Q. What is the treatment option for Parkinson's disease other than Levodopa?

Answered by
Dr. Muhammad Majid Hanif
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 05, 2015 and last reviewed on: Feb 25, 2021

Hi doctor,

I feel extreme fatigue in the morning. I have tremor and right leg tingling. I am experiencing brain fog, Parkinson like symptoms but I did not feel any improvement with Levodopa. My manganese levels are high. Please help.



Welcome to

I want to assure you that do not worry as everything is going to be fine soon. I have thoroughly gone through your case and can well understand your genuine concerns.

The Probable causes:

First thing is unless the diagnosis is made by an expert physician, the resembling symptoms do not mean straight that you have Parkinson's disease.
There are many other drugs that are to be used as an adjunct to the Levodopa and that show a good result in many patients. Such as Levodopa with Carbidopa (a peripheral decarboxylase inhibitor) is a good combination.
Also we have Ach-Acetylcholinesterase inhibitors, NMDA (N-Methyl-D-Aspartate) antagonists, COMT (catechol-O-methyl transferase) inhibitors, MAO-B (Monoamine oxidase-B) inhibitors, anticholinergics, etc.
Your symptoms can also be due to other conditions such as liver disease (hepatitis and cirrhosis), anemia, fluid and electrolyte imbalance, thyroid disease and blood pressure issues.

Please answer the below mentioned questions for better diagnosis and treatment.
1. What is your age, gender, height, weight and waist circumference?
2. What is your manganese level? If you have the laboratory reports kindly upload.
3. Have you checked your pulse rate, blood pressure and blood sugar level recently?
4. Please send me all laboratory reports, MRI, CT, radiographs, etc., relevant to your query.

Investigations to be done:

Investigations you need includes,
1. Comprehensive metabolic panel.
2. Liver viral markers for hepatitis B and C.
3. Thyroid profile.

Differential diagnosis:

1. Liver disease.
2. Anemia.
3. Thyroid disease.
4. Diabetes.

Treatment plan:

Treatment will be decided according to your laboratory reports. As there are many possibilities, we have to proceed with care.

Hi doctor,

I am a 60 year old male. I am 5'11". My weight is 190 lbs and my waist circumference is 34 inches. My average blood pressure is 135/85 mmHg, and my sugar is normal. I have lost 35 lbs in a year for unknown reason. I am HIV negative. I had taken Levodopa/Carbidopa in all strengths and also Pramipexole in all strengths with no results. I suspect the reason might be manganese or thyroid/adrenal problems. My body is in a constant state of tension, hyper anxiety and shaking. My energy is best in the late evening and worst upon waking. I have sleep apnea and I am using cpap machine. Please check my attached blood history.



Welcome back to

I want to assure you that do not worry as everything is going to be fine soon. I have thoroughly gone through your case and can well understand your genuine concerns.

The Probable causes:

Your main issue is dyslipidemia (deranged lipid profile). Over the last 4 years, in all laboratory reports you have high bad cholesterol and low good cholesterol.

Treatment plan:

1. Whenever a patient presents with complaint as you have and the lipid profile too the same as yours then I usually prescribe him first of all to follow diet and lifestyle modification.
In majority of patients, it works very well and gets lipid under control.
2. Very few number of patients need some medication for long-term like Fenofibrate or Pravastatin.
3. You need to lose some weight with diet control and exercise. All the symptoms you have are consistent with the diagnosis.
4. Take Sea-Mega capsules and fatty fish in food (for example herring fish).
5. No fat and carbohydrates in excess and say no to fried foods, fast food, energy drinks and beverages.
6. Avoid red meat, chicken, alcohol and cigarette.
7. Avoid excess salt and sugar.
8. Take plenty of water.
9. Start proper physical activity and make it a habit. It will help you get HDL up, LDL and triglycerides low.

After some weeks come back to me with a fresh comprehensive metabolic panel including fasting lipid profile to see how you doing and I will be able to decide if you need medications to lower the levels.

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