As of Tuesday, December 10, 2013
DEAR DOCTOR K: I’ve been taking levodopa for years to treat my Parkinson’s disease. Lately, though, it hasn’t been as effective. Are there any other treatment options?
DEAR READER: It is quite common for the effectiveness of levodopa to change over time. Fortunately, there are other treatments available. Some are very high-tech, reflecting the latest scientific knowledge. Others are very low-tech, reflecting the wisdom of the past.
Parkinson’s disease occurs when a certain part of the brain does not make enough of the chemical signal dopamine. Dopamine is one of the natural “neurotransmitter” chemicals that one brain cell uses to send a signal to another cell. It has many effects, one of which is to help coordinate movement. Without dopamine, hands tremble, arms and legs become stiff, movement slows, and balance and coordination fail. You may have trouble walking, talking, swallowing and doing everyday tasks.
Drugs such as levodopa can fill in for natural dopamine and ease symptoms. If the drug has become less effective, your doctor can try adjusting the dose or schedule of your medication. That often restores effectiveness. There also are other types of medicines, which can be used alone or in combination with levodopa, and your doctor may want you to try one of these.
A non-drug type of treatment that has been used for more than a decade to help control Parkinson’s symptoms is known as deep-brain stimulation (DBS). It involves placing a tiny wire called a lead in the part of the brain that controls movement. A matchbook-sized stimulator is implanted under the skin below the collarbone. The lead and stimulator are connected to each other by a second wire. This wire runs under the skin of the shoulder, neck and head. The device emits small pulses of electricity that are received by the wire in the brain and help to coordinate movement. DBS — either alone or in combination with levodopa — might help control your symptoms.
Another, much lower-tech option is tai chi. Tai chi is an ancient Chinese practice that we’ve talked about several times before in this column. It involves slow, graceful movements that flow smoothly from one challenging pose to the next.
Tai chi enhances balance and muscle strength. It helps prevent falls and girds against physical decline. People with Parkinson’s can also reap these benefits of tai chi. An excellent book about tai chi, “The Harvard Medical School Guide to Tai Chi,” by my faculty colleague Dr. Peter Wayne, is described on my website, AskDoctorK.com.
The benefits of tai chi in people with Parkinson’s disease were demonstrated in a study published in the New England Journal of Medicine. Researchers randomly assigned study participants with mild to moderate Parkinson’s disease to twice-weekly sessions of tai chi, strength-building exercises or stretching. After six months, Parkinson’s patients who did tai chi were stronger and had much better balance than patients in the other groups. The tai chi group also had significantly fewer falls and slower rates of decline in overall motor control.
When I was a medical student, there were few treatments for Parkinson’s disease. That has changed dramatically, due not only to scientific progress but also to the scientific study of ancient practices.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)