Ask the Doctor: Saulena Shafer, D.O.

Q. I have recently been diagnosed with Parkinson’s disease (PD). How will this impact my quality of life and what treatment options are available?

A. Parkinson's disease (PD) is a very slow progressive disorder of chemicals in the brain called neurotransmitters. The main chemical affected is dopamine, a substance that is naturally in the brain and helps nerve cells that control movement in your body. By the time most patients are diagnosed with PD, most produce approximately 80 percent less dopamine compared to normal. Dopamine levels drop while other neurotransmitters (serotonin, norepinephrine, melatonin, etc.) may increase or decrease.

These neurotransmitters affect every system in your body. They are involved in movement, such as when you experience walking slow, stiffness, tremors, and can impact other aspects of your health including the onset of anxiety and/or depression, digestion issues, blood pressure irregularities, changes in vision, loss of sense of smell and/or taste, and changes in speech and handwriting. People with PD may also experience vivid dreams or nightmares. Normally in REM sleep (when we dream) people lack muscle tone and cannot act out their dreams, however that is not true for those with PD, as they can scream, talk, move, and fully act out dreams.

While these symptoms may sound daunting, there are numerous treatment options available for patients to maintain a quality life. As a leader in the management and treatment of movement disorders, the Movement Disorders Program at the Pickup Family Neurosciences Institute at Hoag approaches patient care holistically and creates a unique treatment plan tailored for each patient. Treatment options can include a variety of methods such as rehabilitation, medication therapy, and surgical options.

Rehabilitation, including physical, occupational and speech therapy, can help patients maintain or improve their strength and flexibility, upper limb functions related to daily activities, and clarity and volume with speech. Exercising regularly is important as it helps to slow the progression of PD. In some cases, inpatient acute rehabilitation could also be beneficial to the patient.

There are numerous medications available to patients, such as carbidopa/levodopa, which is the main oral medication used for treatment. Levodopa is metabolized to dopamine in the brain and carbidopa is added to allow more levodopa to get to the brain. Another option includes dopamine agonist (ropinirole, pramipexole, rotigotine), which are medications that look like dopamine to the brain, but are not. Others include MAOB inhibitors (rasagiline, selegiline) that work on dopamine pathways, and amantadine which works to stabilize dopamine and its effects.

As PD progresses, the amount of dopamine within the brain decreases. Sometimes, patients in advanced stages may begin to experience frequent episodes in a day when their scheduled oral medications are not adequately working, and daily activities become increasingly challenging. In these advanced cases, surgery may be needed.

If you have been diagnosed with PD, it is important to consult with your physician to determine the most appropriate treatment options best for you.

Saulena Shafer, D.O., is a neurologist with the Movement Disorders Program at the Pickup Family Neurosciences Institute at Hoag.