Parkinson’s Disease

Overview

Parkinson`s Disease (PD) belongs to a group of conditions called movement disorders and patients may experience trembling in the hands, arms, legs, stiffness of limbs, slowness of movements and impaired balance and coordination. Patients are generally in the age group 60 year old or above and rarely young patients develop the disease. As these symptoms progress, patients may have difficulty walking, talking or completing fine and simple tasks. Such a disease can progress over time. Although there is no cure yet for Parkinson`s Disease, there are a variety of medications which can provide relief from the symptoms.

 

 
 
 


 
 
 
 

Symptoms

Early symptoms of Parkinson`s Disease occur gradually. Patients may notice feeling unwell, shaky or having difficulty getting out of a chair. Handwriting can become small; speech volume can become low and inaudible and generally patients may seem stiff, unsteady and slow.  The clinical features of Parkinson`s Disease are resting tremor, bradykinesia (slowness of movements) which is the most characteristic symptom of PD, rigidity associated with patients` complaints of stiffness and in later stages postural instability which is lack of balance or unsteadiness whilst standing or changing position. In addition, other signs of PD include loss of facial expression, drooling of saliva, sudden and transient inability to move as the feet are glued to the ground. Patients may also develop additional problems such as sleep disorder, constipation, inability to control bladder function and depression.

  

Causes

Parkinson`s Disease occurs when the nerve cells, of an area of the brain called substantia nigra, die or become impaired. They produce dopamine responsible for planning and controlling body movements. The cause of cell death or their impairment is not entirely known although many researchers believe that a combination of environmental toxins (herbicides & pesticides), genetic predisposition, accelerated aging and oxidative damage may be shown to cause the disease. MOST CASES OF PD HAVE AN UNKNOWN CAUSE. HEREDITARY CAUSES ARE VERY RARE

 

 
 
 


 
 
 
 

Diagnosis

The diagnosis of PD rests on clinical criteria such as asymmetry of signs at onset, the presence of 2 or more cardinal signs including resting tremor and a substantial improvement on medication called Levodopa. Taking a detailed history of symptoms, their evolution and performing a neurological examination is the best way of making diagnosis. Since other forms of parkinsonism have similar presentation but require different treatment, making a precise diagnosis as soon as possible is of paramount importance for starting a patient on proper medication tailored to patient`s needs.NO INVESTIGATIONS ARE NEEDED FOR PARKINSON`S DISEASE.  NO LABORATORY OR IMAGING STUDY IS REQUIRED IN PATIENT WITH TYPICAL PD PRESENTATION. MR SCAN EVALUATION IS NOT HELPFUL FOR DIAGNOSING PD BUT MAY BE NECESSARY IF PATIENTS PRESENT WITH UNUSUAL CLINICAL FEATURES MIMICKING PD SUCH AS ABSENCE OF TREMOR, FALLS AT EARLY STAGE OF DISEASE, BILATERAL BRADYKINESIA AND NO RESPONSE TO LEVODOPA

 

Treatment

Because there is no cure, the goal of treatment in PD is to provide patients with the best quality of life that is possible. IN GENERAL IN PARKINSON’S DISEASE LIFE EXPECTANCY IS THE SAME AS PEOPLE WITHOUT DISEASE. Several medications are available. When recommending a precise course of treatment, the Physician determines how much the symptoms disrupt the patient`s life. Moreover the treatment is based on degree of disability, occupational needs, age and compliance issues.

MEDICATIONS WHICH MAY BE PRESCRIBED INCLUDE:

  • Levodopa/carbidopa which is considered to be the gold standard of symptomatic treatment. It is considered the most effective and widely used drug in PD
  • Dopamine agonists can be used in monotherapy in early stage of disease and as adjunctive therapy to levodopa therapy in moderate to advanced PD
  • Monoamine oxidase (MAO)–B inhibitors: Consideration can be given to use these medications for initial treatment of early disease
  • Anticholinergic agents are sometimes used as second-line drugs only for tremor

When PD symptoms cannot be adequately controlled with current available medications, surgery may be an option for selective patients. Two primary types of surgeries are available and these include creating a lesion in the brain largely now replaced by DBS (deep brain stimulation) which involves implanting an electrode into a target nucleus in the brain. The lead is connected to an implantable pulse generator placed under the skin. Stimulation can be changed to control symptoms as disease progresses or to reduce adverse effects. DBS is reversible and does not destroy the brain thus patients could take advantage of future therapies. DBS IS NOW CONSIDERED TO BE THE SURGICAL PROCEDURE OF CHOICE FOR VERY SELECTIVE PATIENTS




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Parkinson’s Disease