About 35,000 Israelis are currently living with Parkinson’s disease – a degenerative and progressive neurological disorder that affects not only movement, but almost every aspect of life. About 6,000–7,000 of them are in advanced stages, in which the impairment in functioning is already significant and sometimes requires close assistance. Despite this, public discourse still tends to focus mainly on the well-known symptoms, such as tremor or slowness, while in practice this is a much broader and more complex disease.
“Parkinson’s affects dopamine production in the brain, and therefore causes motor symptoms such as tremor, stiffness, and slowness of movement,” explains Dr. Michal Cohen, senior neurologist and specialist in movement disorders at Shaare Zedek Medical Center. “But alongside this, there are also many non-motor symptoms: Sleep disturbances, depression, constipation, problems with bladder control, changes in heart rate, drooling, and difficulty swallowing and speaking. Each patient has a different expression of the disease, and it is very individual.”
Much More Than Movement: A Complex Range of Symptoms
In the early stages, treatment is based on oral medications, primarily levodopa – considered the main treatment for Parkinson’s. “Drug treatment significantly improves functioning and quality of life, especially in the early years,” says Dr. Cohen. However, over time its effectiveness diminishes: “After a while, sometimes after just a few years, the duration of each pill’s effect becomes shorter. Patients experience off states – moments when they are unable to move, sometimes accompanied by anxiety. This greatly affects quality of life.”
When this stage is reached, more advanced treatment options are considered. One of them is DBS surgery (deep brain stimulation), in which electrodes are implanted in brain areas responsible for movement. This is a treatment that can significantly improve motor function, but it is not suitable for all patients – whether due to cognitive status, disease characteristics, or the desire to avoid an invasive surgical procedure. In addition, there are symptoms such as speech, swallowing, or freezing of gait that do not respond well to this treatment.
Another option, which has existed for years, is a pump that continuously infuses the medication directly into the digestive system. This avoids sharp “peaks” of effect and provides a more stable level of medication throughout the day, but here too it is a treatment that requires an invasive procedure and a permanent device.
In recent years, a new option has come into use, bringing a significant change for some patients: A subcutaneous pump that continuously delivers levodopa without the need for surgery. This treatment allows continuous delivery of the medication for 24 hours a day, thereby more closely mimicking the physiological state in the body. The drug is delivered via a patch with a thin, flexible tube inserted under the skin, similar to an insulin pump, and is replaced approximately every 48 hours by the patient or caregiver.
“The main advantage is continuity,” explains Dr. Cohen. “Instead of a short effect from a pill, there is a more stable level of the drug in the blood. This allows better control of motor symptoms throughout the day and also at night.”
In addition, the dosage can be individually adjusted for each patient, and even modified in real time as needed, including giving a “boost” before an event outside the home, for example when the patient wants to maintain better control for a longer period.
One of the areas where the most significant improvement is seen is precisely the one less discussed – sleep. About 90% of Parkinson’s patients suffer from sleep disturbances: They have difficulty turning over in bed due to stiffness, wake up frequently, are at risk of falls when getting up, and sometimes suffer from severe daytime fatigue. Family members are not immune either: About 90% of caregivers report that their sleep is also affected.
“When the treatment works at night as well, the patient is less ‘stuck’ in bed and can move,” says Dr. Cohen. “Sleep improves, and this has a dramatic impact on quality of life, both for the patient and for the person caring for them.”
Not Only the Patient: The Impact on the Immediate Environment
In addition, as the disease progresses, the loss of independence increases and the role of the caregiver becomes more and more central. Disease management includes daily coping with fluctuating symptoms, complex medication regimens, and sometimes significant emotional burden. Therefore, solutions that provide stability, reduce fluctuations, and ease treatment management can affect not only the patient but also their immediate environment.
Although there is currently no way to stop the progression of the disease, the medical world continues to advance and offer new solutions. “The field of movement disorders is developing rapidly, and not all advanced options are necessarily known to all community physicians, especially those who do not specifically specialize in movement disorders,” explains Dr. Cohen. “Therefore, sometimes patients who exhaust initial treatment are not exposed to all available options.”
According to her, it is important to be aware of the possibility of further evaluation: “When treatment is no longer sufficient, it is worth considering referral to a specialized movement disorders clinic, where advanced and personalized solutions can be examined. These clinics also conduct research activities, including clinical trials, which may be relevant for some patients.”
Alongside all this, there is one element that remains critical at every stage of the disease: Physical activity. “It may sound paradoxical, but precisely when it is difficult to move – it is important to keep moving,” she concludes. “Physical activity is one of the most important tools for maintaining function.”
Whether through medication, new technologies, or lifestyle adjustments, the message today is clearer than ever: Even with Parkinson’s, it is possible to improve symptom control, reduce fluctuations, and above all maintain a better quality of life over time.