No specific test exists to diagnose Parkinson’s disease. Your doctor trained in nervous system conditions (neurologist) will diagnose Parkinson’s disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination.
Furthermore, making the diagnosis is even more difficult since there are currently no blood or lab tests available to diagnose the disease. Some tests, such as a CT Scan (computed tomography) or MRI (magnetic resonance imaging), may be used to rule out other disorders that cause similar symptoms.
Given these circumstances, a doctor may need to observe the patient over time to recognize signs of tremor and rigidity, and pair them with other characteristic symptoms. The treatment decisions made early in the illness can have profound implications on the long-term success of treatment.
Because the diagnosis is based on the doctor’s exam of the patient, it is very important that the doctor be experienced in evaluating and diagnosing patients with Parkinson’s disease.
Medicines are the most common treatment for Parkinson’s disease. The goal is to correct the shortage of the brain chemical dopamine, which causes the symptoms of Parkinson’s.
Medicines often improve symptoms, but they also may cause side effects. It may take some time to find the best combination of medicines for you.
Medications your doctor may prescribe include:
- Carbidopa-levodopa. Levodopa, the most effective Parkinson’s disease medication, is a natural chemical that passes into your brain and is converted to dopamine.
Levodopa is combined with carbidopa (Rytary, Sinemet), which protects levodopa from premature conversion to dopamine outside your brain, which prevents or lessens side effects such as nausea.
Side effects may include nausea or lightheadedness (orthostatic hypotension).
- Carbidopa-levodopa infusion. Duopa is a medication that is made up of carbidopa and levodopa. However, it’s administered through a feeding tube that delivers the medication in a gel form directly to the small intestine.
Duopa is for patients with more advanced Parkinson’s who still respond to carbidopa-levodopa, but who have a lot of fluctuations in their response.
- Dopamine agonists. Unlike levodopa, dopamine agonists don’t change into dopamine. Instead, they mimic dopamine effects in your brain.
They aren’t as effective as levodopa in treating your symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.
Dopamine agonists include pramipexole (Mirapex), ropinirole (Requip) and rotigotine (given as a patch, Neupro). A short-acting injectable dopamine agonist, apomorphine (Apokyn), is used for quick relief.
- MAO-B inhibitors. These medications include selegiline (Eldepryl, Zelapar) and rasagiline (Azilect). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO-B). This enzyme metabolizes brain dopamine.
- Catechol-O-methyltransferase (COMT) inhibitors. Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.
- Anticholinergics. These medications were used for many years to help control the tremor associated with Parkinson’s disease. Several anticholinergic medications are available, including benztropine (Cogentin) or trihexyphenidyl.
However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.
- Amantadine. Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson’s disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson’s disease to control involuntary movements (dyskinesias) induced by carbidopa-levodopa.
Side effects may include a purple mottling of the skin, ankle swelling or hallucinations.
- Deep brain stimulation. In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce your Parkinson’s disease symptoms.