More than 50 years after its discovery, levodopa is still the most effective treatment for Parkinson’s, but some people experience “off” periods or dyskinesias with oral medications. Dr. Mark Guttman describes new delivery methods that promise to help with some of these problems, especially for people who have had Parkinson’s for many years. For example, levodopa infusions directly into the gut are currently available, and skin patches and special pills that stay in the stomach and release drug over a period of time are in development.

Parkinson’s can be unpredictable – symptoms can come and go or get better and worse throughout the day. These so-called “on-off” fluctuations (also called motor fluctuations) and dyskinesias can be troubling, but movement disorder specialists can help with the choice of medication, dosages, and timing. Dr. Irene Malaty explains more about what causes these changes and how you can work with your doctor to manage them.

Nutrition is increasingly part of the conversation when it comes to good Parkinson's care. Dr. Bas Bloem describes how diet can help improve some of the symptoms of Parkinson's and optimize the effects of medication, and he offers tips on getting adequate nutrition.

Regular exercise is essential for people with Parkinson's. Dr. Bas Bloem describes what is known about exercise and PD and what is still in the research stages, and he offers some tips on overcoming barriers to getting enough exercise.

Dr. Peter Schmidt of the Parkinson’s Foundation explains where people with Parkinson’s can go to receive the best interdisciplinary care and how the Foundation is improving standards of Parkinson’s care around the world. The Foundation's Centers of Excellence network and the Parkinson's Outcomes Project – the largest-ever clinical study of Parkinson’s – are key aspects of the discussion.

In this debut episode of Substantial Matters: Life and Science of Parkinson's, Dr. Michael Okun talks about early warning signs of Parkinson's and offers practical advice on how to proceed after a diagnosis.