In the early stages of Parkinson's disease, you may not need any treatment because the symptoms will usually be mild. However, you may need to have regular appointments with your specialist so that the condition can be monitored.

At the moment, there is no cure for Parkinson's disease, but there are a range of treatments available to help control your symptoms, and maintain your quality of life. Medication is the main treatment option and there are three main types that are commonly used - levodopa, dopamine agonist, and monoamine oxidase-B inhibitors. These are described below in greater detail.

Levodopa

Levodopa is a medication that is absorbed by the nerve cells in your brain, and turned into dopamine. It is usually taken by mouth, in tablet or liquid form, and is often combined with other medication, such as benserazide, or carbidopa. This prevents the levodopa from being destroyed by enzymes (proteins) in your gut. These medicines also reduce the side effects of levodopa, which include nausea, vomiting, tiredness, and dizziness.

The first effects of levodopa often show a dramatic improvement in the symptoms of Parkinson's disease. However, levodopa tends to be less effective over time. This is because as more nerve cells in the brain gradually die, there are less to absorb the medicine. This means that the dose may need to be increased from time to time.

If the dose of levodopa is increased, there is an increased risk of developing side effects. For example, you may experience 'on-off' effects, where you can suddenly switch between being able to move (on) and being immobile (off). Muscle problems that cause uncontrollable, jerky movements (dyskinesias) is another problem associated with long-term levodopa use.

Dopamine agonists

Dopamine agonists have a similar effect to levodopa, but they work in a different way. They lock on to the dopamine receptors in your brain, which receive signals from the dopamine that tell your body to move. Therefore, dopamine agonists act as a substitute for dopamine.

Unlike levodopa, dopamine agonists do not need to be converted in your body to become active. They are mostly prescribed in tablet form, but can also be taken by intravenous injection (injection in the vein). Dopamine agonists are sometimes taken at the same time as levodopa, in order to allow lower doses of levodopa to be used.

The possible side effects of dopamine agonists are similar to those of levodopa, and also include nausea and vomiting. However, episodes of confusion, or hallucinations, are more common with dopamine agonists, so they need to be used cautiously, particularly in the elderly, who may be more susceptible to these symptoms.

If you are prescribed a course of dopamine agonists, the initial dose will usually be very small, to prevent problems with nausea. The dosage is then gradually increased over a few weeks. If nausea is a problem, your doctor may prescribe anti-sickness medication, such as domperidone.

Dopamine agonists used to be regarded as a 'top-up' treatment in addition to levodopa. However, in recent years, it has become a first-line treatment because people who take dopamine agonists are less likely to develop muscle problems (dyskinesias) than those on levodopa. Most people with Parkinson's disease will need to have levodopa eventually. However, dopamine agonists can delay the need for levodopa for months or, sometimes, years.

Monoamine oxidase-B inhibitors

Monoamine oxidase-B inhibitors are another alternative to levodopa as a treatment for early Parkinson's disease. They include selegiline and rasagiline which work by blocking the effects of a chemical called monoamine oxidase-B in the brain. This chemical destroys dopamine, so by blocking it, dopamine is able to last longer in the brain. Both of these medicines improve the symptoms of Parkinson's disease, although their effects are small compared to levadopa. They can be used alongside levodopa or dopamine agonists.

In some patients, selegiline can cause confusion. Rasagiline is more powerful than selegiline and has few side effects. Rasagiline has been proven to improve symptoms of Parkinson's disease at all stages of the illness.

As with dopamine agonists, people using these monoamine oxidase-B inhibitors will eventually need to use levodopa. However, by using the inhibitors first, the need for levodopa can be delayed.

Each of the medicines described above has to be prescribed to suit the individual needs of each person who has Parkinson's disease. Factors that can influence which medicine is prescribed include:

• your age,
• the severity of your symptoms,
• how well you respond to treatment, and
• whether or not you experience side effects.

Your specialist will advise you about the best medicine to take for your circumstances. Regular reviews will be needed as the disease progresses and your needs change.

Surgery

Surgery is sometimes used to treat people who have had Parkinson's disease for many years. However, surgery is not suitable for everyone.

Chronic deep brain stimulation is a surgical technique that is sometimes used to treat Parkinson's disease. This is where a pulse generator (like a heart pacemaker) is inserted in your chest wall. A fine wire is placed under the skin that attaches to your brain. A tiny electric current is produced from the pulse generator, which runs through the wire and stimulates the part of your brain which is affected by Parkinson's disease.

Although surgery does not cure Parkinson's disease, it does ease the symptoms for many people, particularly if medication is not working well.

Therapies

There are a number of therapies that can make living with Parkinson's disease easier. The three main therapies that are used are:

• physiotherapy,
• speech and language therapy, and
• occupational therapy.

Physiotherapy involves learning techniques which will help improve your movement, and make moving easier. A physiotherapist can help to relieve muscle stiffness and joint pain through movement and exercise.

About half of people with Parkinson's disease experience problems with communication, such as slurred speech, or poor body language. If you have problems with communication, a speech and language therapist can help you to improve your speech and use of language.

An occupational therapist can help identify problem areas in your everyday life, such as dressing yourself, or getting to your local shops. They can then help you to work out practical solutions.