From the Guidelines
Yes, there are treatments that can slow the progression of Parkinson's disease, though none completely halt it. Disease-modifying approaches include vitamin D supplementation, which has been shown to slow disease progression, at least in patients with high-risk genotype of the vitamin D receptor 1. Exercise is strongly recommended, with studies showing that regular physical activity can slow symptom progression and improve motor function. Some research indicates potential benefits from vitamin B12 and folate supplementation, as they can reduce homocysteine levels, which are elevated in patients treated with levodopa 1. However, the use of levodopa can cause hyperhomocysteinemia, and supplementation with vitamin B12 and folate might be warranted 1. Deep brain stimulation, while primarily for symptom management, may indirectly slow functional decline by maintaining better motor control, but its use is not recommended for the treatment of secondary REM sleep behavior disorder due to a medical condition in adults 1. The most effective approach combines pharmacological treatment with regular exercise and appropriate rehabilitation therapies, started as early as possible after diagnosis. Key considerations include:
- Monitoring of body weight and nutritional status, as weight loss and malnutrition are common in Parkinson's disease patients and can affect disease progression 1
- Regular monitoring of vitamin status, particularly vitamin D, and supplementation as needed 1
- Management of homocysteine levels through supplementation with vitamin B12 and folate, especially in patients treated with levodopa 1
- Careful consideration of the risks and benefits of deep brain stimulation, particularly in patients with secondary REM sleep behavior disorder due to a medical condition 1
From the FDA Drug Label
Rationale for the Use of a Selective Monoamine Oxidase Type B Inhibitor in Parkinson’s disease ... MAO-B inhibition may be useful in this setting because, by blocking the catabolism of dopamine, it would increase the net amount of dopamine available (i.e., it would increase the pool of dopamine). Whether or not this mechanism or an alternative one actually accounts for the observed beneficial effects of adjunctive selegiline is unknown. Selegiline's benefit in Parkinson's disease has only been documented as an adjunct to levodopa/carbidopa
The treatments known to affect the progression of Parkinson's disease are MAO-B inhibitors, such as selegiline, which may increase the net amount of dopamine available by blocking its catabolism. However, the exact mechanism of selegiline's beneficial effects is unknown. Selegiline's benefit has only been documented as an adjunct to levodopa/carbidopa 2.
- Key points:
- MAO-B inhibitors, like selegiline, may affect Parkinson's disease progression
- Selegiline's benefit is documented as an adjunct to levodopa/carbidopa
- The exact mechanism of selegiline's effects is unknown
- No conclusion can be drawn about selegiline as a sole treatment or its effects on disease progression without levodopa/carbidopa 2.
From the Research
Treatments for Parkinson's Disease
There are several treatments available to manage the symptoms of Parkinson's disease, although none have been proven to slow the progression of the disease. Some of the available treatments include:
- Dopaminergic drugs, such as levodopa, dopamine agonists, and monoamine oxidase type B inhibitors, which can help improve motor symptoms 3, 4, 5
- Deep brain stimulation, which can be effective for motor symptoms in appropriate patients 3, 4
- Nonpharmacologic approaches, such as exercise and neurorehabilitation, which can help combat motor symptoms 3
- Nondopaminergic drugs, which may help with non-levodopa-responsive motor symptoms 3
Disease-Modifying Treatments
Currently, there are no proven disease-modifying treatments for Parkinson's disease, meaning that none of the available treatments have been shown to slow the progression of the disease 4, 6. However, some studies suggest that certain treatments, such as monoamine oxidase B inhibitors, may have neuroprotective effects and potentially slow disease progression 7.
Emerging Treatment Approaches
Several emerging treatment approaches are being studied, including regenerative cell-based and gene therapies, which aim to restore striatal dopamine and limit adverse effects 6. Additionally, novel approaches to reducing α-synuclein pathology are being explored, which may potentially slow disease progression 6.
Treatment Strategies
Different treatment strategies may be effective for different patients, and the most appropriate treatment approach will depend on the individual patient's symptoms and needs. Some studies suggest that initial treatment with a dopamine agonist or monoamine oxidase B inhibitor, followed by the addition of levodopa, may be associated with fewer motor complications than treatment with levodopa alone 5, 7.