Treatment is very individual; the main aim being to improve and smooth out the delivery of dopamine to the brain and provide what is called continuous dopaminergic stimulation, that is, stabilising levodopa levels in the blood stream. This does not necessarily mean taking more levodopa - there are a number of possible adjustments and options available. For example, your doctor may suggest taking smaller levodopa doses, but more frequently.
The effectiveness of levodopa therapy can be improved to reduce wearing off as shown by the following diagram:
One option your doctor may suggest is to swap your medication to a controlled-release form of levodopa to help keep dopamine levels more stable. This can also prolong the time needed between doses by up to 50%. Adding a dopamine agonist to your levodopa regime may also be useful, as the brain is ‘tricked’ into believing it is receiving dopamine. Alternatively, drugs called entacapone (Comtess) and tolcapone (Tasmar) can prolong the duration of levodopa and reduce the impact of wearing off by stabilising dopamine levels in the blood. However, tolcapone is potentially dangerous for some people and can result in liver damage. Selegiline (Eldepryl) may also be suggested by your doctor as this drug slows the breakdown of dopamine in the brain, enabling levodopa to be more effective. For further information please see the Parkinson’s Disease
Society factsheet: The Drug Treatment of Parkinson's Disease.
Whatever treatment you undergo, you will need to work closely with your doctor to find the right medication regime for you. Together you will need to monitor your response to medication, as well as any adjustments he/she may make to ensure that wearing off is as well managed as possible.
