Diagnosis and Treatment
There is no laboratory test nor any other testing that can diagnose Parkinson’s disease. Your doctor makes the diagnosis by obtaining a comprehensive neurologic history of your symptoms and performing a detailed neurologic examination. Once the diagnosis of Parkinson’s disease is confirmed, your doctor will develop a treatment plan tailored specifically to your needs.
In addition to a neurologist, our Center may arrange for you to meet with a psychiatrist, who can help you with problems concerning mood or depression. We can also arrange for a meeting with a speech therapist to help you overcome speech problems and swallowing difficulties, which can lead to choking.
Weight loss is also a common problem for those with Parkinson’s disease; we may prescribe nutritional supplements to help you maintain a healthy weight. Our physical therapists can help improve strength and coordination and determine if assistive devices might help, and our occupational therapists can help improve daily living skills.
The mainstay of treatment for Parkinson’s disease is dopamine replacement therapy, with the gold standard being levodopa. The majority of patients with Parkinson’s disease respond well to levodopa, achieving significant improvements in walking and rates of movement as well as reductions in stiffness and tremors.
Other medications are available that work through other mechanisms — usually targeting either the synthesis or breakdown of dopamine in the body. These include:
- Dopamine agonists, which stimulate dopamine receptors to produce more dopamine. Dopamine agonists pramipexole, ropinirole, and apomorphine are available in the United States.
- Enzyme inhibitors, which inhibit the breakdown of dopamine and therefore extend the effectiveness of dopamine. These include rasagiline, selegiline, and entacapone.
- Anticholinergics, such as trihexyphenidyl, which are an older class of medications that may have a role in controlling tremor in some Parkinson’s patients.
In addition to taking medications, it is very important to engage in a regular exercise regimen and to eat a healthy, balanced diet.
Deep Brain Stimulation Surgery
Deep brain stimulation is an FDA-approved surgical procedure for Parkinson’s disease. In deep brain stimulation, electrodes are placed in a brain nucleus called the subthalamic nucleus, located in both sides of the brain. The brain electrodes are then connected through a wire to a neurostimulator, also called a battery pack, which will deliver the electrical stimulation to the brain in order to control the symptoms of Parkinson’s disease.
The electrical parameters of the device can be adjusted to obtain very good control over Parkinson’s-related symptoms. In some cases, patients experience dramatic improvements in their symptoms and are able to reduce their medication dosages after the surgery.
One of the most important aspects of deep brain stimulation is determining whether a patient is an appropriate candidate for the surgery. Physicians at our Robert and John M. Bendheim Parkinson and Movement Disorders Center are highly trained and experienced in the evaluation of patients for deep brain stimulation and in adjusting the deep brain stimulation electrical parameters.
Robert and John M. Bendheim Parkinson and Movement Disorders Center
5 East 98th Street, Box 1138
New York, NY 10029-6574