PARKINSON'S:


Description
In 1817 a British doctor, James Parkinson, published a paper on what he called "shaky palsy". He described the common symptoms of shaking/trembling hands. Parkinson's disease was named for Dr. Parkinson's description of the disease. More than 500,000 people in the United States are affected by Parkinson's.

Parkinson's Disease (PD) is due to a lack of production of dopamine in an area of the brain known as the substantia nigra, located deep in the base of the brain. There is a delicate balance between the effect of acetylcholine (a neurotransmitter that carries messages along the nerves) and dopamine. Acetylcholine inhibits motor activity, while dopamine facilitates motor activity. If dopamine is decreased, then the effect of acetylcholine is enhanced and motor activity becomes slower.

The cause of the lack of dopamine is unclear. The process can be either degenerative, viral, toxic, or traumatic in etiology. The disease is chronic and usually worsens over time.

Parkinson's disease is a movement disorder. The disorder progresses slowly. It affects about one million people in the United States. It is most common in people over 50 years old.

Fortunately, treatments can often delay your symptoms for at least five years. And promising research is being done.

Parkinson's gradually reduces a vital chemical in the brain called dopamine. This brings on symptoms of tremor, slowness in movement, stiff limbs, and walking or balance problems.

It's important to remember that Parkinson's is not a fatal illness. Treatment is available.

Symptoms
Parkinson's can begin at any age. Most people experience their first symptoms when they are 40 years or older. The four major symptoms are: rigidity-stiffness in arms, legs and neck; resting tremor-shakiness of hands; bradykinesia-slowness in initiating movement which may contribute to decreased facial expression, change in speech, shuffling gait, smaller-lettered handwriting, trouble with fine finger movements; and loss of postural reflexes-poor balance and coordination.

Secondary symptoms can include: depression, emotional changes, memory and sleep problems, changes in speech patterns, urinary or bowel difficulties, low blood pressure upon standing or problems chewing or swallowing. Patients can experience difficulty rising from the chair, and have trouble walking. Their feet may feel like they are sticking to the ground when they are trying to walk.

Disease progression varies among individuals. For some progression is slow, over 20-30 years, while others may progress more rapidly.

The main symptoms are:
  • Rigidity – stiffness in arms and legs
  • Tremor – often most pronounced when the limb is at rest
  • Poor balance and coordination
  • Bradykinesia – slowness in initiating movement, which may lead to less facial expression, change in speech pattern, shuffling gait, smaller handwriting, or trouble with fine finger movements
Other symptoms may include:
  • Depression
  • Memory problems
  • Sleep problems
  • Pain
  • Drooling
  • Constipation
It’s important to remember that you will likely not experience the full range of symptoms. Most people do not. Symptoms can appear gradually. They may affect one side of the body more than the other. About 60 percent of people have tremor. Often, symptoms begin with occasional trembling of one hand. The trembling gradually increases. Over time, the tremor can progress to the other hand and to the legs. In some people, it can affect the face.

The progress is different for each person. For some, the disorder can progress slowly over 20 to 30 years. For others, it can progress much faster.

Diagnosis
Diagnosis is made from a complete medical history, physical exam, laboratory tests and a CT scan of the head.

There is no definitive lab test or brain scan for Parkinson’s disease. So it is vital for you to be diagnosed by a doctor experienced in treating the disorder. Neurologists can make a diagnosis. They will then prescribe a course of action based on the latest knowledge.

Treatments
Medications as specified below can provide dramatic relief from Parkinsonian symptoms. There are new therapies available aimed at mimicking the action of dopamine and are known as dopamine agonists. In some cases, the use of levadopa can be delayed if Parkinson's patients are given dopamine agonists early during diagnosis. This is important as many can become resistant to levadopa after prolonged use or at high doses.

Treatment for the symptoms of Parkinson's is usually successful, especially in the early years. But the treatment does not stop the progression or cure the disorder.

A complete approach to treatment is the most effective. This includes early diagnosis, exercise, good nutrition, and medications. If you do not respond well to medication, surgery may help control your symptoms.

You may find that Parkinson’s support groups are a source of help, comfort, and information. You can also learn about research results and new treatments through these groups.

Medications
Medication can give dramatic relief from your symptoms. A neurologist will prescribe therapies tailored to you. But it may take time and patience to identify the medicine and dose that works best.

Side effects can occur. They may include nausea, vomiting, and restlessness. Changing the dosages usually stops the side effects.

Medications include:
  • Levodopa - One of the most effective treatments. Helps replenish the supply of dopamine in the brain.
  • Carbidopa - Combined with levodopa. Extends the effects of levodopa and helps reduce side effects.
  • Dopamine agonists - Bromocriptine, pergolide, pramipexole and ropinirole. All mimic the role of dopamine in the brain. Can be used alone in the early phase. Later, can be used to prolong the response to levodopa.
  • Selegiline/Rasagiline - Can delay the need for levodopa. Can also be taken with levodopa to extend the response. Inhibits the enzyme that breaks down dopamine in the brain.
  • COMT inhibitors - Entacapone and tolcapone are taken with levodopa. They block the enzyme that breaks down levodopa before it can reach the brain.
  • Anticholinergics - Mainly used to control tremor. These drugs block the neurotransmitters that counter the action of dopamine.
  • Amantadine - An antiviral drug. Can be used alone in early stages of the disorder. Used later with levodopa.
Diet and exercise
Eating a well-balanced diet helps you maintain your health and strength. Exercise helps keep your muscle tone and strength and improves your mobility. Swimming and walking are especially helpful. Physical therapy may also be helpful.

Surgery
If you have not responded well to drugs, surgery is an option. Pallidotomy and thalamotomy can reduce specific symptoms for some people. The surgeries destroy a small group of cells in areas of the brain that cause tremor.

Deep brain stimulation uses a device implanted in the brain. The device is similar to a cardiac pacemaker. The electrical brain stimulation blocks the signals that cause tremors and can improve other movement symptoms.

Progress through research
New drugs and surgical methods are constantly being developed. These advances can improve the quality of life for people with the disorder. There is great hope that this progress will lead to a cure and prevention in the future.

You may find taking part in clinical research trial to be rewarding. Benefits include taking a more active role in your health care and gaining access to expert medical care.