Advanced Parkinson's treatments and therapies

Medication is the main treatment used for the movement symptoms of Parkinson's.

You may have been taking medication to control your Parkinson's symptoms for some time.

Changes may be made to your medication as your condition progresses, to help you keep control of your symptoms.

As your Parkinson's progresses, you may find that you have to take a more complicated combination of medications to treat your symptoms.

Many people find that their Parkinson's medication works very well when they start taking it, but this can change over time and side effects can develop.

Some people's side effects will have a big impact on their lives and have to be kept under control along with the symptoms.

Speak to your GP, specialist or Parkinson's nurse, as changing or adding to your medication might help.

Find out more about drug treatments for Parkinson's.

Non-motor symptoms is a term used for symptoms other than the main movement symptoms of tremor, rigidity and slowness of movement.

In some cases, non-motor symptoms will mean that Parkinson's medication will need to be adjusted by your specialist or Parkinson's nurse.

People with Parkinson's will often receive the same or similar treatment for other symptoms, such as sleeping problems, as people without Parkinson's would.

This is as long as the medication used is compatible with your Parkinson's medication and other factors of the condition.

There may come a time when medication taken as tablets, capsules or patches is no longer working so well to control your symptoms.

This is when other solutions may be considered, such as surgery or stronger types of medication.

You should also explore different types of therapy, such as physiotherapy and occupational therapy. 

Other treatment options include:

• apomorphine - an injection or infusion of a dopamine agonist under the skin
• levodopa/carbidopa gel inserted into your stomach by a tube
• deep brain stimulation surgery (DBS)

Don't be surprised if your specialist or Parkinson's nurse starts to discuss these options when you have complex symptoms or your drugs regime has become complicated.

You should start to think about alternative treatment options when you're at a stage where your condition is controlled by the medication you're taking. This will make it easier to have the best symptom control possible.

If you've previously had surgery for Parkinson's, you may find you need to take more Parkinson's medication alongside this treatment to control your symptoms.

For many people with advanced Parkinson's, your specialist or Parkinson's nurse may look into reducing Parkinson's medication if side effects outweigh the benefits of taking it.

In the later stages of Parkinson's, when non-motor symptoms begin to dominate quality of life, it may be appropriate for some drugs to be withdrawn.

This can sometimes be difficult to accept, as over the course of time you will have had new medications added to your regime.

But if some of the drugs are reduced, you may find you get the benefits of the remaining ones, rather than the side effects.

You should never stop taking or reduce your Parkinson's medication without advice from your specialist or Parkinson's nurse.

As the condition advances and your symptoms become more complex, the number of people involved in your care may increase to involve a range of different health and social care professionals.

You and your carer, if you have one, are key members of this team.

Specialist Parkinson's team

Your specialist and Parkinson's nurse are your first port of call for Parkinson's-related enquiries. They aim to find the best combination of treatments that will help you to manage your symptoms as well as possible.

They will also be able to refer you to other healthcare professionals. The services available and the types of professionals you can see will vary between different areas.

Other health and social care professionals

Other health and social care professionals in the advanced stages of Parkinson's could include the following:

Macmillan nurse or hospice

These are not just for the end of life, or for people with conditions such as cancer, so don't be alarmed if you're referred to a Macmillan nurse or a hospice.

They can help at earlier stages with managing pain and symptom control.

Continence adviser

A continence adviser is a specialist nurse who assesses and manages incontinence.

Chiropodist

A chiropodist diagnoses and treats problems with feet and can help you to choose the right footwear.

Social worker

You may be in contact with a social worker from your local authority, regarding any care or housing arrangements.

Mental health team

Your local NHS or Health Service mental health team can be a useful point of contact if you are experiencing certain symptoms, such as hallucinations, delusions, paranoia or anxiety.

And they can help with emotional issues, such as coping with more complex symptoms.

Care worker

As your condition progresses, it may be that you have home carers or carers in a residential home, who will help you with day-to-day tasks.

Sex therapist

If the service is available in your area, you may see a sex therapist who will explore issues to do with Parkinson's and sex. 

Palliative care is about helping you to keep your quality of life through managing symptoms, relieving pain and managing any other distressing aspects of advanced Parkinson's.

As Parkinson's progresses, many people will need some element of care and support alongside their treatment.

Palliative care isn't just for 'end of life'. It relies on healthcare professionals making you aware of, and directing you towards, services and support at an early stage.

There is no set time for how long the palliative phase lasts. It can potentially be a long time, and Parkinson's can still change and develop further within this time.

What does palliative care involve?

Palliative care must address physical problems, including pain, breathlessness, losing your appetite, immobility and constipation.

But it should also support the personal, social, psychological and spiritual needs of you and your family.

Find out more about palliative care.