Early treatment

When the first symptoms of Parkinson’s disease (PD) appear, a medication may or may not be prescribed. This decision depends on many factors such as whether disease symptoms are having a negative effect on life at work or at home, and whether the person with PD has other medical conditions to be considered. The treatment decision should therefore be discussed in detail between the person with PD and their doctor/PD nurse. The aim of this discussion is to ensure that each person receives the treatment best suited to their individual needs.

In addition, there is a lot of debate regarding whether starting treatment early (i.e., soon after the disease has been diagnosed) has a long-term advantage over a delayed treatment start.

Those who support early treatment argue that the use of a suitable medication will improve control of symptoms. Those who support delayed treatment initiation feel that, in the early stages of PD, any small treatment benefits on mild symptoms are outweighed by the risk of short-term and long-term side effects of medication. However, if medications are approved for modifying the course of PD and slowing its progression, then starting treatment as early as possible is likely to become a more relevant treatment strategy.

Whenever treatment is started, a single medication will usually be given, with the doctor and person with PD working together to establish the most effective dose. This medication is most commonly an MAO-B inhibitor, a dopamine agonist, or levodopa – although the use of levodopa may be delayed for use later on in the disease. As PD progresses, doses may need to be altered and medications switched or added to provide the best control for the particular symptoms experienced. However, throughout the disease, the person with PD will always have the final say on when and how treatment is given.