WINCHESTER, Va. (WDVM) — When a patient is diagnosed with Parkinson’s disease, the first thing neurologists ask is what kind of changes they’ve noticed.

When it comes to prescribing medication, Dr. Fowler says there are a few different options.

“Is it tremor? Is it balance trouble? Is it sleeping trouble? Then, we’re going to try to adjust medications to really help control all of those things to give them the best quality of life,” said Dr. Fowler, a neurologist with Winchester Neurological Consultants.

“The one that is the most efficacious is still the first one we began using in the 1970’s,” Dr. Fowler added. “It’s Carbidopa-Levodopa, and basically gives the brain back a chemical called dopamine, which is low in certain motor parts of the brain.”

There are also extended release formulations, patch formulations and medications that increase dopamine in other ways.

“There’s a lot of studies, especially with Parkinson’s, that exercise can improve symptoms almost as much as prescription medications,” Dr. Fowler said.

One type of exercise specific to Valley Health in Winchester is the Rock Steady Boxing Program.

“I had trouble standing up from a chair,” said Edward Collins, who suffers from Parkinson’s disease. “Now, I’m able to get in and out of a chair, I’m able to get in and out of my car.”

If medication and exercise are not effective, the third step is deep brain stimulation surgery.

“It actually can replace those signals that are not coordinating those movements anymore, such that those nerves can then be highly-coordinated and go from a tremor to being very smooth again,” said Virginia Brain and Spine neurosurgeon Dr. Lee Selznick.

Dr. Selznick said this is a low-risk surgery that he feels is somewhat under-utilized.

“When I finally made the decision to get it done, I was glad I did, because I’d get it done again if I had to,” Collins added.

Collins said medication, exercise and deep brain stimulation have been the best combination for his therapy and treatment.

“All of them together helped me out,” he explained. “It has pretty much stopped my progression of Parkinson’s.”

Dr. Fowler said in the next five to 10 years, she expects to see even more treatment options for patients with Parkinson’s.