Materiały źródłowe

• #1

  https://www.nhs.uk/conditions/parkinsons-disease/treatment/

  There’s currently no cure for Parkinson’s disease, but treatments are available to help relieve the symptoms and maintain your quality of life. […] These treatments include: supportive therapies, such as physiotherapy, medication, surgery (for some people). […] A care plan should be agreed with your healthcare team and your family or carers. […] Medication can be used to improve the main symptoms of Parkinson’s disease, such as shaking (tremors) and movement problems. […] Three main types of medication are commonly used: levodopa, dopamine agonists, monoamine oxidase-B inhibitors. […] Most people with Parkinson’s disease eventually need a medication called levodopa. […] Increasing the levels of dopamine using levodopa usually improves movement problems. […] Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and „on-off” effects, where the person rapidly switches between being able to move (on) and being immobile (off).

• #2 Parkinson’s Disease: Causes, Symptoms, and Treatments | National Institute on Aging

  https://www.nia.nih.gov/health/parkinsons-disease/parkinsons-disease-causes-symptoms-and-treatments

  Although there is no cure for Parkinsons disease, medicines, surgical treatment, and other therapies can often relieve some symptoms. […] The main therapy for Parkinsons is levodopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. […] People living with Parkinsons disease should never stop taking levodopa without telling their doctor. […] The doctor may prescribe other medicines to treat Parkinsons symptoms, including: […] For people with Parkinsons disease who do not respond well to medications, the doctor may recommend deep brain stimulation. […] Other therapies that may help manage Parkinsons symptoms include:

• #3 Parkinson’s disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062

  Parkinson’s disease can’t be cured, but medicines can help control the symptoms. Medicines often work very well. When medicine is no longer helping, some people may have surgery. Your healthcare team also may recommend aerobic exercise, physical therapy that focuses on balancing and stretching, and speech therapy. […] Medicines may help improve problems with walking, movement and tremor. The medicines work by increasing or substituting for dopamine in the brain. […] Your symptoms may improve significantly after you start treatment. The benefits may lessen over time, but usually medicines still control symptoms well. […] Carbidopa-levodopa (Rytary, Sinemet, others). Levodopa is the most effective Parkinson’s disease medicine. It is a natural chemical that passes into the brain and becomes dopamine.

• #4 Parkinson’s Disease: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8525-parkinsons-disease-an-overview

  Parkinsons disease is a condition where a part of your brain deteriorates, causing more severe symptoms over time. […] The condition isnt curable, but there are many different treatment options. […] For now, Parkinsons disease isnt curable, but there are multiple ways to manage its symptoms. The treatments can also vary from person to person, depending on their specific symptoms and how well certain treatments work. Medications are the primary way to treat this condition. […] Medication treatments for Parkinsons disease fall into two categories: Direct treatments and symptom treatments. Direct treatments target Parkinsons itself. Symptom treatments only treat certain effects of the disease. […] Medications that treat Parkinsons disease do so in multiple ways. […] The most common and effective treatment for Parkinsons disease is levodopa.

• #5 Parkinson’s disease: etiopathogenesis and treatment | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/91/8/795

  A majority of patients with PD require levodopa therapy within 2 years of symptom onset. […] Levodopa, the most effective drug in the treatment of PD, is almost always combined with carbidopa or benserazide, aromatic acid decarboxylase inhibitors that prevent its peripheral metabolism and markedly reduce the risk of nausea. […] The global antiparkinsonian efficacy of levodopa is so predictable that a positive therapeutic response is used to support the diagnosis of PD. […] Besides levodopa, there are many other types of medications available for the treatment of PD-related motor symptoms: anticholinergics, amantadine, MAOIs, COMTIs, dopamine agonists and istradefylline. […] Anticholinergics, such as trihexyphenidyl and benztropine, antagonise the effects of acetylcholine at muscarinic receptors postsynaptic to striatal interneurons.

• #5 Parkinson’s disease: etiopathogenesis and treatment | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/91/8/795

  Amantadine (originally developed as an anti-influenza drug) is currently the main drug used in the treatment of levodopa-related dyskinesia. […] Although selegiline and rasagiline are most frequently used in early, mild PD, these MAOIs are also effective in patients with moderately advanced PD with levodopa-related motor complications. […] Dopamine receptor agonists stimulate dopamine receptors and when introduced early in the course of PD treatment, they delay levodopa-related complications such as motor fluctuations and dyskinesias. […] Despite optimal medical therapy, many patients with moderate to advanced disease have a poor quality of life because of fluctuating response, troublesome dyskinesia or levodopa-unresponsive symptoms. […] The chief advantage of DBS over ablative lesioning is that the stimulation parameters can be customised to the needs of the patient in order to optimise the benefits.

• #5 Parkinson’s disease: etiopathogenesis and treatment | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/91/8/795

  The first such trial, DATATOP (Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism), randomised patients with early PD to treatment with selegiline (selective monoamine oxidase, MAO-B inhibitor or monoamine oxidase inhibitors (MAOI)), tocopherol (vitamin E), or both, and followed them until their disability was severe enough to require levodopa. […] Development of neuroprotective strategies has been challenging, partly because of lack of reliable and sensitive biomarkers of progression and yet incomplete understanding of the pathogenesis of the disease. […] One of the most exciting developments of potential neuroprotective or disease-modifying therapies is the use of -synuclein monoclonal antibodies to minimise accumulation and spread of aggregated, toxic, -synuclein. […] Other antisynuclein strategies currently in development include active immunisation against synuclein, antiaggregation drugs, certain Abelson (c-Abl) kinase inhibitors, such as Nilotinib and K0706 and strategies designed to increase clearance.

• #6 Patient education: Parkinson disease treatment options — medications (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/parkinson-disease-treatment-options-medications-beyond-the-basics

  There are several types of medications available to treat symptoms of Parkinson disease: levodopa, dopamine agonists, inhibitors of enzymes that inactivate dopamine (monoamine oxidase type B [MAO-B] inhibitors and catechol-O-methyl transferase [COMT] inhibitors), adenosine A2A receptor antagonists, anticholinergic drugs, and amantadine. […] Levodopa is the most effective drug for the treatment of symptoms of Parkinson disease. It is particularly effective for helping people who have slowness of movements caused by Parkinson disease, a problem called bradykinesia. […] Dopamine agonists work by directly stimulating dopamine receptors in the brain. […] Selegiline, rasagiline, and safinamide are monoamine oxidase type B (MAO-B) inhibitors. These work by blocking the effect of enzymes that inactivate dopamine.

• #6 Patient education: Parkinson disease treatment options — medications (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/parkinson-disease-treatment-options-medications-beyond-the-basics

  The catechol-O-methyl transferase (COMT) inhibitors tolcapone, entacapone, and opicapone may be used to prolong and enhance the effect of levodopa. […] An anticholinergic medication may be recommended to reduce symptoms of bothersome tremor in people with Parkinson disease under age 70 who do not have significant slowness or difficulty walking. […] Amantadine is an antiviral drug that was originally developed to prevent influenza but was found to improve mild symptoms (tremor, slowness, rigidity) in people with Parkinson disease. […] Effective medications are available to treat specific nonmotor symptoms seen in people with Parkinson disease. […] Currently, no treatment has been proven to slow, stop, or change the progression of Parkinson disease. However, medications for Parkinson disease are usually effective in controlling the symptoms of the disease. […] Levodopa, dopamine agonists, or monoamine oxidase type B (MAO-B) inhibitors can be used initially for patients who require treatment for symptoms of Parkinson disease. Among these agents, levodopa is the most effective for motor symptoms.

• #7 Parkinson’s Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1215/p2046.html

  The most important goal is to help patients maintain maximal autonomy and quality of life. […] Levodopa is the most effective pharmacologic treatment for Parkinsons disease symptoms, especially bradykinesia and rigidity. […] Motor complications in patients with advanced Parkinsons disease can be treated by adding a dopamine agonist, monoamine oxidase-B inhibitor, or catechol-O-methyltransferase inhibitor to levodopa therapy. […] Deep brain stimulation of the subthalamic nucleus can improve Parkinsons disease symptoms. […] Symptomatic therapy for Parkinsons disease should be initiated at the onset of functional impairment. […] The American Academy of Neurology (AAN) recommends levodopa or a dopamine agonist, when dopaminergic treatment is required, depending on the need to improve motor disability (levodopa is better) or decrease motor complications (dopamine agonists cause fewer motor complications).

• #7 Parkinson’s Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1215/p2046.html

  Treatment of these symptoms is described in Table 4. […] Surgical treatment is becoming more common for Parkinsons disease because of advances in brain imaging and neurosurgical techniques. An evidence-based review concluded that deep brain stimulation of the subthalamic nucleus effectively improves motor function and reduces motor fluctuations, dyskinesia, and antiparkinsonian medication use.

• #8

  https://www.nhs.uk/conditions/parkinsons-disease/treatment/

  There’s currently no cure for Parkinson’s disease, but treatments are available to help relieve the symptoms and maintain your quality of life. […] These treatments include: supportive therapies, such as physiotherapy, medication, surgery (for some people). […] A care plan should be agreed with your healthcare team and your family or carers. […] Medication can be used to improve the main symptoms of Parkinson’s disease, such as shaking (tremors) and movement problems. […] Three main types of medication are commonly used: levodopa, dopamine agonists, monoamine oxidase-B inhibitors. […] Most people with Parkinson’s disease eventually need a medication called levodopa. […] Increasing the levels of dopamine using levodopa usually improves movement problems. […] Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and „on-off” effects, where the person rapidly switches between being able to move (on) and being immobile (off).

• #8

  https://www.nhs.uk/conditions/parkinsons-disease/treatment/

  Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect compared with levodopa. […] Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinson’s disease. […] Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinson’s disease. […] Most people with Parkinson’s disease are treated with medication, although a type of surgery called deep brain stimulation is used in some cases. […] Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall. […] Although surgery does not cure Parkinson’s disease, it can ease the symptoms for some people. […] As well as the main symptoms of movement problems, people with Parkinson’s disease can experience a wide range of additional symptoms that may need to be treated separately.

• #8

  https://www.nhs.uk/conditions/parkinsons-disease/treatment/

  Much progress has been made in the treatment of Parkinson’s disease as the result of clinical trials, where new treatments and treatment combinations are compared with standard ones. […] Some people with Parkinson’s disease find complementary therapies help them feel better. […] But there’s no clinical evidence they’re effective at controlling the symptoms of Parkinson’s disease.

• #9 Treatment Modalities for Parkinson’s Disease

  https://www.medscape.org/viewarticle/575587

  At present, there is no cure for PD. The goal of therapy is to relieve symptoms to provide maximal function and comfort and to improve quality of life while minimizing acute and long-term side effects. […] The combination product carbidopa/levodopa remains the cornerstone of symptomatic therapy. However, in patients with early stage PD, symptoms can be adequately managed with non-levodopa medications such as dopamine agonists or monoamine oxidase type B (MAO-B) inhibitors. Eventually, as a result of disease progression and the worsening of motor impairment, it becomes necessary to add carbidopa/levodopa to the treatment regimen. […] In early disease, dopamine agonists (pramipexole, ropinirole) are very effective and associated with a reduced risk of dyskinesias. […] The addition of the monoamine oxidase-B inhibitor rasagiline or Zydis selegiline is also effective for managing motor fluctuations as demonstrated by recent clinical trials.

• #9 Treatment Modalities for Parkinson’s Disease

  https://www.medscape.org/viewarticle/575587

  Although carbidopa/levodopa is a mainstay of pharmacotherapy in PD, a disadvantage of long-term therapy is the development of motor complications. […] Levodopa-induced dyskinesias can be particularly challenging to manage and are characterized by involuntary excessive movements of the extremities, neck, and torso. […] Nonpharmacologic interventions are also important. Physical therapy, occupational therapy, psychosocial support, diet, as well as proper hearing, dental, and vision care are crucial for optimizing the quality of life in patients with PD. […] Parkinson’s disease is a neurological disorder with motor and non-motor manifestations. In addition to carbidopa/levodopa, several other drugs (eg, dopamine agonists, monoamine oxidase-B inhibitors) are available and play an important role in symptom management. Additionally, nonpharmacologic treatments (ie, surgery) and modalities (eg, physical therapy) are valuable adjuncts to pharmacotherapy.

• #10 Parkinson Disease Treatment & Management: Approach Considerations, Symptomatic Therapy, Early Disease, Symptomatic Therapy, Advanced Disease

  https://emedicine.medscape.com/article/1831191-treatment

  The goal of medical management of Parkinson disease is to provide control of signs and symptoms for as long as possible while minimizing adverse effects. Studies demonstrate that a patient’s quality of life deteriorates quickly if treatment is not instituted at or shortly after diagnosis. […] Pharmacologic treatment of Parkinson disease can be divided into symptomatic and neuroprotective (disease modifying) therapy. At this time, there is no proven neuroprotective or disease-modifying therapy. […] Levodopa, coupled with carbidopa, a peripheral decarboxylase inhibitor (PDI), remains the gold standard of symptomatic treatment for Parkinson disease. […] Monoamine oxidase (MAO)-B inhibitors can be considered for initial treatment of early disease. […] Dopamine agonists (ropinirole, pramipexole) provide moderate symptomatic benefit and delay the development of dyskinesia compared with levodopa.

• #11 Pharmaceutical Treatment of Parkinson’s Disease

  https://practicalneurology.com/articles/2018-may/pharmaceutical-treatment-of-parkinsons-disease

  Dopamine levels in the CNS can be enhanced using monoamine oxidase (MAO) inhibitors or catechol-o-methyltransferase (COMT) inhibitors. […] MAO inhibitors may be useful as monotherapy for mild symptoms, and both MAO and COMT inhibitors are often used as adjunctive therapy for motor fluctuations later in the course of PD. […] Dopamine agonists are most helpful as adjunctive agents in patients with difficult motor fluctuations but may also be recommended for use as initial treatment especially in patients under the age of 60 in order to delay development of motor fluctuations and dyskinesia. […] Anticholinergic medications (eg, trihexyphenidyl, benztropine) can be helpful for tremor that persists despite dopaminergic therapy, and modestly reduce rigidity and dystonia. […] The antiviral agent amantadine was serendipitously noted to modestly reduce motor symptoms for patients with PD, likely through antagonism of the NMDA glutamate receptor.

• #12 Parkinson Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1201/p679.html

  Amantadine should be considered for treatment of dyskinesias in patients with advanced Parkinson disease. […] Physicians should consider referring patients with Parkinson disease to an interprofessional team to improve motor symptoms, mood, and quality of life. […] Deep brain stimulation (DBS) is the surgical implantation of an intracranial electrode device in the subthalamic nucleus or the globus pallidus interna. DBS should be used for patients who do not achieve adequate control of symptoms with levodopa. DBS is most effective for patients with significant motor fluctuations, dyskinesias, and tremors. […] Patients should be encouraged to be physically active to their functional ability because exercise has been shown to improve functionality and motor skills. […] Levodopa should be administered at least 30 to 45 minutes before a high-protein meal because levodopa competes with amino acids in the gut for transport to the brain. […] Nonmotor symptoms of Parkinson disease should be reviewed and addressed at each visit.

• #13 Parkinson Disease Treatment Advances

  https://practicalneurology.com/articles/2022-sept/parkinson-disease-treatment-advances

  In 2017, a delayed-/extended-release (DR/ER) formulation of amantadine that is taken once daily (at bedtime) was approved. […] Istradefylline is an adenosine A2A receptor antagonist approved in 2019 for adjunctive treatment of PD to reduce motor fluctuations. […] Magnetic resonance-guided high-intensity focused ultrasound (FUS) targeting the thalamus was approved in 2018 for the treatment of tremor-dominant PD. […] FUS targeting the globus pallidus internus (GPi) for bradykinesia, rigidity, and dyskinesia was approved in 2021. […] Recently developed directional leads for deep brain stimulation (DBS) consist of 2 middle rings segmented into thirds for a total of 8 contacts vs the 4 circumferential rings in conventional electrodes. […] Innovations in advanced therapies for PD include novel formulations of levodopa for continuous delivery via subcutaneous infusion as an alternative to surgical enteral tube placement.

• #14 Parkinson’s disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062

  Deep brain stimulation involves putting an electrode deep within the brain. The amount of stimulation delivered by the electrode is controlled by a device placed under the skin in the chest. […] Deep brain stimulation, also called DBS, involves putting electrodes within the brain. The electrodes are connected to a pacemaker-like device that is inserted under the skin on the chest. […] DBS can be very helpful for improving severe tremor and controlling involuntary muscle movements, called dyskinesia. It is effective for controlling changing responses to levodopa or for controlling dyskinesia that doesn’t improve with medicine changes. […] MRI-guided focused ultrasound, also called MRgFUS, is a minimally invasive treatment that helps manage tremor in some people with Parkinson’s disease.

• #15 Get Parkinson’s Disease Care | Cleveland Clinic

  https://my.clevelandclinic.org/services/parkinsons-disease-treatment

  At Cleveland Clinic, we know the best test for diagnosing Parkinsons disease is a physical exam by a movement disorder specialist (neurologist). […] Our movement disorder specialists can access hundreds of medications and treatments for Parkinsons disease. […] Cleveland Clinics movement disorder specialists understand that we can best manage your Parkinsons disease when we factor every symptom into your treatment plan. […] With so many medications for Parkinsons disease to choose from, your team will work to find the correct medication or medications for you. […] If your Parkinsons disease is further along, your provider might recommend deep brain stimulation (DBS) or MR-guided focused ultrasound. […] Exercise also plays an important role in your treatment. […] While you might not need more aggressive treatment right away, our healthcare providers can go over treatment options that might be right for you if and when your symptoms get worse.

• #16 Parkinson’s Disease – AANS

  https://www.aans.org/patients/conditions-treatments/parkinsons-disease/

  This is an antiviral medication that also helps reduce symptoms of Parkinsons (unrelated to its antiviral components) and is often used in the early stages of the disease. […] For many patients with Parkinsons, medications are effective for maintaining a good quality of life. As the disorder progresses, however, some patients develop variability in their response to treatment, known as motor fluctuations. […] Neurosurgeons relieve the involuntary movements of conditions like Parkinsons by operating on the deep brain structures involved in motion control the thalamus, globus pallidus and subthalamic nucleus. […] This procedure may be recommended for patients with aggressive Parkinsons or for those who do not respond to medication. […] DBS offers a safer alternative to pallidotomy and thalamotomy. It utilizes small electrodes which are implanted to provide an electrical impulse to either the subthalamic nucleus of the thalamus or the globus pallidus, deep parts of the brain involved in motor function. […] This form of stimulation helps rebalance the control messages in the brain, thereby suppressing tremor. DBS of the subthalamic nucleus or globus pallidus may be effective in treating all of the primary motor features of Parkinsons and may allow for significant decreases in medication doses.

• #17

  https://umiamihealth.org/en/treatments-and-services/neurology/movement-disorders/treatments-for-parkinsons-disease

  Although most patients still need to take medication after undergoing DBS, many patients experience a considerable reduction of their Parkinsons disease symptoms and some patients are able to reduce the dose of medications by 20-50%. The reduction in the dose of medication leads to a significant improvement in side effects such as dyskinesias (involuntary movements caused by long-term use of levodopa). In some cases, the stimulation itself can suppress dyskinesias without a reduction in medication.

• #18 March 2022 – News

  https://www.umaryland.edu/news/archived-news/march-2022/a-new-era-for-parkinsons-disease-treatment.php

  A New Era for Parkinsons Disease Treatment […] A non-invasive ultrasound treatment for Parkinsons disease that was tested in a pivotal trial led by University of Maryland School of Medicine (UMSOM) researchers is now broadly available at the University of Maryland Medical Center (UMMC). […] The device, called Exablate Neuro, was approved in November by the U.S. Food and Drug Administration to treat advanced Parkinsons disease on one side of the brain. The approval was based on findings from the UMSOM clinical trial and effectively expands access to focused ultrasound beyond clinical trial participation. […] Focused ultrasound is an incisionless procedure, performed without the need for anesthesia or an in-patient stay in the hospital. Patients, who are fully alert, lie in a magnetic resonance imaging (MRI) scanner, wearing a transducer helmet. Ultrasonic energy is targeted through the skull to the globus pallidus, a structure deep in the brain that helps control regular voluntary movement. MRI images provide doctors with a real-time temperature map of the area being treated. During the procedure, the patient is awake and providing feedback, which allows doctors to monitor the immediate effects of the tissue ablation and make adjustments as needed.

• #19 Parkinson’s Disease – Focused Ultrasound Foundation

  https://www.fusfoundation.org/diseases-and-conditions/parkinsons-disease/

  Focused ultrasound has the potential to achieve symptomatic relief by making thermal lesions deep in the brain to interrupt circuits involved with tremor and dyskinesia. […] Preclinical studies suggest focused ultrasounds potential to restore function in Parkinsons models. […] There are several recent trials that assess the feasibility, safety, and preliminary efficacy of focused ultrasound to treat different symptoms of Parkinsons. […] The Exablate system manufactured by Insightec is approved in Europe and in the US for treating tremor-dominant Parkinsons disease. In November 2021, it also earned approval in the US for treating additional movement disorders associated with Parkinsons disease, including mobility, rigidity and dyskinesia.

• #20 Surgical Treatment Options | Parkinson’s Foundation

  https://www.parkinson.org/living-with-parkinsons/treatment/surgical-treatment-options

  In the first few years of living with Parkinsons, your doctor will most likely utilize medications to help manage your symptoms. […] However, there are occasions when medication is not enough and advanced treatment options are considered. […] It is important to explore surgical options with your PD specialist if this is something you may consider. […] Currently, the two most common surgical treatments available for people living with PD are called deep brain stimulation (DBS) and Duopa. […] This powerful therapy can improve several movement and some non-movement symptoms. […] Designed to increase on time throughout the day, this therapy replaces most medications taken in pill form. […] While not as common, there are other advanced treatments that can help minimize symptoms.

• #21 Treatments | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/parkinsons-disease/treatments.html

  Focused ultrasound This noninvasive procedure treats tremor and other movement problems that result from Parkinsons disease. Guided by MRI images, doctors aim ultrasound beams directly at the areas of your brain that are causing Parkinsons symptoms. The ultrasound beams destroy the abnormal tissue without damaging healthy brain tissue. […] Duopa During this surgical procedure, your doctor creates an opening in your stomach (stoma) and places a small tube that goes into your intestine. Every day, you use a pump to deliver a dose of medication directly into your intestine through the tube. […] Many people with Parkinsons disease experience depression and other mood changes. To address these concerns, your doctor may recommend counseling or therapy with a trained psychologist. You may find it helpful to talk through your feelings and share your experiences with a specialist who works with people who have Parkinsons disease.

• #22 Parkinson’s Disease Types, Treatment | Froedtert & MCW

  https://www.froedtert.com/parkinsons-disease

  Duopa was approved by the FDA in 2015 as an enteral suspension for the treatment of these motor fluctuations for people with advanced Parkinson’s disease. […] While there is no known cure for Parkinsons disease, available treatments help reduce symptoms, and carbidopa/levodopa is recognized as one of the most effective treatment for the disease. […] DBS involves implanting a thin wire, or lead, containing one or more electrodes, in the brain. The lead extends through a small opening in the skull and connects to a neurostimulator a device that is similar to a heart pacemaker, only for the brain. […] After programming, the neurostimulator delivers controlled and adjustable levels of electrical signals to the brain to soothe symptoms of Parkinsons disease. […] Staying active and pursuing therapy can help you adjust your lifestyle with Parkinson’s disease. We offer a full range of therapy and other services to help you, including: Exercise, physical, occupational and recreational therapy to keep you mobile, living your life and doing things your enjoy. […] We will also provide you with resources to manage your Parkinson’s Disease including new patient orientation, classes, support groups and links to national associations.

• #23 An update on the diagnosis and treatment of Parkinson disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5088077/

  Levodopa achieves somewhat better control of motor symptoms of Parkinson disease than dopamine agonists and monoamine oxidase B inhibitors, but dyskinesias and motor fluctuations develop after long-term use or high-dose treatment. […] Most patients taking dopamine agonists will also need levodopa after two to five years. […] About 40% of patients with Parkinson disease use one or more forms of alternative therapies to complement their standard treatments. […] Exercise therapy may be considered as a means of improving motor function in patients with Parkinson disease, but there is no good evidence that it is neuroprotective. […] There is good evidence for physiotherapy, but the effect often dissipates when the intervention stops. […] Surgical therapies, including deep brain stimulation and levodopacarbidopa intestinal gel, may be offered to patients who continue to have troublesome motor fluctuations and dyskinesia.

• #24 Infusion Therapies for Parkinson’s Disease: Essential Facts for Patients

  https://www.movementdisorders.org/MDS/Resources/Patient-Education/Infusion-Therapies-for-Parkinsons-Disease.htm

  Patients with PD do not have enough of the chemical dopamine in the brain. Medication can help PD symptoms. […] Infusion therapies are treatments either through a small needle inserted under the skin or through a tube (catheter) inserted into your small intestine. This provides a continuous flow of drugs throughout the day. Levodopa and apomorphine are two common infusion therapy drugs that address the lack of dopamine in the brain. […] Infusion therapy delivers medication more continuously and provides more consistent and reliable symptom relief. Infusion therapy also reduces the need to take oral medication so many times throughout the day. Infusion therapies are usually more effective than long-acting PD pills and patches. […] Infusion therapies are recommended if oral medication helps you but you have developed wearing off and/or dyskinesias (involuntary movements that happen with too much medication).

• #25 Types of Physical Therapy for Parkinson’s Disease – PAM Health

  https://pamhealth.com/resources/types-of-phsyical-therapy-for-parkinsons-disease/

  Parkinsons disease is a nervous system disorder that affects over 1 million Americans. This disease involves the part of the brain that controls movement. The main symptoms include tremors, muscle rigidity and difficulty with coordination, balance and walking. […] Although there is no cure for Parkinsons disease, various treatments can relieve symptoms and help patients maintain their quality of life. Physical therapy is one form of treatment known to help individuals with Parkinsons disease increase mobility, strengthen their muscles, improve coordination and balance, and ultimately, remain independent. […] Physical therapy is an important part of a treatment plan for Parkinsons disease. It aims to help individuals with Parkinsons disease remain active and independent as long as possible. According to a recent meta-analysis, physical therapy significantly improves symptoms related to motor skills. The Parkinsons Foundation states that increasing physical activity to 2.5 hours a week or more can help people with Parkinsons disease maintain their quality of life.

• #25 Types of Physical Therapy for Parkinson’s Disease – PAM Health

  https://pamhealth.com/resources/types-of-phsyical-therapy-for-parkinsons-disease/

  Even if you are at a later stage of the disease, it is still worth starting a physical therapy program. Physical therapy can improve symptoms for patients at any stage of Parkinsons disease. […] The type of therapy you receive for Parkinsons disease depends on your symptoms, needs and what you wish to achieve. Common therapy options for Parkinsons disease management include: Amplitude Training, Reciprocal Movements, Balance Training, Stretching, Strength Training, Dual-Task Practice. […] Amplitude training is a physical therapy strategy designed to reduce bradykinesia and hypokinesia. Bradykinesia is a slowness of movement and one of the main symptoms of Parkinsons disease. Hypokinesia refers to small movements and is another common symptom of Parkinsons disease. […] With amplitude training, patients practice making exaggerated movements, such as swinging their arms or taking high steps. This therapy form helps retrain your muscles and prevent you from taking small, slow movements.

• #25 Types of Physical Therapy for Parkinson’s Disease – PAM Health

  https://pamhealth.com/resources/types-of-phsyical-therapy-for-parkinsons-disease/

  Your physical therapist can incorporate balance training in your exercise plan and teach you techniques you can use at home. Balance training is typically an essential part of Parkinsons disease treatment because it improves gait and helps prevent falls. […] Stretching improves flexibility and reduces the muscle stiffness associated with Parkinsons disease. […] Muscle strength is vital to staying active and maintaining independence. Parkinsons disease and aging can both lead to muscle weakness without a strength training routine. […] Talk to your physical therapist about your most important goals so they can help you in the way you need. […] Parkinsons disease can make it challenging to multitask or switch from one task to the next, increasing fall risk and making everyday activities more difficult.

• #25 Types of Physical Therapy for Parkinson’s Disease – PAM Health

  https://pamhealth.com/resources/types-of-phsyical-therapy-for-parkinsons-disease/

  Overall, physical therapy can help with the following: Increasing endurance, Strengthening muscles, Reducing muscle stiffness, Improving gait, Reducing freezing episodes, Improving balance and coordination, Increasing flexibility, Improving posture, Decreasing falls, Reducing pain. […] Because physical therapy improves motor skills and decreases pain, you can expect it to help with many of your regular activities, such as getting up from a chair, climbing stairs and getting into and out of a car. […] Physical therapy can also improve other symptoms associated with Parkinsons disease, such as depression, anxiety and fatigue. Lastly, it can help with other health issues that impair mobility, like joint pain. […] Doctors recommend beginning an evidence-based physical therapy program as soon as possible. Exercise can induce neuroplasticity, or the brains ability to change in response to behavioral changes. When you begin physical therapy, your brain learns new ways to move and think. Exercise also helps brain cells stay healthy. In other words, physical therapy may slow the progression of Parkinsons disease.

• #26 What to Know About Managing Parkinson’s Disease > News > Yale Medicine

  https://www.yalemedicine.org/news/what-to-know-about-managing-parkinsons-disease

  Its important to note that people with Parkinsons arent always treated with medication right away. Instead, they may be encouraged to stay active. Research shows that exercise can help control symptoms and might even slow the disease’s progression. […] When symptoms begin to significantly impact daily life, however, medications are usually prescribed to help increase dopamine levels, which decrease as the disease progresses. […] One of the most effective medications is levodopa, which the body converts into dopamine. […] For very severe symptoms, such as intense tremors or frequent „off periods,” a surgical option called deep brain stimulation (DBS) may be recommended. […] Basic lifestyle changes can have a beneficial impact on quality of life for people with Parkinsons disease. […] Research shows that exercise can help with maintaining balance, flexibility, and mobility, and may even help slow the progression of the disease.

• #27 Parkinson’s Treatment Options | Parkinson’s New Zealand

  https://www.parkinsons.org.nz/understanding-parkinsons/parkinsons-treatment

  Several clinical studies have shown that dopamine agonists can be effective treatments for several years when used alone. […] Exercise is very important for people with Parkinson’s. As well as improving general health and well-being, it seems to improve the response of the body to dopamine and may even protect nerve cells from degeneration. […] Physiotherapy can help with local problems such as shoulder pain and more general health including exercise programmes. […] An occupational therapist can assist in maintaining independence both at work and at home by modifying the environment and providing aids for mobility and other adaptive equipment. […] A speech language therapist can provide advice and specific strategies to improve communication. […] Deep Brain Stimulation (DBS) uses mild electrical pulses to stimulate a precisely targeted area of the brain.

• #28 Parkinson’s Treatment in NJ | Hackensack Meridian Health

  https://www.hackensackmeridianhealth.org/en/services/neurosciences/parkinsons

  While there is currently no cure for Parkinsons disease, our New Jersey-based neurological specialists and neurosurgeons continue to pioneer new advances to provide you with access to the latest surgical and nonsurgical treatments and therapies for Parkinsons disease, dystonia, essential tremors and other movement disorders. […] […] Non-Surgical Treatment for Parkinsons Disease in New Jersey […] – Chemodenervation uses Botox injections to block nerve signals to your muscles, reducing the degree of abnormal movement. […] – Dietary therapy. Our neurological specialists collaborate with registered dietitians to design a dietary plan to provide optimal nutrition while maximizing the effectiveness of your medications and managing other symptoms, such as difficulty swallowing. […] – Medication, such as dopamine substitutes, anti-seizure, and blood pressure medications can also relieve symptoms of movement disorders.

• #29 Parkinson’s Disease Treatment | Ohio State Medical Center

  https://wexnermedical.osu.edu/brain-spine-neuro/movement-disorders/parkinsons/treatment

  Our movement disorders speech therapists can help you with difficulties swallowing and with slurred speech. […] If youre struggling with typical daily activities, such as cooking, grooming, eating or any specific skills needed for your work or hobbies, our occupational therapists will share techniques that can reduce the impact of your PD symptoms.

• #30 Parkinson disease therapy: current strategies and future research priorities | Nature Reviews Neurology

  https://www.nature.com/articles/s41582-024-01034-x

  Parkinson disease (PD) is the fastest growing neurological disorder globally but, currently, no therapeutic intervention can modify disease progression and treatment is still based on levodopa (either alone or in combination with dopamine agonists or monoamine oxidase B or catechol-O-methyltransferase inhibitors) and device-aided therapies. […] Disease-modifying therapies targeting -synuclein that are under investigation include active and passive immunization and small molecules that can inhibit protein aggregation. […] Medications that can alleviate symptomatic manifestations, including new levodopa formulations, dopamine agonists with different dopamine receptor stimulation profiles or modes of administration, and gene and cell transplantation therapies, are under investigation. […] Early detection of PD is crucial, and educational programmes aimed at the general population could aid this effort by increasing awareness of the early symptoms. […] Biomarker discovery and validation initially require considerable financial and human resources, but the development of safe, easy-to-perform biomarker assays for example, using blood samples or skin biopsies would allow screening of large cohorts in a cost-effective manner.

• #31 Pipeline Parkinson’s drugs could revolutionise treatment

  https://www.clinicaltrialsarena.com/features/trials-to-watch-parkinsons-disease/

  If the clinical data shows that tavapadon causes very little sleepiness, dyskinesia or radial compulsions, that would be a plus in the dopamine agonist market. […] Glucagon-like peptide 1 receptor (GLP-1R) agonists which were originally developed for diabetes but are being used as obesity medications are now being repurposed as DMT for Parkinsons disease.

• #32 Parkinson’s disease: biotech’s pursuit for more treatments

  https://www.labiotech.eu/in-depth/parkinsons-disease-biotechs-pursuit-for-more-treatments/

  „Parkinsons disease is the fastest growing neurodegenerative disorder in the world, and a significant need exists for a new treatment option that provides the right balance of dopamine signaling and delivers sustained motor control without the burdensome side effects associated with current treatments.” […] „GLP-1 agonists have made waves for their ability to treat type 2 diabetes and obesity. New research shows that these drugs may also have an effect on Parkinsons disease.” […] „In the U.K., the National Health Service (NHS) has rolled out a wearable 24-hour infusion for the treatment of advanced Parkinsons disease.” […] „Meanwhile, gene therapy could be a promising therapy to combat the disease.” […] „Research by Haukeland University Hospital led by Charalampos Tzoulis, professor at the University of Bergen, has shown that the oral intake of nicotinamide riboside (NR) enhances NAD-metabolism in individuals with Parkinsons disease, and offers encouraging insight into its therapeutic potential.” […] „If NAD-replenishment proves to have neuroprotective, disease-modifying action in Parkinsons disease, this would revolutionize the field, offering for the first time, hope for an improved prognosis and perhaps, even a cure.”

• #33 Some Novel Therapies in Parkinson’s Disease: A Promising Path Forward or Not Yet? A Systematic Review of the Literature

  https://www.mdpi.com/2227-9059/12/3/549

  Nanotechnology-based drug transfer approaches offer several advantages for focused drug transportation to the brain, such as improved bioavailability, enhanced retention in the brain, and reduced systemic toxicity. […] In addition to approaches aimed at replacing or repairing damaged neurons, there is also a great deal of interest in the growth of neuroprotective agents that may slow or halt the progression of PD. Neuroprotective agents are compounds aiming to protect neurons from degeneration and death, as promising tools for the enlargement of disease-modifying medications for PD. […] High-frequency repetitive transcranial magnetic stimulation (rTMS), as a non-invasive, safe PD therapy, improves motor symptoms by generating a magnetic field on the basal ganglia that leads to the neural plasticity of the activated neurons in the motor cortex. […] The expansion of novel therapeutics for PD represents a promising path forward that has the potential to transform the treatment of this devastating neurodegenerative disorder. Gene therapy encourages the transforming of the PD therapy by addressing the underlying molecular mechanisms of the disease. The preclinical and early clinical data for gene therapy in PD are encouraging, with promising results from AAV-based approaches targeting neurotrophic factors, dopamine production, and neuronal circuits. However, there are significant challenges and limitations that need to be overcome to entirely recognize the potential of gene therapy in PD.

• #33 Some Novel Therapies in Parkinson’s Disease: A Promising Path Forward or Not Yet? A Systematic Review of the Literature

  https://www.mdpi.com/2227-9059/12/3/549

  Cell-based therapies for PD are aimed at replacing the lost or damaged dopaminergic neurons in the brain, restoring the balance of neurotransmitters, and ultimately improving motor function and reducing symptoms. Several types of cell-based approaches have been explored in preclinical and clinical studies, including fetal tissue transplantation, stem cell transplantation, and iPSC therapy. […] Induced pluripotent stem cells (iPSC), which are acquired from a patient’s own skin cells, hold great potential for the expansion of personalized cell-based medications for PD. By reprogramming a patient’s own cells into iPSCs and their differentiation into dopamine-producing neurons, researchers can potentially create a personalized source of cells for transplantation that could minimize the risk of rejection and other complications.

• #34 Potential Treatment for Parkinson’s Using Investigational Cell Therapy Shows Early Promise | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/news/potential-treatment-for-parkinsons-using-investigational-cell-therapy-shows-early-promise

  The researchers found that after 18 months, the injected cells had taken hold in the brain with no serious side effects. Notably, some patients appeared to have stabilization or an improvement in their Parkinsons-related symptoms. […] Based on these preliminary results, the U.S. Food and Drug Administration (FDA) has given approval to proceed directly to a phase 3 clinical trial in a much larger patient group. […] The phase 3 trial is the culmination of research going back 25 years, when Dr. Studer first came to MSK and began investigating embryonic stem cells as a potential treatment for various diseases. […] Parkinsons disease has been seen as a prime candidate for stem cell-based therapy because it involves degeneration and loss of a single cell type (dopamine-producing neurons) in a specific location a region of the brain called the putamen.

• #35 Stem cells to treat Parkinson’s? 2 small studies hint at success : Shots – Health News : NPR

  https://www.npr.org/sections/shots-health-news/2025/04/17/g-s1-60796/parkinsons-stem-cell-transplant-treatment

  Two new studies suggest that stem cell treatments may be getting closer to becoming widely available for Parkinson’s patients. […] Patients suffering from Parkinson’s disease may soon benefit from a powerful treatment option: stem-cell transplants. […] In a pair of small studies designed primarily to test safety, two teams of researchers found that stem cells transplanted into the brains of Parkinson’s patients began producing the chemical messenger dopamine and appeared to ease symptoms like tremor, researchers reported in the journal Nature. […] The Food and Drug Administration has cleared one of the stem-cell treatments for a Phase 3 study, the last hurdle before approval. […] PET scans taken 18 months later showed that the transplanted cells were producing dopamine. An assessment using a standard rating scale of Parkinson’s progression suggested the treatment was also easing symptoms.

• #35 Stem cells to treat Parkinson’s? 2 small studies hint at success : Shots – Health News : NPR

  https://www.npr.org/sections/shots-health-news/2025/04/17/g-s1-60796/parkinsons-stem-cell-transplant-treatment

  A second study by researchers in Kyoto, Japan, used induced pluripotent stem cells, which are derived from a patient’s own cells, rather than an embryo. […] As in the U.S. and Canadian study, the transplanted cells produced dopamine and the patients appeared to see their symptoms decrease. […] The apparent success comes after decades of frustration trying to replace the brain cells killed off by Parkinson’s. […] Now that many of the technical hurdles have been cleared, stem cells appear poised to offer a new treatment option for Parkinson’s, and perhaps other brain diseases like epilepsy or Alzheimer’s. […] Schiess also notes that stem cells don’t cure an underlying disease like Parkinson’s. So the new neurons may eventually succumb to the same disease process. […] Even so, she thinks they could offer new hope to many patients, including those who are no longer responding to drug treatment.

• #36 This New Treatment Can Adjust to Parkinson’s Symptoms in Real Time | UC San Francisco

  https://www.ucsf.edu/news/2025/02/429506/new-treatment-can-adjust-parkinsons-symptoms-real-time

  Starting today, people with Parkinsons disease will have a new treatment option, thanks to U.S. Food and Drug Administration approval of groundbreaking new technology. […] The therapy, known as adaptive deep brain stimulation, or aDBS, uses an implanted device that continuously monitors the brain for signs that Parkinsons symptoms are developing. When it detects specific patterns of brain activity, it delivers precisely calibrated electric pulses to keep symptoms at bay. […] aDBS is a significant advancement over a treatment called continuous DBS, or cDBS, which delivers constant stimulation to the brain. cDBS has been used to improve Parkinsons symptoms since it was approved by the FDA in 1999. […] aDBS, unlike cDBS, can sense and adjust when a patients brain activity changes, which often happens when people with Parkinsons take their medications. aDBSs constant monitoring also enables it to smooth out the peaks and valleys of brain activity, fending off symptoms like stiffness and involuntary movements before they arise.

• #36 This New Treatment Can Adjust to Parkinson’s Symptoms in Real Time | UC San Francisco

  https://www.ucsf.edu/news/2025/02/429506/new-treatment-can-adjust-parkinsons-symptoms-real-time

  Since coming to UCSF in 2019, Little has continued to develop and test even newer aDBS algorithms for treating motor symptoms like stiffness and tremors as well as non-motor symptoms like mood dysfunction and insomnia that people with Parkinsons experience. […] The new algorithm and location improved symptoms and reduced side effects better than cDBS. […] Little anticipates that in the future, artificial intelligence will make it easier to customize the algorithms. Future technology will also address other Parkinsons symptoms, like depression and sleep dysfunction. […] Well be able to give people with Parkinsons round-the-clock personalized DBS therapy, he said.

• #37 Major Breakthrough in the Treatment of Parkinson’s Disease: A Neuroprosthesis Restores Fluid Walking – Inserm Newsroom

  https://presse.inserm.fr/en/percee-majeure-dans-le-traitement-de-la-maladie-de-parkinson-une-neuroprothese-permet-de-restaurer-une-marche-fluide/67725/

  Major Breakthrough in the Treatment of Parkinsons Disease: A Neuroprosthesis Restores Fluid Walking […] Neuroscientists from Inserm, CNRS and Universit de Bordeaux in France, along with Swiss researchers and neurosurgeons (EPFL/CHUV/UNIL), have designed and tested a neuroprosthesis to correct the gait disorders associated with Parkinsons disease. […] Developing new strategies that enable patients to walk fluidly again, avoiding the risk of falls, is therefore a priority for the research teams that have been studying this disease for many years. […] In this new study, the team developed a similar neuroprosthesis to compensate for falls and the phenomenon of freezing when the feet remain glued to the ground during walking that is sometimes associated with Parkinsons disease. […] Unlike conventional treatments for Parkinsons, which target the brain regions directly affected by the loss of dopamine-producing neurons, this neuroprosthesis targets the spinal cord region responsible for activating the leg muscles during walking, which is not believed to be directly affected by the disease.

• #37 Major Breakthrough in the Treatment of Parkinson’s Disease: A Neuroprosthesis Restores Fluid Walking – Inserm Newsroom

  https://presse.inserm.fr/en/percee-majeure-dans-le-traitement-de-la-maladie-de-parkinson-une-neuroprothese-permet-de-restaurer-une-marche-fluide/67725/

  The idea of developing a neuroprosthesis that electrically stimulates the spinal cord to harmonize gait and correct the locomotor disorders of Parkinsons patients is the result of several years of research on the treatment of paralysis caused by spinal cord lesions. […] These promising results paved the way for clinical development, to test the device in a patient. […] This neuroprosthesis therefore opens up new prospects for treating the gait disorders suffered by many people with Parkinsons disease. […] The scientists are therefore working to develop a commercial version of the device that incorporates all the essential features for optimal daily use. […] Our ambition is to enable widespread access to this innovative technology in order to significantly improve the quality of life of patients with Parkinsons disease, throughout the world, conclude the researchers.

• #38 Treatment | Parkinson’s Foundation

  https://www.parkinson.org/living-with-parkinsons/treatment

  There is no standard treatment for Parkinsons. Explore the types of treatments available to help you better manage this disease. […] There is no one-size-fits all treatment for Parkinsons. Rather, treatment should be tailored to an individuals symptoms via a shared decision-making process with your healthcare provider. […] Treatment may include things that you do yourself, such as exercise, or things that you do with oversight, such as physical therapy, occupational therapy, and speech therapy or talk therapy. It may also include medications specific to your needs, such as medications aimed at improving your movement, and others aimed at improving non-movement symptoms such as constipation, urinary dysfunction, or sleep. The treatment of Parkinsons is often best served via a team approach, with you the person with PD at the center and incorporation of your care partner, healthcare provider, therapists and other healthcare providers who treat specific symptoms of Parkinsons.

• #39 Treatment & Medication | American Parkinson Disease Assoc.

  https://www.apdaparkinson.org/living-with-parkinsons-disease/treatment-medication/

  Assembling a team that will provide you with physical and emotional support and adapt to your needs over time is one of the best ways to remain healthy. Parkinsons disease is complex and requires an interdisciplinary approach to care. […] Clinical trials are a critical step in the development of new PD treatments. Before a treatment can be approved to be used in a patient population it is rigorously tested, in increasingly larger groups of people, to ensure that it is safe and effective.

• #40 Parkinson’s-Related Hallucinations and Delusions Treatment | NUPLAZID® (pimavanserin)

  https://www.nuplazid.com/

  Ask your healthcare provider about treatment […] If you or your loved one is seeing, hearing, or experiencing things that others don’t (hallucinations) or believing things that aren’t true (delusions), NUPLAZID may help. […] NUPLAZID is the only medicine approved to treat hallucinations and delusions associated with Parkinson’s disease (PD). […] Around 50% of people living with Parkinsons disease (PD) may experience hallucinations and/or delusions over the course of their disease, and these symptoms can get worse over time. […] The sooner your doctor knows about new or worsening symptoms, the sooner they can help. […] NUPLAZID is a prescription medicine used to treat hallucinations and delusions associated with Parkinsons disease psychosis.

• #41 Treatments for Parkinson’s Disease | ParkinsonsDisease.netShare to Facebookprint pageBookmark for latercaret iconFollow us on facebookFollow us on facebookFollow us on linkedincaret icon

  https://parkinsonsdisease.net/diagnosis-treatment

  Depression and mental health struggles can be common for people with PD. There are ways to improve your mental health: Joining a support group to connect with other people with PD, Speaking with a mental health professional in talk therapy, such as a psychologist or social worker, Taking antidepressants.

• #42 Parkinson’s Disease Treatment | UVA Health

  https://uvahealth.com/services/parkinsons-movement-disorders/parkinsons-disease

  Many different types of medications help ease Parkinsons disease symptoms. They each have pros and cons. And they work differently in different people. […] Our team has the knowledge and expertise needed to find the best medication for you. Our goal is to help you find the most relief with the fewest side effects. […] Sometimes, medications dont help your symptoms enough. You could have severe side effects to the drugs. Surgeries offer another way to control movement (motor) symptoms and give you greater quality of life. […] At UVA Health, we have two high-tech options for Parkinsons disease surgery. […] Our therapists are specially trained to treat patients with Parkinsons. They can help with a range of symptoms, from difficulty walking to problems with swallowing. […] Parkinsons disease goes beyond physical symptoms. It also impacts your thinking and mental processes. We offer neuropsychology services from experienced psychologists. These professionals have special training to treat patients with Parkinsons and other neurological disorders. […] We understand how difficult living with an ongoing illness like Parkinsons disease can be. Its normal to experience sadness, worry, and overwhelm.

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