Treatment options

[Michele__0__0]

  My 87-year-old mother has been diagnosed with Parkinson's. Her most
  obvious symptom is a tremor in her right arm. She also has minor tremors
  in her left arm, but not as frequently, and may exhibit other symptoms
  such as impaired balance and coordination. The doctor who made the
  diagnosis left us with two options. He said mother could begin treatment
  immediately or could wait until symptoms worsen before starting
  medication. He said the medication (I am presuming from what I have read
  that he referred to levodopa) can cause long-term side effects, such as
  involuntary movements, and seemed to suggest that the longer we held off,
  the better. He said mother's overall health indicated that she would
  probably live long enough for the long-term side effects to affect her.
  Mother, who is already taking a number of medications for congestive heart
  failure, opted to delay treatment for the time being. Lately, however, she
  is questioning whether she made the right decision. Her brother, who has
  advanced Parkinsons, has been on medication for many years and does suffer
  from involuntary movements, suggested she get a second opinion. Also, a
  recent television program on the subject suggested that the earlier
  Parkinson's was treated, the better. Would you recommend we pursue early
  treatment for the tremors? What can I tell my mother about the avisability
  of early treatment as opposed to the risks of long-term side effects?
  Thank you.
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Treatment for PD, as you know, is aimed strictly at covering up symptoms (by replacement dopamine) and not at arresting the underlying loss of dopamine-producing cells. Therefore, I always tell my patients that the decision when to treat is completely different than it would be for diabetes or hypertension (for example), conditions in which delayed treatment can actually be harmful.
In PD, delayed treatment just means missed opportunity to improve function. It is possible to treat too early - if symptoms are so mild you can't tell the difference between treated and untreated, or if that difference is not enough to make it worth the hassle of taking meds.
It is possible to treat too late - missing the opportunity to make your life easier - just because of stubbornness or fear of long-term effects. It's not actually dangerous to delay treatment, however.
There has been controversy over levodopa for 30 years. It is still not resolved. Our practice has been to try to limit exposure to levodopa with the belief that levodopa may somehow "prime" one for development of dyskinsia. Truth is, everyone with PD gets dyskinesia when they've had it long enough. There may be something to the argument that levodopa could bring that out a bit sooner than it might otherwise happen, but NO ONE REALLY KNOWS THE ANSWER.
Your mom may benefit from dopamine analogs ("agonists") such as Requip, Mirapex, or Permax. These have been used in patients with early PD all by themselves, and they certainly have their utility in combination with levodopa in more advanced patients. In an 87 year old, however, levodopa may be more appropriate (all factors must be weighed).
Treatment of PD is individualized. The choice of when to treat, which of many medications to use, the dosage and timing, all vary from person to person and change as the disease evolves with the person.
My recommendation is to see a movement disorders specialist. Have your mother examined, confirm the diagnosis of PD, and discuss these options in person. No one but your mother can really make the decision, but talking to an expert can give her the information needed to make an intelligent decision.
I hope this helps. CCF MD mdf.