Parkinson’s Disease (PD) is a chronic (long-standing), progressive (getting worse over time) neuro degenerative disorder of the brain, belonging to a group of conditions called movement disorders.
What are the features of Parkinson’s Disease ?
Major features are
- Tremor (Shaking or Trembling – hence it is also called ‘Shaking Palsy’):
- Rigidity (Stiffness due to muscles being constantly tense)
- Bradykinesia (Slowing down of all movements)
- Postural instability (Imbalance while walking) which causes them to fall easily.
Parkinson’s disease does not affect everyone the same way and rate of progression differs among individuals. Symptoms typically begin on one side of the body eventually affecting both sides. Friends or family members may see that the person’s face lacks expression and animation (known as “masked face”) or that the person moves more slowly.
Affected people may first experience mild tremor or have difficulty getting out of a chair. Activities may take longer to complete than in the past and individuals may note some stiffness in addition to slowness. They speak too softly or their handwriting becomes slow and looks cramped or small. The symptoms of Parkinson’s disease may begin to interfere with daily activities later. Often they begin to walk with a tendency to lean forward, taking small steps, as if shuffling, and with reduced swinging in one or both arms. They may have trouble initiating movement (start hesitation), and they may stop suddenly as they walk (freezing).
Any other symptoms occur in Parkinson’s?
Depression, Emotional changes, irritability, difficulty in speech/ swallowing, bowel and bladder problems, back pain, muscle cramps, may all become troublesome. Dementia, cognitive decline, visual hallucinations may occur as the disease advances.
Sleep problems are very common, including excessive day time sleepiness, nightmares and emotional dreams (people may act out dreams, potentially injuring themselves or their partners)
What Causes Parkinson’s disease?
The cause of the disease is unknown. One important area affected in the brain is the area near the base of the brain called Sustantia nigra which contains dopamine-producing cells. The neurons from this region project to another area of the brain (corpus Striatum) which is responsible for producing smooth, purposeful movements.
Most people with Parkinson’s have lost 60 to 80 percent or more of the dopamine producing cells in the substantia nigra by the time symptoms appear. Other areas of the brain and other chemical transmitters in the brain are also affected in Parkinson’s, causing many other manifestations i.e. dizziness, fainting, bladder, bowel problems etc.
In addition to a genetic susceptibility in Parkinson’s disease, exposure to certain environmental toxins may also contribute to the degeneration of the brain cells. 15- 20% of patients may have a known relative with the disease in the family.
Who gets Parkinson’s disease?
Most people affected are older individuals (after 60) and incidence rises with advancing age. In the early stages of the disease, many assume their symptoms are the result of ‘getting old’ and do not seek medical attention.
How do we diagnose Parkinson’s disease?
There is no diagnostic test for Parkinson’s disease. MRI imaging of the brain is often done to rule out other disorders that may mimic Parkinson’s . Special Scans such as SPECT scan are rarely done in difficult cases or when a diagnostic dilemma exists.
How do we treat Parkinson’s ?
At present, there is no cure for PD, but medications or surgery (in selected patients) can improve their symptoms as well as the quality of life remarkably.
The most common medication used is Levodopa/Carbidopa. Noticeable improvement occurs in their symptoms but they may need to increase the dose gradually for maximum benefit.
Pramipexole, ropinirole, and rotigotine, Rasagiline, Amantadine, Trihexiphenidyl are some of the other medications used.
Since no two people will react the same way to a given drug, it may take time and patience to get the correct medication or the correct dose.
Is there a Surgery for Parkinson’s Disease
Surgery is generally considered for people with PD for whom drug therapy is no longer sufficient.
- Pallidotomy and Thalamotomy involve selectively destroying small areas of specific parts of the brain to improve symptoms
- Deep Brain Stimulation ( DBS)is being widely used these days and has become a better option as there is no destruction of any area of the brain and it may improve the quality of their lives remarkably.
What about Stem cell therapy for Parkinson’s?
Researchers working with laboratory rats showed it is possible to make dopamine cells from human embryonic stem cells and transplant them into the brain, replacing the cells lost to the disease. Because stem cells are so versatile, they could potentially be used to repair and replace damaged human tissue. This is being tested in clinical research studies in patients.
What is the prognosis of PD:
The average life expectancy of a person with PD has improved remarkably over the last 3 decades. Many lead independent and fruitful life with adequate treatment. But PD is a slowly progressive disorder and in the late stages, patients may no longer respond to medications. Serious complications such as choking, pneumonia, and falls may lead to death.
Any role for Complementary and Supportive therapy of PD?
In addition to standard physical, occupational, and speech therapy, a healthy diet, regular Exercise improves their mobility and flexibility. Walking, gardening, swimming, aerobics, yoga, massage therapy, acupuncture can have significant benefit for some.
Dr. Harirama K. Acharya MD., MRCP, MD (Neurology, USA)
Senior Consultant Neurologist