Patient's Query
Hello doctor,
My 61-year-old wife was diagnosed with Parkinson’s disease about eight months ago, and we have been noticing that her symptoms seem to be progressing quite quickly. The tremors in both of her hands have become so severe that she is no longer able to write properly or hold a cup steadily. The muscle rigidity has also worsened, making simple tasks like getting dressed or buttoning her clothes very difficult.
She has been taking Carbidopa/Levodopa 25/100 mg three times a day, but despite this, she is still experiencing significant motor symptoms. Her DaTscan confirmed the diagnosis of Parkinson’s disease, but we are wondering if there might be additional treatment options that could help manage her symptoms better.
What worries us the most is the emotional impact the diagnosis has had on her. She has been struggling with depression, cries frequently, and has lost interest in activities she once enjoyed. Her voice has also become very soft, and people often have difficulty hearing her when she speaks.
In addition, she has been experiencing several non-motor symptoms, including constipation and urinary urgency, which her neurologist mentioned can be related to Parkinson’s disease. She also has frightening “freezing” episodes where she suddenly stops while walking and cannot move her feet. Her sleep is disturbed as well because of restless legs.
We have been trying physical therapy, which does help somewhat, but she feels self-conscious about how slowly she moves now. We have also started considering deep-brain stimulation as a possible option, though we are concerned about the risks given her age.
Could you please advise whether there are other medications or treatments that might help manage both her motor and non-motor symptoms more effectively?
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query.
I am really sorry to hear about what your wife is going through. Parkinson’s disease (a progressive brain disorder that affects movement, causing symptoms like tremors, stiffness, and slow movements) can be challenging for both the patient and the family, especially when symptoms seem to progress quickly. Your concern and support for her are very important during this time.
When Carbidopa or Levodopa alone does not provide enough relief, her neurologist may adjust the dose, shorten the dosing intervals, or add other Parkinson’s medications. These may include MAO-B (monoamine oxidase-B) inhibitors such as Rasagiline or Selegiline, COMT (catechol-O-methyltransferase) inhibitors like Entacapone or Opicapone, or dopamine agonists such as Pramipexole or Ropinirole. These medicines can help improve motor control and reduce periods when symptoms worsen.
For freezing episodes, medications like Amantadine may sometimes help. Physiotherapy is also very useful, especially when it includes cueing techniques such as visual floor markings or rhythmic auditory cues, which can help her initiate movement more easily.
Her restless leg syndrome (a condition that causes an uncontrollable urge to move the legs) may improve with low-dose dopamine agonists or medications like Gabapentin taken in the evening.
The non-motor symptoms you mentioned are also common in Parkinson’s disease and deserve proper treatment. Depression can often be managed with Parkinson-safe antidepressants such as Sertraline or Citalopram, along with counseling or psychological support.
Constipation may improve with increased fiber intake, adequate fluids, osmotic laxatives if needed, and gentle abdominal exercises. Urinary urgency can sometimes be managed with bladder training techniques or medications such as Mirabegron, which is generally safer for cognition than some other bladder medications.
Because her voice has become softer, speech therapy-especially programs designed for Parkinson’s patients-can help strengthen her voice and improve communication.
Regarding deep brain stimulation (DBS, a surgical treatment where small electrodes are implanted in the brain to help control symptoms like tremors and stiffness in Parkinson’s disease), it can still be a suitable option even in people in their 60s if they are otherwise healthy and their symptoms still respond to Levodopa. A specialized movement-disorder team would carefully evaluate her to determine whether she is a good candidate and discuss the potential benefits and risks.
Finally, I encourage her to continue physiotherapy, even if she feels self-conscious about moving slowly. Regular physical therapy is one of the most effective ways to maintain mobility, independence, and confidence over time.
Please reassure her that she is not alone in this journey, and with the right adjustments in treatment and supportive therapies, many patients experience meaningful improvement in their quality of life.
I hope this helps.
Kindly revert so I can assist you further.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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