Parkinson’s Disease (PD)

Parkinson’s disease (PD) is a disease of the central nervous system which causes the death of dopamine-secreting cells in a portion of the brain called the substania nigra. PD is a progressive and incurable disorder which is diagnosed most frequently in older adults (age 50 and above). It is one of the most common neurodegenerative disorders in the world and the risk of developing PD increases with advancing age.

Causes

The cause of PD is not known, but known to play a role are genetic and environmental factors, particularly exposure to certain toxins and pesticides. Men are more likely to have PD than women.

Terminology

Most people with PD have idiopathic PD, that is, there is no known cause for the disorder. PD also causes the brain to lose neurons (nerve cells) and astroyctes (star-shaped glial cell). Most of the symptoms of PD relate to a lack of dopamine and low levels of norepinephrine, two crucial brain chemicals. In histopathology (tissue cultures) studies, PD is associated with the presence of unusual clumps of protein called Lewy bodies, whose function is unknown.

Symptoms

PD produces motor symptoms, that is, symptoms associated with walking and movement as well as non-motor symptoms. The characteristic motor symptoms of PD have been termed “parkinsonian syndrome.” They include:

  • Tremour, usually occuring at rest and diminishing or disappearing during sleep or voluntary movement
  • Slow movements (bradykinesia) and difficulty with movements
  • Rigidity or stiffness and resistance to moving arms or legs
  • Joint pain, associated with rigidity
  • Postural instability, impaired balance, and gait disturbances
  • Difficulty swallowing
  • Impaired sleep
  • Fixed or mask-like facial expression
  • Small and irregular handwriting

Movement disorders may not always be consistent. For example, some PD patients may be unable to walk, yet perform other complex motor tasks with ease. It has been observed that patients may have fewer motor problems when they have cues or coaching as they perform tasks.

Non-motor symptoms include:

  • Cognitive deficits, particularly in terms of abstract thinking and planning
  • Slower cognitive speed and difficulty with concentration
  • Memory impairment
  • Dementia
  • Mood disorders, most commonly depression, apathy, and anxiety
  • Constipation
  • Visual impairments, decreased blink rate, dry eye
  • Changes in the sense of smell and pain perception
  • Tingling or numbness of the skin

Treatment

The main goals of treatment are to delay disease progression and to help the patient manage his symptoms to maintain a good quality of life. PD patients are treated with drug therapy. Levodopa or L-DOPA has been a mainstay of PD treatment for decades, but long-term use of this drug may result in motor impairments. PD patients typically take multiple drugs as combination pharmacological therapy. Patients with advanced PD often receive treatment to help manage the effects of their drug therapy.

Deep brain stimulation (DBS) is the most common surgery for PD and seems to be particularly helpful to control tremour. During DBS, an electrode is implanted in the brain which is connected to a wire. The wire plugs into a pacemaker-like device that sends out low-voltage electrical signals. While DBS may be effective in treating PD, it cannot cure it and most people who undergo DBS must still take drug therapy after the procedure.

Other treatments include physical therapy, assist devices (such as wheelchairs and lifts to prevent falls), and lifestyle modifications, including dietary changes.

Prognosis

PD is a progressive and incurable disorder, but its course is very individual. Patients who receive excellent medical care and have the opportunity to benefit from the latest treatments and therapeutic innovations have optimized outcomes. Neuro Spinal Hospital specializes in treating PD and can offer patients and their families expert consultation, leading-edge therapies, and ongoing care as the disease progresses.

Risk Factors

It is widely believed that PD is associated with exposure to certain toxins, although it is unclear exactly what those substances are. Exposure to certain pesticides and herbicides has been associated with increased risk of PD. Indirect exposure to such toxins may occur in individuals who live in farming communities or rural areas. Curiously, smoking confers a protective benefit in that smokers have a much reduced risk of developing PD, possibly because nicotine is a known dopamine stimulant.

Conclusion

PD is a common, progressive,  degenerative disorder of the central nervous system that is incurable. PD results in a lack of dopamine and low levels of norepinephrine in the brain and causes distinctive motor symptoms (parkinsonism syndrome) and other symptoms. Patients with PD are typically managed with combination drug therapy (several drugs taking concurrently) but over time, symptoms from the prolonged use of L-DOPA (a common drug used to treat PD) may require further treatment. New surgical advances in deep brain stimulation have been helpful for certain PD patients. Neuro Spinal Hospital offers advanced, state-of-the-art treatment for PD which can help patients control their symptoms, delay disease progression, and maintain a good quality of life.