Mid Stage Treatment

PD Stages
On-Off flucutations

Treatment of motor flucutations requires additional medication with the goal of

  • Reducing off time
  • Increasing on time
Levodopa  dosing strength can be increased, the number of doses daily increased or other medicines added. Side effects may limit which medicines can be used. Examples of medicines that can be added to levodopa to reduce off times includes:
  • Dopamine agonists- Ropinirole, pramipexole, rotigotine
  • MAO B Inhbitiors- Rasagiline, Selegeline
  • COMT Inhibitors- Entacapone (Stalevo)
  • Amantadine
  • Apomorphine- rescue medicine injected under the skin
Dyskinesia is difficult to treat medically since it is caused by dopaminergic medication needed to treat movement. Medication can be reduced if motor offs are not a problem. If motor offs are present then medicine reduction can increase this off time. The following startegies can help dyskinesia:
  • Adding longer acting medicines (listed above) along with reduction in levodopa
  • Addition of amantadine- only dopamine medicine that can reduce dyskinesia rather than increase
  • Deep Brain Stimulation
Deep Brain Stimulation (DBS)

DBS is a surgical treatment often described as a brain pacemaker in which electrical stimulation or impulses are applied to specific areas of the brain involved in motor control.  For Parkinson’s, these brain regions are the globus pallidus internus (Gpi) or the subthalamic nucleus (STN). 

DBS is especially helpful in midstage PD since this surgery can treat:

  • Tremor
  • Reduce Off Time
  • Reduce Dyskinesia
Personalizing your Therapy
  • A motor diary can help you and your doctor tailor medicine doses to time of day that you are having the most trouble. 
  • Learn about medicine side effects that you can monitor before adding additional medicine.
  • Review DBS therapy with your health care provider. DBS does not treat all movement problems so be sure to review the DBS section, Expectations, before considering this therapy.
  •  Ask for rehabilitation therapy such as physical therapy, occupational  therapy and speech, the Comprehensive Care Worksheet  can help.
Find these and other helpful forms in My Medical Chart.

Monique L. Giroux, MDMonique L. Giroux, MD
Guest Blogger, Former Medical Director of NWPF