work to improve symptoms by either increasing dopamine in the brain or acting like dopamine. Levodopa is the most effective drug for managing Parkinson’s symptoms. During the course of Parkinson’s, most people will take levodopa at some point.
Anxiety and depression can also be common in Parkinson’s and can impact well-being even more than motor symptoms. Treating these symptoms using a combination of medication, such as an SSRI, SNRI or mirtazapine — a tricyclic antidepressant drug — along with therapy, stress management and staying active, can significantly decrease disability.
People newly diagnosed with Parkinson’s often wonder when to begin prescription medication. Studies show there is no benefit in holding off. Most doctors agree you should start medication when symptoms begin to bother you.
Because no two people experience PD in exactly the same way, treatments vary from person to person, as does the rate of progression. However, knowing the typical stages of Parkinson’s can help you anticipate changes:
In the first five years following diagnosis, you may find symptoms don’t significantly impact your daily life. Your doctor might recommend a clinical trial. Participation in Parkinson’s research can potentially give you early access to new treatments, improve care and lay the foundation for a cure.
Within one to 10 years, as symptoms begin to interfere with activities, most people with Parkinson’s can expect a long-lasting, steady response to medication.
Between five and 20 years after diagnosis, it becomes increasingly harder for the brain to store dopamine. Your body’s response to levodopa can become shorter and less efficient. This can lead to motor fluctuations — "on" periods, when medication works well, and "off" periods, when medication wears off and symptoms return. It is important to work closely with your doctor to adjust your treatment and find what works best for you.
After 10 or more years of living with Parkinson’s, a person can experience more significant issues. Some people can develop significant memory and thinking problems. Trouble with balance, falls and freezing, a temporary inability to move, can also become an issue. Your doctor can discuss medication adjustments or drug therapies or provide a referral to the right healthcare professional for your needs, which might include a neuropsychologist, psychiatrist, or a speech or occupational therapist.
Types of Medications Used in Parkinson’s
It can be common for people with Parkinson’s to take a variety of medications, at different doses and different times of day, to manage symptoms. This can include:
Dopamine agonists: Early on, drugs that stimulate dopamine in the brain, such as pramipexole, ropinirole and rotigotine, can usually treat Parkinson’s movement symptoms. Dopamine agonists pose less risk for dyskinesia — involuntary erratic movements that usually begin after a few years of levodopa treatment.
Side effects can include nausea, dizziness, sleepiness, confusion and impulse control disorders, such as uncontrolled shopping, gambling, eating and sexual urges. Studies show 28% of people with Parkinson’s stop taking dopamine agonists due to side effects, while 40% need to add another medication within two years.
Levodopa: Levodopa, the most effective drug for Parkinson’s movement symptoms, replaces dopamine in the brain. It is usually given in combination with the drug carbidopa to reduce nausea, a common side effect. Taking levodopa with meals can also reduce nausea, but protein may interfere with the drug’s effectiveness. About 2% of people taking levodopa stop due to side effects, while 15% need to add another medication within two years.
Dyskinesia, also linked to levodopa, can often be managed by a dose adjustment or through direct treatment, using a medication called amantadine. It works by blocking NMDA, a chemical that causes extra movement. Immediate-release amantadine is also sometimes used alone for Parkinson’s movement symptoms. There is an increased risk of confusion and hallucinations with amantadine use in people over 75. It can also be associated with leg swelling, skin changes and other side effects.
Anticholinergics:The medications trihexyphenidyl and benztropine are sometimes used to improve tremor or dystonia — painful, sustained cramping . They work by blocking acetylcholine, a brain chemical tied to movement. However, their use should be avoided in people 70 and older due to the risk of confusion and hallucinations. Anticholinergics can also be associated with blurred vision, dry mouth, constipation and urinary retention.
Medications your doctor might consider to improve the effects of levodopa include:
MAO-B inhibitors: Monoamine oxidase-B inhibitors rasagiline, selegiline and safinamide make more dopamine available to the brain. These medications can be used alone or in combination with levodopa to extend effectiveness. MAO-B inhibitors are generally well tolerated, but 70% of people taking them alone for Parkinson’s will need to add another medication within twoyears.
COMT inhibitors: Medications such as entacapone and opicapone increase available levodopa in the brain by blocking the catechol-O-methyl transferase enzyme.
A2A receptor antagonist: Istradefylline, an adenosine A2A antagonist, blocks adenosine at A2A receptors in the brain to reduce levodopa “off “time.
Inhaled levodopais often used with levodopa, as needed, for sudden “off” time. Injectable apomorphine can also be used on demand, for “off” time relief. Both medications can increase the risk of dyskinesia.
It is important to work with your doctor to find the right balance for you. Your doctor might increase or decrease your levodopa based on your symptoms. For example, tremor, stiffness or mobility issues might benefit from an increase in levodopa. However, hallucinations, confusion and low blood pressure might improve with a decrease in levodopa.
There are also strategies and medications to manage drooling, runny nose, sleep issues, gut issues, thinking changes and other Parkinson’s challenges.
What if levodopa doesn’t seem to be working?
If you are taking levodopa but aren’t seeing benefits, talk to your doctor. Here are some questions to ask:
Is the symptom troubling you one that doesn’t respond well to levodopa? Could it be related to another health issue?
Could something be interfering with how your body is absorbing medication? Some people experience less benefit when taking levodopa with a high-protein meal.
It is also important to discuss whether your dose needs to be adjusted. For example, the effects of Sinemet, a form of levodopa, only last a short time — after 90 minutes half of it is gone. Your doctor might adjust the timing and dose of levodopa, use a longer-acting formulation or recommend taking your medications 30 minutes before or 60 minutes after eating a meal.
Advanced Therapies
If it becomes difficult to control motor fluctuations by adjusting oral medications, there are other options to improve medication absorption and reduce “off” time:
Duopa therapy delivers carbidopa-levodopa gel directly to your intestine through a surgically placed tube.
Foscarbidopa and foslevodopa (Vyalev) therapy uses a pump to steadily deliver a form of levodopa under the skin through a small tube called a cannula. A needle is used to place the cannula.
Continuous apomorphine therapy (Onapgo) uses a pump to deliver continuous apomorphine through a fine needle placed under the skin.
These medications require lifestyle adjustments, training to use and a commitment to good skin care to reduce the risk of irritation and infections.
Options Beyond Medication
More advanced Parkinson’s symptoms can sometimes benefit from other treatment strategies, such as deep brain stimulation (DBS) — which involves surgically implanting an electrical pulse generator connected to electrodes placed in the brain to address Parkindeep-brainson’s movement symptoms and some non-movement symptoms.
DBS might be considered for someone who:
lives with classic Parkinson’s disease
has symptoms that respond to levodopa
experiences frequent motor fluctuations and tremor, despite consistent medication dosing
has bothersome dyskinesia
Following DBS, many people can reduce their medications and still experience a reduction of their PD symptoms. The reduction in dose of medication can lead to decreased dyskinesia.
Focused ultrasound, a non-invasive therapy, does not require a surgical incision. During the procedure, high-frequency sound waves are aimed at a specific area of the brain connected to tremor to relieve Parkinson’s tremor. Unlike DBS therapy, which is adjustable and reversible, focused ultrasound changes are permanent.
If you have questions about PD treatment options, contact our Helpline at 1-800-4PD-INFO (473-4636) or Helpline@Parkinson.org.
Learn More
Explore our resources about medications to treat symptoms of Parkinson’s:
I was diagnosed with Parkinson’s disease (PD) in October 2023, and so far, I’ve been able to manage independently. I’ve been able to do my activities of daily living independently. I manage my finances and do my own shopping. I use my computer and go on Zoom meetings. I have a dog, and the great thing about having a dog is it forces me to get out and walk, whether I want to or not. I get a little behind on mail since I was diagnosed, and my housekeeping is not the same as it used to be, but I get everything I need to done.
One of the first things I did when I was diagnosed with Parkinson’s was to call around looking for support groups. Through that process, I found the Parkinson’s Foundation. Their guides, such as the Hospital Safety Guide, have helped me tremendously. I have kept the resource books I’ve gotten from them and I still refer to them. They are reference books to me and are very valuable. The Parkinson’s Foundation Helpline is like a safety net for me, knowing if I have any questions I can call them.
I’m a member of the PD Solo Group, and I am on the PD Solo Group Steering Committee. PD Solo is a group for people who have Parkinson’s and live alone.
I think it is important for people to be aware that there are people who have Parkinson’s who choose to live alone, and are able to live alone.
Being part of PD Solo has been very helpful. We talk about living alone with Parkinson’s and as a member of the steering committee, we help determine what the agenda will be for each meeting and pick topics we think would be good to discuss.
The group does more than just that though. Two members came up with the ideas of having a show-and-tell so we could learn what people do besides coping with Parkinson’s. People shared their hobbies and what they do, including things such as photography and poetry — it was just wonderful.
I want to bring more awareness to this community of people who are living alone with Parkinson’s. I also want anyone who is new to Parkinson’s to know that they are not alone. There is a wealth of information out there, and I suggest they get in touch with the Parkinson’s Foundation.
I suggest finding ways to stay active, join a support group, try to find a neurologist who is a movement disorder specialist for your care. Take part in Parkinson’s activities near you such as Rock Steady Boxing and Dance for PD which provides Zoom classes. These activities help physically, but I believe it really helps reduce stress levels as well. Most importantly, do not isolate. There’s a tendency to look for pity but being active will be so much better for you.
