How can my wife manage Parkinson’s and dyskinesia at 68?

Question

Hi doctor,

My 68-year-old wife was diagnosed with Parkinson’s disease about three years ago, and the symptoms are progressing faster than we expected. She started with a tremor in her right hand, but now both hands shake so badly that she cannot hold a cup of coffee without spilling.

The neurologist has her on Carbidopa-Levodopa 25 to 100 three times daily, but she is experiencing severe dyskinesia, especially a few hours after taking the medication. Her handwriting has become so small that I can barely read it, and she shuffles when she walks, which has caused her to fall four times in the past month.

Parkinson’s disease is also affecting her mind; she sometimes sees things that are not there and gets confused about the day. Her face has lost expression, and people think she is unfriendly, but it is just the disease.

Her sleep is terrible because of restless legs, and she acts out dreams violently, which has frightened me several times. We tried physical therapy, but she became too tired after just 20 minutes.

Is deep brain stimulation safe for Parkinson’s disease at her age? Will it help with all her symptoms or just the tremors? I am really struggling to take care of her alone.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

At this stage, she is experiencing motor fluctuations and dyskinesias, which are common after a few years on Carbidopa-Levodopa.

The “on–off” effect means she has periods of good movement after taking medicine, followed by excessive movements (dyskinesia) or stiffness before the next dose. Adjusting the dose timing or adding medications such as Amantadine, MAO-B inhibitors (monoamine oxidase B inhibitors) such as Rasagiline, Safinamide, or COMT (catechol-O-methyltransferase inhibitors) such as Entacapone may help reduce these fluctuations. Her neurologist can tailor this to her needs.

The visual hallucinations and confusion suggest that the disease is also affecting her brain’s chemical balance. These symptoms may worsen with dopaminergic medicines. Drugs such as Quetiapine or Pimavanserin (if available) can help control hallucinations without worsening Parkinson’s symptoms.

Her dream-acting and restless sleep are part of REM (rapid eye movement) sleep behavior disorder, which is common in Parkinson’s disease. Melatonin or low-dose clonazepam at bedtime may help, under medical supervision.

Deep brain stimulation (DBS) can greatly improve tremor, stiffness, and “off” time, but it has a limited effect on balance, speech, or cognitive problems. The best results occur when cognitive function is still preserved. If confusion or hallucinations are frequent, DBS is usually avoided, as it can worsen these issues. Age itself (late 60s) is not an absolute barrier, but overall physical and mental fitness matters most.

Non-drug care remains crucial, and therefore, gentle daily exercises, balance training, and avoiding long periods of immobility are important. Even short sessions twice daily are better than longer, exhausting ones.

It may be time to involve a multidisciplinary team, including a neurologist, physiotherapist, occupational therapist, and possibly a movement disorder specialist, to review DBS suitability and fine-tune medications. You also deserve caregiver support, as this stage can be physically and emotionally draining.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.

Thank you.