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How Is Parkinson's Disease Treated?
There is no outright cure for Parkinson's disease. Treatment options typically involve some combination of medications, physical and occupational therapy, and lifestyle changes. Another therapy, called deep brain stimulation, is considered in difficult cases that are resistant to other treatments.
Parkinson's disease is a neurodegenerative disorder that primarily impacts motor function. Symptoms include tremors, bradykinesia (slow and interrupted movements), and rigidity. This disorder is progressive, meaning it worsens over time. Parkinson's disease can have a severe impact on mental health, behavior, cognitive ability, and sleep, which can significantly impact your quality of life.
Parkinson's disease is the second most common disorder affecting the brain. The disorder is most often seen in people older than 65 and men.
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Dopaminergic therapy, or the use of medications to restore dopamine levels, is a primary treatment for Parkinson's disease. Symptoms arise due to the degeneration and death of brain cells (neurons) in the substantia nigra. This region of the brain regulates body movements. These neurons are responsible for creating dopamine, a critical brain chemical that helps nerve cells communicate with each other. Symptoms occur due to the lack of dopamine in the body due to neuron degeneration. Medication therapies are typically individualized, with adjustments and changes made as needed. Follow a healthcare provider's indications. They may recommend several types of medications. Levodopa-Carbidopa The first-line medication for Parkinson's disease is usually derivations of levodopa and carbidopa. The brand names for this combination are Sinemet and Rytary. These medications are available in capsule or tablet form. The recommended initial dosage of Sinimet is 75 milligrams (mg) per day, with the amount gradually increasing as needed. The most common side effects include dyskinesia (sudden, uncontrolled, and erratic movements), headache, and nausea. Non-Ergot Dopamine Agonists Three drugs of this class may be indicated: Mirapex (pramipexole): Dosages start at 0.125 mg, three times per day. Neupro (transdermal rotigotine): The dosage is delivered via a skin patch worn throughout the day. Requip (ropinirole): Dosages start at 0.25 mg, three times per day. Side effects of these medications include nausea, vomiting, low blood pressure (hypotension), sleepiness, confusion, and hallucinations. Monoamine Oxidase Type B (MAO B) Inhibitors MAO B inhibitors, such as Zelapar (selegiline), Azilect (rasagiline), and Xadago (safinamide), are typically considered for milder or less-advanced cases. Dosages vary based on type. The Food and Drug Administration (FDA) advises 5 mg of Zelapar, for example, twice per day. Potential side effects of MAO B inhibitors are similar to other therapies. These side effects include headache, nausea, confusion, hallucinations, and dyskinesia. Amantadine Gocovri (amantadine) is typically considered alongside Sinemet. This medication works to relieve symptoms when Sinemet wears off. Gocovri is an extended-release derivation, meaning it lasts longer in your body. You'll take Gocovri once per day at a dose of 137 mg for the first week, which then increases to 274 mg after that. Possible adverse effects of Gocovri include hallucinations, dizziness, low blood pressure, and swelling in the limbs or arms (peripheral edema), among others. Anticholinergics Anticholinergics are medications that inhibit the activity of the neurotransmitter acetylcholine. This chemical messenger is an important part of the central and peripheral nervous system. Acetylcholine is essential for muscle control, cognitive function, and autonomic bodily functions like breathing, heart rate, and sweating. Drugs like Artane (trihexyphenidyl) and Cogentin (benztropine) are anticholinergics that treat tremors in younger people. Healthcare providers typically do not advise this approach for older adults with Parkinson's disease and those with cognitive impairment. Artane, the most common of these drugs, is initially prescribed at doses of 0.5–1 mg twice daily, with this dosage eventually increased to 2 mg. There are many potential side effects of this medication, including dry mouth, blurry vision, constipation, nausea, as well as confusion, and hallucinations. Healthcare providers generally reserve deep brain stimulation for refractory and Parkinson's disease. Refractory cases are those that don't respond to medications. Deep brain stimulation is a surgical procedure in which electrodes are implanted in the subthalamic nucleus of the brain. A healthcare provider will then connect the electrodes to a small device in the chest. This array is able to transmit directed electricity to areas associated with motor function to treat rigidity, bradykinesia, and tremors. Parkinson's disease primarily affects motor function and coordination. Physical and occupational therapy may help ease symptoms. A healthcare provider may consider several physical therapy approaches, including: Aerobic exercise (cardiovascular conditioning): A physical therapist develops regular aerobic exercise routines of moderate to high intensity. Balance training: The ability to maintain balance is often impacted by Parkinson's disease. You may undergo a set of exercises that manipulate and develop posture. Gait training: A physical therapist works to develop a set of specific exercises to improve gait (walking ability). Resistance training: This involves the use of weights, bands, machines, or medicine balls to target specific muscle groups for muscle building and endurance. Task-specific training: Exercises to promote fine coordination or limb function may be incorporated into physical therapy. Advanced Parkinson's disease can also impact speech ability, causing dysarthria. This causes a breathy, monotone, hoarse, or quiet speaking voice and an inability to articulate words. People with dysarthria may benefit from speech therapy, which involves a set of exercises that work to restore vocalization and articulation. Parkinson's disease can significantly impact mental health and lead to depression. Psychiatric therapy and counseling may be helpful. For example, cognitive behavioral therapy (CBT) helps develop coping strategies to ease the mental and emotional burden. A healthcare provider may recommend lifestyle changes to help manage symptoms alongside medical treatment and physical therapy. These may include: Diet: Dietary adjustments that may help include incorporating more vitamins, minerals, fiber, and antioxidants. Avoiding processed foods, sugars, and excess carbs can help manage symptoms. Physical activity: Promoting physical activity is another way to help with the motor symptoms of the condition. Interval and strength training, especially with guidance from a physical therapist, can be helpful. Sleep management: Sleep disturbances and insomnia can be features of Parkinson's disease. Working to improve the quality of your rest can be part of management. Try to go to bed and wake up at consistent times every day. Develop routines to help you sleep, try to manage stress, and get daily exercise. Stress management: Figuring out ways to cope with stress is another way of helping with the disorder. Incorporating meditation, baths, or other relaxing activities can help reduce stress. Yoga and stretching: These low-intensity exercises help improve mobility, promote relaxation, and manage stress. Parkinson's disease is a difficult diagnosis because it's progressive, and there's no known cure. There are significant individual differences in how fast the disease spreads. Parkinson's disease generally leads to disability in most people within 10 years. The disorder isn't itself fatal. Symptoms increase the mortality (rate of death) three times, however, compared to those without Parkinson's disease. What makes Parkinson's disease particularly challenging is that, over time, it affects daily functioning and independent living. Living with a chronic condition like this can be stigmatizing and emotionally challenging. Several other strategies may help, including: Advocacy: Advocacy organizations, such as the American Parkinson Disease Association and the National Institute of Neurological Disorders and Stroke (NINDS), can connect you to support groups, provide useful information, and work to promote research. Family and social assistance: Talk to your family or friends about your condition and be ready to ask for help with essential tasks. These people can also provide emotional support and social engagement. Support groups: Finding support from others with this condition or other chronically disabling issues can also be helpful. Such groups can provide useful information, emotional support, and social connections for those with the condition. Easing the severity of symptoms is the primary goal of treating Parkinson's disease. Treatments primarily include medications, therapies, and lifestyle changes. A healthcare provider may advise deep brain stimulation for refractory or more advanced cases. People living with Parkinson's disease may eventually need living assistance and require dedicated management and support. No one should have to go through a condition like Parkinson's disease alone. Reaching out to loved ones, attending support groups, and finding a mental health therapist or counselor can help you cope with the condition and all potential challenges that may arise.Thanks for your feedback!
Lupus: Causes And Treatments
Lupus is a long-term disease of the immune system that causes pain and inflammation. When people talk about "lupus," they're often referring to the most common type, systemic lupus erythematosus (SLE).
Joint pain, fatigue, and a butterfly-like rash may be the first signs that you have lupus. With treatment, you can manage this disease and the symptom flare-ups associated with it. (Photo Credit: iStock/Getty Images)
Your immune system protects your body from infection. But when you have lupus, your immune system attacks your own tissues. This leads to tissue damage and illness.
Most people with lupus have a mild form with periodic flare-ups. During these periods, symptoms may worsen for a bit, then get better or even go away for a time.
The symptoms of lupus vary from one person to another. Some people have just a few symptoms, while others have many.
Lupus can affect any part of your body. Common symptoms include:
Early lupus symptoms
The early stages of lupus typically don't exhibit a consistent pattern of symptoms. However, initial signs may include fever, weakness, weight loss, or fatigue. Another early symptom may be pain in your joints.
Lupus rash
A rash on your face that looks like a butterfly's wings is often considered the most telltale sign of lupus. The rash often will appear or worsen after you've been in the sun. Even exposure to fluorescent lights can trigger your rash.
Doctors don't know what causes lupus. But they think something or a combination of things triggers your immune system to attack your body. That's why most treatments are aimed at weakening your immune system. The things that lead to this faulty immune response aren't clear, but scientists think they may include:
Genes. There is very little evidence that particular genes directly cause lupus, but some genes seem to raise your risk for lupus. For example, people of certain ethnicities — Hispanic, Native American, African, Asian, Pacific Islander — are more likely to get lupus, possibly due to shared genes.
Still, it seems clear that genes aren't enough to cause the disease. Even in identical twins (which have identical genes) where one twin has lupus, the other twin is only about 30% more likely than normal to develop the disease.
Hormones. Women, or those assigned female at birth, get lupus far more often than men. In addition, lupus symptoms seem to increase before monthly periods and during pregnancy when estrogen is higher.
But medications with estrogen, such as birth control pills and hormone replacement therapy, don't seem to raise the risk of lupus. Scientists are trying to figure out what, if any, connection there is between hormones and lupus and why women get the disease more often.
Environment. It can be hard to figure out exactly which things around you act as causes of lupus. But there are some factors that scientists have strong suspicions about. These include:
Medications. Some prescription medications such as hydralazine and procainamide can cause lupus. The symptoms usually get better after you stop taking the drug.
Other risk factors. Several other things could make you more likely to get lupus, such as:
Systemic lupus erythematosus (SLE)
This is the most common form of lupus, where a faulty immune system inflames several organs or organ systems. About 70% of people with lupus have this form of the disease.
Lupus nephritis
This is inflammation of the kidneys due to SLE. If the damage is severe, you could need dialysis or a kidney transplant.
Cutaneous lupus
With this, your faulty immune response causes skin rashes or lesions. There are three types of cutaneous lupus:
Discoid lupus
Discoid lupus is a type of chronic cutaneous lupus and is the most common. Its rash looks like a disc and most often appears on your scalp or face. Sores from the rash are often red and scaly and can lead to scarring, discoloration of your skin, or hair loss. If you have these symptoms, a dermatologist or rheumatologist may be able to help you.
If you have dark skin, you're more likely to get it than white people. Black women are particularly at risk, with a four times higher chance of developing discoid lupus than white women.
Drug-induced lupus
Medication causes this type of lupus, which is a form of subacute cutaneous lupus. Types of drugs that may cause it include proton pump inhibitors (often prescribed for acid reflux) and calcium channel blockers (prescribed for a variety of ailments, such as high blood pressure). Symptoms may stop when you stop taking the medication.
Neonatal lupus
This form of lupus happens to infants whose mothers have SLE.
Your doctor will look for key signs of the disease based on your symptoms and lab tests.
They'll do a physical exam to check for symptoms such as:
Other symptoms could include:
Blood and urine tests can help your doctor see if you have other conditions that could be caused by lupus, including:
Antinuclear antibody test
Your body makes proteins called antibodies in response to invaders such as bacteria and viruses. Antinuclear antibodies target certain things in the nucleus of a cell. You have a lot of them when your immune system is working against your tissues.
An ANA test can spot autoimmune diseases including lupus. It measures how many times your blood must be diluted to get a sample that doesn't have any antibodies.
Does a positive ANA test mean I have lupus?
Not necessarily. The ANA test is positive in most people who have lupus, but it also may be positive in many people who have another autoimmune disease or who don't have any diseases. A positive ANA test alone isn't enough for your doctor to diagnose lupus. You would also need at least three of the other criteria.
Your lupus treatment will depend on several things, including your age, your overall health, your medical history, which part of your body is affected, and how severe your case is.
Because lupus can change over time, it's crucial to have regular visits to a doctor, such as a specialist called a rheumatologist.
Some people with mild cases don't need treatment. Those who have more serious symptoms such as kidney problems may need strong medications. Types of medications that treat lupus include:
Biologics
Immunosuppressants
These types of drugs are designed to suppress your immune system if you have a serious form of lupus. They include:
Corticosteroids
You can put steroid creams directly on rashes. They're usually safe and effective, especially for mild rashes. Low doses of steroid creams or pills (such as prednisone) can ease mild or moderate signs of lupus. You can also take steroids in higher doses if lupus is affecting your internal organs. But high doses also are most likely to have side effects.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Over-the-counter NSAIDs, such as ibuprofen and naproxen, may help with pain and fever from lupus.
Antimalarial drugs
Chemotherapy drugs
Lupus alternative treatments
Some people use complementary or alternative treatments to ease lupus symptoms. But there's no proof that any of them treat or cure the disease. Some herbal supplements can even interact with prescription drugs or make your symptoms worse. Talk to your doctor before starting any treatments.
Research has found some benefits with certain treatments, including:
Vitamins and supplements. Vitamins C and D and antioxidants may help with symptoms and boost your overall health.
Fish oil. This contains omega-3 fatty acids, which may help those with lupus. Early studies have found some promising benefits of the supplement.
Dehydroepiandrosterone (DHEA). This hormone may lessen symptom flare-ups but can also have mild side effects such as acne or hair growth.
Acupuncture. Small studies show that acupuncture can lessen pain and fatigue.
Mind-body therapy. Meditation and cognitive behavioral therapy could ease pain as well as mental health issues such as depression and anxiety.
There is no cure yet for lupus. But progress is being made in the treatment of the disease, including:
The American College of Rheumatology offers various ways you can be involved in advocacy for those with lupus. You can stay aware of treatment updates on its website, rheumatology.Org.
The Lupus Foundation of America provides several updates in the Advancing Research section of its website, lupus.Org. You can also subscribe to regular emails from the organization on lupus updates and available resources.
Many people who have active lupus feel ill in general. They have fever, weight loss, and fatigue. When their immune system attacks a certain organ or part of the body, they can also have more specific problems. Lupus can affect your:
Skin. Skin problems are common with lupus. So are hair loss and mouth sores. If you have a type called discoid lupus, you get large, red, circular rashes that may cause scars. Sunlight usually irritates skin rashes. A common lupus rash called subacute cutaneous lupus erythematosus often gets worse after you go out in the sun. You might have it on your arms, legs, and torso. A rare but serious form of lupus rash called a bullous lupus rash causes large blisters.
Joints. Arthritis is very common in people who have lupus. It can cause pain, with or without swelling. Stiffness and pain may be worse in the morning. Arthritis may be a problem for only a few days or weeks, or it may be permanent. It's usually not severe.
Kidneys. Up to half of people who have lupus get kidney problems, which can be dangerous. These problems are more likely when you also have other lupus symptoms, such as fatigue, arthritis, rash, fever, and weight loss. But they can also happen when you don't have other symptoms.
Blood. People with lupus may have dangerously low numbers of red blood cells, white blood cells, or platelets (particles that help your blood clot). Changes in blood counts may cause fatigue (with a low red cell count, also known as anemia), serious infections (with a low white cell count), or easy bruising or bleeding (with a low platelet count). But many people don't have symptoms from low blood counts. It's important to have regular blood tests to spot these problems. Blood clots are more common in people with lupus. They often happen in your legs (called deep venous thrombosis or DVT), in your lungs (called pulmonary embolism or PE), and sometimes in your brain (stroke). These clots may be tied to how your body makes things called antiphospholipid (APL) antibodies. These are unusual proteins that may make your blood more likely to clot.
Brain and spinal cord. Rarely, lupus can cause problems in your brain. You might have confusion, depression, or seizures. When it affects your spinal cord (transverse myelitis), lupus can cause numbness and weakness.
Heart and lungs. Heart and lung problems are often caused by inflammation of the tissue covering your heart (pericardium) and lungs (pleura). When these become inflamed, you may have chest pain, an uneven heartbeat, and fluid buildup around your lungs (pleuritis or pleurisy) and heart (pericarditis). Your heart valves and lungs can also be affected, leading to shortness of breath.
If you develop new lupus symptoms or existing symptoms worsen, you should see your doctor.
Go to an emergency room if you have trouble breathing, are in terrible pain, or think you may be having a heart attack. Some heart attack symptoms include:
If your medication isn't helping as much as it used to, check with your doctor to see if they should update or change the drugs you take.
Some daily changes can ease symptoms and improve your quality of life:
Exercise. Low-impact exercises such as walking, swimming, and biking can help you keep muscle and lower your chances of osteoporosis (thinning of the bones). It might also boost your mood.
Get enough rest. Pace yourself. Follow periods of activity with periods of rest.
Eat well. Get a healthy, well-balanced diet.
Avoid alcohol. Alcohol can interact with your medications to cause stomach or intestinal problems, including ulcers.
Don't smoke. Smoking can hurt blood flow and make lupus symptoms worse. Tobacco smoke also harms your heart, lungs, and stomach.
Play it safe in the sun. Limit your time in sunlight, especially between 10 a.M. And 2 p.M. Wear sunglasses, a hat, and sunscreen with an SPF of at least 55 when you're outdoors.
Treat fevers. Take care of high temperatures right away. A fever may be a sign of an infection or a lupus flare-up.
Be a partner in your care. Work toward an honest and open relationship with your doctor. Be patient. It often takes time to find the medication and dosage that works best for you. Follow your doctor's treatment plan, and don't be afraid to ask questions.
Get to know your disease. Keep track of your lupus symptoms, which parts of your body are affected, and any situations or activities that seem to trigger your symptoms.
Ask for help. Don't be afraid to ask for help. Consider joining a support group. It often helps to talk to other people who have been through similar experiences.
Lupus diet
While there is no "one-diet-fits-all" for lupus, eating nutritious foods can help you deal with symptoms of the disease. For example, eat a variety of healthy fats and proteins, whole grains, and plenty of fruits and vegetables. Be aware that, if you have lupus nephritis, you may need to be on a special diet to keep your kidneys healthy.
It's OK to eat a vegan or vegetarian diet if you have lupus, but you'll want to take a vitamin B12 supplement. According to some experts, you should avoid food or supplements that contain alfalfa.
Because lupus increases your risk for heart disease and osteoporosis (a bone disease), be sure to get adequate calcium and omega-3 fatty acids in your diet.
Talk to your doctor about any questions related to your nutrition, and they can even refer you to a dietitian for more guidance.
If someone close to you has lupus, the disease will probably affect your life, too. Here are tips for living with someone who has lupus:
Lupus is an autoimmune disease that causes pain and inflammation throughout your body. It typically includes periods of worsening symptoms (flares) followed by remission, when you won't have symptoms. While there is no cure for lupus, the outlook varies depending on which organs are affected and how bad your symptoms are. Research continues to develop new treatments and medications to improve the quality of life for those with lupus. A healthy lifestyle and diet may also help prevent flare-ups.
Is lupus cancer?
No, lupus is a disease of the immune system.
Is lupus deadly?
The majority of people who have lupus will not die from it. However, if organs such as the kidneys are affected by lupus and treatment plans aren't closely followed, the related kidney disease could result in death.
What is the life expectancy of a person with lupus?
About 80%-90% of people with lupus will live out their expected lifespan.
What are three triggers of lupus?
Some lupus triggers might be:
How does a person with lupus feel?
Many people who have active lupus feel ill in general. They have fever, weight loss, and fatigue. If your immune system attacks a certain organ or part of your body, you can also have more specific problems.
What happens if lupus goes untreated?
Lupus can affect many of your organs, so if you choose not to treat your symptoms, there's a higher risk of worse symptoms, damaged organs, and increased flare-ups. If organ damage is severe, that can be life-threatening.
Behind The Lens: A History In Pictures
By Stanley B. Burns, MDEditor's Note: This essay series is written by Mercy Street's medical, historical and technical advisor, Stanley B. Burns, MD of The Burns Archive.
Before war in the twentieth century, disease was the number one killer of combatants. Of the 620,000 recorded military deaths in the Civil War about two-thirds died from disease. However, recent studies show the number of deaths was probably closer to 750,000. Crowded conditions, poor hygiene, absence of sanitary disposal of garbage and human waste, inadequate diets, and no specific disease treatments was a formula for disaster. Small pox vaccination, citrus fruits and fresh vegetables for scurvy, and quinine for malaria were among the only specific and valid therapies. Diseases were generally treated by attempting to alleviate symptoms. There was no understanding of bacteria as a cause of disease or insect-borne infections. As the war progressed, the total number of cases of disease fell due to improvement in food, sanitation and hygiene. However, the compiled data is perplexing as it shows that while the number of cases of disease decreased, the percentage of deaths from disease increased.
The Civil War stories of heroic battlefield actions and adventures fill thousands of volumes. The undignified death of hundreds of thousands who died horrible, at times painful, deaths due to disease and wound infection contradicts the image of the noble soldier. The total reported sick cases for all disease was over 5.8 million. At the beginning of the war, soldiers routinely constructed latrines close to streams contaminating the water for others downstream. Diarrhea and dysentery were the number one killers. (Dysentery is considered diarrhea with blood in the stool.) 57,000 deaths were directly recorded to these most disabling maladies. The total recorded Union cases was 1,528,098. Thousands of the afflicted went into battle fatigued with abdominal pain, malaise and dehydration. If wounded, they often died due to their poor constitutional state, but were not counted as a death from disease.
The second most common disease was malaria with over 1.3 million cases and more then 10,000 deaths. The second leading cause of death was typhoid fever. It was included with other vague 'continued fevers' and described as typhomalarial disease or camp fever. There were 148,631 cases in Union troops with 34,833 deaths. Pneumonia was also a significant cause of death, 77,335 cases and 19,971 deaths. Tuberculosis killed 6,946 out of the 29,510 infected.
America was an agricultural nation. Those from rural areas were exposed for the first time to deadly childhood and other diseases for which they had no immunity. Crowding together in large numbers meant exposure to small pox, measles, chicken pox, diphtheria and mumps. Small pox, for which a vaccine was available, killed 7,058 of the 18,952 infected. Measles infected 76,318, killing 5,177.
Sexually transmitted diseases were a problem. There were 102,893 cases of gonorrhea and 79,589 cases of syphilis with only about 130 deaths. Union General Joseph Hooker's 1863 directive to improve soldier moral by allowing prostitutes into his encampment has forever associated his name with prostitutes.
All common physical and psychiatric diseases were encountered, including rheumatic diseases, typhus and cholera. 30,714 cases of scurvy were recorded. Civil War physicians labored with inadequate knowledge and therapies to deal with the largest number of diseased persons encountered in America in the nineteenth century. Tens of thousands left military service with chronic intestinal and lung diseases that killed them in the following decade. The Confederate disease experience resembles the Union.
Mercy Street's Mansion House Union Hospital deals with its share of disease. Windows which were sealed shut, are opened under new sanitation directives allowing increased ventilation to limit the spread of infection and disease. Dr. Foster's isolation hints of the 'speckled monster,' small pox. The medical examination of prostitutes illustrates an attempt to curb venereal disease. Chronic disease is evident in the emaciated patients.
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