Parkinson's Disease
Parkinson's disease (PD) is a progressive movement disorder that causes:
- Muscle rigidity
- Tremor at rest
- Slowing down of movements (bradykinesia)
- Difficulty moving and gait instability
It is caused by a loss of nerve cells in the brain. This includes loss in an area called the substantia nigra . The loss decreases the amount of dopamine in the brain. Low dopamine results in PD symptoms.
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Factors that cause the loss may be from the genes, the environment, or some combination of the two. A small amount of people with PD have an early onset form. This type is caused by an inherited gene defect.
Secondary PD has similar symptoms but is caused by several factors such as:
- Antipsychotic drugs, such as haloperidol (Haldol), fluphenazine (Prolixin), trifluoperazine (Stelazine), and chlorpromazine (Thorazine)
- Carbon monoxide poisoning
- Manganese poisoning
- Hydrocephalus
- Brain tumors
- Stroke
- Encephalitis
- Meningitis
- Intravenous drug abuse of MPTP (a type of neurotoxin)
- Reserpine
- Insecticide exposure
- Trauma
- AIDS
Factors that increase the chance of parkinson's disease include:
- Age: 50 or older
- History of polio
- Gender: men (slightly more likely to develop PD)
- Family members with PD
- Nonsmokers
- Exposure to toxins, drugs, or conditions listed above
Symptoms of PD begin mildly. They will worsen over time.
Symptoms include:
- "Pill-rolling" tremor in the hands
- Tremors are present at rest, improve with movement, and are absent during sleep
- Stiffness and rigidity of muscles, usually beginning on one side of the body
- Difficulty and shuffling when walking
- Short steps
- Slowness of purposeful movements
- Trouble performing usual tasks, due to shaking in hands
- Trouble speaking
- Flat, monotonous voice
- Stuttering
- Shaky, spidery handwriting
- Poor balance
- Difficulty with rising from a sitting position
- “Freezing”
- Anxiety
- Seborrhea (a skin problem that causes a red rash and white scales)
- Loss of smell
- Tendency to fall
- Stooped posture
- Increasingly mask-like face, with little variation in expression
- Trouble chewing and swallowing
- Depression
- Dementia
- Difficulty thinking, problems with memory
- Decreased sense of smell
- Sleep problems such as REM-behavior disorder
The doctor will ask about your symptoms and medical history. A physical exam will be done. There are no tests to definitively diagnose PD. The doctor will ask many questions. This will help to rule out other causes of your symptoms.
Tests to rule out other conditions may include:
- Blood tests
- Urine tests
- CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
- MRI scan —a test that uses magnetic waves to make pictures of structures inside the head
- PET scan —a scan that makes images that show the amount of activity in the brain
Currently, there are no treatments to cure PD. There are also no proven treatments to slow or stop its progression. Some medications are used to improve symptoms. Over time the side effects may become troublesome. The medications may lose their effectiveness.
Medications include:
- Levodopa/carbidopa ( Sinemet )
- Amantadine (Symmetrel)
- Anticholinergics: benztropine (Cogentin) and biperiden (Akineton)
- Selegiline (Eldepryl)
-
Dopamine agonists:
bromocriptine
(Parlodel),
pergolide
(Permax),
pramipexole
(Mirapex),
cabergoline
(Dostinex), and
ropinirole
(Requip)
- o Pergolide (Permax) was withdrawn in March 2007. It had a high risk of serious heart valve damage. Cabergoline (Dostinex) has also been linked to this risk. *
- Apomorphine (Apokyn)
- COMT inhibitors: entacapone (Comtan) and tolcapone (Tasmar)
Depression or hallucinations may also occur with PD. Medicine may be given to relieve these. The drugs may include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Antipsychotic clozapine
These drugs can worsen other symptoms. You will need to be closely followed.
Different brain operations are available, and many more are being researched including:
- Deep brain stimulation (DBS)—implanting a device to stimulate certain parts of the brain; can decrease tremor and rigidity
- Thalamotomy and pallidotomy—destroying certain areas of the brain to improve tremor when medication does not work (not as common as deep brain stimulation)
- Nerve-cell transplants (research only)—to increase amount of dopamine made in the brain
Therapy can improve muscle tone, strength, and balance. It will include exercises and stretches.
Join a support group with other people with PD. It will help to learn how others are learning to live with the challenges of PD.
If you are diagnosed with PD, follow your doctor's instructions .
Last reviewed February 2009 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
