There is currently no cure for Parkinson’s, but things like medication, surgical treatment and lifestyle changes can provide effective symptom control for a long time.

As treatment types are so broad, you’ll probably work with a variety of healthcare professionals, which are called your Multidisciplinary Team (MDT).

IMPORTANT
Parkinson’s treatment is different for everyone – the best way to find the right treatment options for you is to consult your healthcare professionals.

Medication

Many of the wide range of Parkinson’s symptoms – motor (movement-related) and non-motor – can be treated with medication:

Motor symptoms medication

Parkinson’s motor symptoms are caused by a lack of the chemical dopamine in the brain. Medication to treat these symptoms work in different ways to:

  • Increase the amount of dopamine in the brain
  • Stimulate how dopamine moves through the neuronal pathways
  • Block the action of other chemicals or enzymes that get in the way of dopamine as it moves through the brain

Motor symptom Parkinson’s medications include:

Levodopa

This is the most widely used Parkinson’s medication – it works as a chemical building block which your body then converts to dopamine in your brain. It can really help with stiffness and slowness of movement, as well as non-motor symptoms like swallowing and speech problems.

You’ll start with quite a low dosage of levodopa and build up gradually, and your doctor might experiment with different dosage levels and forms (controlled-release tablets, dispersible tablets or intestinal gel) to find the right balance for you.

One of the side-effects of levodopa is dyskinesia (involuntary body movements) which happen when the way your body absorbs and responds to the Levodopa changes over time. As your Parkinson’s progresses the Levodopa may not last as long in your system and therefore you may experience ‘off periods’. This is why it’s important to keep speaking to your doctor so they know you may need a different treatment regime.

Medication names and Patient Information Leaflets

Generic name: Co-careladopa or Co-beneldopa

Common brand names: Sinemet, Lecado, Madopar, Stalevo (oral tablets) and Duodopa (intestinal infusion)

COMT inhibitors

The symptoms of Parkinson’s are caused by a decrease in the levels of dopamine in the brain – so to reduce symptoms, you need to find ways to increase dopamine (like levodopa) or block/“inhibit” any enzymes that break down dopamine in the brain, like Catechol-O-methyl transferase (COMT).

There are three main COMT inhibitors: entacapone, opicapone and tolcapone, although the latter is only used if the first two aren’t suitable, as it can cause liver damage. The levodopa drug Stalevo also contains COMT inhibitors.

Medication names and Patient Information Leaflets

Generic names: Entacapone, opicapone, tolcapone

Common brand names: Comtess/Comtan, Ongentys, Stalevo, Tasmar

Dopamine Agonists

Prescribed both on their own or alongside other drugs like levodopa, dopamine agonists work by supporting the action of dopamine in the brain’s neuronal synapses.

Although not quite as effective as levodopa, they can provide good symptom control.

Dopamine agonists can be prescribed as tablets (including prolonged release ones), as a skin patch, pen injection or pump infusion. As well as helping to control movement issues, they also help with non-motor symptoms like sleep problems, pain and low mood.

Medication names and Patient Information Leaflets

Generic names: Bromocriptine, Cabergoline, Pergolide (older), Lisuride, Pramipexole, Ropinirole (newer), Rotigotine (skin patch), Apomorphine (infusion)

Common brand names: Parlodel, Cabaser, Revanil, Celance, Mirapexin/Sifrol, Requip, Neupro, Apo-go, Dacepton

MAO-B Inhibitors

Like COMT inhibitors (above), MAO-B inhibitors work by blocking an enzyme in the brain’s neuronal synapses – this time Monoamine Oxidase B, or MAO-B – which breaks down dopamine. This helps to maintain dopamine levels in the synapse for longer.

MAO-B inhibitors are either used on their own (usually in the beginning stages of Parkinson’s) or alongside other drugs like levodopa. They’re usually prescribed as tablets, but there’s also a version that dissolves on the tongue, and a liquid preparation for those who have swallowing issues.

Medication names and Patient Information Leaflets

Generic names: Rasagiline, Selegiline, Safinamide

Common brand names: Azilect, Eldepryl, Zelapar, Xadago

Anticholinergics

In the brain, there is normally a balance between the activity of dopamine and the activity of acetylcholine, a neurotransmitter that helps to send messages from your nerves to your muscles

But in Parkinson’s a deficiency in the brain of the neurotransmitter dopamine causes over-activity of acetylcholine. Anticholinergics work by blocking acetylcholine’s activity to restore this balance and help reduce your Parkinson’s symptoms.

These medications are older and are not used very often for Parkinson’s today. Sometimes they are prescribed for reducing tremor and muscle stiffness, either on their own (in the early stages of Parkinson’s) or alongside drugs like levodopa. They can also have positive effects on drooling issues.

Side-effects, such as memory impairment and other neuropsychiatric complications, limit their use, particularly in the elderly.

Medication names and Patient Information Leaflets

Generic names: Benztropine, Orphenadrine, Procyclidine, Trihexyphenidyl (formerly benzhexol)

Common brand names: Cogentin, Disipal, Apricolin Kemadrin, Broflex

Amantadine

Amantadine is an old medication which can mimic the action of dopamine in the brain. It improves mild slowness, tremor and stiffness, and recent research suggests it can help treat dyskinesia (involuntary body movements) that result from taking levodopa. It may, however, cause side-effects such as hallucinations, insomnia, ankle swelling and skin mottling.

Medication names

Generic name: Amantadine

Common brand names: Symmetrel

Non-Motor Symptom Medications

People with Parkinson’s may also develop non-motor symptoms (not related to movement), such as word finding or memory problems, pain or depression. These are treated with the standard medicines that would be given to a person without Parkinson’s.

Surgery: Deep Brain Stimulation (DBS)

As Parkinson’s progresses you may find that medication does not adequately control your symptoms. If this happens, your doctor may recommend a surgery called deep brain stimulation (DBS).

How does DBS work?

DBS therapy uses a small, pacemaker-like device to send electronic signals to a precise area in the brain that controls movement via very thin wires. Stimulation of these areas appears to block the brain messages that cause disabling motor symptoms and so can provide greater symptom control.

What does DBS surgery involve?

Typically, surgery to implant the DBS system lasts several hours. Your hospital stay is usually a few days and includes:

A pre-operative assessment, including an MRI or CT scan to map your brain

The surgery itself, in two parts:

  • Placing the leads in your brain: very thin leads are placed in a precise area of your brain using the mapping from your MRI or CT scan. In some cases, you will be awake and lightly sedated, and the surgeon may ask you to complete activities like moving certain body parts, or pretending to drink from a cup, to help find the best lead positions in the brain. In other cases, this procedure will be performed while you are asleep under anesthetic.
  • Implanting the neurostimulator: The same day, or shortly after, the neurostimulator will be implanted under the skin of your chest, and will then be connected to the leads from your brain using extensions that are placed under the skin from the chest, up to your neck and head. You will be asleep for this part of the procedure.

You should be ready to return home a few days after surgery. Healing will continue for several weeks.

Programming: Once you’re healed from surgery, a specialist will configure your programmer, adjusting it over several sessions to give a level of stimulation that provides the best possible symptom control. Depending on your device, you may have a controller that allows you to turn the system on and off, adjust the stimulation and check the battery.

Benefits and risks of DBS

For the right candidate, this can provide greater control over motor issues like tremor, stiffness and slow movement, as well as reduce dyskinesia (involuntary muscle spasms).

Like all surgeries, however, it also comes with risks – for instance, complications during surgery like coma, bleeding inside the brain or seizures, and post-surgery issues like infection, skin discomfort or mechanical problems.

There can also be side-effects including speech difficulties, or a change in your thinking or personality, for example depression, mania, apathy or confusion.

DBS is not suitable for everyone, so you should speak to your doctor about whether it is right for you.

Further information

Find out more advice about DBS:

Our 2023 survey on access to DBS

Parkinson’s Life articles about DBS

For specific information about DBS devices developed by different medical technology companies, please see:

Medtronic DBS therapy

Abbott DBS therapy

Boston Scientific DBS therapy

 

Neuroprotection

In the context of Parkinson’s, neuroprotection refers to any intervention which delays or prevents the death of dopamine-producing cells and, therefore, slows or halts disease progression.

The best known neuroprotection strategies are currently:

  • Physical activity and exercise
  • Keeping your brain as active and challenged as possible, for instance by doing puzzles like Sudoku and crosswords, mental arithmetic, stimulating conversations and reading

Meanwhile, identifying other neuroprotection strategies and compounds remains one of the most important goals of current Parkinson’s research, with current studies investigating:

  • Anti-oxidants, both as supplements and in naturally occurring forms
  • Creatine – a dietary supplement which is often taken by athletes to improve their performance
  • Coenzyme Q10 (CoQ) – a fat-soluble anti-oxidant compound found in the body, as well as in a number of foods
  • Non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen and aspirin
  • Curcumin, a substance in turmeric
  • Caffeine
  • Polyphenols – naturally occurring anti-oxidants found, for example, in green tea and tangerines
  • Smoking, in particular nicotine (however, we do not endorse or advocate the smoking of cigarettes because of the many health risks associated with it)
  • Ginseng, a traditional Chinese herbal remedy

Please note: studies remain ongoing so none of the above are currently recommended as neuroprotective substances.

Conventional Therapies

There are a wide range of healthcare professionals who can provide specific therapies to help you manage your Parkinson’s symptoms:

Occupational therapy

Occupational therapy (which in some European countries is known by a different name, like ‘Ergotherapie’ in Germany, France and the Netherlands, and ‘Arbetsterapi’ in Sweden) can help you find easier ways to do important daily activities.

For instance, as your Parkinson’s progresses you might find it harder to do things like turning in bed, eating and drinking, doing up buttons, using a computer and writing. Your occupational therapist will suggest different techniques and gadgets to help you, as well as ways to adapt your home or workplace to make life easier.

Some things they can help with include:

  • Techniques for everyday activities, like getting dressed or taking your medication
  • Equipment and gadgets to overcome issues with cooking, eating or washing, or handrails or a stairlift to make movement easier.
  • Improving tiredness and emotional problems, for instance by helping you prioritise tasks, and suggest relaxation techniques
  • Communication issues – for example using telephones with large buttons, or pen grips to help with writing
  • Coping strategies to improve your quality of life
  • Advice for carers to help both you and their own life

Referral procedures depend on where you live – in some countries, occupational therapy is prescribed by doctors, but in others you can contact them directly.

Training and accreditation varies throughout Europe, so it’s best to check your therapist’s details and make sure they have experience working with people with Parkinson’s.

Appointments can take place at your home, a hospital, a clinic or in a residential or nursing home. They usually last 30 to 60 minutes, and your therapist will likely give you various techniques to try, and recommend weekly meetings to check on your progress.

Physiotherapy

A physiotherapist (also known as a physical therapist) uses exercise and other forms of physical therapy to keep you moving safely and independently, with your body in as good a working condition as possible.

People with Parkinson’s are around a third less active than the general population of the same age, but exercise should be an important part of your routine, not just to improve your Parkinson’s but a range of other health conditions, from heart health to diabetes. It’s a good idea to consult a physiotherapist on the most suitable kinds of exercise for you.

The key aims of physiotherapy in Parkinson’s are to help you:

  • Maintain and improve functional ability and independence
  • Correct and improve posture and balance
  • Minimise the risk of falls
  • Allow strength and flexibility to be maintained
  • Enhance daily activities, like getting in and out of bed, or rising from a chair
  • Maintain a safe walking pattern (with or without mobility aids)
  • Help you with freezing
  • Improve manual activities like reaching and grasping
  • Maintain respiratory function through breathing exercises
  • Teach relaxation techniques
  • Educate carers, and help them look after their own health, for instance when helping you get in and out of bed or the car
  • In later stages, helping prevent complications from using a wheelchair or being bedridden

Referral procedures depend on the country in which you live; in some countries physiotherapy is prescribed by a doctor or your neurologist, but in others you can contact a physiotherapist directly. Either way, it’s best to make sure your physiotherapist has experience of working with people with Parkinson’s.

Your physiotherapy appointments might be in hospital and community settings, or at your home. During the appointments, they’ll assess your ability to perform physical activities and help you set goals and a treatment plan tailored to your needs. You might find it helpful to take notes before your appointment, and bring a family member with you.

Related reading

Speech and language therapy

It has been estimated that speech problems affect around 90% of people with Parkinson’s, from slurred speech to limited facial expressions, and a weak or quieter voice.

Parkinson’s speech therapy will help you overcome these communication difficulties, and also help with the many eating, swallowing and drooling problems that people with Parkinson’s may experience, like difficulty taking your medication, chewing issues, or producing too much or too little saliva.

A speech and language therapist can offer a range of treatments to help, including:

  • Breathing exercises or Lee Silverman Voice Treatment (LSVT) to improve the volume of your speech
  • The Parkinson Voice Project’s SPEAK OUT! programme which helps convert speech from an automatic function to an intentional act
  • Exercises for your mouth and throat muscles to make speaking and swallowing easier
  • Adjusting your environment, such as avoiding background noise, reducing distractions, and using other methods of communication like gestures and writing.
  • Communication aids like voice amplifiers, alphabet charts or installing a speech synthesiser on your computer or tablet
  • Techniques and postures to make swallowing safer, reduce the risk of choking and improve saliva control
  • Advising on foods that are easier to swallow
  • Advising your doctor on any adjustments to your medications that may help with speech and eating issues
  • Recommending your doctor prescribes treatments to reduce saliva production, such as anticholinergic medications or botox injections.
  • In severe cases, advising on alternative methods of eating and drinking, such as gastronomy feeding (inserting a tube directly into the stomach)

Referral procedures depend on the country in which you live and treatment may or may not be accessible through your country’s national health system, but if you are concerned about your speech, communication or swallowing you should first talk with your doctor about a referral to a speech and language therapist (SLT),

At your initial appointments, you’ll have an assessment, get advice on techniques to try at home, and suggest how regularly and how long you should attend speech and language therapy. You may also be referred to group therapy.

For more advice, see Communication and Parkinson’s

Dietician

There is no specific Parkinson’s diet, but you should eat a well-balanced and healthy diet to maintain good health. A dietician may offer advice on how to improve nutritional intake by eating energy-rich foods, the use of nutritional supplements and how diet can ease symptoms such as constipation. They may also liaise with a speech and language therapist about swallowing and eating difficulties.

For more advice, see Diet and Nutrition

Other types of conventional therapy providers include:

  • Elderly care physician
  • Chiropodist (podiatrist)
  • Continence advisor
  • Psychologist
  • Sex therapist

Lifestyle Changes

Making the right lifestyle choices around exercise, diet and work can help you lead a full life with Parkinson’s. You can make positive changes to the following areas of your life:

  • Sleep
  • Nutrition and diet
  • Physical activity and exercise
  • Leisure and Creativity
  • Travel/getting around
  • Body and mind
  • Communicating with Parkinson’s
  • Work and finances

For more detailed information about all of these, see our Living Well section.

Help monitoring your symptoms

During your Parkinson’s treatment and as your condition progresses, your symptoms will fluctuate, and it can be useful to keep track of this to help your healthcare professionals understand your current needs. The following tools might help:

Wellbeing Map

The Parkinson’s Well-Being Map™ is a tool to help you record and monitor your Parkinson’s symptoms, keeping track of the ones that are causing you most concern, and helping you prepare what issues to raise and questions to ask at your next appointment with a healthcare professional.

You can either download a PDF copy of the map to print and complete by hand, or you can complete the Map online and save it as a PDF, which you can either print or take along to your next appointment on your phone or tablet.

Find the map in various languages below:

Printable map
Online map

 

Rating Scales

Parkinson’s rating scales are a way for you and your healthcare team to assess your symptoms – how they are progressing, how your treatment is working, and your overall quality of life

Unified Parkinson’s Disease Rating Scale

The Unified Parkinson’s Disease Rating Scale (UPDRS) is the most comprehensive and widely used rating scale to monitor the course of your Parkinson’s. The test is carried out by a healthcare professional, with points assigned to every question, giving a total cumulative score ranging from 0 (no disability) to 199 (total disability).

The UPDRS has six key sections:

Part I: Evaluation of mental activity, behaviour and mood

This will measure:

  • Intellectual impairment
  • Thought disorder
  • Motivation / initiative
  • Depression
  • Sleep
  • Pain
  • Bladder and bowel problems
  • Fatigue

Part II: Self-evaluation of activities of daily living

This will measure

  • Speech
  • Salivation
  • Swallowing
  • Handwriting
  • Cutting food
  • Dressing
  • Hygiene
  • Turning in bed
  • Falling
  • Freezing
  • Walking
  • Tremor
  • Sensory difficulties

Part III: Evaluation of motor function

This will measure:

  • Speech
  • Facial expression
  • Tremor at rest
  • Action tremor
  • Rigidity
  • Finger taps
  • Hand movements
  • Rotation of hands and forearms so palms face downward
  • Rotation of hands and forearms so palms face upward
  • Toe taps
  • Leg agility
  • Rising from chair
  • Posture
  • Gait
  • Postural stability
  • Bradykinesia

Part IV: Evaluation of complications of therapy

This will measure:

  • Dyskinesia
  • Early morning
  • ‘Off-period’ deterioration, including the duration of ‘off’ periods, predictability based on dosage, and whether onset is sudden or gradual
  • Anorexia (including nausea and/or vomiting)
  • Sleep disturbance

Part V: Hoehn and Yahr Scale

This will measure where your symptoms are on a scale of 0 to 5:

  • Stage 0 – No signs of disease
  • Stage 1 – Symptoms on one side only (unilateral)
  • Stage 1.5 – Symptoms unilateral and also involving the neck and spine
  • Stage 2 – Symptoms on both sides but no impairment of balance
  • Stage 2.5 – Mild symptoms on both sides, with recovery when the ‘pull’ test is given (the doctor stands behind the person and asks them to maintain their balance when pulled backwards)
  • Stage 3 – Balance impairment, mild to moderate disease, physically independent
  • Stage 4 – Severe disability, but still able to walk or stand unassisted
  • Stage 5 – Needing a wheelchair or bedridden unless assisted.

Part VI: Schwab and England Activities of Daily Living Scale

This will measure your ability to carry out daily activities, with the result given as a percentage:

  • 100% – Completely independent. Able to do all activities without slowness, difficulty or impairment
  • 90% – Completely independent. Able to do all activities with some slowness, difficulty or impairment. Activities may take twice as long to complete
  • 80% – Independent in most activities, but activities take twice as long. Conscious of difficulty and slowing
  • 70% – Not completely independent. More difficulty with activities, which may take three to four times as long. May take large part of day for chores
  • 60% – Some dependency. Can do most activities, but very slowly and with much effort, but some chores are impossible
  • 50% – More dependent. Help required with half of chores. Difficulty with everything
  • 40% – Very dependent. Can assist with all chores but can manage few alone
  • 30% – With effort, now and then does a few chores alone or begins alone. Much help needed
  • 20% – Cannot do anything alone. Can give some slight help with some chores. Severe invalid
  • 10% – Totally dependent, helpless
  • 0% – Vegetative functions such as swallowing

Other rating scales

  • PDQ-39
  • PD NMS Questionnaire: measuring non-movement difficulties like sleep, constipation, vision, smell, sexual problems and memory
  • NMS Survey: measuring non-motor symptoms
  • Parkinson’s Disease Composite Scale: devised by My PD Journey – a multi-stakeholder, pan-European coalition led by Parkinson’s Europe – the PDCS measures both motor and non-motor symptoms. View scale
  • King’s PD Pain Scale
  • Parkinson’s Disease Sleep Scale
  • Lindop Parkinson’s Assessment Scale: a measurement of mobility in Parkinson’s
  • Short-Form 36 (SF-36): A brief but comprehensive questionnaire to assess health status
  • Sickness Impact Profile (SIP): A general quality of life scale which measures factors including walking, movement and mobility, body care, communication and social interaction
  • Mini Mental State Examination (MMSE): A simple means of assessing cognitive function (mental ability) using a brief 30-point questionnaire
  • Montreal Cognitive Assessment scale (MoCa): a brief cognitive screening tool for Mild Cognitive Impairment
  • Caregiver Strain Index (CSI): a questionnaire for carers that measures the burden of different aspects of caring, and identifies areas of concern.