Overview
Parkinson’s disease can affect a person’s ability to control his body movements. Certain nerve cells in the brain normally produce a chemical substance called dopamine. Dopamine is a neurotransmitter or a chemical mediator, through which nerve cells control the movements of the body. In Parkinson’s disease, these nerve cells that produce dopamine are destroyed, this leading to low levels of it. When this happens, problems related to body movements can occur. Parkinson’s disease gives a wide range of symptoms and complications. This article covers only the general treatment of the disease and no specific symptoms. The treatment can control the symptoms in the early stages of the disease’s evolution and it is started as soon as the symptoms affect the daily activities and the ability of the sick person to work. For example, a right-handed person to whom the tremor is installed on the left side may not feel embarrassed by the appearance of this symptom and may not feel the need for treatment until symptoms worsen. A person who can not perform his job duties because of the disease’s symptoms will want to start the treatment much faster than a person who does not work or who is not affected in the daily activities by any of the symptoms. The symptoms of the disease usually occur in people aged between 50 and 60 years. The condition develops slowly and can sometimes go unnoticed by the family, friends and even the individual in question. A few number of people develop the symptoms on only one side of the body, these not extending to the other side as well. Drugs can control the symptoms to some extent, but with the evolution of the disease, they become increasingly ineffective. Parkinson’s disease can cause a variety of complications as it evolves. The link between Parkinson’s disease and the risk factors is still researched. These risk factors include: genetic factors, age, environmental toxins or free radicals (antioxidants). Although these studies are about to reveal some answers, experts do not know for sure the cause of this disease.
Article Contents:
Overview
Causes
Symptoms
Diseases with similar symptoms
Risk factors
Consulting a specialist
Watchful waiting
Recommended medical specialists
Diagnosis and investigations
Treatment – Overview
Maintenance treatment
Treatment if the condition gets worse
Home Treatment
Medication
Surgery
Other treatments
Prophylaxis
Causes
There are ongoing studies that aim at determining if there is a genetic cause of Parkinson’s disease. Only a small percentage of those with Parkinson’s disease have a parent, brother or sister with this disease. However, the transmission of some abnormal genes (the basic unit of heredity, composed of deoxyribonucleic acid) seems to be the cause of the early onset of Parkinson’s disease in families where the disease is found at much younger ages.
The low levels of dopamine (the chemical mediator) involved in controlling the movements, give the symptoms of this disease. The lack of this neurotransmitter occurs when the nerve cells in a certain part of the brain (black substance – substantia nigra), which produce dopamine, deteriorate or are destroyed. The exact cause of the impairment of nerve cells is unknown.
Symptoms
The type and severity of symptoms varies from one patient to another and according to the disease’s stage. Symptoms, which can occur in a patient in the early stages, can not develop until the late stages of the disease in other patients or may not appear at all.
The most common symptoms are:
- Tremor (slow and regular oscillations), most times of the hand, arm or leg. The tremor of Parkinson’s disease occurs when the person affected by this disease is awake, in a sitting or standing position (resting tremor) and fails when the person moves the affected part of the body;
- Continuous muscle stiffness and pain. One of the most common signs appeared at the onset of the illness is the reduction of the swinging of the affected arm while walking, due to muscle rigidity. Stiffness can affect the muscles of legs, face, neck or other parts of the body and can lead to muscle fatigue and stiffness;
- Slowed down and limited movements (bradykinesia), especially when the person tries to move from a position of rest. For example, lifting from a chair or changing the position in bed can be difficult;
- Weakness of the face and neck muscles. Speech and swallowing may become more difficult and that people can choke, cough or lose saliva to the corners of their mouth. Speech is a monotone and whispering one. The loss of the ability to contract facial muscles may lead to a fixed facial expression, the so called “parkinsonian mask”;
- Difficulty in movement (walking problems) and in maintaining balance (postural instability). People with Parkinson’s disease can make small steps, crawling their legs, which are very close and can bend a little in front, from the waist (stooped position), also there are problems with turns during walking. Balance and balance problems can lead even to falls. However, these problems usually occur later in the evolution of the disease. The tremor is one of the first signs that patients or those from their family notice. Initially, the tremor may affect only one leg or arm or it can be seen on a whole body part. Tremor may also affect tongue and lips. As the disease progresses, the tremor may extend on both sides of the body, although in some cases it remains only on one side. The emotional stress and the physical effort make the tremor be more obvious. Sleep, complete relaxation, or the intent to move or the movement in itself reduce or even stop tremor.
Although tremor is one of the most common signs of Parkinson’s disease, nearly half of those who have a tremor do not have Parkinson’s disease. In contrast to the tremor of Parkinson’s disease, the tremor from other cases ameliorates at rest, it does not improve with the movement of that limb and gets worse when the person attempts to complete a task. The most common cause of the non-Parkinsonian tremor is the essential tremor, a treatable condition, most often incorrectly diagnosed as Parkinson’s disease.
Other symptoms
Parkinson’s disease can cause a variety of other symptoms.
These may include:
- Reduced dexterity and coordination. Handwriting changes are common and writing becomes smaller (micrographic). The athletic abilities decrease and daily activities, such as dressing or eating, become more difficult;
- Muscle cramps and joint damage;
- An oily skin and the appearance or increase of dandruff;
- Digestive and urinary problems. Constipation is common. The control of urination is difficult and frequent or urgent urination may occur. The medications used to treat the disease can help or worsen these symptoms;
- Problems arising in the involuntary or automatic control of some body functions such as: increased sweating, low blood pressure when people are in an orthostatic position (orthostatic hypotension) and sexual dysfunction. But these symptoms can be given also by the treatment used in Parkinson’s disease;
- A sudden and brief inability to move. It can often affect the person while walking;
- Sleeping, mood and thinking troubles of those affected by the disease may also occur.
Sleepiness or insomnia may occur in these patients due to anxiety, depression, or physical fatigue. People affected by this disease may not have a normal sleep because they can not change the position in bed easily. A person affected by Parkinson’s disease can easily become a person dependent on others, a fearful, indecisive and passive person. It is possible that these persons talk much less than before, withdraw even from the family and friends and remain inactive and antisocial persons, if they are not encouraged to overcome this situation. Depression is very common in these people and it can be caused both by the chemical changes that occur in the brain, as well as a reaction on hearing that he suffers from a disease which leads to disability. But with a proper treatment, the patient’s state can be improved. Up to one in three people suffering from Parkinson’s disease may develop dementia and confusion, similar to those of Alzheimer’s disease (primary degenerative dementia, characterized by the occurrence of dementia with a slow evolution), in the final stage of the disease. Depression may contribute to memory loss and the appearance of confusion.
Memory loss, hallucinations (hearing or seeing things that do not exist in reality) and imaginative dreams can sometimes be caused by drugs used to treat Parkinson’s disease. There is a variety of diseases with symptoms similar to that of Parkinson’s disease. Some of these may be reversible.
Diseases with similar symptoms
Parkinson’s disease can be difficult to diagnose because many conditions have symptoms that are common in Parkinson’s disease (tremor, muscle rigidity, slowed movements, balance disorders).
Other conditions that can cause symptoms similar to those of Parkinson’s disease are:
- The essential tremor (name which includes the types of tremor without an apparent and especially hereditary pathological significance), which has no symptoms other than the fine and fast tremor. It can appear before the age of 25 years;
- Parkinson’s syndrome encountered in the progressive supranuclear palsy (a degenerative heterogeneous condition, involving the the damage of the nerve cells in the brain, the basal ganglia or cerebellum) and in the multiple system atrophy (term proposed for the variable combination of the following disorders: dysfunction of the autonomic nervous system, extrapyramidal signs, ataxia occurring especially in adulthood);
- Alzheimer’s disease. The confusion and memory loss similar to those in the early stages of Alzheimer’s disease do not appear until the late stages of Parkinson’s disease;
- Central nervous system lesions;
- Various thyroid diseases;
- Diseases of the liver;
- Infections of the central nervous system (such as encephalitis);
- Tumours in the brain;
- Myocardial infarction;
- Carbon monoxide poisoning;
- Poisoning with heavy metals (such as manganese);
- Psychiatric disorders.
Certain drugs (such as antipsychotics and certain drugs used to treat high blood pressure) may also give symptoms similar to that of Parkinson’s disease
Other symptoms that may occur in this condition may include depression and sexual dysfunction. These issues must be discussed with your doctor.
Risk factors
Risk factors in this disease are difficult to identify because the cause is not known. Old age is the only known risk factor for Parkinson’s disease ( Parkinson’s disease with an early onset is not included). Most of them start after 50 years, although the disease can occur also in people between 30 and 50 years and even, in rare cases, in young people. A very small number of people who have been diagnosed with this condition have a close relative suffering from Parkinson’s disease. It seems that a family history of Parkinson’s disease does not increase significantly the risk of disease for a family member. Having family cases of Parkinson’s disease with an early onset, these can be an important risk factor of illness for other family members as well, but this is a rare form. Some studies have shown that prolonged exposure to certain environmental factors, such as pesticides, chemicals, the use of water from wells, may increase the risk of disease, but until now this has not been demonstrated. There are many diseases that can develop Parkinsonism (a group of symptoms including tremor, muscle stiffness, slow movement and impaired balance). The symptoms and evolution of the disease can vary a lot from person to person. There is no known cure for this disease. However, drugs, surgery, exercise and lifestyle changes can reduce some of the symptoms of the disease. The emotional state can affect symptoms. Anxiety, nervous tension and sadness can worsen the evolution of the disease and its symptoms. Relaxation usually reduces symptoms. In a stressful time, a person with Parkinson’s disease may have a “paradoxical outburst.” This has as a result a time when the person with Parkinson’s disease has not symptoms anymore and can move normally.
Consulting a specialist
It is best to consult your family doctor when symptoms of Parkinson’s disease occur. There is no need for an emergency treatment, if the tremor has been lasting since some time ago. However, you must talk to your doctor about the appearance of this tremor to the next checkup. If the tremor affects the daily activity of a person or if other symptoms occur as well, you should go to the doctor as soon as possible.
A person who was diagnosed with Parkinson’s disease, must consult a doctor immediately, if:
- There are significant changes in symptoms, such as severe episodes of rigidity – the sudden loss of mobility – that can affect walking;
- Symptoms are not relieved by medication;
- Other complications occur;
- Depression occurs.
People suffering from Parkinson must go to the doctor regularly (every 3-6 months or depending on what the doctor decides) in order to modify the treatment, as the disease progresses.
Watchful waiting
If the occurrence of a tremor is discovered, this must be closely watched and you must discuss with the doctor about it at the next medical examination. A more accurate description can help your doctor make an accurate diagnosis.
The patient’s description should answer the following questions:
- The tremor appeared suddenly or gradually?
- What led to its improvement or worsening?
- What part of the body was affected?
It is advisable to call the emergency services if symptoms such as sudden weakness, paralysis, loss of balance, impaired speech or visual problems occur. These may be the signs of a heart attack. The symptoms of Parkinson’s disease usually develop slowly, over a period of several months.
Recommended medical specialists
The following doctors can diagnose and treat Parkinson’s disease:
- GP;
- Doctor of internal medicine;
- Neurologist.
Other specialists that may be involved in monitoring the patient suffering from Parkinson’s disease are:
- Speech therapist;
- Physiotherapist;
- Specialist in occupational therapy.
Diagnosis and investigations
1. Early diagnosis
At this point there is no screening test for Parkinson’s disease. The diagnosis of Parkinson’s disease is based on the medical history and a thorough neurological examination.
2. Investigation
There are no laboratory tests to diagnose Parkinson’s disease. If the patient’s symptoms and the results obtained by the doctor during the consultation are not entirely typical of Parkinson’s disease, certain tests can be done in order to diagnose other diseases with similar symptoms. For example, blood tests can be done to check if it is all about a thyroid or liver disease. An MRI can be done to rule out a heart attack or a tumour of the central nervous system. Another imaging test called PET (positron emission tomography) can detect the low levels of dopamine in the brain, thereby making the diagnosis of Parkinson’s disease. However, this investigation is not usual because it is very expensive and not available in many hospitals, this still being experimented.
Treatment – Overview
In the beginning, patients with Parkinson’s disease may not need treatment if symptoms are mild. The doctor may postpone prescribing the treatment until symptoms become troublesome and interfere with daily activities. Additional treatment methods such as physical exercises, physiotherapy and occupational therapy can be helpful in all stages of Parkinson’s disease, especially in maintaining the tone, mobility and independence. If medication is needed, there are some options. Although Levodopa is still considered the best medicine for Parkinson’s disease, its side effects (which include involuntary movements and other motor complications) can cause problems in the later stages of the disease. Recent studies suggest that the initial treatment with dopamine agonists like pramipexole and ropinirole may delay the need for starting the treatment with Levodopa and thus may delay the appearance of its secondary effects. Other non-dopaminergic drugs that can be used in the early stages of the evolution of the disease are amantadine, monoamine oxidase inhibitors (e.g. selegiline) and anticholinergics (such as trihexifenidil). The doctor together with the entire team that supervises the patient suffering from Parkinson’s disease, can advise him in terms of the emotional support and medical education, specific of this disease. These are important for all the stages in the evolution of the disease. There is no treatment to stop the destruction of nerve cells that causes disease. However, some medications can improve symptoms. Surgery may also be useful in treating symptoms, but for a small number of people.
The treatment is different for each person and may change as the disease progresses. Age, occupation, family and living conditions can influence the decisions made with respect to the start of the treatment, its type and when medications should be changed. If the state of health changes, the treatment must also be adjusted in order to achieve a balance between the quality of life, the side effects of the disease and the treatment costs.
Maintenance treatment
There is a series of measures that can be taken also at the home of the person affected by Parkinson’s disease in order to make it easier for that person to cope with the symptoms. The patient should be advised to use his energy for strictly necessary activities and to design his home so as to be very easy for him to move and the necessary things to be at hand. All these will help him be an independent person.
Regular physical exercises, a good nutrition are very important during the treatment. Exercises can help to maintain muscle tone, coordination and resistance, but also in maintaining weight and reducing the likelihood of developing constipation. With respect to the diet of people with Parkinson’s disease, it is very important that they ask the doctor about all the information on diet, because protein intake may interfere with drug absorption and can alter their effectiveness. It is recommended that patients keep a state of health as good as possible. A balanced diet, rest, and emotional and practical support from family, can be helpful. Recognizing and treating depression is an important part of home therapy. Depression is common in people with Parkinson’s disease and may appear before the disease is diagnosed.
A person in an advanced stage of the disease is limited in terms of freedom of movement and the performance of daily activities. The symptoms may change from day to day and the adverse effects of the drugs used in the treatment may limit its effectiveness. Your doctor will need to modify the treatment depending on the changes that occur in the symptoms of the disease. A speech therapist may recommend speech and breathing exercises that can help patients who have a monotonous, imprecise, whispering speech, which is specific to those affected by Parkinson’s disease, especially in the final stages. There should be a change also in terms of nutrition, with respect to what and how they eat. For example, they can feed while standing and eating little by little, and food must be as easy to chew as possible. All these can relieve the patient of any problems related to food. Keeping the chin up, swallowing often and avoiding sweets may reduce salivation. The muscular blocking can be solved by making some intentional movements. Moving towards a fixed point on earth, making a precise, long step for the first time, in a march style, can help overcome the episodes of muscle stiffness.
Treatment if the condition gets worse
As the disease progresses, symptoms become increasingly troublesome. Most patients develop a tremor from easy to moderate. The movements are slow and limited due to muscle rigidity and the slowing or loss of automatic reflexes (bradykinesia).
The treatment at this stage is weighed according to the severity of symptoms and drug side effects. The symptoms change as the disease goes through the various evolutionary stages. The doctor will monitor the evolution of each patient and modify the treatment according to the appearance of new symptoms. Levodopa is the most common drug used to treat Parkinson’s disease. Still it can have a series of adverse effects at high doses or after a prolonged treatment. The doctor may prescribe dopamine agonists, like pramipexole or ropinirole in order to prepare the patient to start the treatment with levodopa. Recent studies have shown that these drugs can delay the appearance of adverse effects of levodopa. Also, the doctor may prescribe dopamine agonists at the same time with levodopa.
Home Treatment
The daily life of a patient with Parkinson. Initially, the disease does not affect a the life of the person in question too much, but over time it becomes increasingly annoying.
Home treatment helps those affected to adapt and as the disease progresses to remain independent as long as possible. The quality of their life depends largely on the continuation of the job duties, maintaining a close contact with the family and maintaining independence. Using a cane or a walking frame can be useful as the disease progresses.
The aspects that may be useful in the home treatment of a patient with Parkinson’s disease are:
- Amendment of certain activities and rearranging the house so that daily activities should be as much simplified as possible and place the furniture so that there should always be something to support the patient when moving;
- To follow a healthy diet that includes fruits, vegetables, grains, vegetables, fish, poultry, lean meat, low dairy products;
- Physical exercises and physiotherapy, which are very effective in all phases of the disease;
- To cope with the appearance of tremor and in order to reduce it, it might be better to take in the hand a weight that is shaking;
- To work with a speech therapist in order to improve speech;
- Reduce problems regarding eating and excessive salivation by changing food and the way it is eaten;
- To cope with motor blockage by various methods such as walking towards a target on the floor;
- To cope with sexual dysfunction. Talk to your doctor about this problem as well. This may suggest a series of changes in the therapy, such as changing the medications or the physical exercises.
Medication
Drug treatment is the usual treatment of Parkinson’s disease. The purpose of this treatment with drugs is to compensate for the absence of the neurotransmitter – dopamine, which causes the symptoms of this disease. The treatment is usually started when the symptoms of the disease lead to the invalidity of the person who can not carry out anymore the daily activities.
The treatment may vary depending on the symptoms, the patient’s age and his response to drugs. Drugs can alleviate symptoms, but they have a number of adverse effects as well. It takes time for the doctor to establish an effective combination of drugs which should take effect on each person.
Nowadays, levodopa is considered the most effective drug in controlling the symptoms of Parkinson’s disease and it was the preferred drug for the treatment of newly diagnosed patients with Parkinson’s disease for many years. However, due to its use for a long time and in high doses, there was a number of motor complications, which were difficult to treat. Therefore, some doctors prefer to use dopamine agonists, recently appeared ( like pramipexole and ropinirole), especially in the early stages of the disease. Using these drugs in the early stages of the disease leads to the delay of the introduction of levodopa in the treatment and thus it delays the emergence of motor complications. But the use of these drugs can also lead to motor complications.
The question concerning which of these two drugs, levodopa or dopamine agonists, is beneficial in the early stages of the disease, is not fully clarified. Levodopa controls the symptoms better than dopamine agonists do. However, given the existent studies, doctors’ concern regarding the long-term effects of the administration of levodopa in the initial stages and in high doses, has led them to recommend the initial treatment with dopamine agonists, especially to those under 60 years . As the disease progresses, the doctor will be able to prescribe both levodopa and dopamine agonists.
Apomorphine is a dopamine agonist used to treat the occasional episodes of immobility associated with Parkinson’s disease. This is the first drug that can be injected when the muscles become rigid and stuck and that person in questio can not rise from a chair anymore or can no longer perform the daily activities. The treatment with apomorphine administered when it is necessary, may make the reduction of the dose of dopamine agonists possible.
This leads to the decrease of side effects such as involuntary movements and seizures. There may be also some cases in which the treatment with constant doses of levodopa and dopamine agonists and sometimes doses of apomorphine is followed, when needed, rather than taking a treatment in which the oral medication doses are adjusted depending on the emergencies that arise. Apomorphine should be given together with the antiemetic drugs in order to prevent nausea and vomiting. Recent studies show that the treatment with high doses of coenzyme Q10 antioxidant may slow the progression of Parkinson’s disease, but it should be taken in the early stages of the disease. Further research is needed to determine how safe the treatment is and its effectiveness.
Medication Choices
Several drugs can be used to treat Parkinson’s disease, in its different phases.
In general, the initial treatment of Parkinson’s disease begins with:
- Dopamine agonists (bromocriptine, pergolide, pramipexole, ropinirole);
- levodopa and carbidopa;
- Peripheral inhibitor of catechol-0-methyltransferase (COMT)-entacapone, tolcapone;
- Anticholinergic agents (benztropine, trihexifenidil);
- Selegiline – Monoamine oxidase type B inhibitor;
- Amantadine.
Keep in mind!
All drugs used to treat Parkinson’s disease can have unpleasant side effects. An ideal drug regimen is that which controlls the symptoms of the disease and the side effects are well tolerated by patients. Generally, doctors try one drug at a time and recommend low doses in order to minimize the side effects.
It is good to know that:
- Levodopa and other drugs may be more effective if they are taken before meals;
- Stopping the medication suddenly can worsen symptoms and may be dangerous.
There may be a series of complications from a long-term treatment in Parkinson’s disease, which may include:
- Spontaneous changes in the patient’s response to medication;
- Spasms or convulsions.
Problems can occur also as a result of the disease itself, such as:
- inability to move
- Loss of muscle tone.
One possible serious side effect of the treatment with dopamine agonists is daytime sleepiness. The sudden and overwhelming sleepiness, without that person realizing that he is about to fall asleep, can be called “sleep attacks”. This can occur also when the patient is driving the car and it can be a serious threat to his safety. It must be discussed with the doctor about this type of effects, if the patient follows the treatment with dopamine agonists. Changing the dosage or the use of a different combination of drugs can be helpful in such situations. The necessary medicines in order to treat this disorder are prescribed by the doctor and the patient must be well informed about how they must be taken. It is important that patients strictly comply with doctor’s recommendations for as good a result of the therapy as possible.
Surgery
Surgery may be taken into consideration when drugs can not control symptoms anymore or when side effects are quite severe and affect the everyday activities of the patient.
Deep brain stimulation therapy is a new treatment for Parkinson’s disease. This therapy uses electrical impulses in order to stimulate certain areas of the brain. The electrical impulses are generated by a series of electrodes placed through surgery in the brain. This technique can be used in combination with drug therapy with levodopa or other drugs, when it no longer controls the symptoms in an appropriate manner. This surgical technique is about to become the preferred surgical method of therapy, especially in cases that are in an advanced stage of the disease. It does not destroy the nerve substance in the brain and it has much lower risks than the older, most destructive methods, such as pallidotomy and thalamotomy. Pallidotomy and thalamotomy are rarely made today. They involve the precise destruction of a small portion of the deep surface of the brain which causes the symptoms of the disease.
Neurotransplantul is an experimental process that is under study for Parkinson’s therapy. Implant consists of cells that produce dopamine in the brain. These cells can come from a fetal brain, although the use of fetal tissue is controversial. In the future, neurotransplantul may include transplanting nerves from healthy areas in the affected areas or the use of genetically modified cells.
The neurotransplantation was made to a small number of people and it can only be made in several medical centers in the world. The information about the efficiency of this process is limited and so far, it is not a real option for the vast majority of people.
Surgical options
- Cranial electrotherapy stimulation;
- Pallidotomy (is rare);
- Thalamotomy (is rare);
- Transplantation of nerve cells (still at the experimental stage).
1. Deep brain stimulation
Deep brain stimulation neither cures Parkinson’s disease, nor eliminates the need for medication. The thalamic deep brain stimulation is made in order to treat tremor given by the disease. The procedures through which the subthalamic nucleus is stimulated and the globus pallidus controls a wide range of the symptoms besides the tremor, are used more frequently than the stimulation of the thalamus.
2. Pallidotomy and thalamotomy
Some neurosurgeons can do these surgeries, but none of them is frequently done anymore.
3. Neurotransplantation
This procedure is still at the experimental stage and was made only for a few people. Its effects are visible after a few months or more and until now it was not documented any benefit of this intervention. People who want to take into consideration a surgery within the treatment of Parkinson’s disease, should seek for the advice of the best neurosurgeon available. You can get information about this condition of a number of organizations that support people affected by Parkinson’s disease.
Keep in mind!
Surgery becomes an option for those affected by Parkinson’s disease when the disease is advanced and medication can not control it in an appropriate manner anymore. If a disease can evolve, the symptoms get worse, some people may have a series of manifestations that can not be controlled anymore. However, when a person has a severe tremor on one side of the body, deep brain stimulation should be taken into consideration because it has better results than medication. Those with an advanced Parkinson’s disease or who have other diseases (such as heart or lung diseases, cancer or kidney diseases) are not good candidates for one of the type of surgeries. Also, surgery is not an option for those with dementia or psychiatric problems.
Surgery is not a solution for those with Parkinson’s disease. Usually, after this, medication is still necessary, but surgery may reduce the number and the doses of medication necessary to control the symptoms of the disease. All these lead to the reduction of adverse effects caused by drugs and at the same time a control of the disease is obtained.
Other treatments
Physiotherapy, speech therapy and occupational therapy can be very helpful for Parkinson’s disease therapy. Several nutritional therapies have been suggested as treatments for Parkinson’s disease. None of these has proven to be effective. However, it is important to maintain the best possible health state and follow a balanced diet.
Before trying other complementary therapies such as diet, you should discuss with your doctor about the safety of the treatment and the possible adverse effects. All this information is helpful in making decisions about the treatment. Complementary therapies should not replace the medicines necessary to treat the disease, if it is very likely that these drugs give good results. The depression which is unresponsive to medication may improve with electroconvulsive therapy. This may improve for a short period of time also movement, but the cause of this improvement is not known yet.
Prophylaxis
Any way to prevent Parkinson’s disease is still unknown.
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