By Ashvini Premkumar, MD

What are the most effective medications for the treament of Parkinson’s disease?
The most effective medications for the treatment of Parkinson’s disease are the dopaminergic medications. Carbdiopa/levodopa is by far the most effective, followed by dopamine agonists and lastly mao-b inhibitors.  Non-dopaminergic medications include anticholinergics, which are sometimes useful for treatment of tremor but have to be used with caution because of the side effect profile, particularly in elderly patients.

What are the most common side effects of carbidopa/levodopa? 
The most common side effects for carbidopa/levodopa that we see clinically include: nausea/vomiting, lightheadedness, sleepiness, hallucinations, and dyskinesias.

Do you recommend the early use of carbidopa/levodopa? Delay its use?  
The early vs. delayed use of carbidopa/levodopa has been debated for many years.  The crux of the debate rests on the concern that early use of carbidopa/levodopa may increase one’s risk for motor complications, namely fluctuations (“on” and “off” periods) and dyskinesias. The risk is approximately 40 percent within four to six years, particularly among young patients. Whether or not to start carbidopa/levodopa has to be highly individualized decision, which will be based on many factors, including disease severity, age, co-existing symptoms (i.e. cognitive impairment) and occupational concerns.

Please discuss Neupro transdermal therapy
Neupro transdermal therapy, or the rotigotine patch, is dopamine agonist that is FDA approved for the treatment of Parkinson’s disease. It can be used in early Parkinson’s disease. It also can be used as an adjunctive medication in advanced Parkinson’s disease as it was shown in studies to reduce “off” time by roughly one hour a day. It has also been approved in the treatment of moderate to severe restless legs. The side effects include: nausea/vomiting, somnolence (sleep attacks), reactions at application site, dizziness, anorexia and compulsive behavior. The specific benefit of Neupro, like other extended-release dopamine agonists, is that it maintains as constant a level of drug as possible throughout the day.

Some say that exercise eases Parkinson's diease symptoms. What exercises or physical activities are recommended for people with Parkinson’s disease?
We recommend an exercise program that combines aerobic activity and core muscle strengthening. And this should preferably be complemented by exercises aimed at balance and stretching (i.e. yoga and Tai Chi). 

Is it safe to ride a bicycle with PD? 
This question needs to be routinely addressed by the patient’s treating neurologist. In general, in the early stages of PD, where balance is not significantly affected, it’s considered safe. However, once postural instability becomes noted, either by reported falls or upon routine examination, then it would be advisable to ride only stationary bicycles.

How can I prevent falls if I have PD? 
Prevention of falls should be emphasized at each clinic visit with one’s treating neurologist. The best way to prevent falls is to be educated as to what causes falls in Parkinson’s disease and then to take every precaution to avoid those “missteps.”