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ParkinsonsJournal
Treatment database

Treatment options at a glance.

From medications and device-assisted procedures to physical and occupational therapy — compared in a structured way: how it works, what it is suited for, and what to keep in mind.

7
Procedures
3
Categories
Device-assisted

Medication pumps

Continuous delivery of medication via a pump (subcutaneously or through a tube).

Strength: Steady drug level
To note: Demanding to handle
Used for: For severe off periods
Device-assisted

Deep brain stimulation (DBS)

Electrodes deliver targeted impulses to the brain’s movement centres.

Strength: Marked relief, reduced medication
To note: Surgical procedure, not suitable for everyone
Used for: Advanced disease, with motor fluctuations
Medication

COMT inhibitors

Slow the breakdown of dopamine and levodopa so both work longer and more steadily.

Strength: Smooth out fluctuations in effect and reduce off periods
To note: Only effective in combination with levodopa; monitor liver values under tolcapone
Used for: As an add-on to levodopa when effects fluctuate
Medication

Dopamine agonists

Mimic the action of dopamine directly at the receptors.

Strength: Smoother effect, well suited to younger patients
To note: Possible impulse-control disorders
Used for: Often as initial therapy
Medication

L-Dopa (levodopa)

Converted into dopamine in the brain, replacing the missing messenger.

Strength: Strongest effect on motor symptoms
To note: Long-term motor fluctuations possible
Used for: All stages, especially from the moderate stage onward
Medication

MAO-B inhibitors

Slow the breakdown of dopamine in the brain.

Strength: Well tolerated, easy to take
To note: Usually not sufficient on their own
Used for: Early stage or as an add-on
Non-drug

Physiotherapy, occupational & speech therapy

Targeted training of mobility, daily activities, voice and swallowing.

Strength: No side effects, highly effective
To note: Requires regular practice
Used for: Recommended at every stage