Can adjusting medications help my uncle’s Parkinson’s symptoms?

Question

Hello doctor,

My uncle has Parkinson’s disease, and his symptoms, such as hand tremors and slowness of walking, have become more noticeable.

Although his MRI brain was unremarkable, a DaTscan confirmed dopamine deficiency, and despite being on Levodopa, its effect seems to “wear off” before the next dose.

Could adjusting the dosing schedule or adding another medication help smooth his movements?

He also experiences lightheadedness on standing with occasional falls. Could this be related to the disease itself or the medications, and what supportive therapies, such as physiotherapy or speech therapy, should be considered at this stage?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I can completely understand your concern.

Your uncle’s Parkinson’s disease appears to be at a stage where motor fluctuations, such as the “wearing off” effect of Levodopa, and some non-motor symptoms are becoming more prominent.

This is a common progression and often requires refinement of treatment rather than indicating treatment failure.

Wearing off of Levodopa can often be managed by taking smaller, more frequent doses or by adding medications such as COMT inhibitors (catechol-O-methyltransferase inhibitors, including Entacapone and Opicapone) or MAO-B inhibitors (monoamine oxidase B inhibitors, including Rasagiline and Safinamide) to prolong Levodopa’s effect.

In selected patients, Dopamine agonists (Pramipexole, Ropinirole, Rotigotine) may also be used to smooth motor fluctuations, with adjustments tailored by the neurologist based on age and tolerance.

The lightheadedness on standing and falls are suggestive of orthostatic hypotension, which can occur due to Parkinson’s disease itself and may be worsened by dopaminergic medications.

Measures such as standing up slowly, adequate hydration, increased salt intake (if appropriate), and compression stockings can help, while medications may be needed in more severe cases.

Supportive therapies are very important at this stage to maintain function and safety.

Physiotherapy can improve balance, gait, and posture, and reduce fall risk, while speech therapy can help with low voice volume, speech clarity, and swallowing difficulties.

I hope this helps you.

Please feel free to reach out in case of further queries.

Thank you.