Parkinson's Disease

What is Parkinson's disease?

Parkinson's disease (PD or, simply, Parkinson's) is the most common form of parkinsonism, a group of motor system disorders. It is a slowly progressing, degenerative disease that is usually associated with the following symptoms, all of which result from the loss of dopamine-producing brain cells:

tremor or trembling of the arms, jaw, legs, and face
stiffness or rigidity of the limbs and trunk
bradykinesia (slowness of movement)
postural instability, or impaired balance and coordination

Facts about Parkinson's disease:

It is incorrectly believed that Parkinson's disease disappeared after the introduction of levodopa (L-dopa) in the 1960s. In fact, about 50,000 Americans are newly diagnosed with Parkinson's disease each year, with more than half a million Americans affected at any one time. Further, more people suffer from Parkinson's disease than multiple sclerosis, muscular dystrophy, and amyotrophic lateral sclerosis combined.

What causes Parkinson's disease (PD)?

The specific cause of PD is unknown, however, medical experts believe the symptoms are related to a chemical imbalance in the brain caused by brain-cell death. Parkinson's disease is chronic (persists over a long period of time), and progressive (symptoms grow worse over time).

Although the disease may appear in younger patients (even teenagers), it usually affects people in late middle age. The disease affects men and women in almost equal numbers. It is not contagious, nor is it likely passed on from generation to generation.

Parkinson's Syndrome, Atypical Parkinson's, or Parkinsonism:

Parkinson's disease is also called primary parkinsonism or idiopathic Parkinson's disease. (Idiopathic is the term for a disorder for which no cause has yet been identified).

In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another primary neurological disorder that may have both primary and secondary symptoms of Parkinson's disease. These disorders, described as Parkinson's Syndrome, Atypical Parkinson's, or, simply, parkinsonism, may include the following:

tumors in the brain
repeated head trauma
drug-induced parkinsonism - prolonged use of tranquilizing drugs, such as the phenothiazines, butyrophenones, reserpine, and the commonly used drug, metoclopramide for stomach upset.
toxin-induced parkinsonism - manganese and carbon monoxide poisoning.
postencephalitic parkinsonism - a viral disease that causes "sleeping sickness."
striatonigral degeneration - the substantia nigra of the brain is only mildly affected, while other areas of the brain show more severe damage.
parkinsonism that accompanies other neurological conditions - such as Shy-Drager syndrome (multiple system atrophy), progressive supranuclear palsy, Wilson's disease, Huntington's disease, Hallervorden-Spatz syndrome, Alzheimer's disease, Creutzfeldt-Jakob disease, olivopontocerebellar atrophy, and post-traumatic encephalopathy.

What are the four primary symptoms of Parkinson's?

The following are the most common symptoms of Parkinson's disease. However, each individual may experience symptoms differently. Symptoms may include:

rigidity - stiffness when the arm, leg, or neck is moved back and forth.
resting tremor - tremor (involuntary movement from contracting muscles) that is most prominent at rest.
bradykinesia - slowness in initiating movement.
loss of postural reflexes - poor posture and balance that may cause falls; gait or balance problems.

Other symptoms of Parkinson's disease (PD):

Symptoms of Parkinson's disease vary from patient to patient. The symptoms may appear slowly and in no particular order. Early symptoms may be subtle and may progress over many years before reaching a point where they interfere with normal daily activities. These often include the following:

fatigue or general malaise
trembling
difficulty arising from a seated position
lowered voice volume (dysarthria)
small, cramped, spidery handwriting
losing track of a word or thought
irritability or sadness for no apparent reason
lack of expression in the face
lack of animation
remaining in a certain position for long period of time
unable to normally move arm or leg

What are the secondary symptoms of Parkinson's?

depression
senility
difficulty with speaking
emotional changes (fearful and insecure)
memory loss and slow thinking
difficulty in swallowing and chewing
urinary problems or constipation
skin problems
sleep problems

As the disease progresses, walking may become affected, causing the patient to stop in mid-stride or "freeze" in place, and maybe even fall over. Patients also may begin walking with a series of quick, small steps as if hurrying forward to keep balance, a practice known as festination.

The symptoms of Parkinson's disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is Parkinson's disease diagnosed?

Making an accurate diagnosis in the early stages of Parkinson's disease can be difficult, and may require observation of the patient for some time until it is apparent that the tremor is consistently present and is joined by one or more of the other classic symptoms.

Currently, there are no specific tests for diagnosing PD, although there are several methods for evaluating its presence, including the following:

neurological examination (including evaluation of symptoms and their severity)
trial test of drugs - when symptoms are significant, a trial test of drugs (primarily levodopa [L-dopa]) may be used to further diagnose the presence of PD. If a patient fails to benefit from levodopa, a diagnosis of Parkinson's disease may be questionable.
computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Treatment for Parkinson's disease:

Specific treatment for a Parkinson's disease will be determined by your physician based on:

your age, overall health, and medical history
extent of the condition
type of condition
your tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference

With today's medicine, we have yet to find a cure for Parkinson's disease. However, based upon the severity of the symptoms and medical profile, the physician will establish an appropriate treatment protocol. Treatment for Parkinson's disease may include the following:

medications
surgery

Medication for Parkinson's disease:

Once the diagnosis of PD has been made, the next decision is whether a patient should receive medication, which depends on the following:

the degree of functional impairment
the degree of cognitive impairment
ability to tolerate antiparkinsonian medication
the advice of the attending physician

No two patients react the same way to a given drug, therefore, it takes time and patience to find an appropriate medication and dosage to alleviate symptoms.

Surgery for Parkinson's disease:

Based on the severity of the condition and the medical profile, the physician may recommend surgery as one treatment option for Parkinson's disease.

There are several types of surgery that may be performed that can help patients with Parkinson's disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms of Parkinson's disease, including the following:

There are three types of surgeries that may be performed for Parkinson's disease, including the following:

lesion surgery (burning of tissue)
In this procedure, deep parts of the brain are targeted and small lesions are made in critical parts of the brain that help control movement. The surgery may be done while the patient is awake to help determine the exact placement of the lesion. The lesion is placed to help control, or stop, the area of the brain that is causing the tremor.
deep brain stimulation (DBS)
With this type of surgery, a small electrode is placed in the critical parts of the brain that help to control movement. The electrode is attached to a small battery in the chest wall and is connected by wires that are placed under the skin. The stimulator is then turned on and interrupts the normal flow of information in the brain and can help to decrease symptoms of Parkinson's disease.
neural grafting or tissue transplants
Experimental research is being done to find a replacement for the part of the brain that functions improperly in Parkinson's disease.

It is important to remember that surgery may help with symptoms of Parkinson's disease, but does not cure the disease or stop the progression of the disease.