The Five Stages of Parkinson’s Disease

Once your neurologist has made a definitive diagnosis of Parkinson’s disease, he or she will consider treatments for the disease based on the perceived stage of Parkinson’s present. The five stages of Parkinson’s disease offered by the Hoehn and Yahr scale are characterized by the degree of disability and the severity of the symptoms.

Stage I

Unilateral disease

In Stage I Parkinson’s disease, the symptoms are confined to one side of the body. It’s a relatively early stage of the disease, and for most people, it may last for years. One of the most promising treatments in Stage I of Parkinson’s is neuroprotective treatment – various strategies that may shield the nervous system from further damage. Among the drugs that have been investigated for their neuroprotective benefits are vitamin E, which has so far proved ineffective, and a selective MAO-B inhibitor called Rasigiline, which has shown promise in preliminary tests.

Stage II

Bilateral Disease

In Stage II Parkinson’s disease, the symptoms have spread to both sides of the body. Even if the ‘crossover’ is very trivial – an occasional tremor on the opposite side of the body, for instance – the disease is considered to have progressed to Stage II. A newer therapy that is being used in Stages I and II is the early prescription of dopamine agonists which have traditionally been used in the later stages of the disease. Researchers theorize that the complications that arise from treatment with Levodopa in latter stage Parkinson’s may not exist if the treatment is started early in the disease’s life – that in fact, levodopa may actually confer some protection to the neurological system.

Stage III

Stage III Parkinson’s disease is characterized by progressing symptoms, and the onset of postural instability and falling. Stage III Parkinson’s disease is the stage when treatment with L-dopa or other dopamine agonists (medications that are the immediate precursors of dopamine) is traditionally begun. In recent years, L-dopa is commonly given with another drug that helps the body use it more efficiently.

Stage IV

Stage IV Parkinson’s disease is characterized by an increase in balance problems (postural instability) and more falling. In some patients, particularly those who have young-onset Parkinson’s disease and are otherwise in good health, surgery to alleviate some of the symptoms may be considered.

Stage V

At Stage V, the Parkinson’s patient is typically wheelchair bound an unable to walk without assistance. The available treatments include L-dopa, with a COMT inhibitor to give longer lasting results. There are also several types of brain surgery which may be helpful. Those include a pallidotomy – a procedure that kills off a small group of cells in the brain to stop the tremors and rigidity associated with Parkinson’s disease, and DBS – Deep Brain Stimulation, in which electrodes are implanted in the brain to deliver a consistent low level of electronic pulses to the brain.

The treatment of Parkinson’s disease is changing rapidly as new research shows new possible avenues for alleviating or eliminating the symptoms of Parkinson’s. Among the promising treatments are stem cell implants, deep brain stimulation and new medications that boost the effectiveness of levodopa.